| BACKGROUND AND OBJECTIVEThe metabolic disease of type 2 diabetes mellitus(T2DM)is mainly caused by environmental,genetic,and other factors that increase blood glucose levels,and is a common public health problem.With a rising prevalence,it leads to cardiovascular and cerebrovascular diseases,renal failure,blindness,and disability,as well as a high mortality rate,which brings serious socioeconomic pressure.Sarcopenia is an independent risk factor for the development of T2DM.Skeletal muscle mass and grip strength are important indicators of sarcopenia.The relationship between the skeletal muscle mass index(SMI),relative grip strength and the risk of developing T2DM in China is lacking.We aimed to evaluate the relationship between SMI,relative grip strength and the occurrence of T2DM in Chinese middle-aged and elderly people through a retrospective cohort study to provide new ideas for the early detection and prevention of T2DM.METHODSThis study was derived from the China Health and Retirement Longitudinal Study(CHARLS),which used a multistage stratified cluster random sampling method to select middle-aged and elderly population nationwide from June 2011 to March 2012 at baseline,and was followed up in 2013,2015,and 2018.The baseline was divided into three groups based on the tertiaries of SMI and relative grip strength,with incidence of T2DM compared.Single-factor COX regression and multi-factor COX regression were used to analyze the risk factors for the development of T2DM.The relationship between SMI,relative grip strength and T2DM was analyzed using a multivariate COX proportional risk model.Restricted cubic splines were used to analyze whether there was a nonlinear relationship between SMI,relative grip strength,and T2DM.Further subgroup analysis was performed according to age,sex,and body mass index.Kaplan-Meier(KM)curves were plotted to compare the risk of T2DM among three groups.Finally,sensitivity analysis is carried out to further demonstrate the stability of the results.RESULTSA total of 7585 participants were included in the analysis at baseline,with a median age of 58 years,3488(46%)males.During a median follow-up of 7 years,736 participants developed T2DM.Individuals were divided into three groups based on the baseline SMI and relative grip strength tertiaries(2529 in Q1 group,2528 in Q2 group and 2528 in Q3 group).COX proportional risk regression analysis was performed to explore the relationship between SMI and incident T2DM,and the confounding factors of gender,age,education,marital status,smoking,alcohol consumption,systolic blood pressure,total cholesterol,triglycerides,low-density lipoprotein cholesterol and highdensity lipoprotein cholesterol were adjusted,compared with Q1 group,the risk of developing T2DM was 0.571(95%CI:0.451-0.724)and 0.397(95%CI:0.281-0.560)times higher in the Q2 and Q3 groups,respectively(P for trend<0.001).Similarly,using multivariable adjusted Cox proportional hazards models,adjusted for the same confounding factors,compared with Q1 group,higher relative grip strength was associated with reduced risk of T2DM in Q2 group(HR,0.790[95%CI:0.661-0.945])and Q3 group(HR,0.641[95%CI:0.516-0.797])(P for trend<0.001).Relative grip strength was linearly negatively correlated with the risk of T2DM,and SMI was negatively correlated nonlinearly with the risk of T2DM.Subgroup analysis suggested that SMI、relative grip strength were associated with the T2DM incidence in middleaged and older adults aged<65 years.Sensitivity analysis results remained stable.CONCLUSIONThis study demonstrates that SMI and relative grip strength are protective factors for the development of T2DM.It suggests that reducing body weight and enhancing muscle strength may be an effective measure for T2DM prevention and control. |
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