The distribution of adipose tissue and muscle mass has an impact on mortality in individuals with type 2 diabetes

The distribution of adipose tissue and muscle mass in different regions of the body may reflect various mechanisms influencing mortality in individuals with type 2 diabetes (T2D). The aim of this study was to explore the associations between body fat and muscle mass and mortality from cardiovascular disease (CVD) and non-cardiovascular disease (non-CVD).

The study was carried out on a sample of 1417 adults aged 50 and over with T2D selected from the National Health and Nutrition Examination Survey. Dual-energy X-ray absorptiometry (DXA) was used to assess fat mass index (FMI) and muscle mass index (MMI) for the whole body as well as for the trunk, arms and legs. Mortality data up to 31 December 2019 were extracted from the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from proportional Cox regression models.

The weighted mean age of participants was 63.7 years, with an equal distribution between men and women. During a median follow-up of 13.6 years, 797 deaths were recorded, 371 related to CVD and 426 to non-CVD causes.

• An increase in IMF in the arms was associated with an increased risk of non-CVD mortality, whereas an increase in IMF in the trunk or legs was not significantly associated with CVD or non-CVD mortality.

• An increase in MMI in the arms was associated with a reduced risk of CVD and non-CVD mortality

• A significant interaction between smoking status and FMI in the arms on non-CVD mortality was observed. In current or former smokers, a higher IMF in the arms was associated with a higher risk of non-CVD mortality, but this association was not found in non-smokers.