Association of muscle mass and fat mass with insulin resistance and the prevalence of metabolic syndrome in Korean adults: a cross-sectional study. Sci Rep. 2018;8:2703. [PMID: 29426839 PMCID: PMC5807388 DOI: 10.1038/s41598-018-21168-5]

Impact of Diabetes Mellitus on Outcomes in Patients with Left Ventricular Assist Devices

Heart failure (HF) represents a significant health burden in the United States, resulting in substantial mortality and healthcare costs. Through the array of treatment options available, including lifestyle modifications, medications, and implantable devices, HF management has evolved. Left ventricular assist devices (LVADs) have emerged as a crucial intervention, particularly in patients with advanced HF. However, the prevalence of comorbidities such as diabetes mellitus (DM) complicates treatment outcomes. By elucidating the impact of DM on LVAD outcomes, this review aims to inform clinical practice and enhance patient care strategies for individuals undergoing LVAD therapy. Patients with DM have higher rates of hypertension, dyslipidemia, peripheral vascular disease, and renal dysfunction, posing challenges to LVAD management. The macro/microvascular changes that occur in DM can lead to cardiomyopathy and HF. Glycemic control post LVAD implantation is a critical factor affecting patient outcomes. The recent literature has shown significant decreases in hemoglobin A1c following LVAD implantation, representing a possible bidirectional relationship between DM and LVADs; however, the clinical significance of this decrease is unclear. Furthermore, while some studies show increased short- and long-term mortality in patients with DM after LVAD implantation, there still is no literature consensus regarding either mortality or major adverse outcomes in DM patients.

Osteosarcopenic adiposity (OSA) phenotype and its connection with cardiometabolic disorders: Is there a cause-and-effect?

The objectives were to examine if there is a causal relationship between osteosarcopenic adiposity (OSA) syndrome (coexistence of osteopenia/osteoporosis, sarcopenia, and excess adiposity) and cardiometabolic disorders or if these disorders initiate the development of OSA and its worsening. The search was conducted in PubMed, Scopus, and Web of Science to include articles up to the end of 2023. Of n=539 articles retrieved, n=15 met the eligibility criteria. Only studies conducted in adults and with all three body composition compartments (bone, muscle/lean, adipose) measured were considered. The results revealed that several cardiometabolic disorders, namely, hypertension, dyslipidemia (elevated total and LDL-cholesterol, lower HDL-cholesterol), insulin resistance, hyperglycemia, lower serum vitamin D, and some inflammatory markers were accompanied by OSA. In most cases, the OSA phenotype was associated with worse outcomes than cases with healthy or less impaired body composition. Our initial questions about the reciprocal cause-and-effect relationships could be surmised with more certainty for the OSA and some cardiovascular risks (hypertension, dyslipidemia) and some metabolic abnormalities (several inflammatory markers). The results of this review underscore the importance of body composition in health and from a clinical perspective, all three body composition compartments should be measured by standardized technologies using regulated diagnostic criteria to identify OSA. Randomized trials and prospective studies in diverse groups of older and younger individuals are necessary to determine if the relationships between OSA and clinical endpoints are causal and reversible through intervention and to uncover the mechanisms.

Development of a prediction model for cognitive impairment of sarcopenia using multimodal neuroimaging in non-demented older adults

INTRODUCTION

Despite prior research on the association between sarcopenia and cognitive impairment in the elderly, a comprehensive model that integrates various brain pathologies is still lacking.

METHODS

We used data from 528 non-demented older adults with or without sarcopenia in the Catholic Aging Brain Imaging (CABI) database, containing magnetic resonance imaging scans, positron emission tomography scans, and clinical data. We also measured three key components of sarcopenia: skeletal muscle index (SMI), hand grip strength (HGS), and the five times sit-to-stand test (5STS).

RESULTS

All components of sarcopenia were significantly correlated with global cognitive function, but cortical thickness and amyloid-beta (Aβ) retention had distinctive relationships with each measure. In the path model, brain atrophy resulting in cognitive impairment was mediated by Aβ retention for SMI and periventricular white matter hyperintensity for HGS, but directly affected by the 5STS.

DISCUSSION

Treatments targeting each sub-domain of sarcopenia should be considered to prevent cognitive decline.

HIGHLIGHTS

We identified distinct impacts of three sarcopenia measures on brain structure and Aβ. Muscle mass is mainly associated with Aβ and has an influence on the brain atrophy. Muscle strength linked with periventricular WMH and brain atrophy. Muscle function associated with cortical thinning in specific brain regions. Interventions on sarcopenia may be important to ease cognitive decline in the elderly.

Association of short-term changes in HbA1c with body composition and the importance of muscle maintenance in patients with Type 2 diabetes

AIMS

This study aimed to investigate the relationship between changes in glucose metabolism and body composition in patients with diabetes.

METHODS

We included 380 patients with type 2 diabetes, who underwent bioelectrical impedance analysis, in this longitudinal study. Changes in HbA1c (ΔHbA1c) levels and body composition indices were compared between baseline and 6 months. A multivariate analysis was performed to examine the relationship between ΔHbA1c and changes in body composition.

RESULTS

HbA1c levels were significantly decreased at 6 months (P < 0.01), but there was no significant change in BMI. A linear multiple regression analysis showed that ΔHbA1c was negatively correlated with changes in muscle mass (β = -0.18; P = 0.047) and bone mineral content (β = -0.28; P < 0.001), but there was no significant association between ΔHbA1c levels and a change in body fat percentage.

CONCLUSIONS

This study shows a limited association between short-term changes in glucose metabolism and changes in body composition in patients with type 2 diabetes. Therefore, interventions aimed at reducing adiposity may not affect glucose metabolism in the short term, while interventions focused on maintaining or enhancing muscle mass and bone mineral content may play an important role in diabetes management.

An Indian classical dance form, Kathak in maintaining handgrip strength symmetry and reducing the risk of hypertension

BACKGROUND

The present paper aimed to study handgrip strength (HGS) asymmetry and its association with hypertension in a sample of Kathak dancers and non-dancers of North India.

METHODS

Data on HGS and blood pressure were collected from 206 Kathak dancers and 235 age-matched controls, using standardized protocols. Pearson correlation coefficients assessed the association between HGS and hypertension, and binary logistic regression identified the risk of developing hypertension.

RESULTS

HGS asymmetry was higher among non-dancers. In Kathak dancers, systolic blood pressure (SBP) was positively correlated with HGS and negatively correlated with HGS asymmetry whereas diastolic blood pressure (DBP) was negatively correlated with both HGS and HGS asymmetry. Dancers with high HGS, have significantly reduced risk of developing hypertension. Non-dancers with HGS asymmetry were 1.8 times more likely to report hypertension, relative to dancers.

CONCLUSION

Kathak may be used as an alternative method for maintaining HGS symmetry and reducing the risk of developing hypertension.

Adverse Skeletal Muscle Adaptations in Individuals Born Preterm-A Comprehensive Review

Infants born preterm face an increased risk of deleterious effects on lung and brain health that can significantly alter long-term function and quality of life and even lead to death. Moreover, preterm birth is also associated with a heightened risk of diabetes and obesity later in life, leading to an increased risk of all-cause mortality in young adults born prematurely. While these preterm-birth-related conditions have been well characterized, less is known about the long-term effects of preterm birth on skeletal muscle health and, specifically, an individual's skeletal muscle hypertrophic potential later in life. In this review, we discuss how a confluence of potentially interrelated and self-perpetuating elements associated with preterm birth might converge on anabolic and catabolic pathways to ultimately blunt skeletal muscle hypertrophy, identifying critical areas for future research.

Four-years change of BMI and waist circumference are associated with metabolic syndrome in middle-aged and elderly Chinese

The purpose of the study was to determine whether changes in body mass index (BMI) and waist circumference (WC) in middle-aged and elderly Chinese are associated with metabolic syndrome. In this cohort investigation, 3697 middle-aged and elderly people aged 45 or over were recruited from the China Health and Retirement Longitudinal Study (CHARLS). The National Cholesterol Education Program Adult Treatment Panel III (2005) defined metabolic syndrome (MetS). With Cox regression analysis, we calculated hazard ratio (HR) and 95% confidence intervals (CIs) for MetS based on BMI-WC change categories. To assess the prevalence of MetS, the changes in BMI and WC levels were classified into four quartiles based on their relative and absolute changes. In subjects whose BMI and WC decreased (HR = 0.338; 95% CIs 0.264, 0.433) as well as those whose BMI increased and their WC decreased (HR = 0.375; 95% CIs 0.228, 0.499), metabolic syndrome risk was significantly lower compared with those with increases in both BMI and WC. Regarding the absolute changes in BMI, the lowest percentile of BMI was significantly lower in both males (HR = 0.302; 95% CIs 0.204, 0.448) and females (HR = 0.486; 95% CIs 0.354, 0.667) for the risk of metabolic syndrome. Similar results were observed in the absolute changes in WC, with the lowest quantile of WC having a significant impact on MetS risk in males (HR = 0.170; 95% CIs 0.107, 0.270) and females (HR = 0.303; 95% CIs 0.217, 0.424). The risk of metabolic syndrome was significantly associated with changes in BMI and WC in middle-aged and elderly Chinese. A reduced BMI and WC are associated with lower metabolic syndrome risks in middle-aged and elderly people.

Relationships between Circulating Biomarkers and Body Composition Parameters in Patients with Metabolic Syndrome: A Community-Based Study

Metabolic syndrome (MetS) is a complex disease involving multiple physiological, biochemical, and metabolic abnormalities. The search for reliable biomarkers may help to better elucidate its pathogenesis and develop new preventive and therapeutic strategies. In the present population-based study, we looked for biomarkers of MetS among obesity- and inflammation-related circulating factors and body composition parameters in 1079 individuals (with age range between 18 and 80) belonging to an ethnically homogeneous population. Plasma levels of soluble markers were measured by using ELISA. Body composition parameters were assessed using bioimpedance analysis (BIA). Statistical analysis, including mixed-effects regression, with MetS as a dependent variable, revealed that the most significant independent variables were mainly adipose tissue-related phenotypes, including fat mass/weight (FM/WT) [OR (95% CI)], 2.77 (2.01-3.81); leptin/adiponectin ratio (L/A ratio), 1.50 (1.23-1.83); growth and differentiation factor 15 (GDF-15) levels, 1.32 (1.08-1.62); inflammatory markers, specifically monocyte to high-density lipoprotein cholesterol ratio (MHR), 2.53 (2.00-3.15), and a few others. Additive Bayesian network modeling suggests that age, sex, MHR, and FM/WT are directly associated with MetS and probably affect its manifestation. Additionally, MetS may be causing the GDF-15 and L/A ratio. Our novel findings suggest the existence of complex, age-related, and possibly hierarchical relationships between MetS and factors associated with obesity.

Effects of 12-Month Training Intervention on Physical Fitness, Body Composition, and Health Markers in Finnish Navy Soldiers

BACKGROUND

Most Western adults do not meet the recommendations for sufficient activity, and obesity is a global problem. Similar trends are also seen among Western military personnel. Many successful physical training interventions have been carried out in military environments, but the interventions have been quite short term, and the training has been supervised. Therefore, the aim of this study was to investigate the effects of a 12-month voluntary motivational training intervention among the Finnish Defence Forces' (FDF) Navy soldiers.

METHODS

In total, 77 FDF Navy soldiers, serving in missile patrol boats, took part in the study. The intervention group (IG) contained 45 participants and the control group (CG) contained 32 participants. The IG was divided into four teams that carried out the intervention, while the CG took part in only the measurements.

RESULTS

Most of the participants (65%) in the IG reported that they had increased their exercise volume during the intervention, but no major beneficial impacts on the physical fitness, body composition, or health markers were observed. Nevertheless, there was a clear diversity visible between the subgroups in the IG. The team that reported the most exercise had the best motivation and the most motivated team coach and also had the most improved physical fitness and body composition results.

CONCLUSIONS

The present study points out that in military environments, long-term voluntary training interventions may not be as successful as short-term supervised interventions. The results also suggest that in voluntary training interventions among military personnel, the participants' motivation to exercise is a key factor when improving physical fitness.

Lower skeletal muscle mass is associated with diabetes and insulin resistance: A cross-sectional study

AIMS

The association between skeletal muscle mass and diabetes incidence/insulin resistance/glycated hemoglobin (HbA1C) is unknown. The aim of this study was to investigate such association in clinically apparently healthy males and females.

METHODS

A cross-sectional study of 372,399 Korean males and females who completed bioelectrical impedance analysis (BIA) in a health-screening programme was performed. Skeletal muscle index was used as an indicator of skeletal muscle mass. Skeletal muscle index (%) [appendicular skeletal muscle mass (kg)/body weight (kg)X100] was estimated using BIA. The study outcomes were diabetes incidence, homoeostasis model assessment of insulin resistance (HOMA-IR), and HbA1C.

RESULTS

The mean age of study participants was 38.92 ± 8.54 years. Multiple logistic regression analysis revealed a significant negative association between Skeletal muscle index and diabetes incidence/HOMA-IR/HbA1C after adjusting for various confounding factors. Odds ratios (95% confidence interval (CI)) of diabetes incidence in Q2, Q3, and Q4 compared to the lowest quantile (Q1) were 0.95 (0.85-1.05), 0.88 (0.78-0.99), and 0.79 (0.69-0.9), respectively. Beta coefficients (95% CI) of HOMA-IR in Q2, Q3, and Q3 with Q1 were 0.05 (0.03-0.07), -0.06 (-0.09∼-0.04), and -0.19 (-0.22∼-0.16), respectively. Beta coefficients (95% CI) of HbA1C in Q2, Q3, and Q4 with Q1 were 0.02 (0.01-0.03), -0.001 (-0.01∼0.01), and -0.02 (-0.03∼-0.01), respectively.

CONCLUSIONS

This study demonstrated negative associations of skeletal muscle mass with diabetes incidence, insulin resistance, and HbA1C levels in healthy adults.

Effects of large exercise-induced weight loss on insulin sensitivity and metabolic risk factors in young males with obesity

BACKGROUND

Obesity around the world is increasing at an alarming rate. One of the issues with obesity is whether exercise with large energy expenditure have any effect on obesity risk factors such as insulin resistance and coronary heart diseases.

METHODS

Twenty participants (mean age: 19.5±1.09 years) with Body Mass Index (BMI) of >30 kg/m2, and body fat percentage (BF%) of >25% completed an institutionalized regimented training (IRT) for 16 weeks. 12-hour fasting blood samples were collected at least 48 hours after the last exercise session. Glucose and insulin variables were determined through an oral glucose tolerance test. Participants underwent 446 hours of IRT and ate from four standardized meal menus per day with a caloric intake of 3066 kcal.

RESULTS

IRT resulted in a significant weight loss of 13.48±1.97 kg. Pre- and Post-Training total cholesterol (4.80±0.92 vs. 4.12±0.82 mmol/L) (P<0.01), low-density lipoprotein cholesterol (3.04±0.83 vs. 2.51±0.74 mmol/L) (P<0.01), triglycerides (1.19±0.57 vs. 0.74±0.30 mmol/L) (P<0.01) and apolipoprotein levels (Apo-A: 133.30±13.10 vs. 120.40±14.54 mg/dL; Apo-B: 88.08±25.72 vs. 70.12±18.21 mg/dL) (P<0.01) were significantly reduced, and glucose tolerance and insulin sensitivity were also improved.

CONCLUSIONS

Large exercise-induced weight loss can be achieved through IRT and may be a solution for weight loss for individuals with obesity to reduce obesity related complications.

Total and Regional Fat/Muscle Mass Ratio and Risks of Incident Cardiovascular Disease and Mortality

Background To evaluate the sex-specific associations of total and regional fat/muscle mass ratio (FMR) with cardiovascular disease (CVD) incidence and mortality, and to explore the underlying mechanisms driven by cardiometabolites and inflammatory cells. We compared the predictive value of FMRs to body mass index. Methods and Results This population-based, prospective cohort study included 468 885 UK Biobank participants free of CVD at baseline. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device. FMR was calculated as fat mass divided by muscle mass in corresponding body parts (total body, trunk, arm, and leg). Multivariable Cox proportional hazards models and mediation analyses were used. During 12.5 years of follow-up, we documented 49 936 CVD cases and 4158 CVD deaths. Higher total FMR was associated with an increased risk of incident CVD (hazard ratios [HRs] were 1.63 and 1.83 for men and women, respectively), ischemic heart disease (men: HR, 1.61; women: HR, 1.81), myocardial infarction (men: HR, 1.72; women: HR, 1.49), and congestive heart failure (men: HR, 2.25; women: HR, 2.57). The positive associations of FMRs with mortality from total CVD or its subtypes were significant mainly in trunk and arm for male patients (P for trend <0.05). We also identified 8 cardiometabolites and 5 inflammatory cells that partially mediated FMR-CVD associations. FMRs were modestly better at discriminating cardiovascular mortality risk. Conclusions Higher total and regional FMRs were associated with an increased risk of CVD and mortality, partly mediated through cardiometabolites and inflammatory cells. Early monitoring of FMR should be considered to alleviate CVD risk. FMRs were superior to body mass index in predicting CVD mortality.

Effects of short-term endurance and strength exercise in the molecular regulation of skeletal muscle in hyperinsulinemic and hyperglycemic Slc2a4+/- mice

OBJECTIVE

Intriguingly, hyperinsulinemia, and hyperglycemia can predispose insulin resistance, obesity, and type 2 diabetes, leading to metabolic disturbances. Conversely, physical exercise stimulates skeletal muscle glucose uptake, improving whole-body glucose homeostasis. Therefore, we investigated the impact of short-term physical activity in a mouse model (Slc2a4+/-) that spontaneously develops hyperinsulinemia and hyperglycemia even when fed on a chow diet.

METHODS

Slc2a4+/- mice were used, that performed 5 days of endurance or strength exercise training. Further analysis included physiological tests (GTT and ITT), skeletal muscle glucose uptake, skeletal muscle RNA-sequencing, mitochondrial function, and experiments with C2C12 cell line.

RESULTS

When Slc2a4+/- mice were submitted to the endurance or strength training protocol, improvements were observed in the skeletal muscle glucose uptake and glucose metabolism, associated with broad transcriptomic modulation, that was, in part, related to mitochondrial adaptations. The endurance training, but not the strength protocol, was effective in improving skeletal muscle mitochondrial activity and unfolded protein response markers (UPRmt). Moreover, experiments with C2C12 cells indicated that insulin or glucose levels could contribute to these mitochondrial adaptations in skeletal muscle.

CONCLUSIONS

Both short-term exercise protocols were efficient in whole-body glucose homeostasis and insulin resistance. While endurance exercise plays an important role in transcriptome and mitochondrial activity, strength exercise mostly affects post-translational mechanisms and protein synthesis in skeletal muscle. Thus, the performance of both types of physical exercise proved to be a very effective way to mitigate the impacts of hyperglycemia and hyperinsulinemia in the Slc2a4+/- mouse model.

Low serum creatinine, a surrogate marker of muscle mass, correlates with insulin sensitivity in nonhuman primates

OBJECTIVES

Decreased serum creatinine levels are associated with increased risk of type 2 diabetes (T2DM) in humans, however, its association with muscle mass and insulin sensitivity have not been studied in NHPs.

METHODS

Retrospective data of 229 adult NHPs were studied for association of serum creatinine levels with muscle mass and onset of T2DM.

RESULTS

Serum creatinine levels were positively correlated with lean muscle mass in nondiabetic (non-DM), male and female NHPs. Aged NHPs had significantly reduced lean muscle mass and corresponding creatinine levels compared to young age groups (p < .001). Creatinine was positively correlated with insulin sensitivity in nonDM male NHPs and significant decrease in creatinine was observed in T2DM (p < .001) compared to same age group nonDM NHPs.

CONCLUSIONS

The pathophysiology of T2DM in NHPs is similar to humans, low creatinine further provides utility of surrogate biomarkers of lower muscle mass and risk factor for T2DM NHPs.

Is insulin resistance tissue-dependent and substrate-specific? The role of white adipose tissue and skeletal muscle

Insulin resistance (IR) refers to a reduction in the ability of insulin to exert its metabolic effects in organs such as adipose tissue (AT) and skeletal muscle (SM), leading to chronic diseases such as type 2 diabetes, hepatic steatosis, and cardiovascular diseases. Obesity is the main cause of IR, however not all subjects with obesity develop clinical insulin resistance, and not all clinically insulin-resistant people have obesity. Recent evidence implies that IR onset is tissue-dependent (AT or SM) and/or substrate-specific (glucometabolic or lipometabolic). Therefore, the aims of the present review are 1) to describe the glucometabolic and lipometabolic activities of insulin in AT and SM in the maintenance of whole-body metabolic homeostasis, 2) to discuss the pathophysiology of substrate-specific IR in AT and SM, and 3) to highlight novel validated tests to assess tissue and substrate-specific IR that are easy to perform in clinical practice. In AT, glucometabolic IR reduces glucose availability for glycerol and fatty acid synthesis, thus decreasing the esterification and synthesis of signaling bioactive lipids. Lipometabolic IR in AT impairs the antilipolytic effect of insulin and lipogenesis, leading to an increase in circulating FFAs and generating lipotoxicity in peripheral tissues. In SM, glucometabolic IR reduces glucose uptake, whereas lipometabolic IR impairs mitochondrial lipid oxidation, increasing oxidative stress and inflammation, all of which lead to metabolic inflexibility. Understanding tissue-dependent and substrate-specific IR is of paramount importance for early detection before clinical manifestations and for the development of more specific treatments or direct interventions to prevent chronic life-threatening diseases.

Predicting Postallogeneic Hematopoietic Cell Transplant Glucose Intolerance: The Role of CT-based Body Composition

The description of methodologic approaches to quantifying skeletal muscle and adipose tissue compartments using routinely obtained CT images among patients with cancer have reinvigorated the field of body composition research in this population. In the accompanying article, Bhandari and colleagues demonstrate yet another application of body composition measurement in oncology; identification of glucose intolerance shortly after undergoing allogenic hematopoietic stem cell transplantation among adults with myeloid neoplasms. The authors were able to show that skeletal muscle mass and visceral adipose tissue were associated with an increased risk of incident dysglycemia within 30 days of transplantation. This article further supports the growing evidence that body composition measures can provide clinically meaningful information in oncology allowing identification of individuals at risk of a variety of adverse events during cancer therapy.

See related article by Bhandari et al., p. 2004

Higher Muscle Mass Protects Women with Gestational Diabetes Mellitus from Progression to Type 2 Diabetes Mellitus

BACKGROUND

We evaluated whether postpartum muscle mass affects the risk of type 2 diabetes mellitus (T2DM) in Korean women with gestational diabetes mellitus (GDM).

METHODS

A total of 305 women with GDM (mean age, 34.9 years) was prospectively evaluated for incident prediabetes and T2DM from 2 months after delivery and annually thereafter. Appendicular skeletal muscle mass (ASM) was assessed with bioelectrical impedance analysis at the initial postpartum visit, and ASM, either divided by body mass index (BMI) or squared height, and the absolute ASM were used as muscle mass indices. The risk of incident prediabetes and T2DM was assessed according to tertiles of these indices using a logistic regression model.

RESULTS

After a mean follow-up duration of 3.3 years, the highest ASM/BMI tertile group had a 61% lower risk of incident prediabetes and T2DM compared to the lowest tertile group, and this remained significant after we adjusted for covariates (adjusted odds ratio, 0.37; 95% confidence interval [CI], 0.15 to 0.92; P=0.032). Equivalent findings were observed in normal weight women (BMI <23 kg/m2), but this association was not significant for overweight women (BMI ≥23 kg/m2). Absolute ASM or ASM/height2 was not associated with the risk of postpartum T2DM.

CONCLUSION

A higher muscle mass, as defined by the ASM/BMI index, was associated with a lower risk of postpartum prediabetes and T2DM in Korean women with GDM.

The Effects of Individual Characteristics of the Naval Personnel on Sleepiness and Stress during Two Different Watchkeeping Schedules

BACKGROUND

Naval service can have a significant impact on the wellbeing of seafarers, and the operation of warships is highly dependent on the personnel on board. Nevertheless, there is a lack of knowledge concerning the impact of seafarers' individual characteristics on their wellbeing in a naval environment. Therefore, the aim of this study was to investigate individual characteristics of the naval personnel that may be associated with the amount of sleepiness, fatigue and stress responses experienced during shift work and irregular working hours in a naval environment.

METHODS

The study took place on a Finnish Defence Forces' Navy missile patrol boat on which 18 crewmembers served as study participants. The measurement periods lasted two separate weeks (seven days and six nights) during shift work with two different watchkeeping systems (4:4, 4:4/6:6). The onboard measurements consisted of the Karolinska Sleepiness Scale, salivary stress hormones, cognitive tests (Sustained Attention to Response Task and N-back Task) and heart rate variability.

RESULTS

Participants of older ages or with a longer history in naval service were associated with a greater amount of sleepiness, fatigue and stress responses on board. On the contrary, increased physical activity and a higher level of physical fitness, especially standing long jump, were associated with a lower amount of sleepiness, fatigue and fewer stress responses. In addition, an athletic body composition together with a healthy lifestyle may be beneficial, considering the stress responses on board.

CONCLUSION

The present results are well in line with the previous literature regarding shift work and irregular working hours. The results highlight the importance of regular physical activity and good physical fitness during service in the naval environment.

Fat-to-muscle ratio as a predictor for dyslipidaemia in transitional-age youth

Background

Although dyslipidaemia may have a crucial impact on cardiovascular health in adults, there is a lack of specific data in transitional-age youth. Therefore, this study attempted to evaluate the association of dyslipidaemia with fat-to-muscle ratio (FMR), and establish FMR thresholds for diagnosing dyslipidaemia in transitional-age youth.

Methods

One thousand six hundred sixty individuals aged 16 to 24 years from the baseline of a subcohort in the Northwest China Natural Population Cohort: Ningxia Project were analysed. Anthropometric characteristics were gauged by a bioelectrical impedance analyser, and dyslipidaemia components were measured using a Beckman AU480 chemistry analyser. Additionally, this study used logistic regression to estimate the risk of dyslipidaemia based on FMR quintiles, and calculate the gender-specific ideal cut-off values of dyslipidaemia and its components by the receiver operating characteristic (ROC) curve.

Results

Of the 1660 participants, aged 19.06 ± 1.14 years, 558 males and 1102 females. The prevalence of dyslipidaemia was 13.4% and was significantly associated with FMR quintiles among all participants (P < 0.05). The ideal values of FMR in diagnosing dyslipidaemia were 0.2224 for males and 0.4809 for females, while males had a higher AUC than females (0.7118 vs. 0.6656). Meanwhile, high FMR values were significantly associated with adverse outcomes of dyslipidaemia, hypercholesterolemia and hypertriglyceridaemia (P < 0.05).

Conclusions

The FMR was positively correlated with the prevalence of dyslipidaemia. The FMR can be used as an effective body composition index for diagnosing dyslipidaemia, especially in males, and preventive strategies should be initiated in transitional-age youth to decrease obesity-related dyslipidaemia.

The associations between health-related physical fitness and fasting blood glucose in war veterans: a population-based study

The main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. In this cross-sectional study, we recruited 764 men and women aged 45-75 years, who were part of the Homeland War between 1990 and 1995 (33.5% women). Health-related physical fitness included: (1) fat mass and fat-free mass (body composition), (2) push-ups in 30 s (muscular dynamic endurance of upper extremities), (3) sit-ups in 30 s (repetitive upper body strength), (4) chair-stands in 30 s (lower body strength), (5) sit-and-reach test (flexibility) and (6) the 2-min step test (cardiorespiratory function). Laboratory measurement of fasting blood glucose was performed according to standardized procedures in resting seated position after a 12-h overnight fast. Generalized estimating equations with multiple regression models were used to calculate the associations between health-related physical fitness and fasting blood glucose. In men, fasting blood glucose was significantly correlated with fat-free mass (β = - 0.25, p < 0.001), push-ups in 30 s (β = - 0.55, p < 0.001), chair-stands in 30 s (β = - 0.50, p < 0.001), sit-ups in 30 s (r = - 0.45, p < 0.001), the sit-and reach test (r = - 0.46, p < 0.001) and the 2-min step test (r = - 0.19, p < 0.001), while fat mass was positively correlated with fasting blood glucose (β = 0.14, p = 0.004). In women, fasting blood glucose was significantly correlated with fat mass (β = 0.20, p = 0.002), fat-free mass (β = - 0.15, p = 0.014), push-ups in 30 s (β = - 0.49, p < 0.001), chair-stands in 30 s (β = - 0.43, p < 0.001), sit-ups in 30 s (β = - 0.52, p < 0.001), the sit-and reach test (β = - 0.40, p < 0.001) and the 2-min step test (β = - 0.35, p < 0.001). This study shows that fasting blood glucose may be predicted by health-related physical fitness test in war veterans.

Skeletal Muscle Mass Has Stronger Association With the Risk of Hyperuricemia Than Body Fat Mass in Obese Children and Adolescents

Background

Hyperuricemia has been increasing among children with obesity in recent years. However, few studies in such a study group had explored the relationship between obesity-anthropometric indexes and hyperuricemia. This study aimed to examine the associations between hyperuricemia and different body components in children and adolescents with obesity, and further explore gender differences in these associations.

Methods

In this cross-sectional study, a total of 271 obese children and adolescents (153 boys and 118 girls) aged 6–17 years were recruited from Shanghai Xinhua Hospital. Data about basic information, anthropometric assessments, body composition, and laboratory tests of participants were collected.

Results

In this study, 73 boys (47.71%) and 57 girls (48.31%) were diagnosed to have hyperuricemia. The impacts of percentage of skeletal muscle (PSM) (OR = 1.221, P < 0.001) and skeletal muscle mass (SMM) (OR = 1.179, P < 0.001) on the risk of hyperuricemia was the largest, followed by hip circumference (HC) (OR = 1.109, P < 0.001), waist circumference (WC) (OR = 1.073, P < 0.001), and body fat mass (BFM) (OR = 1.056, P < 0.05) in whole sample, which was adjusted for age, gender and body mass index (BMI). After being stratified by gender, PSM (boys: OR = 1.309, P < 0.001) and SMM (boys: OR = 1.200, P < 0.001; girls: OR = 1.147, P < 0.05) were still the most predictors of hyperuricemia, followed by HC (boys: OR = 1.147, P < 0.001; girls: OR = 1.080, P < 0.05). WC showed a significant association with hyperuricemia only in boys (OR = 1.083, P < 0.05), while BFM showed no association with hyperuricemia in both gender groups after adjusting for age and BMI.

Conclusion

Our findings suggested that SMM was a stronger predictor of hyperuricemia than BFM in children and adolescents with obesity, especially in boys.

Association between total protein intake and low muscle mass in Korean adults

Background

Adults with low muscle mass have a poor prognosis. Studies that examined the association between total protein intake and low muscle mass among adults are limited. Thus, we investigated the association between total protein intake and low muscle mass among Korean adults aged ≥19 years.

Methods

We included 15,995 adults (6528 male and 9467 female) aged ≥19 years from the Korea National Health and Nutrition Examination Surveys (2008–2011). We divided the participants into groups according to protein intake quartile: Q1, Q2, Q3 and Q4 groups. The odds ratios (ORs) and 95% confidence intervals (CIs) of low muscle mass according to protein intake were analysed via multivariable logistic regression analysis. Stratified analyses according to sex, age and comorbidities were also performed.

Results

Of the participants, 3.8% had weight-adjusted low muscle mass. The prevalence rates of low muscle mass were 1.5, 3.0, 3.9 and 7.2% in the Q4, Q3, Q2 and Q1 groups, respectively (p < 0.001). Compared with the Q4 group, the Q1 group had the highest ORs for low muscle mass, followed by the Q2 and Q3 groups (Model 5; OR, 95% CI: 2.03, 1.36–3.02 for Q3; 2.44, 1.64–3.61 for Q2; and 4.32, 2.89–6.45 for Q4) after adjusting for confounding variables (p for trend < 0.001). The associations between protein intake and low muscle mass were stronger in younger individuals, men, individuals without hypertension, those with diabetes mellitus and those without dyslipidemia.

Conclusions

The prevalence of low muscle mass in Korean adults significantly increased with lower protein intake. Nutrition education for proper protein intake is also important for adults.

Trial registration

Retrospectively registered.

Effect of lifestyle modification for two years on obesity and metabolic syndrome components in elementary students: A community- based trial

Background

Lifestyle modifications, especially improving nutritional patterns and increasing physical activity are the most important factors in preventing obesity and metabolic syndrome in children and adolescents. For this purpose, the following interventional study was designed to investigate the effects of educational programs for students, as well as the changes in diet and physical activity on obesity and components of the metabolic syndrome.

Methods

This study is part of an interventional research project (elementary school) conducted on all students of Sama schools in Zanjan and Abhar in three levels;elementary, middle and high school, including 1000 individuals in Zanjan (intervention group) and 1000 individuals (control group) in Abhar in 2011. Interventions were based on educating students, teachers and parents, changes in food services and physical activity. We primarily measured anthropometric indices, fasting blood sugar, lipid profiles and blood pressure and completed standard nutrition and physical activity questionnaires. Also, blood insulin levels were randomly measured in a number of students. Data analysis was done by SPSS software Version 16.0.

Results

Overall, 589 individuals (252 males, 337 females) entered the case group and 803 individuals (344 males, 459 females) entered the control group. After two years of intervention, the mean waist circumference (63.8±10.9) and diastolic BP (63.8±10.4) were significantly lower, however, the mean systolic BP (10.1.0±12.5), food score (25.0±5.0) and drinking score (12.1±2.3) were higher in the intervention group (p<0.001). Comparing the components of metabolic syndrome between the second year and at the time of recruitment within the intervention group, showed that although the number of overweight/obese individuals, individuals with hypertriglyceridemia and high LDL increased, while those with abdominal obesity, high BP, hyperglycemia, and insulin resistance decreased (p<0.001). On the other hand, in the control group, the number of individuals with high BP increased significantly.

Conclusion

The prevalence of abdominal obesity and hypertension, which are the two major components of metabolic syndrome, are much higher in our study than the other regions of the country. However, interventions for modification of diet and increasing physical activity, are effective in lowering of their prevalence.

Health-related quality of life and insulin resistance over a 10-year follow-up

The aim of the study was to investigate the association between insulin resistance (IR) and health-related quality of life (HRQoL) among citizens of Palanga in a 10-year follow-up. A randomized epidemiological study was performed with 835 subjects. The following data were examined using questionnaires: sociodemographic characteristics, behavioural factors, HRQoL and self-perceived health. Fasting blood samples were drawn from all participants, and biochemical tests were performed for glucose and insulin. IR was evaluated by the homeostasis model assessment of IR (HOMA-IR). In subjects with IR, after adjusting for various factors, logistic regression analysis showed that within 10 years, there was a significantly higher chance of deteriorating HRQoL in the areas of physical functioning (odds ratio [OR] = 1.15, p < 0.001), emotional role limitations (OR = 1.07, p = 0.034), social functioning (OR = 1.26, p = 0.004), pain (OR = 1.09, p = 0.005) and general health perception (OR = 1.07, p = 0.022). People with IR have a worse HRQoL, and as they age, they are significantly more likely to have a deterioration in their HRQoL than people without IR in the areas of physical functioning, emotional role limitations, social functioning, pain and general health perception.

Relative Lean Body Mass and Waist Circumference for the Identification of Metabolic Syndrome in the Korean General Population

Lean body mass (LBM) comprises organs and muscle, which are the primary determinants of energy expenditure and regulation of glucose and lipid metabolism. Excessive abdominal fat is associated with metabolic abnormality. Little is known about the relationship between metabolic abnormality and LBM and waist circumference (WC), especially in the Asian general population. The aim of this study was to clarify this relationship. We performed a cross-sectional study with 499,648 subjects who received health check-ups at 16 health promotion centers in 13 Korean cities between January 2018 and October 2019. The subjects were categorized into four groups: (a) High (H)-RLBM (relative lean body mass)/Normal (N)-WC, (b) High-RLBM/Abnormal (A)-WC, (c) Low (L)-RLBM/Normal-WC, and (d) Low-RLBM/Abnormal-WC. RLBM was calculated using fat mass data that were estimated via bioelectrical impedance analysis. L-RLBM/A-WC was significantly associated with metabolically unhealthy status (OR: 4.40, 95% CI: 4.326–4.475) compared to H-RLBM/N-WC. L-RLBM/N-WC (OR: 2.170, 95% CI: 2.122–2.218) and H-RLBM/A-WC (OR: 2.713, 95% CI: 2.659–2.769) were also significantly related to metabolic unhealthy status. The cut-offs of RLBM for predicting metabolic syndrome (MetS) were 74.9 in males and 66.4 in females (p < 0.001). L-RLBM and A-WC are associated with metabolic abnormality in the Korean general population. RLBM is an anthropometric index that can be used to predict MetS in primary health care.

Association between sarcopenic obesity with insulin resistance and metabolic syndrome

BACKGROUND

There is a debate as to whether sarcopenic obesity leads to an increased risk of metabolic syndrome (MS) in young adults.

OBJECTIVE

To determine the association between sarcopenic obesity with MS and insulin resistance (IR).

METHODS

A 5-year retrospective cross-sectional study. Subjects of the specialty consultation between 18 and 55 years old, with BMI≥35 with comorbidity or BMI≥40 with and without comorbidity were included. The association was calculated using an odds ratio (OR) with 95% confidence intervals (95% CI).

RESULTS

Two hundred and fifty-four subjects were analyzed, 76.4% were women and average age was 38.36±8.78 years. The OR of IR in subjects with or without sarcopenic obesity was 2.224 (95% CI, 1127 to 4389, P=.02). The OR of MS in subjects with or without sarcopenia was 1.045 (95% CI, 0.624 to 1.748, P=.868). A difference was found between the fat mass in the group with IR vs. without IR of 60.58±14.4kg vs. 53.98±12.2kg (P<.001); likewise, between the BMI and muscle mass of 46.15±6.78kg/m² vs. 43.51±6.11kg/m² (P<.05) and 30.05±7.48kg vs. 27.86±5.91kg (P<.05) respectively.

CONCLUSION

The association between sarcopenic obesity with IR in young adults was significant, but not with MS. Our findings emphasize the need to become aware of the importance of maintaining lean mass in obese subjects.

Association of waist circumference with muscle and fat mass in adults with a normal body mass index

BACKGROUND/OBJECTIVES

We aimed to investigate the association of waist circumference (WC) with body composition among individuals with a normal body mass index (BMI) to distinguish muscle and fat mass, as both affect health differently.

SUBJECTS/METHODS

We analyzed dual-energy X-ray absorptiometry data (derived from the Korean National Health and Nutrition Survey, which includes information on fat and lean mass) of 7,493 adults with a normal BMI. Subjects were categorized into four groups of increasing WC. The fourth group was defined as being centrally obese. Each number of subjects are as follows: 1,870, 695, 231, and 39 among men and 3,054, 1,100, 406, and 98 among women. We conducted a sex-stratified linear regression analysis of body composition according to WC group after adjustments for covariates.

RESULTS

We observed a positive association of body fat with increasing WC in both men and women (all P for trend: < 0.001). The adjusted mean values for percent body fat with 95% confidence intervals (CIs) according to the four WC groups in ascending order were 17.8 (17.5–18.3), 21.0 (20.6–21.5), 22.1 (21.5–22.8), and 25.1 (24.2–26.1) in men and 29.7 (29.4–30.0), 32.0 (31.6–32.3), 32.9 (32.4–33.4), and 34.7 (33.2–36.1) in women. However, there was an inverted J-shaped association between muscle mass and WC. The fourth group had a higher percent body fat and lower muscle mass than other groups. The adjusted mean values for appendicular skeletal muscle mass index (kg/m²) with 95% CIs according to the four WC groups in ascending order were 7.55 (7.51–7.59), 7.62 (7.56–7.68), 7.65 (7.56–7.74), and 7.22 (7.04–7.41) in men and 5.83 (5.80–5.85), 5.96 (5.92–6.00), 6.03 (5.96–6.10), and 5.88 (5.73–6.03).

CONCLUSIONS

There was a positive association between body fat and WC among individuals with normal BMI; conversely there was an inverted J-shaped association between lean body mass and WC. Our findings support the WC measurement should be included in obesity evaluations for adults with a normal BMI.

Abdominal Muscles and Metabolic Syndrome According to Patient Sex: A Retrospective Cross-Sectional Study

Computed tomography (CT) is a reference method for measuring skeletal muscle mass, and the amount of fat in the skeletal muscle can be calculated based on CT attenuation. This study aimed to comprehensively investigate the effect of muscle quality and quantity on metabolic syndrome (MetS) according to sex. This retrospective cross-sectional study enrolled 8081 individuals aged ≥20 years who underwent self-referral abdominopelvic CT at our hospital. The total abdominal muscle area (TAMA), low-attenuation abdominal muscle area (LAMA), normal-attenuation abdominal muscle area (NAMA), and extramyocellular lipid area (EMCLA) were measured using cross-sectional CT data of the L3 lumbar vertebrae. The TAMA and NAMA showed negative correlations with risk factors for MetS and a positive correlation with high-density lipoprotein cholesterol, whereas the LAMA and EMCLA showed an inverse trend in both the sexes (p < 0.001). After adjusting for various factors, a higher LAMA index and the ratio of LAMA to TAMA were associated with a higher prevalence of MetS. High TAMA indices were associated with a lower prevalence of MetS. Furthermore, muscle quality and quantity were associated with the prevalence of MetS in both males and females. However, the LAMA showed a stronger association with MetS in males than in females.

Weight Gain Predicts Metabolic Syndrome among North Korean Refugees in South Korea

Previous cross-sectional studies showed that immigrants from low-income to high-income countries have higher risk of cardiovascular disease and type 2 diabetes mellitus. We investigated the association between weight gain during the resettlement in South Korea and risk of metabolic syndrome (MetS) among North Korean refugees (NKRs) in this cross-sectional study. In total, 932 NKRs aged 20-80 years in South Korea voluntarily underwent health examination from 2008 to 2017. We compared the risk of MetS and its components between the weight gain group (gained ≥5 kg) and the non-weight gain group (gained <5 kg, maintained or lost body weight) during resettlement in South Korea after defection from North Korea. Multiple logistic regression analysis predicted odds ratio of MetS on the basis of weight change, adjusting for covariates and current body mass index (BMI). We also evaluated the difference in body composition of NKRs between two groups. The prevalence of MetS in the weight gain group was 26%, compared to 10% in the non-weight gain group (p-value < 0.001). The weight gain group had a two-fold higher risk of MetS than the non-weight gain group after adjusting for current BMI (odds ratio 1.875, p-value = 0.045). The prevalence of central obesity, impaired fasting glucose, elevated blood pressure, and hypertriglyceridemia were higher in the weight gain group than the non-weight gain group (36% vs. 12%, p-value < 0.001; 32% vs. 19%, p-value < 0.001; 34 vs. 25%, p-value = 0.008; 19% vs. 13%, p-value = 0.025, respectively). The analysis of body composition showed that the percentage of body fat in the weight gain group was higher than in the non-weight gain group, indicating increased fat mass rather than muscle mass in the weight gain group as their body weight increased during resettlement (33.4 ± 6.53% vs. 28.88 ± 7.40%, p < 0.005). Excess weight gain after defection from North Korea increased the risk of MetS among NKRs in South Korea. It is necessary to monitor weight change among NKRs and their effect on their metabolic health in the long term.

Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes

Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.

Central nervous system regulation of organismal energy and glucose homeostasis

Growing evidence implicates the brain in the regulation of both immediate fuel availability (for example, circulating glucose) and long-term energy stores (that is, adipose tissue mass). Rather than viewing the adipose tissue and glucose control systems separately, we suggest that the brain systems that control them are components of a larger, highly integrated, 'fuel homeostasis' control system. This conceptual framework, along with new insights into the organization and function of distinct neuronal systems, provides a context within which to understand how metabolic homeostasis is achieved in both basal and postprandial states. We also review evidence that dysfunction of the central fuel homeostasis system contributes to the close association between obesity and type 2 diabetes, with the goal of identifying more effective treatment options for these common metabolic disorders.

TCF7L2 rs7903146 polymorphism association with diabetes and obesity in an elderly cohort from Brazil

Background

Type 2 diabetes mellitus (T2DM) and obesity are complex pandemic diseases in the 21st century. Worldwide, the T allele rs7903146 in the TCF7L2 gene is recognized as a strong GWAS signal associated with T2DM. However, the association between the C allele and obesity is still poorly explored and needs to be replicated in other populations. Thus, the primary objectives of this study were to evaluate the TCF7L2 rs7903146 association with T2DM according to BMI status and to determine if this variant is related to obesity and BMI variation in a cohort of elderly Brazilians.

Methods

A total of 1,023 participants from an elderly census-based cohort called SABE (Saúde, Bem Estar e Envelhecimento—Health, Well-Being and Aging) were stratified by BMI status and type 2 diabetes presence. The TCF7L2 genotypes were filtered from the Online Archive of Brazilian Mutations (ABraOM—Online Archive of Brazilian Mutations) database, a web-based public database with sequencing data of samples of the SABE’s participants. Logistic regression models and interaction analyses were performed. The BMI variation (∆BMI) was calculated from anthropometric data collected in up to two time-points with a ten-year-assessment interval.

Results

The association between the rs7903146 T allele and T2DM was inversely proportional to the BMI status, with an increased risk in the normal weight group (OR 3.36; 95% CI [1.46–7.74]; P = 0.004). We confirmed the T allele association with risk for T2DM after adjusting for possible confound ing variables (OR 2.35; 95% CI [1.28–4.32]; P = 0.006). Interaction analysis showed that the increased risk for T2DM conferred by the T allele is modified by BMI (P_interaction = 0.008), age (P_interaction = 0.005) and gender (P_interaction = 0.026). A T allele protective effect against obesity was observed (OR 0.71; 95% CI [0.54–0.94]; P = 0.016). The C allele increased obesity risk (OR 1.40; 95% CI [1.06–1.84]; P = 0.017) and the CC genotype showed a borderline association with abdominal obesity risk (OR 1.28; 95% CI [1.06–1.67]; P = 0.045). The CC genotype increased the obesity risk factor after adjusting for possible confounding variables (OR 1.41; 95% CI [1.06–1.86]; P = 0.017). An increase of the TT genotype in the second tertile of ∆BMI values was observed in participants without type 2 diabetes (OR 5.13; 95% CI [1.40–18.93]; P = 0.009) in the recessive genetic model.

Conclusion

We confirmed that the rs7903146 is both associated with T2DM and obesity. The TCF7L2 rs7903146 T allele increased T2DM risk in the normal weight group and interacted with sex, age and BMI, while the C allele increased obesity risk. The TT genotype was associated with a lesser extent of BMI variation over the SABE study’s 10-year period.

Cardiometabolic Profile of Different Body Composition Phenotypes in Children

CONTEXT

Cardiometabolic profiles of different body composition phenotypes are poorly characterized in young children, where it is well established that high adiposity is unfavorable, but the role of lean mass is unclear.

OBJECTIVE

We hypothesized that higher lean mass attenuates cardiometabolic risk in children with high fat mass.

METHODS

In 6-year-old children (n = 377) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) prospective birth cohort, whole-body composition was measured by quantitative magnetic resonance, a novel validated technology. Based on fat mass index (FMI) and lean mass index (LMI), 4 body composition phenotypes were derived: low FMI-low LMI (LF-LL), low FMI-high LMI (LF-HL), high FMI-low LMI (HF-LL), high FMI-high LMI (HF-HL).

MAIN OUTCOME MEASURES

Body mass index (BMI) z-score, fasting plasma glucose, insulin resistance, metabolic syndrome risk score, fatty liver index, and blood pressure.

RESULTS

Compared with the LF-HL group, children in both high FMI groups had increased BMI z-score (HF-HL: 1.43 units 95% CI [1.11,1.76]; HF-LL: 0.61 units [0.25,0.96]) and metabolic syndrome risk score (HF-HL: 1.64 [0.77,2.50]; HF-LL: 1.28 [0.34,2.21]). The HF-HL group also had increased fatty liver index (1.15 [0.54,1.77]). Girls in HF-HL group had lower fasting plasma glucose (-0.29 mmol/L [-0.55,-0.04]) and diastolic blood pressure (-3.22 mmHg [-6.03,-0.41]) than girls in the HF-LL group. No similar associations were observed in boys.

CONCLUSION

In a multi-ethnic Asian cohort, lean mass seemed to protect against some cardiometabolic risk markers linked with adiposity, but only in girls. The FMI seemed more important than lean mass index in relation to cardiometabolic profiles of young children.

Interaction between major dietary patterns and cardiorespiratory fitness on metabolic syndrome in Iranian adults: a cross-sectional study

Background

Several researches have been conducted on the associations between diet and cardiorespiratory fitness (CRF) and major cardiovascular risk factors. However, there is no report about the interaction between major dietary patterns and CRF on metabolic syndrome (MetS) and its components. To investigate the combined association of major dietary patterns and CRF on MetS and its components.

Methods

This cross-sectional study was conducted on 270 apparently healthy adults living in Tehran, Iran. Dietary intake was evaluated using a validated food frequency questionnaire (FFQ). CRF was assessed using a graded exercise treadmill test. Socio-economic status, anthropometric measures, biochemical parameters, and blood pressure were evaluated according to standard methods. Major dietary patterns were identified by factor analysis.

Results

Three major identified dietary patterns were (healthy, mixed, and western). Significant positive association was found between mixed dietary pattern and metabolic syndrome (OR = 2.68, 95% CI (1.92,7.78), P = 0.04). There were not relations between tertiles of identified dietary patterns and remained outcomes. Those who had higher adherence to mixed pattern with also higher CRF showed a significant decrease for diastolic blood pressure (P < 0.01). Also we found that there was no significant interaction between any of dietary patterns and CRF on odds of MetS.

Conclusions

Overall, adherence to mixed dietary pattern in this population was associated with increasing odds of MetS. However, nor CRF neither the combination of dietary patterns and CRF was related to the odds of MetS among Iranian adults. More studies are needed to clarify these associations and to consider interpersonal determinants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00695-4.

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

INTRODUCTION

Child malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs.

METHODS

Our peer-reviewed search strategy focused on 'severe childhood malnutrition', 'LMICs', 'famine', and 'cardiometabolic NCDs' to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist.

RESULTS

We identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome.

CONCLUSION

Severe malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors' long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.

Changes in Body Composition Are Associated with Metabolic Changes and the Risk of Metabolic Syndrome

In a cohort of 190,599 participants from The National Health Insurance Service-National Health Screening (NHIS-HEALS) study, we investigated the association of changes in the predicted body composition and metabolic profiles with the risk of metabolic syndrome (MetS) in the general population, which was hitherto incompletely elucidated. At baseline and follow-up examinations, the body composition, including lean body mass (LBM), body fat mass (BFM), and appendicular skeletal mass (ASM), were estimated using a prediction equation, and the risk of MetS was analyzed according to relative body composition changes. An increase in relative LBM and ASM decreased the risk of MetS in men and women (adjusted odds ratio (aOR), 0.78 and 0.80; 95% confidence interval (CI), 0.77-0.79 and 0.79-0.81, respectively; all p < 0.001). As relative LBM and ASM increased, the risk of MetS was more significantly reduced in the group with higher baseline BMI and body fat mass index (BFMI)(all p-trend < 0.001). In men, when the relative LBM increased (aOR, 0.68; 95% CI, 0.63-0.73), the risk of MetS was low despite increased BMI. Thus, our findings suggested that an increase in the relative LBM and ASM reduced the risk of MetS, whereas an increase in the relative BFMI increased the risk of MetS; this result was consistent in men despite an increase in BMI.

Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial

BACKGROUND

Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible.

OBJECTIVE

We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise.

METHODS

Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program.

RESULTS

Of the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference -2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference -1.8% vs -0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group.

CONCLUSIONS

This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080.

Visceral fat accumulation is associated with risk of diabetes in community-dwelling Japanese older adults

AIM

The prevalence of diabetes generally increases with age, and older adults with diabetes are at a higher risk of adverse outcomes. Visceral fat accumulation is a well-known risk factor for diabetes in middle-aged adults, and its association with diabetes increases with age. The present study investigated the association between visceral fat and risk of diabetes in older adults that is yet to be completely elucidated.

METHODS

This cross-sectional study enrolled 2850 community-dwelling older adults. Participants underwent abdominal bioelectrical impedance analysis to estimate the visceral fat area (VFA). The risk of diabetes was assessed using the value of hemoglobin A1c according to the diagnostic criteria of diabetes. We examined the relationship of VFA and risk of diabetes, and explored the optimal cut-off value stratified by sex.

RESULTS

In total, 47 of 1640 (2.9%) women and 41 of 1210 (3.4%) men had a high risk of diabetes. Higher values of VFA in units of 10 cm² were significantly associated with a higher risk of diabetes for both women (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [95% CI]: 1.02-1.34) and men (aOR: 1.18; 95% CI: 1.06-1.31) in multivariate logistic regression analysis. The cut-off value to classify 30% of subjects into high VFA (72 cm² ) had a relatively higher sensitivity of 0.660 and was significantly associated with a higher risk of diabetes for women (aOR: 3.49; 95% CI: 1.54-8.12), whereas all cut-off values we examined had no relation in men.

CONCLUSIONS

Increases in VFA is associated with a high risk of diabetes in older adults but the optimal cut-off value is inconclusive in men. Geriatr Gerontol Int 2021; ••: ••-••.

Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes?

BACKGROUND

Whilst skeletal muscles' primary role is allowing movement, it has important metabolic roles, including in glycemic control. Indeed, evidence indicates that low muscle mass and function are associated with an increased risk of type 2 diabetes, highlighting its importance in the development of metabolic disease.

METHODS

In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes and the efficacy of resistance exercise in improving glycemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors' knowledge of the filed supplemented by a Pubmed search using the terms "muscle," "glycemic control," "HbA1c," "type 2 diabetes," and "resistance exercise."

RESULTS

The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing Glycated Haemoglobin (HbA1c) in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialized equipment and knowledge of how to use it.

CONCLUSIONS

The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.

Normalized Hand Grip and Back Muscle Strength as Risk Factors for Incident Type 2 Diabetes Mellitus: 16 Years of Follow-Up in a Population-Based Cohort Study

PURPOSE

Muscle strength is associated with type 2 diabetes mellitus (T2DM). However, it is controversial whether muscle strength and normalized muscle strength is a risk factor for T2DM. Moreover, the relationship of back muscle strength (BMS) and incident T2DM has not been reported. In this study, we investigated the relationship between HGS, BMS, normalized HGS and BMS, and incident T2DM.

METHODS

A total of 2699 non-diabetes subjects aged 40-69 years (1313 women and 1386 men) in the Korean Genome and Epidemiology Study (KoGES) Ansan cohort were followed for 16 years. At the baseline and biennial follow-up visits, fasting glucose, postprandial 2-h glucose, clinical examinations, HGS, and BMS were measured by trained interviewers and examiners. HGS and BMS were measured at baseline. The relationships between incident T2DM, HGS, BMS, and normalized HGS and BMS were estimated using Cox proportional hazard regression models after adjusting for the confounding factors.

RESULTS

HGS and BMS were not associated with incident T2DM in multivariate analysis. However, the hazard ratio (HR) per one standard deviation (SD) increase in the body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR)-normalized HGS, and BMS was associated with a lower risk for incident T2DM in both women and men after adjusting for the confounding factors (HR = 0.842-0.880-fold for women, p ≤ 0.015; HR = 0.887-0.903-fold for men, p ≤ 0.024). In the sub-analysis of menopause status, the HR per one SD increase in BMI, weight^2/3, WC, and WHR-normalized HGS was associated with a lower risk for incident T2DM in both pre- and post-menopausal women after adjusting for the confounding factors (HR = 0.860-0.820-fold for premenopausal, P ≤ 0.006; HR = 0.900-0.867-fold for postmenopausal, p ≤ 0.024). Additionally, we confirmed that the quartile group with higher muscle strength was associated with a lower risk for incident T2DM.

CONCLUSION

The present study suggested that normalized HGS and BMS were associated with a lower risk for the future development of T2DM. Moreover, weak muscle strength in premenopausal women may be the cause of T2DM. Further research is needed to determine whether efforts to improve muscle strength, such as exercise can reduce the risk of T2DM.

Comparison of different criteria for the definition of insulin resistance and its relationship to metabolic risk in children and adolescents

PURPOSE

Childhood obesity frequently persists into adulthood and is associated with insulin resistance (IR) and increased long-term morbidity and mortality. We compared IR criteria concerning 'age-specific cutoff point' (ACOP) and 'fixed cutoff point' (FCOP) for the identification of IR and investigated their correlation with metabolic syndrome (MS).

METHODS

Data were acquired from the 5th Korea National Health and Nutrition Examination Survey (2010-2011). Participants ranged from 10 to 17 years of age and underwent fasting plasma glucose, insulin concentration, and lipid panel measurements. High fasting plasma insulin levels or increased homeostatic model assessment insulin resistance (HOMA-IR) were defined as IR. We analyzed MS and IR frequencies according to FCOP or ACOP.

RESULTS

Among 719 participants, 165 (22.9%) were overweight or obese based on their body mass index. We found no prevalence of MS in underweight/normal weight participants and 12.7% prevalence rate in overweight or obese participants. IR according to ACOP was more closely associated with MS than IR according to FCOP. No differences were found in predicting the frequency of MS using FCOP or ACOP in both fasting plasma insulin and HOMA-IR.

CONCLUSION

The frequency of MS in participants with IR defined using ACOP and FCOP was similar. However, IR using ACOP was more closely associated with MS than IR using FCOP.

Body composition patterns among normal glycemic, pre-diabetic, diabetic health Chinese adults in community: NAHSIT 2013-2016

Background

Central obesity is known to be associated with diabetes. Increasing lower extremity circumference was hypothesized in association with lower risk of diabetes.

Objective

This study determined which anthropometric patterns correlates the best with pre-diabetic and diabetic status among healthy adults.

Design

Cross-sectional study with nationwide population sampling of participants was designed.

Participants

In total, 1,358 ethnic Chinese adult participants were recruited from the Nutrition and Health Survey in Taiwan 2013–2016; the whole-body composition was measured through dual-energy X-ray absorptiometry.

Main outcome measures

Fat and lean mass in whole and specific parts of body among heathy Asian adults with normal glycemic, pre-diabetic, and diabetic states were measured, separately.

Statistical analyses performed

The generalized linear model was used to investigate the association between body composition (lean and fat mass) and hyperglycemic status. The reduced rank regression (RRR) was used to confirm the correlation between glycemic status and predicting factors (body composition parameters).

Results

Trunk fat positively correlated with the fasting glucose level (r = 0.327, P < 0.001) and HbA1c (r = 0.329, P < 0.001), whereas limb fat negatively correlated with the fasting glucose level (r = −0.325, P < 0.001) and HbA1c (ρ = −0.342, P < 0.001), respectively. In RRR analyses, fasting glucose and HbA1c exhibited a high positive association on fat amount per lean mass of the trunk (factor loading = 0.5319 and 0.5599, respectively) and of android area (0.6422 and 0.6104) and a high negative association fat amount per lean mass of the legs (−0.3863 and −0.3083) and gynoid area (−0.3414 and −0.3725).

Conclusions

For healthy community participants, increasing trunk fat had a greater risk of hyperglycemic status. Increasing lower extremity mass may confer lower risk of diabetes.

Pattern, Trend and Predictors of Adult-Onset Type 1 Diabetes in Uyo, Nigeria

<b><i>Background:</i></b> Unlike what obtains in childhood-onset type 1 diabetes, there remains a paucity of data on adult-onset type 1 diabetes in Nigeria. Hence, the current study aimed to determine the general characteristics of adult-onset type 1 diabetes among subjects (aged ≥18 years) presenting at the University of Uyo Teaching Hospital (UUTH) in Akwa Ibom State, South-south Nigeria. <b><i>Methods:</i></b> A 5-year (2014–2018) retrospective records review of subjects with type 1 diabetes was undertaken, using hospital medical records retrieved from the Department of Health Information Management of UUTH. Diagnosed adult cases of type 1 diabetes were meticulously identified and the relevant data at the point of initial diagnosis were acquired on a specially designed data acquisition template. <b><i>Results:</i></b> A total of 47,357 medical cases were identified of which 362 adults were diagnosed with type I diabetes (mean age 33.12 ± 4.40, range 20–51 years) and the females (<i>n</i> = 204; 56.4%) predominated among those diagnosed. The overall, male gender, and female gender prevalence was 7.4/1,000 (95% confidence interval [CI]: 6.89–7.98), 3.3/1,000 (95% CI: 2.52–4.08), and 4.3/1,000 (95% CI: 3.61–4.99), respectively. The females exhibited the highest trough, peak, annual, and overall prevalence during the study period. The female gender (OR: 2.334; 95% CI: 1.407–3.478; <i>p</i> = 0.010), age ≤30 years (OR: 1.976; 95% CI: 0.875–3.211; <i>p</i> &#x3c; 0.001), urban-dwelling (OR: 3.243; 95% CI: 2.3407.780; &#x3c;0.001), diabetes family history (OR: 1.365; 95% CI: 0.678–2.010; <i>p</i> = 0.033), and the rainy season (OR: 1.129; 95% CI: 0.401–1.910; <i>p</i> &#x3c; 0.001) were independent predictors among the overall adult type 1 diabetics. On gender-segregated analyses, age ≤30 years, urban-dwelling, diabetes family history, and the rainy season remained independent predictors among the male and female adult type 1 diabetics (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> The study demonstrated a high burden of type 1 diabetes among adult residents of Uyo, Akwa Ibom State, South-South Nigeria. The predictors of adult type 1 diabetes, identified in the present study, are valuable epidemiologic evidence for the design of type 1 diabetes-targeted preventive programs by various concerned stakeholders.

Sex and Region-Specific Associations of Bone Mineral Content, Muscle Mass, and Fat Mass with Insulin Resistance

Background: To compare the strengths of the associations between total and region-specific body composition and insulin resistance (IR) considering sex and menopausal status and to compare body composition indicators for discriminating high IR. Materials and Methods: Among 5380 men, 3652 premenopausal women, and 3207 postmenopausal women in the Korean National Health and Nutrition Examination Survey, high IR was defined as the sex-specific highest quintiles of homeostasis model assessment IR and metabolic syndrome. Percentages of bone mineral content (BMC%), muscle mass (MM%), and fat mass (FM%) were measured for the whole body, trunk, and upper/lower extremities by dual-energy X-ray absorptiometry. Results: After adjusting for body mass, age, education, smoking status, alcohol use, and physical activity, one-standard deviation increases in whole-body FM%, MM%, and BMC% were associated with 50%-63%, 19%-26%, and 14%-22% higher odds of high IR in men and pre- and postmenopausal women, 31%-36%, 12%-17%, and 10%-15% lower odds, and 27%-36%, 31%-40%, and 19%-23% lower odds, respectively. Those associations for FM% in men and BMC% in premenopausal women tended to be stronger in the upper body than in lower extremities. In receiver operating characteristic curve analysis, FM% in men and BMC% in women had superior discriminatory abilities for high IR. Conclusions: IR may have a stronger association with FM% in men and BMC% in premenopausal women in upper body, while the association strength in postmenopausal women may be similar across body composition. These findings reveal differences in the strengths of region-, sex, and menopausal status-specific relationships between body composition and IR.

Skeletal Muscle Ratio: A Complete Mediator of Physical Activity and HbA1C in Type 2 Diabetes

BACKGROUND

An increase in the physical activity level reduces body weight, decreases body fat, increases skeletal muscle mass, and improves serum glucose; however, the influence of body composition parameters on the relationship between physical activity and serum glucose remains unclear.

OBJECTIVE

This study investigated whether skeletal muscle and visceral fat affect the relationship between high physical activity and long-term serum glucose goals.

METHOD

This cross-sectional study recruited patients with type 2 diabetes. The Chinese version of the International Physical Activity Questionnaire was used for estimating the physical activity level, and a bioimpedance device was used to measure the skeletal muscle ratio (skeletal muscle mass/total body weight, %) and visceral fat area (cm²). Hierarchical logistic regression models and mediation tests were conducted according to Hayes' procedures.

RESULTS

Of the total 543 Chinese individuals with type 2 diabetes enrolled, HbA1C levels of fewer than half (n = 243, 44.8%) met the target of ≤7.0%. The skeletal muscle ratio was found to be a complete mediator (OR = 0.920, 95% CI: 0.848 to 0.998; indirect effect: -0.238, 95% CI: -0.525 to -0.020) of the relationship between high physical activity and the target HbA1C level after controlling for visceral fat area (indirect effect: -0.013, 95% CI: -0.183 to 0.156), age, time since diabetes diagnosis, and rice intake.

CONCLUSION

Nurses should include an increase in the skeletal muscle ratio as an objective in physical activity interventions for patients with type 2 diabetes to help them achieve their long-term serum glucose goals.

The Relative Handgrip Strength and Risk of Cardiometabolic Disorders: A Prospective Study

Background

This study aims to investigate the association between handgrip strength (HGS) and cardiometabolic disorders (CMD), including hypertension, diabetes, and dyslipidemia, in a prospective study.

Methods

The association between HGS and CMD was examined using the data from 5,271 Chinese adult participants ≥45 years old enrolled in the CHARLS (Chinese Health and Retirement Prospective Cohort Study) during 2011-2015. Relative HGS, calculated as maximal absolute HGS from both hands divided by body mass index, was used in the primary analysis and divided into three groups according to the tertiles (T1, T2, and T3).

Results

The participants with higher relative HGS had a lower risk of hypertension, diabetes, and dyslipidemia than those with lower HGS, although did not reach statistical significance for diabetes and hypertension in males. Participants with higher HGS had significantly lower risk of hypertension [T3 vs. T1: OR = 0.69, 95% CI = 0.51-0.91, P = 0.010] and dyslipidemia (OR = 0.65, 95% CI = 0.51-0.83, P < 0.001) in males. For females, participants with higher HGS had significantly lower risks of dyslipidemia (OR = 0.67, 95% CI = 0.54-0.83, P < 0.001).

Conclusion

A consistent association was observed between higher relative HGS and lower risk of CMD. Further research is required to evaluate whether relative HGS can be a convincing predictor for the occurrence of CMD and as a target for intervention in the high-risk population.

Fat-to-muscle ratio as a predictor of insulin resistance and metabolic syndrome in Korean adults

BACKGROUND

The present study evaluated the associations of the fat-to-muscle ratio (FMR) with metabolic syndrome (MetS) and insulin resistance (IR) in Korean adults using nationally representative survey data.

METHODS

A two-stage stratified sampling method was reflected in a cross-sectional study involving a total of 13 032 participants aged ≥ 19 years who participated in the fourth and fifth Korea National Health and Nutrition Examination Surveys. The homeostasis model assessment for IR (HOMA-IR) was used to evaluate IR and was calculated as follows: [fasting plasma glucose level (mg/dL) × fasting plasma insulin level (uIU/mL)]/405. MetS was defined using the 2006 International Diabetes Federation criteria, and FMR was measured using whole-body dual-energy X-ray absorptiometry and calculated as follows: total fat mass (kg) divided by total lean mass (kg). In addition, the optimal FMR cut-off values for detecting MetS and the odds ratios (ORs) for MetS risk were determined according to the FMR quartile and sex.

RESULTS

Among all participants, the proportion of women was 58.4%, and the mean age was 44.22 ± 0.26 years. The FMR significantly differed between men and women (0.30 ± 0.002 vs. 0.53 ± 0.003, respectively, P < 0.001), and the prevalence of MetS and IR gradually increased as FMR increased (P for trend: <0.001). The optimal FMR cut-off value for detecting MetS was higher in women than in men (0.555 vs. 0.336, respectively). The negative predictive value was the highest in normal-weight participants (0.9992 in women and 0.9986 in men), while the positive predictive value was the highest in obese participants (0.5994 in women and 0.5428 in men). Based on the derived cut-off FMR, a high FMR was associated with poor outcomes in terms of cardiometabolic risk markers (P < 0.001). The multivariable-adjusted ORs for MetS, abdominal obesity, and IR (HOMA-IR ≥ 3) were 5.35 [95% confidence interval (CI): 4.39-6.52], 7.67 (95% CI: 6.33-9.30), and 3.25 (95% CI: 2.70-3.92), respectively, in men and 5.59 (95% CI: 4.66-6.72), 7.48 (95% CI: 6.35-8.82), and 2.55 (95% CI: 2.17-3.00), respectively, in women.

CONCLUSIONS

In the present study, a high FMR was significantly associated with the prevalence of MetS and IR. The present findings also showed that FMR can be a novel indicator for detecting the absence or presence of MetS, particularly in metabolically healthy normal-weight individuals and metabolically obese obese-weight individuals.

Consumption of Biscuits with a Beverage of Mulberry or Barley Leaves in the Afternoon Prevents Dinner-Induced High, but Not Low, Increases in Blood Glucose among Young Adults

We examined the impact of consuming biscuits with a beverage of powdered mulberry or barley leaves in the afternoon on postprandial glucose levels at dinnertime among young adults. A total of 18 young adults participated in a partially double-blinded, randomized crossover trial over 2 weeks, consuming either: (1) no biscuits; (2) a biscuit; (3) a biscuit with a beverage of powdered mulberry leaves; or (4) a biscuit with a beverage of powdered barley leaves, as an afternoon snack followed by a standardized test dinner. Glucose levels were recorded after each meal. Results showed intake of biscuits with a beverage of mulberry and barley leaves significantly reduced postprandial rises in glucose after their immediate consumption and dinner, though there was no direct relationship between the glucose levels at the two meals. Compared to those with low glucose levels, participants with high glucose levels at dinner showed a stronger second meal effect, that was attributed to the mulberry or barley leaves, and were also more likely to have lean body weights and prefer evenings. Our findings indicate that eating snacks alongside mulberry or barley leaves is an effective way to suppress postprandial glucose levels in young adults with high glucose levels who prefer evenings.

Association between calf girth and peripheral artery disease in the Atherosclerosis Risk in Communities Study

BACKGROUND

The pathogenesis of peripheral artery disease (PAD) is associated with impaired calf muscle. We sought to investigate the association between gender-specific calf girth and the prevalence of PAD among participants from a community-based cohort study.

METHODS

A total 13,808 participants in the Atherosclerosis Risk in Communities (ARIC) study without prior PAD were included in the final analysis. Calf girth was measured at baseline (1985-1987). A hospital diagnosis with an ICD-9 code defined incident PAD during follow up. Cox regression analysis adjusted for demographic variables and other covariates was used to estimate hazard ratios (HR) and 95% confidence interval (CI) for the association between calf girth and PAD.

RESULTS

After a medium follow-up of 25.2 years, the overall prevalence of PAD in our study was 5.2% (721/13,808), 335 patients were women and 386 were men. The adjusted HR for PAD with calf girth as continuous variables was 0.99 (95% CI 0.95-1.04) in females and 0.93 (95% CI 0.88-0.99) in males, respectively. Moreover, interaction for gender was statistically significant between calf girth and PAD in overall population (p=0.001).

CONCLUSIONS

Our findings revealed a linear association of calf girth with the prevalence of PAD among male participants in ARIC.

Association of One-Leg Standing Time with Discontinuation of Injectable Medications During Hospitalization Among Patients with Type 2 Diabetes

INTRODUCTION

Persons with type 2 diabetes (T2D) are known to experience impaired physical ability even at the early stages of the disease. However, less attention has been paid to increasing physical ability than to increasing physical activity in the treatment of T2D. The aim of this study was to assess whether improved physical ability parameters are associated with the discontinuation of injectable medications once glycemic targets have been achieved among inpatients with inadequately controlled T2D across a wide range of ages.

METHODS

Forty-three patients with glycated hemoglobin levels of ≥ 7.5% (58 mmol/mol) aged between 19 and 82 years who received insulin, glucagon-like peptide-1 receptor agonists or both at admission were enrolled in the study. Muscle strength for knee extension, one-leg standing time with eyes open test(OLST), whole-body reaction time and maximal oxygen uptake were assessed as parameters of physical ability.

RESULTS

At admission, patients who during hospitalization discontinued injectable medications (n = 29; Discontinued group) had a shorter duration of diabetes, lower fat mass and higher skeletal muscle mass and performed better on all of the physical ability test parameters than those who continued on injectable medications during hospitalization (n = 14; Continued group). At discharge, patients in the Discontinued group had achieved better glycemic control than those in the Continued group, as indicated by lower mean plasma glucose levels according to the 7-point profile. Stepwise logistic regression analysis that included those variables that were significantly different between the Continued group and the Discontinued group, with the aim to identify candidate(s) of explanatory variables, revealed that only OLST was significantly associated with the discontinuation of injectable medication. Patients with an OLST of ≥ 60 s were more likely to discontinue injectable medication than those with an OLST of < 60 s (odds ratio 18.9; 95% confidence interval 2.0-178.8; p = 0.011).

CONCLUSIONS

Among inpatients with inadequately controlled T2D diabetes, longer OLST appear to be associated with discontinuing injectable medications during hospitalization. OLST could possibly be useful as a novel patient factor to consider in de-intensifying injectable medication.