Department of Epidemiology and Statistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China; State Key Laboratory of Common Mechanism Research for Major Diseases, Beijing, China.
Department of Otolaryngology-Head and Neck Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Diabetes Res Clin Pract. 2024 Aug;214:111783. doi: 10.1016/j.diabres.2024.111783. Epub 2024 Jul 11.
The evidence for joint and independent associations of low muscle mass and low muscle strength with diabetes is limited and mixed. The study aimed to determine the associations of muscle parameters (muscle mass, strength, quality, and sarcopenia) and sarcopenia obesity with diabetes, and the previously unstudied mediating effect of inflammation.
A total of 13,420 adults from the 2023 China National Health Survey (CNHS) and 5,380 adults from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were included in this study. Muscle mass was determined using bioelectrical impedance analysis (BIA) in the CNHS, and whole-body dual X-ray absorptiometry (DXA) in the NHANES. Muscle strength was assessed using digital hand dynamometer. Multivariate logistic regression models were used to evaluate the associations of muscle parameters and sarcopenia obesity with diabetes. Inflammatory status was assessed using blood cell counts and two systemic inflammation indices (platelet-to-lymphocyte ratio (PLR) and system inflammation response index (SIRI)). Mediation analysis was conducted to examine inflammation's role in these associations.
Low muscle mass and strength were independently related to diabetes. Low muscle quality was associated with elevated diabetes risk. Sarcopenia has a stronger association with diabetes compared to low muscle strength alone or mass alone (CNHS, odds ratio (OR) = 1.93, 95 % confidence interval (CI):1.64-2.27; NHANES, OR = 3.80, 95 %CI:2.58-5.58). Participants with sarcopenia obesity exhibit a higher risk of diabetes than those with obesity or sarcopenia alone (CNHS, OR = 2.21, 95 %CI:1.72-2.84; NHANES, OR = 6.06, 95 %CI:3.64-10.08). Associations between muscle parameters and diabetes were partially mediated by inflammation (mediation proportion: 1.99 %-36.64 %, P < 0.05).
Low muscle mass and muscle strength are independently or jointly associated with diabetes, and inflammation might be a potential mechanism underlying this association. Furthermore, the synergistic effects of sarcopenia and obesity could significantly increase diabetes risk.
肌肉量和肌肉力量与糖尿病之间的关联证据有限且混杂。本研究旨在确定肌肉参数（肌肉量、力量、质量和肌少症）和肌少症肥胖与糖尿病之间的关联，以及炎症的中介作用，这是之前尚未研究过的。
本研究共纳入了来自 2023 年中国国家健康调查（CNHS）的 13420 名成年人和来自 2011-2014 年全国健康和营养调查（NHANES）的 5380 名成年人。CNHS 中使用生物电阻抗分析（BIA）确定肌肉量，NHANES 中使用全身双能 X 线吸收法（DXA）确定肌肉量。使用数字手持测力计评估肌肉力量。使用多变量逻辑回归模型评估肌肉参数和肌少症肥胖与糖尿病之间的关联。使用血细胞计数和两个全身炎症指数（血小板与淋巴细胞比值（PLR）和系统炎症反应指数（SIRI））评估炎症状态。进行中介分析以检查炎症在这些关联中的作用。
低肌肉量和力量与糖尿病独立相关。低肌肉质量与糖尿病风险增加相关。与单独的低肌肉力量或低肌肉质量相比，肌少症与糖尿病的关联更强（CNHS，比值比（OR）=1.93，95%置信区间（CI）：1.64-2.27；NHANES，OR=3.80，95%CI：2.58-5.58）。与肥胖或肌少症单独相比，肌少症肥胖的参与者患糖尿病的风险更高（CNHS，OR=2.21，95%CI：1.72-2.84；NHANES，OR=6.06，95%CI：3.64-10.08）。肌肉参数与糖尿病之间的关联部分由炎症介导（中介比例：1.99%-36.64%，P<0.05）。
低肌肉量和肌肉力量与糖尿病独立或共同相关，炎症可能是这种关联的潜在机制。此外，肌少症和肥胖的协同作用可显著增加糖尿病风险。
