Circulating levels of TNF-alpha and IL-6-relation to truncal fat mass and muscle mass in healthy elderly individuals and in patients with type-2 diabetes

Background:Obesity is an important health problem, as its prevalence has reached an epidemic level and continues to increase steadily resulting in higher risk of cardiovascular diseases and metabolic disorders. Currently, new methods and criteria are being developed to assess fat and muscle mass, as well as criteria for diagnosing obesity and sarcopenia.Aim:To assess the quantitative composition of muscle and adipose tissue in type 2 diabetes mellitus patients based on the dual-energy X-ray absorptiometry for the diagnosis of obesity and sarcopenia.Materials and methods: We examined 42 type 2 diabetic in-patients admitted to the Department of Therapeutic Endocrinology. Dual-energy X-ray absorptiometry was performed in all patients with subsequent assessment of the composition of muscle and fat tissue.Results:If assessed by the body mass index, all patients had an excess body weight: median, 32.25 [29.75; 35.70]; in men, 31.3 [28.19; 34.63], in women, 32.29 [30.26; 36.54]. 26.2% of the patients (11/42) were overweight, but not obese. Female patients had more severe obesity than male (in total, 33.3% (10/30) of women had 2ndand 3rd degree of obesity, while men 16.7% (2/12)). The assessment by the fat mass index (FMI) showed that 2.4% (1/42) of the patients were normal-weight. Median FMI was 11.91 [10.40; 13.78] (in men, 8.86 [7.46; 12.1], in women, 12.35 [11.55; 15.47]). Overweight was found in 52.4% (22/42) of the patients; in total, 2ndand 3rddegree of obesity was observed in 25% (3/12) of the men and only in 6.6% (2/30) of the women. Median Appendicular Lean Mass Index (ALMI) in the total group was 7.99 [7.32; 9.05], being expectedly higher than in women: 9.19 [8.42; 9.45] and 7.58 [7.24; 8.49], respectively. Median T-score ALMI was 2.32 [1.73; 3.08], Z-score ALMI 2.15 [1.47; 3.54]. In general, there was a decrease in the appendicular muscle mass with age. There was an inverse correlation between the age and T-score ALMI (r = -0.319, р = 0.020), as well as between the age and Z-score ALMI (r = -0.634, p = 0.000). According to the results of T-score ALMI and Z-score ALMI, there were no patients with sarcopenia. However, the calculation of the T- and Z-criteria, corrected for fat mass, has led to a significant decrease of the medians of these parameters and allowed to identify a group of patients meeting the criteria of sarcopenia (97.6%, 41/42).Conclusion:Based on ALMI, T-ALMI, and Z-ALMI, there were no patients with sarcopenia. After these criteria were corrected for fat mass, the number of such patients increased to 97.6% (41/42) and 85.7% (36/42), respectively. The potential use of the adjusted T-ALMI (FMI) and Z-ALMI (FMI) as criteria for sarcopenia and muscle mass reduction compared to the age-related normal values, as well as the classification of obesity by FMI should be studied in large epidemiological studies in different populations.

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The association between fat-to-muscle ratio and metabolic disorders in type 2 diabetes

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00748-y ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Dixing Liu ◽

Jiana Zhong ◽

Yuting Ruan ◽

Zhen Zhang ◽

Jia Sun ◽

...

Keyword(s):

Type 2 Diabetes ◽

Waist Circumference ◽

Muscle Mass ◽

Fat Mass ◽

Metabolic Disorders ◽

Cutoff Point ◽

Risk Indicators ◽

Optimal Method ◽

Abnormal Metabolism

Abstract Background Altered body composition is known to be related to abnormal metabolism. The aim of this study was to determine the association between the fat-to-muscle ratio (FMR) and metabolic disorders in type 2 diabetes (T2DM) population. Method In total, 361 T2DM participants aged ≥ 18 years were included in our research. A bioelectrical impedance analyzer was applied to measure fat mass and muscle mass. FMR was calculated as body fat mass (kg) divided by muscle mass (kg). The performance of FMR to assess metabolic disorders in T2DM was conducted using ROC curves. The independent association between FMR and metabolic syndrome (MS) was tested by logistic regression analysis. Results The FMR was significantly higher in patients with MS than in those without MS (p < 0.001). The optimal FMR cutoff point for identifying MS was higher in females than in males (0.465 vs. 0.296, respectively). In addition, the areas under the ROC curve (AUCs) for the evaluation of MS by FMR, fat mass, muscle mass, BMI and waist circumference were further compared, indicating that the AUC of FMR (0.843) was the largest among the five variables in females, but the AUC of waist circumference (0.837) was still the largest among other variables in males. Based on the derived FMR cutoff point, patients with a high FMR exhibited more cardiometabolic risk indicators (all p < 0.05). Using a low FMR as a reference, the relative risk of a high FMR for MS was 2.861 (95% CI 1.111–7.368, p = 0.029) in males and 9.518 (95% CI 2.615–34.638, p = 0.001) in females following adjustment for confounding factors. Conclusions The fat-to-muscle ratio is independently and positively associated with metabolic disorders in T2DM. FMR may serve as an optimal method for screening T2DM patients coupled with a high risk of abnormal metabolism, especially in females, providing a new perspective for the prevention and treatment of cardiovascular complications in Chinese type 2 diabetes.

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A randomized controlled trial of two diets enriched with protein or fat in patients with type 2 diabetes treated with dapagliflozin

Scientific Reports ◽

10.1038/s41598-021-90879-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yasuhiro Watanabe ◽

Daisuke Suzuki ◽

Nobuichi Kuribayashi ◽

Daigaku Uchida ◽

Mitsutoshi Kato ◽

...

Keyword(s):

Type 2 Diabetes ◽

Muscle Mass ◽

Body Fat ◽

Fat Mass ◽

Serum Insulin ◽

Controlled Trial ◽

Hdl Cholesterol ◽

Body Fat Mass ◽

Randomized Controlled

AbstractSodium-glucose cotranspsorter-2 (SGLT2) inhibitors (SGLT2i) involve loss of skeletal muscle mass, potentially leading to inadequate HbA1c reduction in type 2 diabetes (T2DM), since muscle mass is related to insulin sensitivity. The benefit of protein-enriched diet for improving HbA1c in SGLT2i-treated T2DM patients remains unclear. We conducted a multicenter, double-blind, randomized, controlled, investigator-initiated clinical trial. 130 T2DM patients treated with dapagliflozin (5 mg) were randomized to isoenergic protein-rich formula diet (P-FD) or fat-rich FD (F-FD) (1:1 allocation) to replace one of three meals/day for 24 weeks. Primary outcome was change in HbA1c. Secondary outcomes were changes in serum insulin, body composition and other metabolic parameters. Although HbA1c decreased significantly in both groups [mean (95% confidence interval) − 0.7% (− 0.9 to − 0.5) in P-FD, − 0.6% (− 0.8 to − 0.5) in F-FD], change in HbA1c was not significantly different between the two groups (P = 0.4474). Fasting insulin and body fat mass decreased, while HDL-cholesterol increased significantly in P-FD, and these changes were significantly greater compared with F-FD (all, P < 0.05). In T2DM treated with dapagliflozin, protein-enriched diet does not contribute to HbA1c reduction, although it decreases serum insulin and body fat mass, and increases HDL-cholesterol compared with fat-enriched diet with identical calories and carbohydrate ratio.

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