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Chen Z, Zhong X, Lin R, Liu S, Cao H, Chen H, Cao B, Tu M, Wei W. Type 2 diabetes: is obesity for diabetic retinopathy good or bad? A cross-sectional study. Nutr Metab (Lond) 2024; 21:68. [PMID: 39160558 PMCID: PMC11334401 DOI: 10.1186/s12986-024-00842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The relationship between obesity and diabetic retinopathy (DR) remains controversial, and the relationship between sarcopenic obesity and DR is still unclear. The purpose of this study is to investigate the relationship between obesity, sarcopenic obesity, and DR in patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was conducted on patients with T2DM. Obesity was assessed by body mass index (BMI), fat mass index (FMI), android fat mass, gynoid fat mass, and visceral adipose tissue (VAT) mass. Sarcopenia was defined according to the criteria of Consensus of the Asian Working Group for Sarcopenia (AWGS 2019). Sarcopenic obesity was defined as the coexistence of sarcopenia and obesity. The association between obesity, sarcopenic obesity, and DR was examined using univariable and multivariable logistic regression models. RESULTS A total of 367 patients with T2DM (mean age 58.3 years; 57.6% male) were involved in this study. The prevalence of DR was 28.3%. In total patients, significant adverse relationships between obesity and DR were observed when obesity was assessed by BMI (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.31 to 0.96, p = 0.036), FMI (aOR 0.49, 95% CI 0.28 to 0.85, p = 0.012), android fat mass (aOR 0.51, 95% CI 0.29 to 0.89, p = 0.019), gynoid fat mass (aOR 0.52, 95% CI 0.30 to 0.91, p = 0.021) or VAT mass (aOR 0.45, 95% CI 0.25 to 0.78, p = 0.005). In patients with T2DM and obesity, the prevalence of sarcopenic obesity was 14.8% (n = 23) when obesity was assessed by BMI, 30.6% (n = 56) when assessed by FMI, 27.9% (n = 51) when assessed by android fat mass, 28.4% (n = 52) when assessed by gynoid fat mass, and 30.6% (n = 56) when assessed by VAT mass. Sarcopenic obesity was associated with DR when obesity was assessed by BMI (aOR 2.61, 95% CI 1.07 to 6.37, p = 0.035), android fat mass (aOR 3.27, 95% CI 1.37 to 7.80, p = 0.007), or VAT mass (aOR 2.50, 95% CI 1.06 to 5.92, p = 0.037). CONCLUSIONS Patients with T2DM showed a substantial inverse relationship between DR and obesity, and sarcopenic obesity was considerably favorably associated with DR. Detection of sarcopenia in patients with T2DM, especially in obese T2DM, is essential to guide clinical intervention in DR.
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Affiliation(s)
- Zheyuan Chen
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- Department of Endocrinology, Fujian Longyan First Hospital, Fujian Medical University, Fuzhou, 350004, China
| | - Xuejing Zhong
- Department of Science and Education, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Ruiyu Lin
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Shuling Liu
- Department of Endocrinology, Fujian Longyan First Hospital, Fujian Medical University, Fuzhou, 350004, China
| | - Hui Cao
- Department of Endocrinology, Fujian Longyan First Hospital, Fujian Medical University, Fuzhou, 350004, China
| | - Hangju Chen
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Baozhen Cao
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Mei Tu
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Wen Wei
- Department of Endocrinology, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510280, China.
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Ma L, Li Y, Li G, Sun J, Zhang X, Shi Z, Yan Y, Duan Y, Wang J, Li Z, Zhang L. Adiposity indicators exhibit depot- and sex-specific associations with multimorbidity onset: A cohort study of the UK Biobank. Diabetes Obes Metab 2024; 26:2890-2904. [PMID: 38686512 DOI: 10.1111/dom.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
AIM This study investigated the depot- and sex-specific associations of adiposity indicators with incident multimorbidity and comorbidity pairs. MATERIALS AND METHODS We selected 382 678 adults without multimorbidity (≥2 chronic diseases) at baseline from the UK Biobank. General obesity, abdominal obesity and body fat percentage indices were measured. RESULTS Cox proportional hazard regression analyses of general obesity indices revealed that for every one-unit increase in body mass index, the risk of incident multimorbidity increased by 5.2% (95% confidence interval 5.0%-5.4%). A dose-response relationship was observed between general obesity degrees and incident multimorbidity. The analysis of abdominal obesity indices showed that for every 0.1 increment in waist-to-height ratio and waist-to-hip ratio, the risk of incident multimorbidity increased by 42.0% (37.9%-46.2%) and 27.9% (25.7%-30.0%), respectively. Central obesity, as defined by waist circumference, contributed to a 23.2% increased risk of incident multimorbidity. Hip circumference and hip-to-height ratio had protective effects on multimorbidity onset. Consistent findings were observed for males and females. Body fat percentage elevated 3% (0.2%-5.9%) and 5.3% (1.1%-9.7%) risks of incident multimorbidity in all adults and females, respectively. Arm fat percentages elevated 5.3% (0.8%-9.9%) and 19.4% (11.0%-28.5%) risks of incident multimorbidity in all adults and males, respectively. The general obesity indices, waist circumference, waist-to-height ratio, waist-to-hip ratio and central obesity increased the onset of comorbidity pairs, whereas hip circumference and hip-to-height ratio decreased the onset of comorbidity pairs. These adiposity indicators mainly affect diabetes mellitus-related comorbidity onset in males and hypertensive-related comorbidity onset in females. CONCLUSIONS Adiposity indicators are predictors of multimorbidity and comorbidity pairs and represent a promising approach for intervention.
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Affiliation(s)
- Lu Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
| | - Ying Li
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gaixia Li
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jiajun Sun
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xueli Zhang
- Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Yating Yan
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yutian Duan
- Clinical Medicine, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jing Wang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zengbin Li
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lei Zhang
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
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Wu J, Chen A, Zhang J, Lin W, Wu J, Luo L. Association between A/G ratio and arterial stiffness among Chinese type 2 diabetics: A cross-sectional study. Exp Gerontol 2024; 192:112462. [PMID: 38782217 DOI: 10.1016/j.exger.2024.112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The android-to-gynoid fat ratio (A/G ratio), an emerging indicator of obesity independent of body mass index (BMI), has yet to be conclusively associated with arterial stiffness in type 2 diabetes mellitus (T2DM). This study aimed to construct a nomogram to estimate arterial stiffness risk in diabetics and explore the interaction effect between A/G ratio and traditional obesity indicators on arterial stiffness. METHODS 1313 diabetics were divided into 2 groups based on arterial stiffness identified by brachial ankle pulse wave velocity (baPWV), and demographic and clinical features were measured. The LASSO and multivariate logistics regression were used to develop the nomogram. Calibration curve, decision curve analysis (DCA) and receiver operating characteristic (ROC) were applied to assess calibration and clinical usefulness. Interaction effect analysis was performed to quantify the interactive relationship of A/G ratio and obesity indicators on arterial stiffness. RESULTS 6 independent predictors (age, gender, A/G ratio, SBP, LDL-C and HbA1C) were screened to construct a nomogram prediction model. The calibration curve demonstrated satisfactory agreement between predicted and actual probability, and the nomogram exhibited clinical beneficial at the threshold between 8 % and 95 % indicated by DCA. The area under curve (AUC) was 0.918 and 0.833 for training and external set, respectively. Further investigation revealed A/G ratio and BMI acted positively synergistically towards arterial stiffness, and in BMI-based subgroup analysis, elevated A/G ratio was a significant risk factor for arterial stiffness, especially in normal BMI. CONCLUSIONS A/G ratio showed a substantial association with arterial stiffness, and the nomogram, incorporating age, gender, A/G ratio, SBP, LDL-C, and HbA1c, exhibited high predictive value. A/G ratio measurement in BMI-normal individuals assisted in identifying cardiovascular diseases early.
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Affiliation(s)
- Jianmin Wu
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ai Chen
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, Fujian Province, Fuzhou, China; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Fuzhou, China
| | - Jie Zhang
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, Fujian Province, Fuzhou, China; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Fuzhou, China
| | - Weijun Lin
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, Fujian Province, Fuzhou, China; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Fuzhou, China
| | - Jiaqin Wu
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, Fujian Province, Fuzhou, China; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Fuzhou, China
| | - Li Luo
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Clinical Research Center for Geriatric Hypertension Disease of Fujian Province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Branch of National Clinical Research Center for Aging and Medicine, Fujian Province, Fuzhou, China; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Fuzhou, China.
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Su Y, Sun JY, Su ZY, Sun W. Revisiting Waist Circumference: A Hypertension Risk Factor that Requires a More In-depth Understanding. Curr Cardiol Rev 2024; 20:77-85. [PMID: 38544391 PMCID: PMC11327828 DOI: 10.2174/011573403x290574240322041356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 08/07/2024] Open
Abstract
As a major cause of various cardiovascular diseases, the prevalence of hypertension has been increasing in the past 30 years, leading to significant socioeconomic and health burdens. Obesity is one of the major risk factors for hypertension. Body mass index (BMI) is the most used anthropometric index to measure obesity in clinical practice and to assess the risk of obesity-related diseases. However, obesity is a heterogeneous disease, and the accumulation of fat in different body regions leads to differences in cardiovascular and metabolic risks. BMI only reflects the overall obesity but does not consider the distribution of fat and muscle mass. The limitation of BMI makes it insufficient to assess the risk of hypertension attributed to obesity. In addition, waist circumference is an easily obtainable anthropometric index to evaluate abdominal fat distribution. High waist circumference is an independent risk factor for various cardiovascular diseases and all-cause mortality regardless of BMI. Preliminary data indicate that waist circumference is significantly associated with the risk of hypertension at different BMI levels. However, routine measurement of waist circumference is currently not required in current clinical guidelines or is only recommended for obese populations, indicating an insufficient understanding of waist circumference. In this review, we summarize the measurement methods and diagnostic thresholds of waist circumference for abdominal obesity, the trend of central obesity prevalence, the superiority of waist circumference over other anthropometric indices, and recent cross-sectional and longitudinal studies on the association between obesity and hypertension.
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Affiliation(s)
- Yue Su
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jin-yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhen-yang Su
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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Jensen ET, Rigdon J, Rezaei KA, Saaddine J, Lundeen EA, Dabelea D, Dolan LM, D’Agostino R, Klein B, Meuer S, Mefford MT, Reynolds K, Marcovina SM, Mottl A, Mayer-Davis B, Lawrence JM. Prevalence, Progression, and Modifiable Risk Factors for Diabetic Retinopathy in Youth and Young Adults With Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:1252-1260. [PMID: 37043887 PMCID: PMC10234751 DOI: 10.2337/dc22-2503] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To determine the prevalence, progression, and modifiable risk factors associated with the development of diabetic retinopathy (DR) in a population-based cohort of youth-onset diabetes. RESEARCH DESIGN AND METHODS We conducted a multicenter, population-based prospective cohort study (2002-2019) of youth and young adults with youth-onset type 1 diabetes (n = 2,519) and type 2 diabetes (n = 447). Modifiable factors included baseline and change from baseline to follow-up in BMI z score, waist/height ratio, systolic and diastolic blood pressure z score, and A1C. DR included evidence of mild or moderate nonproliferative DR or proliferative retinopathy. Prevalence estimates were standardized to estimate the burden of DR, and inverse probability weighting for censoring was applied for estimating risk factors for DR at two points of follow-up. RESULTS DR in youth-onset type 1 and type 2 diabetes is highly prevalent, with 52% of those with type 1 diabetes and 56% of those with type 2 diabetes demonstrating retinal changes at follow-up (mean [SD] 12.5 [2.2] years from diagnosis). Higher baseline A1C, increase in A1C across follow-up, and increase in diastolic and systolic blood pressure were associated with the observation of DR at follow-up for both diabetes types. Increase in A1C across follow-up was associated with retinopathy progression. BMI z score and waist/height ratio were inconsistently associated, with both positive and inverse associations noted. CONCLUSIONS Extrapolated to all youth-onset diabetes in the U.S., we estimate 110,051 cases of DR developing within ∼12 years postdiagnosis. Tight glucose and blood pressure management may offer the opportunity to mitigate development and progression of DR in youth-onset diabetes.
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Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kasra A. Rezaei
- Department of Ophthalmology, University of Washington, Seattle, WA
| | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A. Lundeen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lawrence M. Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ralph D’Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Barbara Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI
| | - Stacy Meuer
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI
| | - Matthew T. Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Amy Mottl
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Beth Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jean M. Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Ding L, Fan Y, Qiao J, He J, Wang R, He Q, Cui J, Ma Z, Zheng F, Gao H, Dai C, Wei H, Li J, Cao Y, Hu G, Liu M. Distribution of lean mass and mortality risk in patients with type 2 diabetes. Prim Care Diabetes 2022; 16:824-828. [PMID: 36272915 DOI: 10.1016/j.pcd.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/27/2022] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
AIMS The aim of the study is to evaluate the association of distribution of lean mass with the risk of all-cause mortality among patients with type 2 diabetes. METHODS The present cohort study included 2 335 patients with type 2 diabetes. Lean mass was assessed by dual energy X-ray absorptiometry. Cox proportional hazards regressions were used to estimate the association of lean mass distribution on the risk of mortality. RESULTS The average age of the patients was 58 years at baseline and 51.4% of patients were women. During a median follow-up of 4.31 years, 128 patients died. The multivariable-adjusted hazards ratios for all-cause mortality were 1.00, 1.63 (0.89-2.99), and 2.68(1.51-4.76) across the tertiles of android-to-gynoid lean mass ratio (P for trend < 0.001), respectively. The positive association of android-to-gynoid lean mass ratio with the risk of all-cause mortality was present among patients of different ages, body mass index ≥ 24 kg/m2, hemoglobin A1c ≥ 7.0%, nonsmokers, men, patients using insulin, and patients with diabetes durations of more than 10 years. CONCLUSIONS Higher android-to-gynoid lean mass ratio, assessed by dual energy X-ray absorptiometry, was significantly associated with increased risk of all-cause mortality among patients with type 2 diabetes.
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Affiliation(s)
- Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China; Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Jingting Qiao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Ruodan Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Zhongshu Ma
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Fangqiu Zheng
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Hua Gao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Chenlin Dai
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Jun Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Yuming Cao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China.
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