The Relationships Of Muscle Mass And Muscle Strength With Blood Lipid Levels In Patients With Type 2 Diabetes Mellitus

Background:Type 2 diabetes mellitus(T2DM)is one of the most common chronic noncommunicable diseases.Cardiovascular disease(CVD)is a leading cause of death in patients with T2DM.Particularly,dyslipidemia is considered one of the most common risk factors for inducing CVD.However,there are only less than 36%of patients with T2DM in China have achieved the recommended targets for blood lipid control.Studies have shown that muscle training could reduce blood lipid levels by increasing muscle mass or strength in healthy people.However,the relationship between blood lipid levels and muscle mass and strength in people with T2DM remains unclear.Objective:The aim of this study is to investigate the relationship of muscle mass and strength with blood lipid levels in patients with T2DM(i.e.,to find muscle groups that have a specific relationship with lipid levels)and to provide scientific evidence for the development of evidence-based exercise prescriptions for improving blood lipid levels in the population with T2DM.Methods:Subjects were recruited at Zhongshan Hospital of Fudan University and Yangpu Hospital of Tongji University.In this study,PMM mass,defined as participants’ 3rd lumbar level,was measured using magnetic resonance imaging;upper and lower limb muscle strength was assessed using portable strength assessment system.All participants were assessed for anthropometric indices and blood biochemical indices,including blood lipids,blood glucose,liver and renal function.Patients’ lipid levels were classified according to criteria of the Chinese T2DM Prevention and Treatment Guidelines to determine whether they met the target.Linear regression model,logistic regression model,and trend tests were used to explore the relationship between PMM mass,upper and lower limb muscle strength and blood lipid levels in patients with T2DM,adjusting for effects of age,sex,BMI and medication.Additionally,subgroup analysis was used to explore effects of age,sex and BMI on these relationships.Results:A total of 239 patients with T2DM were included in the study.In patients with T2DM,the achievement rate was 44.8%for HDL-c,39.7%for LDL-c,41.4%for TC and 47.3%for TG.After correction for confounders,the ORs for achieving HDL-c target,LDL-c target,TG target,and TC target in high PMM mass group were 4.83(95%CI 1.32-17.76),0.47(95%CI 0.17-1.72),2.43(95%CI 0.85-6.96),and 2.12(95%Cl 0.80-5.62),respectively,when set the low PMM mass group as the reference.Subgroup analyses showed no significant interaction of age,sex,and BMI with PMM mass(p>0.05).After adjusting the confounding factors,the ORs for achieving LDL-c and TG target in high grip-strength group were 7.20(95%CI 2.14-24.23)and 3.56(95%CI 1.27-10.00),respectively,when using low grip-strength group as the reference.When using low biceps-muscle strength/body mass group as the reference,the ORs for HDL-c target,LDL-c target,and TG target in the high biceps-muscle strength/BMI group were 3.53(95%CI 1.14-10.96),3.90(95%CI 1.12-13.49)and 3.52(95%CI 1.20-10.33),respectively.Additionally,the OR for achieving TG target in the high deltoid-strength group was 3.29(95%CI 1.19-9.12)when using low deltoid-strength group as the reference.Subgroup analyses showed no significant interaction between age,sex,and BMI with each muscle strength index(p>0.05).Conclusion:High PMM mass and upper-limb muscle strength are conducive to achieving lipid levels in patients with T2DM,suggesting that improving PMM mass and upperlimb muscle strength through exercise in patients with T2DM may be an important means of promoting lipid levels in patients and thereby reducing the risk of CVD.In future clinical practice,clinicians and community-based exercise health professionals should pay more attention to the muscle health status of patients with T2DM.By developing scientific and personalized exercise prescriptions,the lipid health of patients with T2DM can be further improved.