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Adrenal hormone concentrations may predict sarcopenia risk in older adults with diabetes
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The ratio between concentrations of serum cortisol and dehydroepiandrosterone sulfate in older Japanese adults with type 2 diabetes may serve as an independent marker for sarcopenia, according to findings published in the Journal of the Endocrine Society.
Toshihiko Yanase, MD, PhD, a professor in the department of endocrinology and diabetes mellitus at Fukuoka University, Japan, and colleagues analyzed data from 108 adults aged at least 65 years with type 2 diabetes who were treated as outpatients (n = 101) or were hospitalized (n = 7) at Muta Hospital between October 2016 and September 2017 (61 women; mean age, 76 years; mean type 2 diabetes duration, 14.3 years; mean BMI, 23.7 kg/m²). Researchers collected morning blood samples to calculate the ratio of cortisol to DHEA sulfate. Patients were classified according to the nine-stage Clinical Frailty Scale as having no frailty (stages 1-4) or frailty (stages 5-9). Sarcopenia was assessed by handgrip strength, walking speed and bioelectrical impedance analysis. Researchers defined pre-sarcopenia as a decrease in muscle mass only, sarcopenia as a decrease in muscle mass plus a decrease in muscular strength or physical ability, and severe sarcopenia as a decrease in all three components. Researchers used binary regression analysis to identify risk factors for sarcopenia.
Within the cohort, 38 patients (35.2%) had sarcopenia.
Compared with patients who did not have sarcopenia, those with sarcopenia had a lower DHEA sulfate concentration (P < .001) and a higher serum cortisol concentration (P = .005), resulting in a higher cortisol to DHEA sulfate ratio in patients with sarcopenia vs. those without sarcopenia (P = .004). Ankle-brachial index score, a screening marker for arteriosclerosis, was lower in patients with sarcopenia vs. those without (P = .027), according to researchers; there were no between-group differences for brachial-ankle pulse wave velocity or Mini-Mental State Examination scores.
In multiple binary regression analysis, researchers found that a diastolic blood pressure of less than 70 mm Hg (P = .023), hemoglobin concentration of less than 13 g/dL (P = .04), a cortisol to DHEA sulfate ratio of at least 0.2 (P = .005) and an ankle-brachial index score of less than 1 (P = .015) were independent risk factors for sarcopenia; however, frailty was not an independent risk factor.
“As frailty is closely associated with sarcopenia, it is reasonable to expect a significantly higher prevalence of frailty in the sarcopenic group compared with the non-sarcopenic group,” the researchers wrote. “However, frailty did not remain a significant risk factor for sarcopenia in the multivariate analysis. These findings clearly indicate that sarcopenia is an important risk factor for frailty, but that these two conditions do not completely overlap and have certain pathological differences.”
When stratified by level of sarcopenia, researchers observed an increase in age (P < .001), cortisol concentration (P = .004) and cortisol to DHEA sulfate ratio (P < .001) across levels of no sarcopenia (n = 54), pre-sarcopenia (n = 16) and sarcopenia (n = 18). Incidence of frailty also increased with the severity of sarcopenia (P = .032), according to researchers.
The researchers noted that the findings may reflect the condition of increased stress in patients with sarcopenia and may be related to the increased catabolic effect of cortisol on muscle and the decreased protective action of DHEA sulfate on muscle mass. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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