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Sarcopenia risk elevated for older adults with diabetes, high body fat percentage, low BMI

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October 16, 2018

High body fat percentage coupled with low BMI increases the risk for sarcopenia in older adults with diabetes, according to findings from researchers in Japan.

“In elderly diabetes patients, sarcopenia has been considered a preliminary stage to the need for long-term care,” Yuki Fukuoka, of the division of endocrinology, metabolism and geriatric medicine at Akita University Graduate School of Medicine in Japan, and colleagues wrote. “The purposes of the present study were to investigate the prevalence of sarcopenia in elderly diabetes patients, investigate its related factors and examine the indicators of physical evaluation that consider the prevention or progression of sarcopenia using a body composition analysis.”

The researchers conducted a cross-sectional observational study of 267 Japanese adults older than 65 years (159 men; mean age, 73.7 years) with diabetes (mean duration, 14.3 years; 20.9% prescribed metformin). All participants were enrolled between February and July 2015 and were outpatients at the Diabetes and Endocrinology Geriatric Medicine Unit of Akita University Hospital. BMI, body fat percentage, skeletal muscle mass index, grip strength and average gait speed were recorded, and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia guidelines.

Participants were divided into four groups based on skeletal muscle mass index and body fat percentage: “appropriate physical” (high skeletal muscle mass, low body fat percentage), “obesity” (high skeletal muscle mass, high body fat percentage), “sarcopenia” (lower skeletal muscle mass, low body fat percentage) and “sarcopenia obesity” (lower skeletal muscle mass, high body fat percentage).

Of the 267 participants, 18.7% (n = 50) had sarcopenia, with an additional 13.9% exhibiting signs of pre-sarcopenia. Severe sarcopenia was identified in 4.9% of the study population. Those with sarcopenia were older, had longer duration of diabetes and less use of metformin as well as lower height, body weight and BMI (P < .01 for all) than those without sarcopenia. The sarcopenia group also had lower skeletal muscle mass, grip strength and gait speed (P < .01).

Sarcopenia was less prevalent in those with higher BMI both for men (P < .0001) and women (P = .003), whereas increasing age had the opposite association (P < .0001). In men, lower BMI, no metformin use and lower bone mineral content were linked to sarcopenia (P < .05), whereas lower bone mineral content, lower serum albumin level and older age were linked to sarcopenia in women (P < .05).

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“An evaluation of obesity in elderly diabetes patients should not be judged by BMI alone; rather, it should be considered in combination with body fat percentage,” the researchers wrote. “A patient with a low BMI and high body fat percentage is likely to develop sarcopenia, which can negatively influence life prognosis. ... It is important to achieve the ‘appropriate physical’ body composition whenever possible. ... To maintain skeletal muscle mass, a high protein diet and vitamin D intake are recommended.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.