Diabetes Metab J.  2024 Nov;48(6):1093-1104. 10.4093/dmj.2023.0243.

Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study

• Kim HJ
• Lee HW
• Kang MK
• Leem GH
• Kim MH
• Song TJ

• KMID: 2561793
• DOI: http://doi.org/10.4093/dmj.2023.0243

Abstract

Background
We investigated the association between body composition changes and new-onset diabetes mellitus (DM) development according to the body mass index (BMI) in a longitudinal setting in the general Korean population.
Methods
From 2010 to 2011 (1st) and 2012 to 2013 (2nd), we included 1,607,508 stratified random sample participants without DM from the National Health Insurance Service-Health Screening dataset of Korean. The predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) were calculated using pre-validated anthropometric prediction equations. A prediction equation was constructed by combining age, weight, height, waist circumference, serum creatinine levels, alcohol consumption status, physical activity, and smoking history as variables affecting body composition.
Results
Decreased pASMMI (men: hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.830 to 0.903; P<0.001; women: HR, 0.748; 95% CI, 0.635 to 0.881; P<0.001), decreased pLBMI (men: HR, 0.931; 95% CI, 0.912 to 0.952; P<0.001; women: HR, 0.906; 95% CI, 0.856 to 0.959; P=0.007), and increased pBFMI (men: HR, 1.073; 95% CI, 1.050 to 1.096; P<0.001; women: HR, 1.114; 95% CI, 1.047 to 1.186; P=0.007) correlated with the development of new-onset DM. Notably, only in the overweight and obese BMI categories, decreases in pASMMI and pLBMI and increases in pBFMI associated with new-onset DM, regardless of gender.
Conclusion
Decreased pASMMI and pLBMI, and increased pBFMI with excess fat accumulation may enhance the risk of newonset DM. Therefore, appropriate changes in body composition can help prevent new-onset DM.

Keyword

Body composition; Diabetes mellitus, type 2; Korean population; Sarcopenia

Figure

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  Fig. 1. Flowchart of participant selection. BMI, body mass index.

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  Fig. 2. Association of changes in the predicted body composition indices with new-onset diabetes mellitus by sex and body mass index subgroup. Association of changes in the predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) with diabetes mellitus. The solid lines indicate hazard ratios, and shaded regions show 95% confidence intervals from restricted cubic spline regression. The restricted cubic splines were constructed with four knots placed at the 5th, 35th, 65th, and 95th percentiles of changes in pASMMI, pBFMI, and pLBMI. The hazard ratios (95% confidence intervals) were calculated using the Cox proportional hazards regression analysis after adjusting for the age, baseline and secondary body mass indices, household income, smoking history, alcohol consumption status, physical activity, fasting serum glucose level, hypertension, dyslipidemia, atrial fibrillation, estimated glomerular filtration rate, and Charlson comorbidity index score. (A) Men. (B) Women.

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