Differential impacts of fat and muscle mass on cardiovascular and non-cardiovascular mortality in individuals with type 2 diabetes

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-07-12 DOI:10.1002/jcsm.13542

Jie Guo, Yuxia Wei, Emerald G. Heiland, Anna Marseglia

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Abstract

Background

The distribution of fat and muscle mass in different regions of the body can reflect different pathways to mortality in individuals with diabetes. Therefore, we investigated the associations between whole-body and regional body fat and muscle mass with cardiovascular disease (CVD) and non-CVD mortality in type 2 diabetes (T2D).

Methods

Within the National Health and Nutrition Examination Survey 1999–2006, 1417 adults aged ≥50 years with T2D were selected. Dual-energy X-ray absorptiometry was used to derive whole-body, trunk, arm, and leg fat mass and muscle mass indices (FMI and MMI). Mortality data until 31 December 2019 were retrieved from the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models.

Results

A total of 1417 participants were included in this study (weighted mean age [standard error]: 63.7 [0.3] years; 50.5% female). Over a median follow-up of 13.6 years, 797 deaths were recorded (371 CVD-related and 426 non-CVD deaths). Higher FMI in the arm was associated with increased risk of non-CVD mortality (fourth quartile [Q4] vs. first quartile [Q1]: HR 1.82 [95% CI 1.13–2.94]), whereas higher FMI in the trunk or leg was not significantly associated with CVD or non-CVD mortality. Conversely, higher arm MMI was associated with a lower risk of both CVD (Q4 vs. Q1: HR 0.51 [95% CI 0.33–0.81]) and non-CVD (Q4 vs. Q1: HR 0.56 [95% CI 0.33–0.94]) mortality. There was a significant interaction between smoking status and arm FMI on non-CVD mortality (P for interaction = 0.007). Higher arm FMI was associated with a higher risk of non-CVD mortality among current or former smokers (Q4 vs. Q1: HR 2.67 [95% CI 1.46–4.88]) but not non-smokers (Q4 vs. Q1: HR 0.85 [95% CI 0.49–1.47]).

Conclusions

Fat mass and muscle mass, especially in the arm, are differently associated with CVD and non-CVD mortality in people with T2D. Our findings underscore the predictive value of body compositions in the arm in forecasting mortality among older adults with T2D.

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脂肪和肌肉质量对 2 型糖尿病患者心血管和非心血管死亡率的不同影响。

背景：脂肪和肌肉质量在身体不同区域的分布可反映糖尿病患者死亡的不同途径。因此，我们研究了2型糖尿病（T2D）患者全身及各区域脂肪和肌肉质量与心血管疾病（CVD）和非CVD死亡率之间的关系：方法：在1999-2006年全国健康与营养调查中，选取了1417名年龄≥50岁的2型糖尿病成人。采用双能 X 射线吸收测量法得出全身、躯干、手臂和腿部脂肪量和肌肉量指数（FMI 和 MMI）。截至 2019 年 12 月 31 日的死亡率数据来自国家死亡指数。根据 Cox 比例危险模型估算出危险比（HRs）和 95% 置信区间（CIs）：本研究共纳入 1417 名参与者（加权平均年龄 [标准误差]：63.7 [0.3] 岁；50.5% 为女性）。中位随访时间为 13.6 年，共记录了 797 例死亡（371 例心血管疾病相关死亡和 426 例非心血管疾病相关死亡）。手臂的 FMI 值越高，非心血管疾病死亡风险越高（第四四分位数 [Q4] 与第一四分位数 [Q1]：HR 1.82 [95% CI 1.13-2.94]），而躯干或腿部的 FMI 值越高，与心血管疾病或非心血管疾病死亡的关系不大。相反，手臂MMI越高，心血管疾病（Q4 vs. Q1：HR 0.51 [95% CI 0.33-0.81]）和非心血管疾病（Q4 vs. Q1：HR 0.56 [95% CI 0.33-0.94]）死亡风险越低。吸烟状况和臂部 FMI 对非心血管疾病死亡率有明显的交互作用（交互作用的 P = 0.007）。在目前或曾经吸烟者中，较高的手臂FMI与较高的非心血管疾病死亡风险相关（Q4 vs. Q1：HR 2.67 [95% CI 1.46-4.88]），但与非吸烟者无关（Q4 vs. Q1：HR 0.85 [95% CI 0.49-1.47]）：结论：脂肪量和肌肉量（尤其是手臂肌肉量）与 T2D 患者的心血管疾病和非心血管疾病死亡率的相关性不同。我们的发现强调了手臂的身体成分在预测患有 T2D 的老年人死亡率方面的预测价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.