Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease

doi:10.4239/wjd.v12.i12.2119

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World Journal of Diabetes

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World J Diabetes. Dec 15, 2021; 12(12): 2119-2129
Published online Dec 15, 2021. doi: 10.4239/wjd.v12.i12.2119

Table 1 Characteristics of male participants according to appendicular skeletal muscle mass (%) quartiles, n (%)

Male	Quartiles of ASM%				P value	Female	Quartiles of ASM%				P value
	Q1	Q2	Q3	Q4			Q1	Q2	Q3	Q4
	n = 343	n = 343	n = 343	n = 342			n = 649	n = 651	n = 649	n = 650
Age (yr)	61.6 ± 8.8	63.2 ± 8.9^a	63.2 ± 8.9^a	69.4 ± 10.1^a	< 0.001	Age, yr	60.8 ± 8.7	61.7 ± 8.8^a	62.9 ± 9.4^a	64.8 ± 9.7^a	< 0.001
BMI (kg/m²)	22.7 ± 2.9	24.3 ± 3.4^a	24.3 ± 3.4^a	25.6 ± 2.9^a	< 0.001	Weight, kg	55.1 ± 8.1	58.0 ± 8.3^a	59.8 ± 8.6^a	62.6 ± 9.7^a	< 0.001
WC, cm	80.6 ± 9.1	85.8 ± 7.7^a	85.8 ± 7.7^a	91.7 ± 8.5^a	< 0.001	BMI, kg/m²	22.0 ± 2.7	23.5 ± 2.9^a	24.4 ± 3.1^a	26.0 ± 3.7^a	< 0.001
FM, kg	17.9 ± 4.6	20.3 ± 4.3^a	20.3 ± 4.3^a	24.5 ± 4.9^a	< 0.001	WC, cm	76.4 ± 7.9	80.5 ± 8.6^a	82.8 ± 8.5^a	87.5 ± 9.4^a	< 0.001
FM%	22.4 ± 4.2	27.2 ± 3.2^a	27.2 ± 3.2^a	33.1 ± 3.3^a	< 0.001	FM, kg	20.0 ± 4.1	22.5 ± 4.2^a	24.8 ± 4.8^a	27.6 ± 5.8^a	< 0.001
ASM%	32.6 ± 1.9	30.6 ± 1.0^a	30.6 ± 1.0^a	27.2 ± 1.6^a	< 0.001	FM%	32.2 ± 3.9	36.3 ± 2.9^a	38.8 ± 3.0^a	42.4 ± 3.4^a	< 0.001
SBP, mmHg	129 ± 18	134 ± 17^a	134 ± 17^a	141 ± 19^a	< 0.001	ASM%	27.7 ± 2.0	25.7 ± 0.8^a	24.5 ± 0.6^a	22.8 ± 1.1^a	< 0.001
DBP, mmHg	76 ± 11	78 ± 11^a	78 ± 11^a	77 ± 10	0.014	SBP, mmHg	129 ± 20	132 ± 19^a	135 ± 20^a	138 ± 19^a	< 0.001
FBG, mmol/L	5.4 ± 1.4	5.7 ± 1.7^a	5.7 ± 1.7^a	6.0 ± 1.7^a	< 0.001	DBP, mmHg	72 ± 10	74 ± 10^a	75 ± 9	76 ± 10^a	< 0.001
2hBG, mmol/L	6.7 ± 2.5	7.6 ± 2.9^a	7.6 ± 2.9^a	8.9 ± 3.7^a	< 0.001	FBG, mmol/L	5.3 ± 1.0	5.4 ± 1.2^a	5.5 ± 1.3^a	5.7 ± 1.7^a	< 0.001
HOMA-IR	1.2 (0.8-1.9)	1.8 (1.2-2.5)^a	1.8 (1.2-2.5)^a	2.5 (1.7-3.9)^a	< 0.001	2hBG, mmol/L	6.8 ± 2.6	7.2 ± 2.5^a	7.7 ± 4.0^a	8.3 ± 3.4^a	< 0.001
TG, mmol/L	1.2 (0.9-1.8)	1.4 (1.0-2.0)^a	1.4 (1.0-2.0)^a	1.6 (1.2-2.2)^a	< 0.001	HOMA-IR	1.6 (1.0-2.3)	1.8 (1.2-2.6)^a	2.1 (1.4-3.2)^a	2.3 (1.6-3.6)^a	< 0.001
TC, mmol/L	4.6 ± 0.8	4.7 ± 0.8^a	4.7 ± 0.8^a	4.7 ± 0.8^a	0.049	TG, mmol/L	1.2 (0.9-1.8)	1.4 (1.0-2.0)^a	1.5 (1.1-2.1)	1.6 (1.2-2.2)^a	< 0.001
HDL-C, mmol/L	1.40 ± 0.37	1.26 ± 0.29^a	1.26 ± 0.29^a	1.20 ± 0.25^a	< 0.001	TC, mmol/L	5.2 ± 0.8	5.3 ± 0.9	5.3 ± 0.9	5.4 ± 1.0^a	< 0.001
LDL-C, mmol/L	2.59 ± 0.72	2.75 ± 0.74	2.75 ± 0.74	2.72 ± 0.72^a	0.004	HDL-C, mmol/L	1.64 ± 0.42	1.54 ± 0.37^a	1.48 ± 0.34	1.46 ± 0.33^a	< 0.001
LFC%	3.9 (1.9-7.8)	5.0 (2.3-10.8)^a	5.0 (2.3-10.8)^a	6.3 (2.6-13.3)^a	< 0.001	LDL-C, mmol/L	2.86 ± 0.75	3.02 ± 0.79^a	3.04 ± 0.83^a	3.14 ± 0.86^a	< 0.001
NAFLD n (%)	68 (19.9)	107 (31.2)^a	107 (31.2)^a	141 (41.2)^a	< 0.001	LFC, %	4.8 (2.5-9.7)	5.8 (2.7-11.6)^a	5.9 (2.7-11.8)^a	7.1 (3.2-13.6)^a	< 0.001
DM n (%)	42 (12.3)	81 (23.6)^a	81 (23.6)^a	123 (35.8)^a	< 0.001	NAFLD n (%)	171 (26.3)	214 (32.9)^a	219 (33.7)^a	275 (42.3)^a	< 0.001
						DM n (%)	88 (13.6)	106 (16.3)	152 (23.4)^a	158 (24.3)^a	< 0.001

^aP < 0.05, compared with Q1. The quartiles of ASM% were divided as follows: Male, (Q1, ≥ 32.0%; Q2, ≥ 30.5%-32.0%; Q3, ≥ 29.0%-< 30.5%; Q4: < 29.0%) and female, (Q1, ≥ 26.8%; Q2, ≥ 25.5% -< 26.8%; Q3, ≥ 24.3%-< 25.5%; Q4, < 24.3%).

BMI: Body mass index; WC: Waist circumference; FM: Fat mass; ASM: Appendicular skeletal muscle mass; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; FBG: Fasting blood glucose; 2hBG: 2-h postprandial blood glucose; HOMA-IR: Homeostasis model assessment for insulin resistance; TG: Triglycerides; TC: Total cholesterol; HDL-C: High-density lipoprotein-cholesterol; LDL-C: Low-density lipoprotein cholesterol; LFC: Liver fat content; NAFLD: Non-alcoholic fatty liver disease; DM: Diabetes mellitus.

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Table 2 Spearman analysis of appendicular skeletal muscle mass (%) and other clinical parameters

	ASM%
	Male (r, P value)	Female (r, P value)
Age (years)	-0.317, < 0.001	-0.164, < 0.001
BMI (kg/m²⁾	-0.347, < 0.001	-0.441, < 0.001
WC (cm)	-0.452, < 0.001	-0.448, < 0.001
FM (kg)	-0.605, < 0.001	-0.590, < 0.001
FM (%)	-0.792, < 0.001	-0.799, < 0.001
FBG (mmol/L)	-0.177, < 0.001	-0.106, < 0.001
2hBG (mmol/L)	-0.254, < 0.001	-0.201,< 0.001
HOMA-IR	-0.385, < 0.001	-0.264, < 0.001
TG (mmol/L)	-0.198, < 0.001	-0.193, < 0.001
TC (mmol/L)	-0.049, 0.071	-0.087, < 0.001
HDL-C (mmol/L)	0.213, < 0.001	0.162, < 0.001
LDL-C (mmol/L)	-0.075, 0.006	-0.119, < 0.001
SBP (mm Hg)	-0.244, < 0.001	-0.192, < 0.001
DBP (mm Hg)	-0.075, 0.006	-0.139, < 0.001
LFC (%)	-0.149, < 0.001	-0.113, < 0.001

ASM: Appendicular skeletal muscle mass; BMI: Body mass index; WC: Waist circumference; FM: Fat mass; FBG: Fasting blood glucose; 2hBG: 2-h postprandial blood glucose; HOMA-IR: Homeostasis model assessment for insulin resistance; TG: Triglycerides; TC: Total cholesterol; HDL-C: High-density lipoprotein-cholesterol; LDL-C: Low-density lipoprotein cholesterol; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; LFC: Liver fat content.

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Table 3 Multivariate-adjusted associations of appendicular skeletal muscle mass (%) quartiles with diabetes mellitus

	Male	Female
	OR (95%CI, P value)	OR (95%CI, P value)
Unadjusted	0.665	0.775
Unadjusted	(0.592-0.746, < 0.001)	(0.710-0.847, < 0.001)
Model 1	0.527	0.505
Model 1	(0.336-0.826, 0.005)	(0.342-0.745, 0.001)
Model 2	0.640	0.728
Model 2	(0.401-1.020, 0.051)	(0.481-1.101, 0.133)
Model 3	0.537	0.985
Model 3	(0.312-0.923, 0.024)	(0.614-1.580, 0.950)

Model 1: Adjusted for age, cigarette smoking, diabetes family history, FM, and FM × ASM% quartiles, and obesity. Model 2: Adjusted for covariates in Model 1 plus SBP, TG, and HDL-C. Model 3: Adjusted for covariates in Model 3 plus HOMA-I. OR: Odds ratio; FM: fat mass; ASM: Appendicular skeletal muscle mass; SBP: Systolic blood pressure; TG: Triglycerides; HDL-C: High-density lipoprotein-cholesterol; HOMA-IR: Homeostasis model assessment for insulin resistance.

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Table 4 Multivariate-adjusted associations of appendicular skeletal muscle mass (%) quartiles with diabetes mellitus in participants with or without non-alcoholic fatty liver disease

	Male	Female
	OR (95%CI, P value)	OR (95%CI, P value)
	Non-NAFLD (n = 2658)
Unadjusted	0.635	0.770
Unadjusted	(0.548-0.736, < 0.001)	(0.682-0.870, < 0.001)
Model 1	0.403	0.581
Model 1	(0.221-0.735, 0.003)	(0.344-0.981, 0.042)
Model 2	0.455	0.807
Model 2	(0.246-0.842, 0.012)	(0.463-1.409, 0.452)
Model 3	0.330	0.800
Model 3	(0.157-0.694, 0.003)	(0.416-1.537, 0.503)
	NAFLD (n = 1311)
Unadjusted	0.789	0.845
Unadjusted	(0.650-0.956, 0.016)	(0.739-0.966, 0.014)
Model 1	1.259	0.508
Model 1	(0.542-2.924, 0.592)	(0.265-0.975, 0.042)
Model 2	1.954	0.710
Model 2	(0.788-4.851, 0.148)	(0.355-1.418, 0.332)
Model 3	1.328	1.106
Model 3	(0.435-4.055, 0.619)	(0.485-2.523, 0.810)

Model 1: Adjusted for age, cigarette smoking, diabetes family history, FM, FM × ASM% quartiles, and obesity. Model 2: Adjusted for covariates in Model 1 plus SBP, TG, and HDL-C. Model 3: Adjusted for covariates in Model 3 plus HOMA-IR. OR: Odds ratio; FM: Fat mass; ASM: Appendicular skeletal muscle mass; SBP: Systolic blood pressure; TG: Triglycerides; HDL-C: High-density lipoprotein-cholesterol; HOMA-IR: Homeostasis model assessment for insulin resistance.

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Table 5 Multivariate-adjusted associations of appendicular skeletal muscle mass (%) quartiles with diabetes mellitus in participants with different liver fat content, n (%)

LFC	DM	OR (95%CI, P value)	OR (95%CI, P value)
Male		Unadjusted	After adjusted
Q1 (n = 389)	82 (21.1)	0.635 (0.504-0.799, < 0.001)	0.308 (0.102-0.932, 0.032)
Q2 (n = 350)	66 (18.8)	0.540 (0.416-0.700, < 0.001)	0.184 (0.049-0.685, 0.012)
Q3 (n = 306)	74 (24.2)	0.760 (0.599-0.963, 0.023)	0.678 (0.158-2.908, 0.601)
Q4(n = 325)	116 (35.7)	0.830 (0.665-1.035, 0.099)	1.561 (0.440-5.539, 0.491)
Female
Q1 (n = 605)	84 (13.9)	0.828 (0.672-1.021, 0.077)	0.964 (0.311-2.990, 0.949)
Q2 (n = 642)	92 (14.3)	0.745 (0.609-0.913, 0.004)	0.517 (0.170-1.578, 0.247)
Q3 (n = 685)	118 (17.2)	0.739 (0.615-1.887, 0.091)	0.750 (0.274-2.048, 0.574)
Q4 (n = 667)	210 (31.5)	0.871 (0.750-1.011, 0.070)	1.122 (0.445-2.830, 0.808)

The quartiles of LFC were divided as follows: Q1: < 2.53%; Q2: ≥ 2.53%-< 5.52%; Q3: ≥ 5.52%- < 11.61%; Q4: ≥ 11.61%. Adjusted factors: Age, cigarette smoking, diabetes family history, FM, FM × ASM% quartiles, obesity, SBP, TG, HDL-C, and HOMA-IR. LFC: Liver fat content; DM: Diabetes mellitus; OR: Odds ratio; FM: Fat mass; ASM: Appendicular skeletal muscle mass; SBP: Systolic blood pressure; TG: Triglycerides; HDL-C: High-density lipoprotein-cholesterol; HOMA-IR: Homeostasis model assessment for insulin resistance.

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Citation: Chen LY, Xia MF, Wu L, Li Q, Hu Y, Ma H, Gao X, Lin HD. Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease. World J Diabetes 2021; 12(12): 2119-2129
URL: https://www.wjgnet.com/1948-9358/full/v12/i12/2119.htm
DOI: https://dx.doi.org/10.4239/wjd.v12.i12.2119