| ObjectiveTo examine the prevalence of sarcopenia in middle-age and elderly patients with type 2 diabetes and clarify its associated risk factors.MethodsWe observed 1125 patients with type 2 diabetes over 50 years old from January 2016 to March 2018,who came from endocrinology department of nine different hospitals in Beijing,which were selected by system random sampling method.All participations consisted of 586 males and 539 females,were divided into 3 groups by BMI:Normal-weight group(BMI<24kg/m2),overweight group(24kg/m2<BMI<28kg/m2)and obese group(BMI?28kg/m2),were divided into 3 groups by age:middle-age group(50-59 years old),young elderly group(60-74 years old)and elderly group(over 75 years old),were divided into 2 groups by the duration of type 2 diabetes mellitus:diabetes duration<10 years group and diabetes duration>10 years group,were divided into 2 groups by HbA1c:HbA1c<7%group and HbA1c?7%group.We obtained medical history by questionnaire,and recorded laboratory examination results from fasting venous blood sample.We got dietary intake by three-day Dietary Recording Method and calculated the macronutrient intake daily by nutrition software.Body composition was measured by bioimpedance analysis.Low muscle mass was determined as the appendicular skeletal muscle mass index(ASMI)below the lower quintile of the homogeneity,same sex and healthy young reference group,the cutoff point was less than 7.18kg/m2 in men and less than 5.73kg/m2 in women.Low muscle strength was defined by the grip strength below the lower quintile of the same sex participations,and the cutoff point was less than 29.5kg in men and less than 21.2kg in women.Sarcopenia was defined by low muscle mass coexisted with low grip strength.High body fat was defined by body fat percentage more than the median of the same sex participations,and the cutoff point was more than 26.7%in men and more than 36%in women.Sarcopenic obesity was defined by low muscle mass coexisted with high body fat.Muscle quality was calculated with grip strength divided by muscle mass of dominant upper limb.Chi-square test was used to compare the prevalence.Multivariate logistic regression was used for correlation analysis.Results1.In all participants,the detection rate of low muscle mass was 14.0%(157/1125),which in male was higher significantly than in female(18.3%vs 9.3%,?2=18.867,P<0.001).The detection rate of low muscle strength was 36%(405/1125),which in male was higher significantly than in female(50.3%vs 20.4%,?2=109.183,P<0.001).The prevalence of sarcopenia was 8.5%(96/1125),which in male was higher significantly than in female(12.8%vs 3.9%,?2=28.509,P<0.001).The prevalence of sarcopenic obesity was 7.6%(86/1125),which in male was higher significantly than in female(10.8%vs 4.3%,?2=16.721,P<0.001).2.In middle-age,young elderly and elderly group,the detection rate of low muscle mass was 8.6%(41/475),15.1%(83/548)and 32.4%(33/102)separately.The detection rate of low muscle strength was 29.5%(140/475),37.2%(204/548)and 59.8%(61/102)separately.The prevalence of sarcopenia was 4.4%(21/475),8.9%(49/548)and 25.5%(26/102)separately.The prevalence of sarcopenic obesity was 4.2%(20/475),8.4%(46/548)and 19.6%(20/102)separately.The difference in three aging groups was significant.3.In normal-weight group,overweight group and obese group,the detection rate of low muscle mass was 32.3%(109/337),8.1%(41/506)and 2.5%(70/282)separately.The detection rate of low muscle strength was 41.8%(141/337),35.0%(177/506)and 30.9%(87/282)separately.The prevalence of sarcopenia was 18.7%(63/337),5.3%(27/506)and 2.1%(6/282)separately.The prevalence of sarcopenic obesity was 12.2%(41/337),7.5%(38/506)and 2.5%(7/282)separately.The difference in three BMI groups was significant.The muscle quality in obese group was lower significantly than which in normal-weight group[male:(10.0±2.3)vs(11.8±3.2),P<0.05;female:(10.5±2.3)vs(13.3±3.1),P<0.05].4.In HbA1c<7%group,the detection rate of low muscle strength was lower significantly than which in HbA1c>7%group[28.6%(108/377)vs 39.7%(297/748),?2=13.305,P<0.001].In male participations,the grip strength[(34.4±7.7)kg vs(32.3±6.7)kg,t=-3.382,P=0.001]and muscle quality[(11.4±2.5)vs(10.4±2.7),t=-4.073,P<0.001]were higher significantly than those in HbA1c?7%group.5.In diabetes duration<10 years group,the detection rate of low muscle strength was lower significantly than which in diabetes duration>10 years group[32.8%(172/524)vs 38.8%(233/601),?2=4.293,P=0.038].6.Logistic regression analysis showed that male,low BMI,aging,high HbA1c,low percentage of protein intake and excessive daily calories were risk factors associated with sarcopenia.The risk of sarcopenia increased obviously in patients who were older than 75 years old(OR=5.500,95%CI:2.668?11.336,P<0.001)or whose HbA1c was over 10%(OR=2.390,95%CI:1.095?5.219,P=0.029).ConclusionType 2 diabetes mellitus was associated with increased risk of sarcopenia,sarcopenic obesity,low muscle mass and low muscle strength.The risk increased with age,which was higher significantly in male than in female.The muscle strength and muscle quality in type 2 diabetes became worse as HbA1c level going up and the muscle quality declined as the BMI increasing.Male,low BMI,aging,high HbA1c,low percentage of protein intake and excessive daily calories were risk factors associated with sarcopenia in type 2 diabetes mellitus.The risk of sarcopenia in type 2 diabetes mellitus would decline by early diagnosis of diabetes,good control in glucose level,restriction on total calories,increase in protein intake and keeping moderate BMI. |
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