Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2021; 12(12): 2119-2129
Published online Dec 15, 2021. doi: 10.4239/wjd.v12.i12.2119
Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease
Ling-Yan Chen, Ming-Feng Xia, Li Wu, Qian Li, Yu Hu, Hui Ma, Xin Gao, Huan-Dong Lin
Ling-Yan Chen, Yu Hu, Hui Ma, Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Ming-Feng Xia, Xin Gao, Huan-Dong Lin, Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Li Wu, Qian Li, Fudan Institute for Metabolic Diseases, Shanghai 200032, China
Author contributions: Chen LY did the study design and literature research, wrote the manuscript, and made critical editing; Chen LY and Lin HD made definition of intellectual content and did data analysis; Chen LY, Xia MF, Wu L, Li Q, Hu Y, Ma H, Gao X, and Lin HD participated in the data acquisition and clinical study; Gao X and Lin HD contributed to study concept and did the critical review and editing of the manuscript; Gao X was the guarantor of integrity of the entire study; Lin HD contributed to statistical analysis; all authors approved the final draft of the manuscript and agreed to submit it for publication.
Supported by the National Key Basic Research Program of China, No. 2012CB524906 and No. 2011CB504004; the Shanghai Municipal Health Bureau Foundation, No. 12GWZX0103; and the Science and Technology Commission of Shanghai Municipality, No. 10411956400.
Institutional review board statement: The present study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (No. 2008-119). The research was carried out in accordance with the World Medical Association Declaration of Helsinki.
Informed consent statement: All participants provided written informed consent before their inclusion in the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The related dataset that do not identify participants’ privacy can be available from the corresponding author at linhuandong_endo@163.com
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huan-Dong Lin, MD, Associate Professor, Chief Doctor, Department of Endocrinology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. linhuandong_endo@163.com
Received: July 2, 2021
Peer-review started: July 2, 2021
First decision: July 15, 2021
Revised: August 5, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 15, 2021
Processing time: 166 Days and 20.9 Hours
Abstract
BACKGROUND

Skeletal muscle, a key insulin target organ, has been reported to be associated with diabetes mellitus (DM). Compared to non-diabetic patients, diabetic patients have decreased muscle mass and a higher prevalence of sarcopenia, and patients with sarcopenia may be at increased risk of developing diabetes. In individuals with nonalcoholic fatty liver disease (NAFLD), sarcopenia is associated with the severity of fibrosis and steatosis. Previous studies have demonstrated that NAFLD is strongly associated with DM and sarcopenia.

AIM

To determine the relationship between skeletal muscle mass and DM in Chinese middle-aged and elderly men, and whether the association is affected by NAFLD.

METHODS

Skeletal muscle mass was calculated as appendicular skeletal muscle mass (ASM) in kg/body weight × 100%. Liver fat content (LFC) was measured using a quantitative ultrasound method.

RESULTS

As the ASM decreased, fasting blood glucose (FBG), 2-h postprandial blood glucose (2hBG), and LFC increased in both genders, as did the prevalence of DM and NAFLD. Spearman analysis showed that the ASM was negatively correlated with the FBG, 2hBG, and LFC. Stepwise logistic regression analysis showed that after adjustments, the ASM quartile was negatively associated with the presence of DM in males, but not in females. Subgroup analysis showed that the ASM quartiles remained negatively correlated with the presence of DM in the non-NAFLD population (including males and females), but no correlation was found between ASM quartiles and the presence of DM in the NAFLD population. When stratified by LFC quartiles, ASM was negatively correlated with the presence of DM in the first and second LFC quartiles in males.

CONCLUSION

Skeletal muscle mass loss was shown to be associated with the presence of DM in males, but not in females; NAFLD weakens this association. The results suggested that the stratified management of diabetes mellitus should be considered according to skeletal muscle mass and NAFLD.

Keywords: Diabetes mellitus; Liver fat content; Non-alcoholic fatty liver disease; Skeletal muscle mass

Core Tip: Aging is becoming more severe in China. The present study showed that decreased skeletal muscle mass is associated with the presence of diabetes mellitus in males but not in females; non-alcoholic fatty liver disease weakens this association. The results suggested that stratified management of diabetes mellitus should be considered according to skeletal muscle mass and non-alcoholic fatty liver disease.