Cortisol Circadian Rhythm and Sarcopenia in Patients With Type 2 Diabetes: A Cross-Sectional Study

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-02-17 DOI:10.1002/jcsm.13727

Fupeng Liu, Qing Yang, Kai Yang, Jing Sun, Yanying Li, Bo Ban, Yangang Wang, Mei Zhang

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Abstract

Background

Patients with Type 2 diabetes mellitus (T2DM) have elevated late-night cortisol levels and a flattened circadian rhythm. Cortisol oversecretion mediates muscle breakdown and reduces muscle strength and mass, thus possibly leading to sarcopenia. This study first investigated the association between cortisol circadian rhythm and sarcopenia in patients with T2DM.

Methods

Patients with T2DM and adrenal nodules were screened for eligibility. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were obtained by analysing computed tomography images at Lumbar 3 level. Sarcopenia was defined as the presence of both myopenia and myosteatosis. Cortisol and adrenocorticotropic hormone levels at 8 AM, 4 PM and 0 AM were measured. The cumulative logit models and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between cortisol circadian rhythm and sarcopenia.

Results

In total, 128 patients with T2DM and nonfunctional adrenal adenomas were enrolled in this study, of whom 25 were diagnosed with sarcopenia. The mean age was 54.4 years, and 83 (64.8%) patients were male. Patients with sarcopenia showed higher nighttime cortisol levels at 0 AM (Cor 0 AM) (4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL, p < 0.001) than those without. The Cor 0 AM was negatively correlated with both SMI and SMD (r = −0.318, p < 0.001 and −0.284, p < 0.001, respectively). As the Cor 0 AM tertiles increased, the odds ratios (ORs) for sarcopenia consistently increased (OR = 4.69 [0.93, 23.53], p = 0.061, for the intermediate group and OR = 11.39 [2.41, 53.84], p = 0.002, for the high group). After adjustment for multiple risk factors, the high Cor 0 AM group still showed a significantly higher risk of sarcopenia than the low group (OR = 7.92 [1.45, 43.29], p = 0.017). ROC curve analyses showed that Cor 0 AM had the highest predictive power for sarcopenia, with an area under the ROC curve (AUC) of 0.760, compared to haemoglobin, age, alanine transaminase and sex (AUC = 0.703, 0.695, 0.679, and 0.633, respectively).

Conclusions

The cortisol circadian rhythm is associated with sarcopenia in patients with T2DM. Patients with higher levels of nighttime cortisol, rather than morning or afternoon cortisol, have a higher risk of sarcopenia. This result offers a new strategy for the further research of sarcopenia.

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背景 2 型糖尿病（T2DM）患者深夜皮质醇水平升高，昼夜节律趋于平缓。皮质醇分泌过多会导致肌肉分解，降低肌肉强度和质量，从而可能导致肌肉疏松症。本研究首次探讨了皮质醇昼夜节律与 T2DM 患者肌肉疏松症之间的关系。方法筛选患有 T2DM 和肾上腺结节的患者。骨骼肌指数（SMI）和骨骼肌密度（SMD）是通过分析腰椎三级计算机断层扫描图像获得的。肌肉疏松症的定义是同时存在肌肉疏松症和肌肉骨质疏松症。测量了上午 8 点、下午 4 点和凌晨 0 点的皮质醇和促肾上腺皮质激素水平。通过累积对数模型和接收器操作特征曲线分析，评估皮质醇昼夜节律与肌肉疏松症之间的关联。结果本研究共纳入了 128 名患有 T2DM 和无功能性肾上腺腺瘤的患者，其中 25 人被诊断为肌肉疏松症。患者平均年龄为 54.4 岁，其中 83 名（64.8%）为男性。与非肌肉疏松症患者相比，肌肉疏松症患者在凌晨 0 点的夜间皮质醇水平（Cor 0 AM）较高（4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL，p < 0.001）。Cor 0 AM与SMI和SMD均呈负相关（r = -0.318，p <0.001和-0.284，p <0.001）。随着 Cor 0 AM 三等分的增加，肌少症的几率比（ORs）也持续增加（中间组的几率比 = 4.69 [0.93, 23.53]，p = 0.061；高组的几率比 = 11.39 [2.41, 53.84]，p = 0.002）。在对多种风险因素进行调整后，高 Cor 0 AM 组发生肌少症的风险仍明显高于低 Cor 0 AM 组（OR = 7.92 [1.45, 43.29]，p = 0.017）。ROC 曲线分析显示，与血红蛋白、年龄、丙氨酸转氨酶和性别（AUC 分别为 0.703、0.695、0.679 和 0.633）相比，Cor 0 AM 对肌少症的预测能力最高，ROC 曲线下面积（AUC）为 0.760。结论皮质醇昼夜节律与 T2DM 患者的肌少症有关。夜间皮质醇水平较高而非上午或下午皮质醇水平较高的患者患肌肉疏松症的风险较高。这一结果为进一步研究肌肉疏松症提供了新的策略。

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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.