Clinical and Dietary Determinants of Muscle Mass in Patients with Type 2 Diabetes: Data from the Diabetes and Lifestyle Cohort Twente.

Annis C Jalving,Milou M Oosterwijk,Gerjan Navis,Stephan J L Bakker,Ilse J M Hagedoorn,Gozewijn D Laverman

doi:10.3390/jcm10225227

Abstract

Low muscle mass in patients with type 2 diabetes is associated with a progressively higher risk of morbidity and mortality. The aim of this study was to identify modifiable targets for intervention of muscle mass in type 2 diabetes. Cross-sectional analyses were performed in 375 patients of the Diabetes and Lifestyle Cohort Twente-1 study. Muscle mass was estimated by 24 h urinary creatinine excretion rate (CER, mmol/24 h). Patients were divided in sex-stratified tertiles of CER. To study determinants of CER, multivariable linear regression analyses were performed. Protein intake was determined by Maroni formula and by a semi-quantitative Food Frequency Questionnaire. The mean CER was 16.1 ± 4.8 mmol/24 h and 10.9 ± 2.9 mmol/24 h in men and women, respectively. Lower CER was significantly associated with older age (p < 0.001) as a non-modifiable risk factor, whereas higher BMI (p = 0.015) and lower dietary protein intake (both methods p < 0.001) were identified as modifiable risk factors for lower CER. Overall body mass index (BMI) was high, even in the lowest CER tertile the mean BMI was 30.9 kg/m2, mainly driven by someone’s body weight (p = 0.004) instead of someone’s height (p = 0.58). In the total population, 28% did not achieve adequate protein intake of >0.8 g/kg/day, with the highest percentage in the lowest CER tertile (52%, p < 0.001). Among patients with type 2 diabetes treated in secondary care, higher BMI and low dietary protein intake are modifiable risk factors for lower muscle mass. Considering the risk associated with low muscle mass, intervention may be useful. To that purpose, dietary protein intake and BMI are potential targets for intervention.

Highlights

Over the past few decades, the prevalence of type 2 diabetes has dramatically increased in parallel to the obesity epidemic [1,2]
Diabetes and Lifestyle Cohort Twente (DIALECT)-1 was performed in the outpatient clinic of the hospital Ziekenhuis Groep Twente (ZGT), Almelo and Hengelo, The Netherlands
This study evaluated the non-modifiable and modifiable factors of muscle mass in patients with type 2 diabetes by using 24 h urine creatinine excretion rate (CER)

Summary

Introduction

Over the past few decades, the prevalence of type 2 diabetes has dramatically increased in parallel to the obesity epidemic [1,2]. Both are closely related to a sedentary lifestyle and adverse dietary habits [3–5]. It is increasingly recognized that low muscle mass per se carries a considerable risk in type 2 diabetes [6,7]. Obese adults with low muscle mass have a higher risk of developing frailty and disability and poor quality of life [6,9]. Low muscle mass is associated with higher mortality in obese patients with chronic diseases, including type 2 diabetes [10]. The progressively higher risk of mortality with lower muscle mass in type 2 diabetes applies to the full range of muscle mass [10]. It is recommended that efforts should be made to prevent or minimize loss of skeletal muscle mass in these patients [6]

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