Where you carry fat matters more than how much for diabetics
A major U.S. study of over 1,400 diabetics found that arm fat—not overall weight—strongly predicts premature death from cancer and other non-heart diseases. The finding challenges conventional weight-loss advice and could reshape how insurers, employers, and clinicians assess health risk in the 37 million Americans with type 2 diabetes.
Originaltitel: Differential impacts of fat and muscle mass on cardiovascular and non‐cardiovascular mortality in individuals with type 2 diabetes
<p>Background</p><p>The distribution of fat and muscle mass in different regions of the body can reflect different pathways to mortality in individuals with diabetes. Therefore, we investigated the associations between whole-body and regional body fat and muscle mass with cardiovascular disease (CVD) and non-CVD mortality in type 2 diabetes (T2D).</p><p>Methods</p><p>Within the National Health and Nutrition Examination Survey 1999–2006, 1417 adults aged ≥50 years with T2D were selected. Dual-energy X-ray absorptiometry was used to derive whole-body, trunk, arm, and leg fat mass and muscle mass indices (FMI and MMI). Mortality data until 31 December 2019 were retrieved from the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models.</p><p>Results</p><p>A total of 1417 participants were included in this study (weighted mean age [standard error]: 63.7 [0.3] years; 50.5% female). Over a median follow-up of 13.6 years, 797 deaths were recorded (371 CVD-related and 426 non-CVD deaths). Higher FMI in the arm was associated with increased risk of non-CVD mortality (fourth quartile [Q4] vs. first quartile [Q1]: HR 1.82 [95% CI 1.13–2.94]), whereas higher FMI in the trunk or leg was not significantly associated with CVD or non-CVD mortality. Conversely, higher arm MMI was associated with a lower risk of both CVD (Q4 vs. Q1: HR 0.51 [95% CI 0.33–0.81]) and non-CVD (Q4 vs. Q1: HR 0.56 [95% CI 0.33–0.94]) mortality. There was a significant interaction between smoking status and arm FMI on non-CVD mortality (<em>P</em> for interaction = 0.007). Higher arm FMI was associated with a higher risk of non-CVD mortality among current or former smokers (Q4 vs. Q1: HR 2.67 [95% CI 1.46–4.88]) but not non-smokers (Q4 vs. Q1: HR 0.85 [95% CI 0.49–1.47])</p><p>Conclusions</p><p>Fat mass and muscle mass, especially in the arm, are differently associated with CVD and non-CVD mortality in people with T2D. Our findings underscore the predictive value of body compositions in the arm in forecasting mortality among older adults with T2D</p>