Jiao Ruoyang, Lin Chu, Cai Xiaoling, Wang Jingxuan, Wang Yuan, Lv Fang, Yang Wenjia, Ji Linong
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Diabetes Obes Metab. 2025 Jan;27(1):259-267. doi: 10.1111/dom.16012. Epub 2024 Oct 21.
Diabetes is an independent risk factor for muscle mass loss, with possible mechanisms including impaired insulin signalling and chronic inflammation. The use of a glucagon-like peptide 1 (GLP-1) receptor-based agonist could lead to weight reduction, which might result from the loss of both fat and skeletal muscle. However, the body composition-modifying effects of GLP-1 receptor-based agonists have not been systematically characterized.
PubMed, EMBASE, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov were searched from inception to October 2023. Randomized controlled trials of GLP-1 receptor agonist or glucose-dependent insulinotropic polypeptide/GLP-1 receptor dual agonist, which reported the changes of body composition, were included. The results were computed as weighted mean differences (WMDs) and 95% confidence intervals (CIs) in a random-effects model.
In all, 19 randomized controlled trials were included. When compared with controls, substantial reductions in fat body mass were observed in patients using GLP-1 receptor-based agonist treatment (WMD = -2.25 kg, 95% CI -3.40 to -1.10 kg), with decrease in areas of both subcutaneous fat (WMD = -38.35 cm, 95% CI, -54.75 to -21.95 cm) and visceral fat (WMD = -14.61 cm, 95% CI, -23.77 to -5.44 cm). Moreover, greater reductions in lean body mass were also observed in GLP-1 receptor-based agonist users compared with non-users (WMD = -1.02 kg, 95% CI, -1.46 to -0.57 kg), while the changes in lean mass percentage were comparable between GLP-1 receptor-based agonist users and non-users.
Compared with the controls, GLP-1 receptor-based agonist users experienced greater reductions in fat body mass, with body shaping effects in terms of both subcutaneous fat mass and visceral fat mass. Although greater reductions in lean body mass were also observed in GLP-1 receptor-based agonist users, the changes in lean mass percentage were comparable between the users and non-users.
糖尿病是肌肉量减少的独立危险因素，其可能机制包括胰岛素信号传导受损和慢性炎症。使用基于胰高血糖素样肽1（GLP-1）受体的激动剂可导致体重减轻，这可能是脂肪和骨骼肌均减少所致。然而，基于GLP-1受体的激动剂对身体成分的改变作用尚未得到系统表征。
检索了PubMed、EMBASE、Cochrane对照试验中心注册库（用于研究）和Clinicaltrial.gov，检索时间从创建至2023年10月。纳入报告了身体成分变化的基于GLP-1受体激动剂或葡萄糖依赖性促胰岛素多肽/GLP-1受体双重激动剂的随机对照试验。结果以随机效应模型中的加权平均差（WMDs）和95%置信区间（CIs）计算。
共纳入19项随机对照试验。与对照组相比，使用基于GLP-1受体激动剂治疗的患者脂肪量显著减少（WMD = -2.25 kg，95% CI -3.40至-1.10 kg），皮下脂肪面积（WMD = -38.35 cm，95% CI，-54.75至-21.95 cm）和内脏脂肪面积（WMD = -14.61 cm，95% CI，-23.77至-5.44 cm）均减小。此外，与未使用者相比，使用基于GLP-1受体激动剂的患者瘦体重减少也更多（WMD = -1.02 kg，95% CI，-1.46至-0.57 kg），而基于GLP-1受体激动剂的使用者与未使用者之间瘦体重百分比的变化相当。
与对照组相比，使用基于GLP-1受体激动剂的患者脂肪量减少更多，在皮下脂肪量和内脏脂肪量方面均有塑形效果。虽然使用基于GLP-1受体激动剂的患者瘦体重减少也更多，但使用者与未使用者之间瘦体重百分比的变化相当。
