Adiposity And Cardiometabolic Risk Factors In Adults With Type 2 Diabetes Mellitus

Objective:Previous studies showed that increased adiposity have been associated with increased incidence of type 2 diabetes mellitus,and unfavorable cardiometabolic profiles,while lower-body subcutaneous adiposity may be metabolically protective.The association between body composition and distribution with glycemic,blood pressure and lipid management among patients with type 2 diabetes is less unclear.The purpose of this study was to evaluate the effect of increased level of adiposity and fat distribution on Hb A_1c,blood pressure and low-density lipoprotein cholesterol levels in adults with type 2 diabetes mellitus.Methods:1.We retrieved data from 4562 consecutive inpatient records with type 2 diabetes mellitus as one of the diagnosis at discharge,consisted of data from 3795 individuals after excluding repeated hospitalization,at the Department of Endocrinology and Metabolic Diseases,Tianjin Medical University General Hospital from June 2013 to May 2018.2.Patients’medical records were collected,including sex,age,medical history,BP,height,weight,Hb A1c,LDL-C,etc.3.Fat mass and percentage in whole body,leg,arm,truncal,android and gynoid regions were assessed with dual energy X-ray absorptiometry.Fat distribution parameters（truncal-to-leg fat ratio,and android-to-gynoid fat ratio）were calculated.4.Comparisons of numerical parameters were performed using Student’s t test,chi-squared test,Mann-Whitney U test.Partial correlation analysis and multiple logistic regression models were used to assess the associations of body composition and distribution parameters with sub-optimal diabetes management（high Hb A1c,blood pressure,and LDL-C）.P<0.05 were considered as significant.All statistical analyses were performed with SPSS for Windows 22.0（Inc.,Chicago,IL）.Results:1.Age,BMI,the proportion of high LDL-C,fat mass and fat percentage were significantly higher,while the proportion of current smoking and alcohol consumption,central fat distribution were significantly lower in women comparing with men.2.Partial correlations adjusted for age,sex,insurance status,family history of diabetes mellitus,current smoking and alcohol consumption,among the whole study population,showed that BMI,fat mass and fat percentage are negatively associated with Hb A1c,while positively correlated with blood pressures and LDL-C.Central fat distribution were positively associated with Hb A1c,blood pressures and LDL-C.3.There were consistent higher odds of having sub-optimal blood pressure and having two sub-optimal management parameters associated with each SD increase of BMI（OR 1.36 for blood pressure,1.28 for two or more sub-optimal management parameters）,and the associations persisted after further adjustment for total fat mass.There were mostly consistent higher odds of having sub-optimal LDL-C management and having one sub-optimal management parameter with each SD increase of BMI（OR 1.16 for LDL-C,1.28 for one sub-optimal management parameter）,and further adjustment for total fat mass attenuated the association.There were significantly lower odds of having sub-optimal glycemic control associated with each SD of leg fat mass,leg and gynoid fat percentage（OR 0.80-0.88）,and the associations persisted after further adjustment for BMI.There were consistent higher odds of having sub-optimal blood pressure with each SD increase of fat mass and fat percentage（OR1.26-1.46）,and further adjustment for BMI attenuated the association,and only the significance for truncal fat mass and android fat mass persisted.There were mostly consistent higher odds of having sub-optimal LDL-C management with each SD increase of fat mass and fat percentage,except for leg fat mass and percentage（OR1.13-1.36）,and further adjustment for BMI slightly attenuated the association.There were mostly consistent higher odds of having one sub-optimal management parameter with each SD increase of fat mass and fat percentage（OR 1.20-1.36）,except for leg fat mass and percentage and gyniod fat and percentage,and further adjustment for BMI attenuated the association.There were consistent higher odds of having two or more sub-optimal management parameters with each SD increase of fat mass and fat percentage（OR 1.13-1.41）.The associations of truncal fat mass and percentage,android fat mass and percentage with sub-optimal blood pressure management persisted after further adjustment for BMI,while there were significantly lower odds of having two or more sub-optimal management parameters with each SD increase of leg fat mass and percentage and gyniod fat and percentage（OR 0.85-0.95）after further adjustment for BMI.There were consistent higher odds of having sub-optimal glycemic control,sub-optimal blood pressure,sub-optimal LDL-C management and having two or more sub-optimal management parameters with each SD increase of T/L and A/G（OR 1.17-1.47）,and the associations persisted after further adjustment for BMI.Conclusion:1.BMI is a risk factor for having sub-optimal blood pressure and having two or more sub-optimal management parameters,independent of total fat mass.2.Leg fat mass and fat percentage,gynoid fat percentage are protective factors for having sub-optimal glycemic control,independent of BMI.T/L and A/G are risk factors for having sub-optimal glycemic control,independent of BMI.Truncal fat mass,android fat mass,T/L and A/G are risk factors for having sub-optimal blood pressure,independent of BMI.Truncal fat mass and fat percentage,android fat mass and fat percentage,total fat percentage,arm fat percentage and central fat distribution parameters,are risk factors for having sub-optimal LDL-C management,independent of BMI.3.T/L and A/G are risk factors for having one sub-optimal management parameter,independent of BMI.Trunkal fat mass,android fat mass and central fat distribution parameters are risk factors for having two or more sub-optimal management parameters,independent of BMI.