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Diabetes linked to excessive loss of skeletal muscle, trunk fat mass in older adults
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In a new study of the impact of type 2 diabetes on body composition, older adults with diabetes — especially women — were at increased risk for excessive loss of skeletal muscle and trunk fat mass.
The Health, Aging and Body Composition (Health ABC) Study compared the total body composition of 2,675 older adults aged 70 to 79 years, both with and without diabetes. Researchers used DXA to examine body composition every year for six years, and computed tomography to measure mid-thigh muscle cross-sectional area at years one and six.
Participants were classified in three groups: diagnosed diabetes (15% of cohort), defined by self-report or use of hypoglycemic agents; undiagnosed diabetes (8.4%), confirmed by fasting plasma glucose (greater/less than 7 mmol/L) or two-hour postchallenge plasma glucose (greater/less than 11.1 mmol/L); and no diabetes.
Total body mass loss was most profound in older adults with undiagnosed diabetes (–435 g per year) compared with diagnosed diabetes (–293 g per year) and no diabetes (–193 g per year; P<.01). Most declines were observed in appendicular lean mass, and particularly in adults with undiagnosed and diagnosed diabetes.
The researchers reported a significant interaction effect of diabetes status and sex on changes in thigh muscle area (P=.044). Compared with women, men with and without diabetes showed more rapid declines in thigh muscle cross-sectional area.
In women, however, undiagnosed (–11.1 cm2) and diagnosed diabetes (–11.7 cm2) was associated with significantly higher declines in thigh muscle cross-sectional area compared with no diabetes (–5.1 cm2; P<.001). Thigh muscle cross-sectional area declined two times faster in older women with diabetes compared with those without diabetes.
Declines were also observed declines in total and trunk fat mass among adults with undiagnosed and diagnosed diabetes compared with no change or small increases in adults without diabetes.
All findings remained significant after adjustment for age, sex, race/ethnicity, clinic site, BMI, weight change intention and weight change over time.
These results have important implications because both sarcopenia and type 2 diabetes increase with age and often remain unrecognized and undiagnosed, according to the researchers.
“Excessive loss of muscle mass in older adults with type 2 diabetes may result in poor muscle strength, functional limitations and physical disability,” the researchers wrote. “Future research should find the factors responsible for excessive loss of lean mass in older adults with type 2 diabetes and develop strategies to prevent the adverse outcomes of sarcopenia in this high-risk population.”
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