Fat-free mass and calf circumference as body composition indices to determine non-exercise activity thermogenesis in patients with diabetes

Differences Between Brachial-Ankle Pulse Wave Velocity and Lower Leg Circumference Ratio in Patients With and Without Type 2 Diabetes Mellitus

Background Vascular endothelial dysfunction in type 2 diabetes mellitus (T2DM) patients causes atherosclerosis and microvascular damage. This study investigated the relationship between leg circumference and arterial stiffness in patients with T2DM compared to non-T2DM individuals. Methods Data from two studies were combined to form T2DM (T2DM group) and non-T2DM (N group) cohorts. The variables included age, sex, systolic blood pressure (SBP), brachial-ankle pulse wave velocity (ba-PWV), ankle-brachial index, height, weight, maximum leg circumference, lower leg circumference ratio, duration of T2DM, Achilles tendon reflex disorder, and the hemoglobin A1c level. Multiple regression analysis was performed with ba-PWV as the dependent variable and the interaction term between leg circumference ratio and T2DM as the independent variable. The control variables included leg circumference ratio, T2DM, SBP, Achilles tendon reflex disorder, age, and sex. IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA) was used for the statistical analysis, with the significance level set to p < 0.05. Results The interaction term between the lower leg circumference ratio and T2DM (β = -0.17, 95% CI: -46.11 to -10.92; p < 0.01) was significantly associated with ba-PWV (AdjR² = 0.51, variance inflation factor <4.12). Simple slope analysis indicated that a decreased lower leg circumference ratio was significantly associated with an increased ba-PWV (β = -0.20, p < 0.05) in the T2DM group. No significant relationship was found in the N group (β = -0.03, p = 0.69). Conclusion A significant interaction was found between the lower leg circumference ratio and T2DM presence, indicating an association between ba-PWV and the leg circumference ratio specific to patients with T2DM. This result suggests that the leg circumference ratio can be substituted for the ba-PWV to evaluate arterial stiffness in T2DM.

Calf circumference refines sarcopenia in correlating with mortality risk

BACKGROUND

Recommendations in current guidelines on the use of calf circumference (CC) as a diagnostic measure in sarcopenia is conflicting. In this study, we incorporated CC into conventional models of sarcopenia and compared their predictive scores on mortality.

OBJECTIVE

To clarify the predictive capacity of CC-added models of sarcopenia on and establish the correlation of CC with mortality risk.

DESIGN, SETTING AND SUBJECTS

From the National Health and Nutrition Examination Survey 1999-2002, 2,532 participants aged 50-85 and comprising 51.7% male were included.

METHODS

Our definitions contained four sarcopenic components, low CC (C), low muscle strength (S), low muscle mass (M) and low gait speed (G). Cox proportional hazard models and the receiver-operator characteristic curves for all-cause, cardiovascular (CV) and cancer mortality were conducted to compare the different sarcopenia definitions.

RESULTS

For all-cause mortality, the hazard ratio (HR) of C + S + M + G was 15.062, which was substantially higher than the conventional definition S + M + G (HR = 6.433). Other CC-added definitions such as C + M (HR = 2.260), C + G (HR = 4.978), C + S + M (HR = 5.761) also revealed higher HR than their without-CC counterparts. Similar patterns were observed in CV mortality, for instance, HR of C + S + M + G was 31.812 comparing to the conventional definition S + M + G (HR = 18.434). Concerning accuracy in predicting mortality, the area under the curve (AUC) of CC + S + G + M (AUC = 0.702) and C + S + G (AUC = 0.708) were higher than the conventional definition S + G + M (AUC = 0.697). A significant correlation was found between CC and each of the three conventional components of sarcopenia.

CONCLUSIONS

CC-added definitions of sarcopenia correlated with higher all-cause and CV mortality risks. CC is potentially a simple but valuable screening tool for sarcopenia that could improve diagnostic accuracy when used with other parameters.

Distinct effects of carbohydrate ingestion timing on glucose fluctuation and energy metabolism in patients with type 2 diabetes: a randomized controlled study

This randomized, open-label, and parallel-group study aimed to investigate the effects of altering the timing of carbohydrate intake at breakfast or dinner on blood glucose fluctuations and energy metabolism. A total of 43 participants with type 2 diabetes were assigned to either the breakfast or dinner group. Participants were provided an isocaloric carbohydrate-restricted diet constituting 10% carbohydrate only at breakfast or dinner for 2 days during the study. Glucose fluctuations were compared using a continuous glucose monitoring system (iPro2) and body composition, energy expenditure, blood biochemistry, and endocrine function changes. The carbohydrate restriction either at breakfast or dinner significantly decreased postprandial glucose excursion and mean 24-h blood glucose levels. The incremental blood glucose area under the curve (AUC) for 2 h (iAUC0-2h) at lunch significantly increased in the breakfast group, whereas no significant differences were observed in the iAUC0-2h between breakfast and lunch in the dinner group. Carbohydrate restriction reduced diet-induced thermogenesis at breakfast (intragroup comparison; 223 ± 117 to 109 ± 104 kcal, p = 0.002) but did not affect diet-induced thermogenesis at dinner. However, fasting plasma free fatty acids were comparable in both groups, prelunch free fatty acids increased significantly only in the breakfast group (0.20 ± 0.09 to 0.63 ± 0.19 mEq/L, p < 0.001). Carbohydrate restriction in the diet once daily decreases mean 24-h blood glucose levels and exerts unique metabolic effects depending on the timing.

Calf circumference: cutoff values from the NHANES 1999-2006

BACKGROUND

Calf circumference (CC) is used in geriatric studies as a simple and practical skeletal muscle (SM) marker for diagnosing low SM and sarcopenia. Currently applied CC cutoff points were developed in samples including older participants; values representative of the full adult lifespan are lacking.

OBJECTIVES

We aimed to develop CC cutoff points and to identify relevant confounding factors from the large and diverse NHANES 1999-2006 population sample.

METHODS

Demographic, anthropometric, and imaging data (DXA, appendicular lean mass) from the adult (age ≥18 y) NHANES sample were partitioned into subgroups according to sex, age, ethnicity, and race. Adults aged 18-39 y and BMI (in kg/m2) 18.5-24.9 were set as a reference population; CC cutoff points were derived at 1 and 2 SDs below the mean.

RESULTS

The sample included 17,789 participants, 51.3% males and 48.7% females, with respective ages (mean ± SD) of 43.3 ± 16.1 y and 45.5 ± 16.9 y. CC was strongly correlated with appendicular lean mass, r = 0.84 and 0.86 for males and females (both P < 0.001), respectively. Significant differences in mean CC were present across sex, ethnic, self-reported race, and BMI groups. Adjusting CC for adiposity using BMI revealed a decrease in CC beginning after the second decade in males and third decade in females. Rounded CC cutoff values for moderately and severely low CC were 34 cm and 32 cm (males), and 33 cm and 31 cm (females), respectively. Our findings support the use of BMI-adjusted CC values for participants outside the normal-weight BMI range (18-24.9).

CONCLUSIONS

This study defined CC values in a diverse population sample along with a BMI-adjustment approach that helps to remove the confounding effects of adiposity and thereby improves CC as a useful clinical estimate of SM mass.

Calf circumference and risk of cardiovascular disease

AIM

Calf circumference (CC) is an anthropometric parameter that is easily obtained. Increasingly, research has shown that CC related to cardiovascular events. We aimed to determine the correlation between CC and Framingham risk score (FRS) for the 10-year cardiovascular disease risk assessment in Taiwanese elderly aged ≥65 years.

METHODS

We included 540 men and 683 women aged ≥65 years. All participants and data were collected from geriatric physical screenings in Tri-Service General Hospital in Taiwan during 2017. The correlation between CC and FRS-coronary heart disease (CHD) were calculated. We used multivariate regression models to investigate the correlation between CC and FRS-CHD. Covariate adjustments were investigated by performing an extended model.

RESULTS

A significantly negative association was observed between FRS-CHD and CC in both genders in both models (all P < 0.05). Male and female participants were divided into quartiles at the CC level (Q1-Q4) and we compared their baseline characteristics separately. We further explored the association between CC divided in quartiles and the FRS-CHD, which exhibited a significant negative correlation comparing the largest quartiles with the first quartile in a fully adjusted model in both genders (P < 0.05). In addition, the higher quartiles of CC seemed to have a lower FRS-CHD with statistical significance (P for trend <0.05).

DISCUSSION

CC had a strongly negative correlation with FRS-CHD in both genders. In the future, CC might be an applicable tool in geriatric research in Taiwan for the early detection of developing cardiovascular events. Geriatr Gerontol Int 2020; 20: 1133-1137.

Severity Indices for Obstructive Sleep Apnea Syndrome Reflecting Glycemic Control or Insulin Resistance

Objective We aimed to identify obstructive sleep apnea syndrome (OSAS) severity indices reflecting the anthropometric and metabolic characteristics of patients with OSAS. Methods A total of 76 patients with OSAS underwent nasal continuous positive airway pressure (nCPAP). We also investigated the effects of nCPAP on OSAS-associated muscle sympathetic nerve activity (MSNA), risk for cardiovascular diseases, and insulin secretion and sensitivity. Results Among the OSAS severity indices, HbA1c was significantly correlated with the apnea-hypopnea index, whereas HOMA-beta, HOMA-IR, and hepatic insulin resistance were significantly correlated with % SpO₂<90%, independent of age, gender, and body mass index (BMI). Burst incidence of MSNA was independently associated with only a 3% oxygen desaturation index. nCPAP therapy significantly lowered the OSAS severity indices and reduced the burst rate, burst incidence, and heart rate. Conclusion The OSAS severity indices reflecting apnea/hypopnea are associated with glycemic control, whereas those reflecting hypoxia, particularly % SpO₂<90%, are associated with hepatic insulin resistance independent of obesity. Both types of OSAS severity indices, especially the 3% oxygen desaturation index (reflecting intermittent hypoxia), are independently associated with MSNA, which is dramatically lowered with the use of nCPAP therapy. These findings may aid in interpreting each OSAS severity index and understanding the pathophysiology of OSAS in clinical settings.

Influence of Body Composition on Arterial Stiffness in Middle-Aged Adults: Healthy UAL Cross-Sectional Study

Background and objectives: Several anthropometric and body composition parameters have been linked to arterial stiffness (AS) as a biomarker of cardiovascular disease. However, little is known about which of these closely related factors is more strongly associated with AS. The aim of the present study was to analyze the relationship of different anthropometric and body composition parameters with AS in middle-aged adults. Materials and Methods: This cross-sectional study included 186 middle-aged participants (85 women, 101 men; age = 42.8 ± 12.6 years) evaluated as part of the Healthy UAL study, a population study conducted at the University of Almería with the main purpose of analyzing the etiology and risk factors associated with cardio-metabolic diseases. Anthropometric measures included neck, waist, and hip circumferences, as well as the waist-to-height ratio (WHtr). Bioimpedance-derived parameters included fat-free mass index (FFMI), fat mass index (FMI), and percent of body fat (%BF). AS was measured by pulse wave velocity (PWV). The relationships of interest were examined through stepwise regression analyses in which age and sex were also introduced as potential confounders. Results: Neck circumference (in the anthropometric model; R²: 0.889; β: age = 0.855, neck = 0.204) and FFMI (in the bio-impedance model; R²: 0.891; β: age = 0.906, FFMI = 0.199) emerged as significant cross-sectional predictors of AS. When all parameters were included together (both anthropometry and bio-impedance), both neck circumference and FFMI appeared again as being significantly associated with AS (R²: 0.894; β: age = 0.882, FFMI = 0.126, neck = 0.093). Conclusion: It was concluded that FFMI and neck circumference are correlated with AS regardless of potential confounders and other anthropometric and bioimpedance-derived parameters in middle-aged adults.

Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes

BACKGROUND AND AIM

Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D.

METHODS

Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as 'hepatic steatosis absent other causes of chronic liver disease,' such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test.

RESULTS

The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m² , Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) versus highest tertile (53.8% in men, 58.2% in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.22-1.68 and OR = 1.56, 95% CI = 1.31-1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95% CI = 1.39-53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95% CI = 2.50-4.05, P < 0.001, highest tertile).

CONCLUSIONS

Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.

Does the Additional Component of Calf Circumference Refine Metabolic Syndrome in Correlating With Cardiovascular Risk?

CONTEXT

Calf circumference (CC) was a useful anthropometric tool, but there was limited study on the effect of CC on metabolic syndrome (MetS) for cardiovascular risk.

OBJECTIVE

The objective of our study was to determine whether adding CC as a component of MetS refined correlating MetS with cardiovascular, all-cause, and cancer mortality risks.

DESIGN, SETTING, PATIENTS, AND INTERVENTIONS

From the National Health and Nutrition Examination Survey data set for 1999 through 2002, we analyzed four types of MetS: (1) increased waist circumference and two or more of four MetS components (WaistMetS); (2) decreased CC and two or more of four MetS components (CalfMetS); (3) increased waist-to-calf ratio and two or more of four MetS components (WCRMetS); and (4) decreased CC and three or more of five MetS components (CC+MetS).

PRIMARY OUTCOME MEASURE

The cause-specific hazard ratios were measured as categorized by the four types of MetS.

RESULTS

For cardiovascular mortality, the adjusted hazard ratios for WaistMetS, CalfMetS, WCRMetS, and CC+MetS were 1.867, 1.871, 1.949, and 2.306, respectively (all P < 0.001). Notably, CalfMetS showed the strongest positive correlation with serum C-reactive protein levels, and WCRMetS had the strongest positive relationship with homeostasis model assessment of insulin resistance.

CONCLUSIONS

Adding CC to the components of MetS correlated with higher cardiovascular and all-cause mortality risk than the traditional definition of MetS.

Weight-adjusted lean body mass and calf circumference are protective against obesity-associated insulin resistance and metabolic abnormalities

Background

To test the hypothesis that preserved muscle mass is protective against obesity-associated insulin resistance and metabolic abnormalities, we analyzed the relationship of lean body mass and computed tomography-assessed sectional areas of specific skeletal muscles with insulin resistance and metabolic abnormalities in a healthy cohort.

Methods

A total of 195 subjects without diabetes who had completed a medical examination were included in this study. Various anthropometric indices such as circumferences of the arm, waist, hip, thigh, and calf were measured. Body composition (fat and lean body mass) was determined by bioelectrical impedance analysis. Sectional areas of specific skeletal muscles (iliopsoas, erector spinae, gluteus, femoris, and rectus abdominis muscles) were measured using computed tomography.

Findings

Fat and lean body mass were significantly correlated with metabolic abnormalities and insulin resistance indices. When adjusted by weight, relationships of fat and lean body mass with metabolic parameters were mirror images of each other. The weight-adjusted lean body mass negatively correlated with systolic and diastolic blood pressures; fasting plasma glucose, HbA1c, alanine aminotransferase, and triglyceride, and insulin levels; and hepatic insulin resistance indices, and positively correlated with HDL-cholesterol levels and muscle insulin sensitivity indices. Compared with weight-adjusted lean body mass, weight-adjusted sectional areas of specific skeletal muscles showed similar, but not as strong, correlations with metabolic parameters. Among anthropometric measures, the calf circumference best reflected lean body mass, and weight-adjusted calf circumference negatively correlated with metabolic abnormalities and insulin resistance indices.

Interpretation

Weight-adjusted lean body mass and skeletal muscle area are protective against weight-associated insulin resistance and metabolic abnormalities. The calf circumference reflects lean body mass and may be useful as a protective marker against obesity-associated metabolic abnormalities.

Fat-free mass and calf circumference as body composition indices to determine non-exercise activity thermogenesis in patients with diabetes

Aims/Introduction

To investigate the clinical and anthropometrical parameters that are associated with non‐exercise activity thermogenesis that is composed of basal energy expenditure (BEE) and diet‐induced thermogenesis (DIT) in patients with diabetes.

Materials and Methods

Body composition was assessed using bioelectrical impedance, and BEE and DIT were measured using indirect calorimetry in 40 Japanese patients with diabetes.

Results

BEE correlated positively with bodyweight, body mass index, fat mass, and fat‐free mass, and correlated negatively with age in both men and women. In multivariate logistic regression analysis, BEE correlated positively with both fat mass and fat‐free mass independently of sex and age. In addition, DIT correlated positively with bodyweight, body mass index, fat mass and fat‐free mass, and correlated negatively with age in women, but not men. Fat‐free mass contributed to DIT at least partly, and an aging‐related decrease in DIT was observed. The best anthropometric parameter that reflected fat mass and fat‐free mass was hip circumference (HC) and calf circumference (CC), respectively, in both men and women. Indeed, both HC (men β = 0.600, P < 0.001; women β = 0.752, P < 0.001) and CC (men β = 0.810, P = 0.012; women β = 0.821, P = 0.002) were correlated with BEE independently of age and sex. In addition, CC (β = 0.653, P = 0.009), but not HC was correlated with DIT significantly only in females, independently of age.

Conclusions

HC reflects fat mass and was positively associated with BEE, but not with DIT. In contrast, CC reflects fat‐free mass, and was positively associated with BEE in both men and women, and with DIT in women.