ALM adjusted by BMI or weight predicts adverse health outcomes in middle-aged and elderly patients with type 2 diabetes.

Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE

Original Publication: London : Nature Publishing Group, copyright 2011-

Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/mortality ; Diabetes Mellitus, Type 2*/physiopathology ; Body Mass Index* ; Muscle, Skeletal*/physiopathology ; Muscle, Skeletal*/pathology ; Body Weight*; Humans ; Female ; Male ; Middle Aged ; Aged ; Retrospective Studies ; Prognosis ; Body Composition ; Proportional Hazards Models ; Cardiovascular Diseases ; Risk Factors

Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
The role of skeletal muscle in the prognosis of patients with Type 2 Diabetes Mellitus (T2DM) remains unclear. This study aimed to systematically evaluate the impact of different muscle-mass adjustment standards on adverse health outcomes in middle-aged and elderly T2DM patients. Retrospective cohort study. A total of 1,818 T2DM patients aged 50 years or older were included in this study. The cohort comprised 45.7% females, with a median age of 63 years. Variables closely correlated with total lean mass (TLM) and appendicular lean mass (ALM) were selected as adjustment indicators. The primary composite endpoints were all-cause mortality, cardiovascular disease (CVD), and fragility fractures. Cox proportional hazards models were used to estimate the risk associated with each indicator, and phenotypic characteristics of high-risk patients were evaluated. During a median follow-up of 63 months, 436 patients reached the primary endpoint. ALM/BMI and ALM/weight were negatively correlated with adverse outcomes in both sexes, even after adjusting for confounding factors (males: ALM/BMI (hazard ratio [HR] = 0.998, 95% confidence interval [CI] = 0.996-0.999, P = 0.005) and ALM/weight (HR = 0.924, 95% CI = 0.864-0.987, P = 0.020); females: ALM/BMI (HR = 0.998, 95% CI = 0.996-1.000, P = 0.030) and ALM/weight (HR = 0.917, 95% CI = 0.860-0.978, P = 0.008), respectively). Individuals with lower ALM/BMI and ALM/weight have poorer metabolic status, greater fat accumulation, more complications, and a lower muscle-to-fat ratio. Our findings demonstrate that both ALM/BMI and ALM/weight can predict adverse health outcomes, suggesting their potential as practical, clinically relevant markers for sarcopenia in T2DM.
(© 2025. The Author(s).)

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Keywords: Appendicular lean mass index; Cardiovascular disease; Fragility fracture; Mortality; Sarcopenia; Type 2 diabetes mellitus

Date Created: 20250307 Date Completed: 20250511 Latest Revision: 20250511

20250512

PMC11889084

10.1038/s41598-025-92860-6

40055426