Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake.

Ilse J M Hagedoorn,Gozewijn D Laverman,Milou M Oosterwijk,Christina M Gant,Stephan J L Bakker,Miriam M R Vollenbroek-Hutten,Gerjan Navis,Bert-Jan F Van Beijnum,Niala Den Braber

doi:10.3390/jcm9103104

Abstract

Objective: In order to promote physical activity (PA) in patients with complicated type 2 diabetes, a better understanding of daily movement is required. We (1) objectively assessed PA in patients with type 2 diabetes, and (2) studied the association between muscle mass, dietary protein intake, and PA. Methods: We performed cross-sectional analyses in all patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT) between November 2016 and November 2018. Patients were divided into four groups: <5000, 5000–6999, 7000–9999, ≥ 10,000 steps/day. We studied the association between muscle mass (24 h urinary creatinine excretion rate, CER) and protein intake (by Maroni formula), and the main outcome variable PA (steps/day, Fitbit Flex device) using multivariate linear regression analyses. Results: In the 217 included patients, the median steps/day were 6118 (4115–8638). Of these patients, 48 patients (22%) took 7000–9999 steps/day, 37 patients (17%) took ≥ 10,000 steps/day, and 78 patients (36%) took <5000 steps/day. Patients with <5000 steps/day had, in comparison to patients who took ≥10,000 steps/day, a higher body mass index (BMI) (33 ± 6 vs. 30 ± 5 kg/m2, p = 0.009), lower CER (11.7 ± 4.8 vs. 14.8 ± 3.8 mmol/24 h, p = 0.001), and lower protein intake (0.84 ± 0.29 vs. 1.08 ± 0.22 g/kg/day, p < 0.001). Both creatinine excretion (β = 0.26, p < 0.001) and dietary protein intake (β = 0.31, p < 0.001) were strongly associated with PA, which remained unchanged after adjustment for potential confounders. Conclusions: Prevalent insufficient protein intake and low muscle mass co-exist in obese patients with low physical activity. Dedicated intervention studies are needed to study the role of sufficient protein intake and physical activity in increasing or maintaining muscle mass in patients with type 2 diabetes.

Highlights

Type 2 diabetes is a predominately lifestyle-related disease and has become one of the major global public health concerns, with highest prevalence in older adults [1]
The vast majority of patients with type 2 diabetes do not adhere to the American Diabetes Association (ADA) guidelines of >150 min per week of moderate to vigorous physical activity (PA), which is comparable with 7000 steps per day [3,4,5]
This study was performed in the DIAbetes and LifEstyle Cohort Twente (DIALECT), an observational cohort study in patients with complicated type 2 diabetes mellitus, treated in the secondary healthcare level in the outpatient clinic of the Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, the Netherlands

Summary

Introduction

Type 2 diabetes is a predominately lifestyle-related disease and has become one of the major global public health concerns, with highest prevalence in older adults [1]. The vast majority of patients with type 2 diabetes do not adhere to the American Diabetes Association (ADA) guidelines of >150 min per week of moderate to vigorous PA, which is comparable with 7000 steps per day [3,4,5]. In order to promote PA and reduce sedentary behaviour, a better understanding of total daily movement is required, especially in patients with complicated type 2 diabetes. We hypothesize that in patients with complicated type 2 diabetes, low protein intake and low muscle mass are associated with low PA, and the former could be an important actionable item to improve PA. Here we (1) objectively measure PA (in steps/day) in patients with complicated type 2 diabetes, and (2) investigate the association between protein intake and muscle mass and PA

Patient Inclusion

Data Collection

Main Outcome

Statistical Analysis

Baseline Characteristics and Total Steps per Day

Conclusions