Abstract
BackgroundSarcopenic obesity, defined as reduced skeletal muscle mass and power with increased adiposity, was reported to be associated with cardiovascular disease risks in previous cross-sectional studies. Whole body dual-energy X-ray absorptiometry (DXA) can simultaneously evaluate both fat and muscle mass, therefore, whole body DXA may be suitable for the diagnosis of sarcopenic obesity. However, little is known regarding whether sarcopenic obesity determined using whole body DXA could predict incident cardiovascular disease (CVD). The aim of this study was to investigate the impact of sarcopenic obesity on incident CVD in patients with type 2 diabetes.MethodsA total of 716 Japanese patients (mean age 65 ± 13 years; 47.0% female) were enrolled. Android fat mass (kg), gynoid fat mass (kg), and skeletal muscle index (SMI) calculated as appendicular non-fat mass (kg) divided by height squared (m2), were measured using whole body DXA. Sarcopenic obesity was defined as the coexistence of low SMI and obesity determined by four patterns of obesity as follows: android to gynoid ratio (A/G ratio), android fat mass or percentage of body fat (%BF) was higher than the sex-specific median, or body mass index (BMI) was equal to or greater than 25 kg/m2. The study endpoint was the first occurrence or recurrence of CVD.ResultsOver a median follow up of 2.6 years (IQR 2.1–3.2 years), 53 patients reached the endpoint. Sarcopenic obesity was significantly associated with incident CVD even after adjustment for the confounding variables, when using A/G ratio [hazard ratio (HR) 2.63, 95% CI 1.10–6.28, p = 0.030] and android fat mass (HR 2.57, 95% CI 1.01–6.54, p = 0.048) to define obesity, but not %BF (HR 1.67, 95% CI 0.69–4.02, p = 0.252), and BMI (HR 1.55, 95% CI 0.44–5.49, p = 0.496).ConclusionsThe present data suggest that the whole body DXA is valuable in the diagnosis of sarcopenic obesity (high A/G ratio or android fat mass with low SMI) to determine the risk of CVD events in patients with type 2 diabetes. Meanwhile, sarcopenic obesity classified with low SMI, and high %BF or BMI was not associated with incident CVD.
Highlights
Sarcopenic obesity, defined as reduced skeletal muscle mass and power with increased adiposity, was reported to be associated with cardiovascular disease risks in previous cross-sectional studies
Clinical characteristics of the study population Among the participants, 187 (26.1%), 171 (23.9%), 275 (38.4%) and 83 (11.6%) patients were classified as normal, sarcopenia, obesity and sarcopenic obesity, respectively, and Table 1 shows the clinical characteristics at baseline in the four categories of body composition, when using android to gynoid fat (A/G) ratio for the classification of obesity
The duration of diabetes was significantly longer in sarcopenic obesity patients than that in patients of the other categories
Summary
Sarcopenic obesity, defined as reduced skeletal muscle mass and power with increased adiposity, was reported to be associated with cardiovascular disease risks in previous cross-sectional studies. The aim of this study was to investigate the impact of sarcopenic obesity on incident CVD in patients with type 2 diabetes. Obesity is well known to be associated with various comorbidities such as type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease (CVD) [1]. Sarcopenia, defined as loss of skeletal muscle mass and strength with aging, has been reported to be associated with physical disability and CVD. There are very few observational studies that investigated the association between sarcopenic obesity evaluated based on direct measures of body fat and muscle mass, and incident CVD
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