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Larsen B, Bellettiere J, Allison M, Ryu R, Tam RM, McClelland RL, Miljkovic I, Vella C, Ouyang P, Criqui M, Unkart J. Associations of Abdominal Muscle Density and Area and Incident Cardiovascular Disease, Coronary Heart Disease, and Stroke: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e032014. [PMID: 38348808 PMCID: PMC11010071 DOI: 10.1161/jaha.123.032014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Muscle density is inversely associated with all-cause mortality, but associations with cardiovascular disease (CVD) risk are not well understood. This study evaluated the association between muscle density and muscle area and incident total CVD, coronary heart disease (CHD), and stroke in diverse men and women. METHODS AND RESULTS Adult participants (N=1869) in the Multi-Ethnic Study of Atherosclerosis Ancillary Body Composition Study underwent computer tomography scans of the L2-L4 region of the abdomen. Muscle was quantified by density (Hounsfield units) and area in cm2. Sex-stratified Cox proportional hazard models assessed associations between incident total CVD, incident CHD, and incident stroke across sex-specific percentiles of muscle area and density, which were entered simultaneously into the model. Mean age for men and women at baseline were 64.1 and 65.1 years, respectively, and median follow-up time was 10.3 years. For men, associations between muscle density and incident CVD were inverse but not significant in fully adjusted models (P trend=0.15). However, there was an inverse association between density and CHD (P trend=0.02; HR, 0.26 for 95th versus 10th percentile), and no association with stroke (P trend=0.78). Conversely, for men, there was a strong positive association between muscle area and incident CVD (HR, 4.19 for 95th versus 10th percentile; P trend<0.001). Associations were stronger for CHD (HR, 6.18 for 95th versus 10th percentile; P trend<0.001), and null for stroke (P trend=0.67). Associations for women were mostly null. CONCLUSIONS For men, abdominal muscle density is associated with lower CHD risk, whereas greater muscle area is associated with markedly increased risk of CHD.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Matthew Allison
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Rita Ryu
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | - Rowena M. Tam
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCAUSA
| | | | - Iva Miljkovic
- Department of EpidemiologyUniversity of PittsburgPAUSA
| | - Chantal Vella
- Department of Movement SciencesUniversity of IdahoBoiseIDUSA
| | - Pamela Ouyang
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Michael Criqui
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Jonathan Unkart
- Department of Family Medicine & Public HealthUniversity of California San DiegoSan DiegoCAUSA
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Ranjan P, Vikram NK, Kumari A, Chopra S, Choranur A, Pradeep Y, Puri M, Malhotra A, Ahuja M, Meeta, Batra A, Balsarkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore AM, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative. J Family Med Prim Care 2022; 11:7549-7601. [PMID: 36994026 PMCID: PMC10041015 DOI: 10.4103/jfmpc.jfmpc_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, New Delhi, India
| | - Ambuja Choranur
- President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India
| | - Yashodhara Pradeep
- Era Medical College and University, Ex Professor and Head Department of Obstetrics and Gynaecology, RML Institute of Medical Sciences, KGMU, Lucknow, Vice President Elect, FOGSI, Ex Vice President, IMS, India
| | - Manju Puri
- Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Anita Malhotra
- Food and Nutrition, Department of Home Science, Vice-Principal, Lakshmibai College, University of Delhi, New Delhi, India
| | - Maninder Ahuja
- President, Society of Meaningful Life Management, Associate Editor, Journal of Midlife Health, India
| | - Meeta
- Indian Menopause Society, Editor-in-Chief, Journal of Mid-Life Health, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Geetha Balsarkar
- Department of Obstetrics and Gynaecology Seth G. S. Medical College, Mumbai, India
| | - Deepti Goswami
- Director Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Verma
- Department of Home Science, University of Delhi, New Delhi, India
| | | | - Jagmeet Madan
- National President, Indian Dietetic Association, India
| | - Anjali Dabral
- Head, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sandhya Kamath
- Ex-Professor of Medicine and Dean, Seth G S Medical College and KEM Hospital, Mumbai, and LT Municipal Medical College and General Hospital, Mumbai, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurishankar Kaloiya
- Clinical Psychology, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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3
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Qiu S, Cai X, Yuan Y, Xie B, Sun Z, Wu T. Is imaging-based muscle quantity associated with risk of diabetes? A meta-analysis of cohort studies. Diabetes Res Clin Pract 2022; 189:109939. [PMID: 35662615 DOI: 10.1016/j.diabres.2022.109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/01/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
AIMS Greater muscle quantity (muscle mass and area) is associated with better glycemic control in adults, but its longitudinal association with risk of diabetes remains debatable. We therefore conducted this meta-analysis to address this issue. METHODS We performed a literature search and included cohort studies that measured muscle quantity objectively by imaging-based approaches and reported their association with risk of diabetes. Study-specific data were pooled using a random-effects model. RESULTS Thirty-three unique datasets, with 10 on total muscle quantity, and 23 on regional (8 on appendicular, 4 on leg, 6 on thigh, and 5 on abdominal) muscle quantity, were included. Muscle quantity was all measured by dual energy x-ray absorptiometry or computed tomography. Most datasets revealed nonsignificant outcomes. Meta-analysis showed collectively that the risk of diabetes was not related to total or regional muscle quantity in either normalized or unnormalized form, with the hazard ratios ranged from 0.92 to 1.09 per every 1 standard deviation higher of corresponding muscle quantity in general (all P > 0.10). Neither sex nor weight status affected the relationship. CONCLUSIONS Our study did not provide adequate evidence to support the concept that large muscle quantity was associated with low risk of diabetes in population-based cohort studies.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China; The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China(1)
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Yuan
- Department of Endocrinology, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Department of General Practice, Zhongda Hospital, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China.
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Kim EH, Kim HK, Lee MJ, Bae SJ, Kim KW, Choe J. Association between type 2 diabetes and skeletal muscle quality assessed by abdominal computed tomography scan. Diabetes Metab Res Rev 2022; 38:e3513. [PMID: 34799961 DOI: 10.1002/dmrr.3513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/18/2021] [Accepted: 09/16/2021] [Indexed: 12/25/2022]
Abstract
AIM To examine the association between type 2 diabetes and the amount and quality of trunk muscle as assessed by computed tomography (CT) scan. MATERIALS AND METHODS A total of 20,986 subjects (13,007 men and 7979 women) who underwent abdominal CT scan as part of a routine health check-up were included. The total abdominal muscle area (TAMA) measured at the third lumbar vertebrae was classified into skeletal muscle area (SMA), and intermuscular adipose tissue area. SMA was divided into good quality muscles (normal attenuation muscle area [NAMA]) and poor quality muscles (low attenuation muscle area). NAMA/TAMA index was calculated. RESULTS Subjects with type 2 diabetes had higher values of TAMA and SMA but significantly lower values of NAMA and NAMA/TAMA index. Compared with those in the lowest quartile of NAMA/TAMA index, subjects in the highest quartile had metabolically favourable laboratory findings, a lower prevalence of type 2 diabetes (Q1 vs. Q4: 19.3% vs. 9.5% in men, 12.3% vs. 3.0% in women) and inverse association with type 2 diabetes (odds ratio for Q2, Q3, and Q4: 0.87, 0.78, and 0.75 in men; 0.82, 0.70, and 0.68 in women) after multivariable adjustment. CONCLUSIONS The amount of good quality muscle on CT scan was associated with a lower prevalence of type 2 diabetes.
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Affiliation(s)
- Eun Hee Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Min Jung Lee
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Sung-Jin Bae
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Biomedical Research Center, Asan Institute for Life Sciences, Seoul, Republic of Korea
| | - Jaewon Choe
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
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Gold RS, Unkart JT, Larsen BA, Price CA, Cless M, Araneta MRG, Allison MA. Association of abdominal muscle area and density with glucose regulation: The multi-ethnic study of atherosclerosis (MESA). Diabetes Metab Res Rev 2022; 38:e3488. [PMID: 34328704 PMCID: PMC8800952 DOI: 10.1002/dmrr.3488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
AIMS Previous characterisation of body composition as a type 2 diabetes mellitus (T2DM) risk factor has largely focused on adiposity, but less is known about the independent role of skeletal muscle. We examined associations between abdominal muscle and measures of glucose regulation. MATERIALS AND METHODS Cross-sectional analysis of 1,891 adults enrolled in the Multi-Ethnic Study of Atherosclerosis. Multivariable regression assessed associations between abdominal muscle area and density (measured by computed tomography) with fasting glucose, homeostasis model assessment of insulin resistance (HOMA-IR), and prevalent T2DM (fasting glucose ≥126 mg/dL or medication use). RESULTS In minimally adjusted models (age, sex, race/ethnicity, income), a 1-SD increment in abdominal muscle area was associated with higher HOMA-IR (β = 0.20 ± SE 0.03; 95%CI: 0.15, 0.25; P < 0.01) and odds of T2DM (OR = 1.47; 95%CI: 1.18, 1.84; P < 0.01), while higher density was associated with lower fasting glucose (-4.49 ± 0.90; -6.26, -2.72; P < 0.01), HOMA-IR (-0.16 ± 0.02; -0.20, -0.12; P < 0.01), and odds of T2DM (0.64; 0.52, 0.77; P < 0.01). All associations persisted after adjustment for comorbidities and health behaviours. However, after controlling for height, BMI, and visceral adiposity, increasing muscle area became negatively associated with fasting glucose (-2.23 ± 1.01; -4.22, -0.24; P = 0.03), while density became positively associated with HOMA-IR (0.09 ± 0.02; 0.05, 0.13; P < 0.01). CONCLUSIONS Increasing muscle density was associated with salutary markers of glucose regulation, but associations inverted with further adjustment for body size and visceral adiposity. Conversely, after full adjustment, increasing muscle area was associated with lower fasting glucose, suggesting some patients may benefit from muscle-building interventions.
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Affiliation(s)
- Rebecca S Gold
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jonathan T Unkart
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Candice A Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Mallory Cless
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Maria Rosario G Araneta
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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6
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Tilves C, Zmuda JM, Kuipers AL, Nair S, Carr JJ, Terry JG, Peddada S, Wheeler V, Miljkovic I. Relative associations of abdominal and thigh compositions with cardiometabolic diseases in African Caribbean men. Obes Sci Pract 2021; 7:738-750. [PMID: 34877013 PMCID: PMC8633926 DOI: 10.1002/osp4.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Regional body compositions are differentially associated with cardiometabolic risk factors. Simultaneous inclusion of both upper and lower body composition predictors in models is not often done, and studies which do include both measures (1) tend to exclude some tissue(s) of potential metabolic relevance, and (2) have used study populations with underrepresentation of individuals with African ancestries. Further, most body composition analyses do not employ compositional data analytic approaches, which may result in spurious associations. OBJECTIVE The objective of this analysis was to assess associations of abdominal and thigh adipose (AT) and muscle tissues with hypertension and type 2 diabetes using compositional data analytic methods. RESEARCH DESIGN AND METHODS This cross-sectional analysis included 610 African Caribbean men (median age: 62 years; mean BMI: 27.8 kg/m2). Abdominal (three components: subcutaneous [ASAT] and visceral [VAT] AT, 'other' abdominal tissue) and mid-thigh (four components: subcutaneous and intermuscular AT, muscle, bone) compositions were measured by computed tomography; additive log ratio transformations were applied to each composition. Regression models were used to simultaneously assess associations of abdominal and thigh component ratios with continuous risk factors (blood pressures, fasting glucose and insulin, HOMA-IR) and disease categories. RESULTS A two-fold increase in ASAT:'Other' ratio was associated with higher continuous risk factors and with odds of being in a higher hypertension (OR: 1.77, 95%CI: 1.10-2.84) or diabetes (OR: 1.81, 95%CI: 1.06-3.10) category. A two-fold increased VAT ratio was only associated with higher log-insulin and log-HOMA-IR (β = 0.10, p < 0.05 for both), while a two-fold increased thigh muscle:bone ratio was associated with a lower diabetes category (OR: 0.37, 95%CI: 0.14-1.01). CONCLUSIONS These findings support ASAT as a significant driver of cardiometabolic disease in African Ancestry populations, independent of other abdominal and thigh tissues.
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Affiliation(s)
- Curtis Tilves
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joseph M. Zmuda
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Allison L. Kuipers
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sangeeta Nair
- Department of RadiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John Jeffrey Carr
- Department of RadiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James G. Terry
- Department of RadiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Shyamal Peddada
- Department of BiostatisticsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Victor Wheeler
- Tobago Health Studies OfficeScarboroughTobagoTrinidad and Tobago
| | - Iva Miljkovic
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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Nonalcoholic Fatty Liver Disease and Sarcopenia: Where Do We Stand? Can J Gastroenterol Hepatol 2020; 2020:8859719. [PMID: 33204675 PMCID: PMC7652636 DOI: 10.1155/2020/8859719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
The link between metabolic syndrome (MetS) and sarcopenia has not been extensively studied, but it is evident that they share several common features. Crucial mechanisms involved in sarcopenia-nonalcoholic fatty liver disease (NAFLD) interplay are based on effects of insulin resistance, chronic inflammation, oxidative stress, and crosstalk between organs by secretion of cytokines (hepatokines, adipokines, and myokines). Currently, published studies confirm the association of sarcopenia with the degree of NAFLD defined by liver histology. However, prospective studies that will give us information regarding the causal effect of NAFLD and sarcopenia are still needed. Furthermore, there is a need for a patient-friendly, noninvasive, low-cost method for detection of loss of skeletal muscle mass, strength, and physical performance in the context of NAFLD. Moreover, potential treatment strategies such as physical exercise and nutritional supplementation, that are usually a part of management of sarcopenia, should also be investigated in NAFLD patients, especially given the fact that for now, we do not have a good treatment option for NAFLD. Therefore, future investigations should combine studies on NAFLD and sarcopenia in terms of physical activity and nutritional interventions such as vitamin D supplementation. This review aims to report recent evidence concerning the links between sarcopenia and NAFLD and methods to assess sarcopenia.
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8
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Larsen B, Bellettiere J, Allison M, McClelland RL, Miljkovic I, Vella CA, Ouyang P, De-Guzman KR, Criqui M, Unkart J. Muscle area and density and risk of all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. Metabolism 2020; 111:154321. [PMID: 32712219 PMCID: PMC8062068 DOI: 10.1016/j.metabol.2020.154321] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lean muscle plays critical roles in physical functioning and metabolism. However, little is known regarding associations between muscle and mortality in adults. OBJECTIVE The purpose was to evaluate associations between abdominal muscle quantity (area) and quality (density) with risk of all-cause mortality in a diverse cohort free of cardiovascular disease. DESIGN Data were taken from the Abdominal Body Composition, Inflammation, and Cardiovascular Disease ancillary study of the Multi-Ethnic Study of Atherosclerosis prospective cohort study. Participants were adults (45-85 years) free of extant cardiovascular disease, and of Hispanic, African American, Chinese, or Caucasian descent. Of the original 6814 MESA participants, a random, representative sample (n = 1974) participated in the ancillary body composition study. Abdominal muscle area and density were measured from computed tomography scans spanning L2-L4. Muscle density was measured as attenuation in Hounsfield units, and area was quantified as cm2. Gender-stratified cox proportional hazard models assessed the risk of all-cause mortality across gender-specific quartiles of muscle area and density adjusting for confounders, with area and density entered simultaneously. RESULTS At baseline, the mean age for men (n = 946) and women (n = 955) was 61.5 and 62.5 years and median follow-up time was 10.6 and 10.9 years, respectively. Muscle density was inversely associated with mortality, with the highest quartile of density showing a 73% reduction in risk for men (HR = 0.27, 95% CI = 0.14-0.51; p-trend<0.001) and 57% reduction for women (HR = 0.43, 95% CI = 0.18-1.01; p-trend = 0.04) compared to the lowest quartile when adjusting for mortality risk factors, lifestyle, BMI and visceral fat. There was no association between muscle area and all-cause mortality for men (p-trend = 0.58) or women (p-trend = 0.47). CONCLUSIONS Greater abdominal muscle density, but not muscle area, is associated with markedly lower risk of all-cause mortality across a decade of follow up. Muscle quality may be a powerful predictor of mortality in community dwelling adults.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America.
| | - John Bellettiere
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburg, Pittsburg, PA, United States of America
| | - Chantal A Vella
- Department of Movement Sciences, University of Idaho, Boise, ID, United States of America
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Kimberly R De-Guzman
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - Jonathan Unkart
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States of America
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9
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Yasuoka M, Muraki I, Imano H, Jinnouchi H, Kubota Y, Hayama-Terada M, Umesawa M, Yamagishi K, Ohira T, Kitamura A, Okada T, Kiyama M, Iso H. Joint impact of muscle mass and waist circumference on type 2 diabetes in Japanese middle-aged adults: The Circulatory Risk in Communities Study (CIRCS). J Diabetes 2020; 12:677-685. [PMID: 32372543 DOI: 10.1111/1753-0407.13049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although evidence about skeletal muscle mass loss and type 2 diabetes risk has accumulated, little information is available on the combined effect of skeletal muscle mass and abdominal obesity on type 2 diabetes. We examined whether skeletal muscle mass and abdominal obesity were synergistically associated with the prevalence of type 2 diabetes. METHODS Skeletal muscle mass and waist circumference (WC) were measured in 1515 Japanese aged 40 to 69 years. Relative muscle mass was calculated as percentage of total skeletal muscle mass in body weight (SMM%). Type 2 diabetes was identified as fasting serum glucose ≥7.0 mmol/L (126 mg/dL), nonfasting serum glucose ≥11.1 mmol/L (200 mg/dL), glycosylated hemoglobin ≥ 6.5%, and/or diabetes medication use. RESULTS The multivariable-adjusted odds ratio (OR) of prevalent diabetes from the lowest to the third quartile of SMM% compared to the highest quartile gradually increased in both sexes. The association between a high WC and prevalent diabetes was similar. The multivariable-adjusted OR (95% confidence intervals) for the prevalence of type 2 diabetes in the low skeletal muscle mass/high WC group was 3.19 (1.78-5.71) for men and 4.46 (2.09-9.51) for women compared with the high skeletal muscle mass/low WC group. The relative excess risk due to interaction was 2.2 (0.5-3.9) in men and 2.8 (0.2-5.3) in women for an excess burden of type 2 diabetes for low skeletal muscle mass and high WC. CONCLUSIONS Low skeletal muscle mass and abdominal obesity were synergistically associated with presence of type 2 diabetes.
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Affiliation(s)
- Mikako Yasuoka
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshige Jinnouchi
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Mina Hayama-Terada
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
- Public Health Center of Yao City, Yao, Japan
| | - Mitsumasa Umesawa
- School of Medicine, Dokkyo University, Mibu, Japan
- Department of Public Health Medicine, Faculty of Medicine, and Health Service Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Service Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Public Health Medicine, Faculty of Medicine, and Health Service Research and Development Center, University of Tsukuba, Tsukuba, Japan
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Cho NH, Kim HS. Letter: Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans (Diabetes Metab J 2018;42:488-95). Diabetes Metab J 2019; 43:123-124. [PMID: 30793553 PMCID: PMC6387878 DOI: 10.4093/dmj.2019.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nan Hee Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Soon Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
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Engaging the ASEAN Diaspora: Type 2 Diabetes Prevalence, Pathophysiology, and Unique Risk Factors among Filipino Migrants in the United States. J ASEAN Fed Endocr Soc 2019; 34:126-133. [PMID: 33442147 PMCID: PMC7784106 DOI: 10.15605/jafes.034.02.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes prevalence is rising rapidly in Southeast Asia (SEA) where urbanization and adoption of ‘western’ behavioral lifestyles are attributed as predominant risk factors. The Southeast Asian diaspora to the United States has resulted in a sizable portion of migrant and US born SEAs, with approximately 4 million Filipino Americans, 2 million Vietnamese-Americans, Cambodians (330,000), and Thai (300,000) as the most populous. Their longer exposure to a western lifestyle and participation in clinical studies with other racial/ethnic groups, provide opportunities to evaluate etiologic factors which might inform trends and intervention opportunities among residents of Southeast Asia. Epidemiologic studies in the US have identified higher T2D prevalence among Filipinos (16.1%) compared to groups perceived to be at highest risk for T2D, namely Latinos (14.0%), Black (13.7%), and Native Americans (13.4%), while SEAs (including Burmese, Cambodian, Indonesian, Laotian, Malaysian, and Thai, 10.5%) and Vietnamese (9.9%) had higher T2D risk compared to Whites (7.7%), despite their absence of general obesity. Asian-Americans, including SEAs, East and South Asians, collectively have higher rates of undiagnosed T2D compared to other racial/ethnic groups in the US. Almost half (44%) of Filipinos with newly diagnosed T2D have isolated post-challenge hyperglycemia and will remain undiagnosed if current screening practices remain limited to measures of glycosylated hemoglobin and fasting plasma glucose. The University of California San Diego Filipino Health Study found excess visceral adipose tissue accumulation, low ratio of muscle to total abdominal mass area, low adiponectin concentration, multiparity (≥ 6 live births), and sleep insufficiency (<7 hours) to be unique T2D risk factors among Filipino-American women, even after adjusting for established T2D risk factors including hypertension and parental history of T2D. Social determinants such as low educational attainment (less than college completion), and sustained social disadvantage during childhood and adulthood were independently associated with T2D risk. Gestational diabetes is a known risk factor for future T2DM among women; Northern California data shows that following Asian Indians, gestational diabetes was highest among Filipina and SEA parturients, who had twice the GDM prevalence as Black, Hispanic, and White women. Identification of novel T2D risk factors among SEAs may guide early diagnosis, inform pathophysiology, and identify unique opportunities for T2D prevention and management.
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Han SJ, Boyko EJ, Kim SK, Fujimoto WY, Kahn SE, Leonetti DL. Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans. Diabetes Metab J 2018; 42:488-495. [PMID: 30302961 PMCID: PMC6300439 DOI: 10.4093/dmj.2018.0022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Skeletal muscle plays a major role in glucose metabolism. We investigated the association between thigh muscle mass, insulin resistance, and incident type 2 diabetes mellitus (T2DM) risk. In addition, we examined the role of body mass index (BMI) as a potential effect modifier in this association. METHODS This prospective study included 399 Japanese Americans without diabetes (mean age 51.6 years) who at baseline had an estimation of thigh muscle mass by computed tomography and at baseline and after 10 years of follow-up a 75-g oral glucose tolerance test and determination of homeostasis model assessment of insulin resistance (HOMA-IR). We fit regression models to examine the association between thigh muscle area and incidence of T2DM and change in HOMA-IR, both measured over 10 years. RESULTS Thigh muscle area was inversely associated with future HOMA-IR after adjustment for age, sex, BMI, HOMA-IR, fasting plasma glucose, total abdominal fat area, and thigh subcutaneous fat area at baseline (P=0.033). The 10-year cumulative incidence of T2DM was 22.1%. A statistically significant interaction between thigh muscle area and BMI was observed, i.e., greater thigh muscle area was associated with lower risk of incident T2DM for subjects at lower levels of BMI, but this association diminished at higher BMI levels. CONCLUSION Thigh muscle mass area was inversely associated with future insulin resistance. Greater thigh muscle area predicts a lower risk of incident T2DM for leaner Japanese Americans.
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Affiliation(s)
- Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Soo Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Wilfred Y Fujimoto
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven E Kahn
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA, USA
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Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr 2017; 72:288-296. [PMID: 29242526 PMCID: PMC5842880 DOI: 10.1038/s41430-017-0034-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/14/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Background/objectives Muscle mass is a key determinant of nutritional status and associated with outcomes in several patient groups. Computed tomography (CT) analysis is increasingly used to assess skeletal muscle area (SMA), skeletal muscle index (SMI) and muscle radiation attenuation (MRA). However, interpretation of these muscle parameters is difficult since values in a healthy population are lacking. The aim of this study was to provide sex specific percentiles for SMA, SMA and MRA in a healthy Caucasian population and to examine the association with age and BMI in order to define age- and BMI specific percentiles. Subjects/methods In this retrospective cross-sectional study CT scans of potential kidney donors were used to assess SMA, SMI and MRA at the level of the third lumbar vertebra. Sex specific distributions were described and, based on the association between age/BMI and muscle parameters, age, and BMI specific predicted percentiles were computed. The 5th percentile was considered as cut-off. Results CT scans of 420 Individuals were included (age range 20–82 years and BMI range 17.5–40.7 kg/m2). Sex specific cut-offs of SMA, SMI and MRA were 134.0 cm2, 41.6 cm2/m2 and 29.3 HU in men and 89.2 cm2, 32.0 cm2/m2 and 22.0 HU in women, respectively. Correlations were negative between age and all three muscle parameters, positive between BMI and SMA/SMI and negative between BMI and MRA, resulting in age- and BMI specific percentiles. Conclusions This study provides sex specific percentiles for SMA, SMI, and MRA. In addition, age- and BMI specific percentiles have been established.
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Han SJ, Kim SK, Fujimoto WY, Kahn SE, Leonetti DL, Boyko EJ. Effects of combination of change in visceral fat and thigh muscle mass on the development of type 2 diabetes. Diabetes Res Clin Pract 2017; 134:131-138. [PMID: 29032053 PMCID: PMC5723555 DOI: 10.1016/j.diabres.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
AIM We investigated the association between combined changes of visceral fat and thigh muscle over 5 years and incident type 2 diabetes in a prospective study of Japanese Americans. METHODS We followed 420 nondiabetic Japanese American subjects for 5 years and assessed visceral fat and thigh muscle by computed tomography (CT) at baseline and at 5 years. We categorized study subjects into 4 body composition change groups: visceral fat loss/thigh muscle gain (VF-loss/TM-gain), visceral fat loss/thigh muscle loss (VF-loss/TM-loss), visceral fat gain/thigh muscle gain (VF-gain/TM-gain), and visceral fat gain/thigh muscle loss (VF-gain/TM-loss) by combining changes from baseline in CT measured visceral fat and estimated thigh muscle areas. We fit a logistic regression model to examine the association between body composition categories and the development of incident type 2 diabetes at 5 years. RESULTS Cumulative incidence of type 2 diabetes was 9.8% at 5 years. VF-gain/TM-gain and VF-loss/TM-loss groups had higher risk for incident type 2 diabetes in a model adjusted for age, sex, family history of diabetes, and body mass index compared to VF-loss/TM-gain group as the reference category (OR=6.83 (1.85-25.17), 4.55 (1.06-19.48), respectively). However, the VF-gain/TM-loss group did not show a significant association with the odds of incident diabetes (3.24; 95% CI. 0.78-13.47). CONCLUSIONS Concordant gain or loss in visceral fat and thigh muscle was related to higher risk of incident type 2 diabetes compared to the reference combination of loss of visceral fat and gain of thigh muscle in Japanese Americans.
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Affiliation(s)
- Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea; Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Soo-Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Wilfred Y Fujimoto
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven E Kahn
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Relationship between rectus abdominis muscle thickness and metabolic syndrome in middle-aged men. PLoS One 2017; 12:e0185040. [PMID: 28915276 PMCID: PMC5600386 DOI: 10.1371/journal.pone.0185040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background and objective Skeletal muscle has been suggested as an important factor in the pathophysiology of metabolic syndrome. During the aging process, muscle mass is lost in specific body parts. However, few studies have investigated the relationship between site-specific muscle loss assessed using computed tomography (CT) and metabolic syndrome. This study was conducted to investigate the association between metabolic syndrome and rectus abdominis muscle thickness at the umbilicus level (RAM), which reflects site-specific muscle loss of the abdomen using CT image. Methods This cross-sectional study was conducted on 725 middle-aged Korean men. Anthropometric evaluation and biochemical tests were performed. The RAMs of the subjects were measured from CT images taken at the umbilicus level. Results The mean RAM (mean ±SD) of subjects with metabolic syndrome was 2.46 ±0.01, which was thinner than that of subjects without metabolic syndrome (2.52 ±0.01, p<0.01). Moreover, RAM decreased as the number of metabolic syndrome components increased (p-value for trend<0.01). RAM was positively correlated with body mass index (r = 0.21, p<0.01), skeletal muscle index (r = 0.26, p<0.01), and creatinine (r = 0.12, p<0.01), while RAM was negatively correlated with age(r = -0.11, p<0.01), abdominal circumference(r = -0.22, p<0.01), fasting glucose (r = -0.10, p<0.01), and triglycerides(r = -0.15, p<0.01). Using a stepwise multiple logistic regression analysis, we found that RAM was an independent factor associated with metabolic syndrome (OR: 0.861, 95%CI, 0.779–0.951, p<0.01). The result was not different in the statistical analysis including the components of MS (OR: 0.860, 95% CI, 0.767–0.965, p = 0.01). Conclusion RAM was associated with metabolic syndrome in middle-aged men. Moreover, site-specific muscle loss at the abdomen, as evaluated by RAM, also may be a predictor of metabolic syndrome like SMI.
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Verlingue L, Dugourd A, Stoll G, Barillot E, Calzone L, Londoño‐Vallejo A. A comprehensive approach to the molecular determinants of lifespan using a Boolean model of geroconversion. Aging Cell 2016; 15:1018-1026. [PMID: 27613445 PMCID: PMC6398530 DOI: 10.1111/acel.12504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2016] [Indexed: 12/11/2022] Open
Abstract
Altered molecular responses to insulin and growth factors (GF) are responsible for late‐life shortening diseases such as type‐2 diabetes mellitus (T2DM) and cancers. We have built a network of the signaling pathways that control S‐phase entry and a specific type of senescence called geroconversion. We have translated this network into a Boolean model to study possible cell phenotype outcomes under diverse molecular signaling conditions. In the context of insulin resistance, the model was able to reproduce the variations of the senescence level observed in tissues related to T2DM's main morbidity and mortality. Furthermore, by calibrating the pharmacodynamics of mTOR inhibitors, we have been able to reproduce the dose‐dependent effect of rapamycin on liver degeneration and lifespan expansion in wild‐type and HER2–neu mice. Using the model, we have finally performed an in silico prospective screen of the risk–benefit ratio of rapamycin dosage for healthy lifespan expansion strategies. We present here a comprehensive prognostic and predictive systems biology tool for human aging.
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Affiliation(s)
- Loic Verlingue
- Institut Curie CNRS, UMR3244 Telomere and Cancer Laboratory PSL Research University 75005 Paris France
- Department of Medical Oncology Institut Curie 75005 Paris France
| | - Aurélien Dugourd
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Gautier Stoll
- Sorbonne Paris Cité Université Paris Descartes 12 Rue de l'École de Médecine 75006 Paris France
- Equipe 11 labellisée Ligue contre le Cancer INSERM U 1138 Centre de Recherche des Cordeliers 15 rue de l'Ecole de Médecine 75006 Paris France
- Université Pierre et Marie Curie 4 Place Jussieu 75005 Paris France
| | - Emmanuel Barillot
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Laurence Calzone
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Arturo Londoño‐Vallejo
- Institut Curie CNRS, UMR3244 Telomere and Cancer Laboratory PSL Research University 75005 Paris France
- UPMC Univ Paris 06 CNRS, UMR3244 Sorbonne Universités 75005 Paris France
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Larsen BA, Wassel CL, Kritchevsky SB, Strotmeyer ES, Criqui MH, Kanaya AM, Fried LF, Schwartz AV, Harris TB, Ix JH. Association of Muscle Mass, Area, and Strength With Incident Diabetes in Older Adults: The Health ABC Study. J Clin Endocrinol Metab 2016; 101:1847-55. [PMID: 26930180 PMCID: PMC4880161 DOI: 10.1210/jc.2015-3643] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Skeletal muscle plays a key role in glucose regulation, yet the association between muscle quantity or quality and the risk of developing type 2 diabetes has not been explored. OBJECTIVE The objective of the study was to assess the association between muscle quantity and strength and incident diabetes and to explore whether this association differs by body mass index (BMI) category. DESIGN AND SETTING Participants were 2166 older adults in the Health, Aging, and Body Composition Study who were free of diabetes at baseline (1997–1998). Computed tomography and dual-energy x-ray absorptiometry were used to measure abdominal and thigh muscle area and total body lean mass, respectively. Strength was quantified by grip and knee extensions. MAIN OUTCOME MEASURE Incident diabetes, defined as fasting glucose of 126 mg/dL or greater, a physician's diagnosis, and/or the use of hypoglycemic medication were measured. RESULTS After a median 11.3 years of follow-up, there were 265 incident diabetes cases (12.2%). In fully adjusted models, no association was found between muscle or strength measures and incident diabetes (for all, P > .05). For women, there was a significant interaction with BMI category for both abdominal and thigh muscle, such that greater muscle predicted lower risk of incident diabetes for normal-weight women (hazard ratio 0.37 [0.17–0.83] and 0.58 [0.27–1.27] per SD, respectively) and a greater risk for overweight and obese women (hazard ratio 1.23 [0.98–1.54] and 1.28 [1.00–1.64], respectively). No significant interactions by BMI category existed for strength measures or any measures for men (for all, P > .05). CONCLUSIONS Greater muscle area is associated with a lower risk of incident diabetes for older normal-weight women but not for men or overweight women.
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Affiliation(s)
- Britta A Larsen
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Christina L Wassel
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Stephen B Kritchevsky
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Elsa S Strotmeyer
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Michael H Criqui
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Alka M Kanaya
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Linda F Fried
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Ann V Schwartz
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Tamara B Harris
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
| | - Joachim H Ix
- Department of Family Medicine and Public Health (B.A.L., M.H.C., I.X.), and Department of Medicine (J.H.I.), University of California, San Diego, San Diego, California 92093-0628; Department of Pathology and Laboratory Medicine (C.L.W.), College of Medicine, University of Vermont, Burlington, Vermont 05446; Wake Forest University and School of Medicine (S.B.K.), Winston-Salem, North Carolina 27157; Graduate School of Public Health (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15219; Division of General Internal Medicine (A.M.K.), Department of Epidemiology and Biostatistics (A.V.S.), University of California, San Francisco, San Francisco, California 94143; University of Pittsburgh School of Medicine and Veterans Affairs Pittsburgh Healthcare System (L.F.F.), Pittsburgh, Pennsylvania 15261; and National Institute on Aging (T.B.H.), Bethesda, Maryland 20892
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Sharma S, Tandon VR, Roshi, Mahajan A. Prescribing Pattern of Oral Antihyperglycaemic Drugs, Rationality and Adherence to American Diabetes Association (ADA) Treatment Guidelines among Type 2 Diabetes Mellitus (T2DM) Postmenopausal Women. J Clin Diagn Res 2016; 10:OC11-5. [PMID: 26894107 DOI: 10.7860/jcdr/2016/16044.7063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oral antihyperglycaemic prescription trends keep on changing and thus the drug prescription trend study may prove to be powerful exploratory tool for health care providers. AIM To investigate trends in prescriptions of oral antihyperglycaemic drugs (OHDs) among postmenopausal women suffering from T2DM in India and evaluate the rationality and adherence to ADA treatment guidelines. MATERIALS AND METHODS An observational, cross-sectional descriptive prescription audit (n=500) was carried. Postmenopausal women were interviewed in their local language using pre-tested pre validated questionnaire after verbal informed consent at a teaching tertiary care hospital of north India. Oral antihyperglycaemic drugs (OHDs) drugs were categorized as per the pharmacological classification. Adherence to available clinical practice guidelines/recommendations issued under American Diabetes Association (ADA) 2015 Guidelines as well as rationality of these prescriptions were assessed using WHO Guide to Good Prescribing. RESULTS Mean age of the study population was 58.14±12.86. Mean duration since menopause was 5.3 years and of T2DM was 9.5 years. A 93.4% of the prescriptions had only OHDs whereas 6.6% of the prescriptions had various insulin preprations + OHDs (p<0.0001). Biguanides followed by sulfonylureas, thiazolidinediones, DPP-inhibitors and alpha-glucosidases inhibitor were prescribed in 85.6%, 59.8%, 26.6%, 26% and 12.2% respectively as monotherapy or in combination. Among biguanides, metformin was the most frequently prescribed OHDs. In spite of black box warning on pioglitazone, it was prescribed in 26.6% as FDC. However, clear increase use of vidagliptine was noticed upto 26%. Among combinations most frequent was metformin plus glimipride followed by voglibose plus metformin, whereas, among FDC, metformin plus glimipride followed by metformin plus vidagliptine were most frequently prescribed. CONCLUSION Metformin was the most common OHDs to be prescribed followed by glimepiride. Although pioglitazone still continues to be prescribed after safety alert but apparently it appears that the share of pioglitazone has been shifted to vidagliptin or combinations like metformin plus glimipride. Polypharmacy, high use of FDC, & prescription by brand names were some of the irrationalities. Relatively low adherence to ADA treatment guidelines was observed.
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Affiliation(s)
- Sudhaa Sharma
- Post Graduate Student, Department of Obstetrics and Gyanecology, Government Medical College Jammu- J&K, India
| | - Vishal R Tandon
- Post Graduate Student, Department of Pharmacology, Government Medical College Jammu- J&K, India
| | - Roshi
- Post Graduate Student, Department of Pharmacology, Government Medical College Jammu- J&K, India
| | - Annil Mahajan
- Professor and Head, Department of General Medicine, Government Medical College Jammu- J&K, India
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Crawford MA, Mendoza-Vasconez AS, Larsen BA. Type II diabetes disparities in diverse women: the potential roles of body composition, diet and physical activity. WOMEN'S HEALTH (LONDON, ENGLAND) 2015; 11:913-27. [PMID: 26648099 PMCID: PMC4864180 DOI: 10.2217/whe.15.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The rates of diabetes in the USA are rapidly increasing, and vary widely across different racial/ethnic groups. This paper explores the potential contribution of body composition, diet and physical activity in explaining diabetes disparities across women of different racial and ethnic backgrounds. For body composition, racial/ethnic groups differ widely by BMI, distribution of body mass and quantity and type of adipose tissue. Dietary patterns that vary across race/ethnicity include consumption of meat, added sugars, high-glycemic carbohydrates and fast food. Additionally, physical activity patterns of interest include aerobic versus muscle-strengthening exercises, and the purpose of physical activity (leisure, occupation, or transportation). Overall, these variables provide a partial picture of the source of these widening disparities, and could help guide future research in addressing and reducing diabetes disparities.
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Affiliation(s)
- Margaret A Crawford
- Department of Family Medicine & Public
Health, University of California, San Diego, CA 92093, USA
| | | | - Britta A Larsen
- Department of Family Medicine & Public
Health, University of California, San Diego, CA 92093, USA
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