Abstract：
OBJECTIVE: The evidence for joint and independent associations of low muscle mass and low muscle strength with diabetes is limited and mixed. The study aimed to determine the associations of muscle parameters (muscle mass, strength, quality, and sarcopenia) and sarcopenia obesity with diabetes, and the previously unstudied mediating effect of inflammation.
METHODS: A total of 13,420 adults from the 2023 China National Health Survey (CNHS) and 5,380 adults from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were included in this study. Muscle mass was determined using bioelectrical impedance analysis (BIA) in the CNHS, and whole-body dual X-ray absorptiometry (DXA) in the NHANES. Muscle strength was assessed using digital hand dynamometer. Multivariate logistic regression models were used to evaluate the associations of muscle parameters and sarcopenia obesity with diabetes. Inflammatory status was assessed using blood cell counts and two systemic inflammation indices (platelet-to-lymphocyte ratio (PLR) and system inflammation response index (SIRI)). Mediation analysis was conducted to examine inflammation\'s role in these associations.
RESULTS: Low muscle mass and strength were independently related to diabetes. Low muscle quality was associated with elevated diabetes risk. Sarcopenia has a stronger association with diabetes compared to low muscle strength alone or mass alone (CNHS, odds ratio (OR) = 1.93, 95 % confidence interval (CI):1.64-2.27; NHANES, OR = 3.80, 95 %CI:2.58-5.58). Participants with sarcopenia obesity exhibit a higher risk of diabetes than those with obesity or sarcopenia alone (CNHS, OR = 2.21, 95 %CI:1.72-2.84; NHANES, OR = 6.06, 95 %CI:3.64-10.08). Associations between muscle parameters and diabetes were partially mediated by inflammation (mediation proportion: 1.99 %-36.64 %, P < 0.05).
CONCLUSIONS: Low muscle mass and muscle strength are independently or jointly associated with diabetes, and inflammation might be a potential mechanism underlying this association. Furthermore, the synergistic effects of sarcopenia and obesity could significantly increase diabetes risk.
METHODS: A total of 13,420 adults from the 2023 China National Health Survey (CNHS) and 5,380 adults from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were included in this study. Muscle mass was determined using bioelectrical impedance analysis (BIA) in the CNHS, and whole-body dual X-ray absorptiometry (DXA) in the NHANES. Muscle strength was assessed using digital hand dynamometer. Multivariate logistic regression models were used to evaluate the associations of muscle parameters and sarcopenia obesity with diabetes. Inflammatory status was assessed using blood cell counts and two systemic inflammation indices (platelet-to-lymphocyte ratio (PLR) and system inflammation response index (SIRI)). Mediation analysis was conducted to examine inflammation\'s role in these associations.
RESULTS: Low muscle mass and strength were independently related to diabetes. Low muscle quality was associated with elevated diabetes risk. Sarcopenia has a stronger association with diabetes compared to low muscle strength alone or mass alone (CNHS, odds ratio (OR) = 1.93, 95 % confidence interval (CI):1.64-2.27; NHANES, OR = 3.80, 95 %CI:2.58-5.58). Participants with sarcopenia obesity exhibit a higher risk of diabetes than those with obesity or sarcopenia alone (CNHS, OR = 2.21, 95 %CI:1.72-2.84; NHANES, OR = 6.06, 95 %CI:3.64-10.08). Associations between muscle parameters and diabetes were partially mediated by inflammation (mediation proportion: 1.99 %-36.64 %, P < 0.05).
CONCLUSIONS: Low muscle mass and muscle strength are independently or jointly associated with diabetes, and inflammation might be a potential mechanism underlying this association. Furthermore, the synergistic effects of sarcopenia and obesity could significantly increase diabetes risk.
摘要：
目的：关于低肌肉质量和低肌肉力量与糖尿病的联合和独立关联的证据是有限的和混合的。该研究旨在确定肌肉参数(肌肉质量，力量,质量,和肌肉减少症）和肌肉减少症肥胖伴糖尿病，以及之前未研究过的炎症的中介作用.
方法：这项研究纳入了来自2023年中国国家健康调查（CNHS）的13,420名成年人和来自2011-2014年国家健康和营养调查（NHANES）的5380名成年人。在CNHS中使用生物电阻抗分析（BIA）确定肌肉质量，和NHANES中的全身双X射线吸收法（DXA）。使用数字手测力计评估肌肉力量。采用多因素logistic回归模型评价肌肉参数和肌少症肥胖与糖尿病的关系。使用血细胞计数和两个全身炎症指数（血小板与淋巴细胞比率（PLR）和系统炎症反应指数（SIRI））评估炎症状态。进行中介分析以检查炎症在这些关联中的作用。
结果：肌肉质量和力量不足与糖尿病独立相关。低肌肉质量与糖尿病风险升高相关。与单独的低肌肉力量或单独的质量相比，肌肉减少症与糖尿病有更强的关联(CNHS，优势比(OR)=1.93，95%置信区间(CI)：1.64-2.27；NHANES，OR=3.80，95CI：2.58-5.58）。与单纯肥胖或肌少症的参与者相比，患有肌少症的参与者患糖尿病的风险更高(CNHS，OR=2.21，95CI：1.72-2.84；NHANES，OR=6.06，95CI：3.64-10.08）。肌肉参数与糖尿病之间的关联部分由炎症介导（介导比例：1.99％-36.64％，P<0.05)。
结论：肌肉质量和肌肉力量低下与糖尿病独立或共同相关，炎症可能是这种关联的潜在机制。此外，肌肉减少症和肥胖的协同作用可显著增加糖尿病风险.
方法：这项研究纳入了来自2023年中国国家健康调查（CNHS）的13,420名成年人和来自2011-2014年国家健康和营养调查（NHANES）的5380名成年人。在CNHS中使用生物电阻抗分析（BIA）确定肌肉质量，和NHANES中的全身双X射线吸收法（DXA）。使用数字手测力计评估肌肉力量。采用多因素logistic回归模型评价肌肉参数和肌少症肥胖与糖尿病的关系。使用血细胞计数和两个全身炎症指数（血小板与淋巴细胞比率（PLR）和系统炎症反应指数（SIRI））评估炎症状态。进行中介分析以检查炎症在这些关联中的作用。
结果：肌肉质量和力量不足与糖尿病独立相关。低肌肉质量与糖尿病风险升高相关。与单独的低肌肉力量或单独的质量相比，肌肉减少症与糖尿病有更强的关联(CNHS，优势比(OR)=1.93，95%置信区间(CI)：1.64-2.27；NHANES，OR=3.80，95CI：2.58-5.58）。与单纯肥胖或肌少症的参与者相比，患有肌少症的参与者患糖尿病的风险更高(CNHS，OR=2.21，95CI：1.72-2.84；NHANES，OR=6.06，95CI：3.64-10.08）。肌肉参数与糖尿病之间的关联部分由炎症介导（介导比例：1.99％-36.64％，P<0.05)。
结论：肌肉质量和肌肉力量低下与糖尿病独立或共同相关，炎症可能是这种关联的潜在机制。此外，肌肉减少症和肥胖的协同作用可显著增加糖尿病风险.
