Sarcopenic Obesity with Normal Body Size May Have Higher Insulin Resistance in Elderly Patients with Type 2 Diabetes Mellitus

Figures & data

Table 1 Clinical Characteristics at Baseline in the Four Categories of Body Compositions Classified Using SMI and PBF

Variables	Normal Body Composition (n = 145)	Low Muscle Mass (n = 64)	High Body Fat (n = 208)	Low Muscle Mass and High Body Fat (n = 71)
Age(years)	68.00(65.00–72.00)	67.00(62.00–77.50)	66.50(63.00–71.00)	68.00(63.00–76.00)
Sex(M/F)	71/74	37/27	128/80^a	32/39^c
Diabetic duration(years)	10.00(1.00–16.50)	10.00(5.00–16.00)	6.00(1.00–20.00)	8.00(4.00–18.00)
SBP(mmHg)	131.00 (122.00–138.00)	125.50 (112.00–136.50)	127.00 (118.00–138.00)	130.00 (123.00–146.00)^b,c
DBP(mmHg)	73.00(69.00–76.00)	72.00(64.25–75.00)	73.00(68.00–78.75)	74.00(69.00–82.00)^b
BMI(kg/m^2)-total	23.60(22.30–25.10)	19.99(18.73–21.34)^a	27.00(25.00–28.53)^a,b	23.03(21.62–23.75)^b,c
BMI(kg/m^2)-male	23.70(22.30–25.10)	20.70(19.20–21.65)^a	26.30(24.63–27.40)^a,b	22.55(20.63–24.15)^b,c
BMI(kg/m^2)-female	23.60(22.25–25.03)	19.00(17.70–20.40)^a	28.40(26.35–29.68)^a,b	23.30(22.20–23.70)^b,c
WHR-total	0.89(0.86–0.92)	0.84(0.81–0.88)^a	0.95(0.91–1.00)^a,b	0.91(0.88–0.94)^b,c
WHR-male	0.89(0.86–0.92)	0.83(0.80–0.87)^a	0.95(0.91–1.00)^a,b	0.90(0.68–0.96)^b,c
WHR-female	0.89(0.86–0.93)	0.85(0.83–0.89)^a	0.94(0.90–1.00)^a,b	0.91(0.89–0.94)^b
PBF(%)-total	24.60(23.05–30.95)	22.30(18.90–27.48)	35.15(30.03–39.45)^a,b	37.0(32.80–39.30)^a,b
PBF(%)-male	23.30(21.40–24.30)	21.60(18.35–22.80)	31.45(28.33–34.75)^a,b	32.45(28.00–34.60)^a,b
PBF(%)-female	30.70(26.85–33.43)	28.00(22.00–31.60)	40.90(36.90–43.78)^a,b	38.80(37.50–39.50)^a,b
SMI(kg/m^2)-total	7.20(6.40–7.70)	6.30(5.40–6.70)^a	7.50(6.83–7.80)^b	5.60(5.40–6.60)^a,c
SMI(kg/m^2)-male	7.70(7.40–8.30)	6.70(6.35–6.85)^a	7.60(7.40–8.00)^b	6.70(6.10–6.90)^a,c
SMI(kg/m^2)-female	6.40(6.10–7.00)	5.30(4.90–5.50)^a	6.60 (6.20–7.00)^b	5.40(5.20–5.50)^a,c
ALT(IU/L)	17.00(13.00–24.00)	15.00(11.00–20.00)	25.00(18.00–38.75)^a,b	20.00(15.00–47.00)^a,b
AST(IU/L)	17.00(15.00–23.50)	18.00(14.25–21.75)	23.00(18.00–29.75)^a,b	21.00(17.00–35.00)^a,b
TG(mmol/L)	1.16(0.90–1.91)	1.21(0.81–1.40)	1.62 (1.13–2.59)^a,b	1.52(1.14–1.92)^a,b
TC(mmol/L)	4.62(3.99–5.69)	4.37(3.38–5.54)	4.83(4.21–5.54)	4.82(3.13–6.00)
HDL-C(mmol/L)	1.09(0.99–1.24)	1.23(0.91–1.32)	1.02(0.90–1.19)^a	0.89(0.82–1.20)^a,b
LDL-C(mmol/L)	2.90(2.38–3.69)	2.57(1.90–3.31)	3.12(2.49–3.52)	3.04(1.60–3.35)
FPG(mmol/L)	7.63(5.63–8.47)	7.94(6.14–9.90)	7.73(6.58–9.40)	7.47(6.76–10.40)^a
FCP(nmol/L)	0.60(0.34–0.91)	0.45(0.23–0.64)	0.71(0.50–1.05)^a,b	0.94(0.65–1.48)^a,b
HbA1c(%)	8.70(6.99–11.12)	9.40(6.55–10.87)	8.82(7.40–10.08)	9.00(6.62–9.54)
HOMA2-IR	1.46(0.92–2.17)	1.14(0.64–1.86)	1.83(1.21–2.60)^a,b	2.25(1.76–3.60)^a,b,c
Creatinine(umol/L)	70.29(55.85–82.12)	67.19(57.05–75.73)	70.05(59.72–87.90)	65.28(47.50–80.00)
UA(umol/L)	291.00 (255.50–326.50)	311.50 (264.50–332.75)	342.00 (287.25–403.75)^a,b	314.00 (248.00–366.00)^c
UACR(mg/g)	13.40(6.50–36.85)	16.45(8.05–34.65)	13.45(10.60–28.15)	22.10(8.60–25.60)
ADL score	100.00 (100.00,100.00)	100.00 (100.00,100.00)	100.00 (100.00,100.00)	100.00 (100.00,100.00)
HTN	87(60.0)	41(64.1)	125(60.1)	43(60.6)
NAFLD	29(20.0)	3(4.7)^a	92(44.2)^a,b	24(33.8)^a,b
Cardiovascular disease history	19(13.1)	15(23.4)	41(19.7)	13(18.3)
Cerebrovascular disease history	75(51.7)	39(60.9)	104(50.0)	59(81.3)^a,b,c
Smoking use	32(22.1)	16(25.0)	53(25.5)	15(21.1)
Alcohol use	30(20.7)	16(25.0)	48(23.1)	15(21.1)
Use of insulin-sensitizing agents	51(35.2)	18(28.1)	99(47.6)^b	28(39.4)^b
Use of lipid-lowering drugs	45(31.0)	7(10.9)^a	75(36.1)^b	29(40.8)^b

Notes: All of the continuous variables were non-normal distributed and were presented as median (interquartile range 25–75%); categorical variables were presented as a number (percentage %). Insulin-sensitizing agents included biguanides and thiazolidinediones; lipid-lowering drugs included statin and fibrate. ^aP<0.05 versus normal body composition group; ^bP<0.05 versus low muscle mass group; ^cP<0.05 versus high body fat group.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; WHR, waist to hip ratio; PBF, percent body fat; SMI, skeletal muscle index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TG, triglyceride; TC, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; FPG, fasting plasma glucose; FCP, fasting C-peptide; HbA1c, glycated hemoglobin A1c; HOMA2-IR, homeostatic model assessment of insulin resistance; UA, uric acid; UACR, urine albumin to creatinine ratio; ADL, activities of daily living; HTN, hypertension; NAFLD, non-alcoholic fatty liver disease.

Figure 1 Percentages of Chinese elderly subjects with T2DM in the four categories of body compositions.

Note: (A) All subjects; (B) male; (C) female.

Abbreviations: NBC, normal body composition; LMM, low muscle mass; HBF, high body fat; LMMHBF, low muscle mass and high body fat.

Table 2 Spearman Correlations Between HOMA2-IR and Parameters of Body Size and Body Composition

Variables	HOMA2-IR
	Total	Male	Female
BMI	0.172**	0.221**	0.115
WHR	0.051	0.103	−0.029
PBF	0.336**	0.329**	0.281**
SMI	0.041	0.220**	0.007

Note: **P<0.01.

Abbreviations: BMI, body mass index; WHR, waist to hip ratio; PBF, percent body fat; SMI, skeletal muscle index; HOMA2-IR, homeostatic model assessment of insulin resistance.

Table 3 Multivariable-Adjusted Odds Ratios for Insulin Resistance in the Four Categories of Body Compositions

	Normal Body Composition	Low Muscle Mass	P value	High Body Fat	P value	Low Muscle Mass and High Body Fat	P value
Univariate	1	0.97 (0.52–1.79)	0.911	2.07 (1.34–3.20)	0.001	5.04 (2.70–9.44)	<0.001
Model 1	1	1.01 (0.52–1.89)	0.956	2.27 (1.44–3.56)	<0.001	5.07 (2.69–9.58)	<0.001
Model 2	1	1.14 (0.58–2.24)	0.698	2.40 (1.49–3.85)	<0.001	5.59 (2.86–10.93)	<0.001
Model 3	1	0.98 (0.47–2.02)	0.950	2.08 (1.26–3.46)	0.004	4.08 (2.02–8.24)	<0.001
Model 4	1	1.34 (0.63–2.84)	0.445	1.76 (1.02–3.02)	0.041	4.47 (2.06–9.68)	<0.001

Notes: Data were presented as odds ratio (95% confidence interval). Model 1 adjusted for age and sex. Model 2 adjusted for SBP, DBP, and diabetic duration, in addition to the factors in model 1. Model 3 adjusted for ALT, AST, TG, HDL-C and UA, in addition to the factors in model 2. Model 4 adjusted for NAFLD, cerebrovascular disease history, and medications use including insulin-sensitizing agents and lipid-lowering drugs, in addition to the factors in model 3.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; UA, uric acid; NAFLD, non-alcoholic fatty liver disease.