November 20, 2019
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Renal decline risk increased with sarcopenia in type 2 diabetes, obesity

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Among adults with type 2 diabetes, estimated glomerular filtration rate may fall to a greater degree if a patient also has sarcopenia and obesity, according to findings published in Diabetic Medicine.

“We showed that sarcopenia was independently associated with the annual rate of decline in eGFR after adjustment for confounding variables in people with type 2 diabetes,” Ryotaro Bouchi, MD, PhD, of the department of molecular endocrinology and metabolism in the Graduate School of Medical and Dental Sciences at Tokyo Medical and Dental University, and colleagues wrote. “We additionally showed that sarcopenic obesity was independently associated with a > 30% decline in eGFR in people with type 2 diabetes.”

Bouchi and colleagues performed a DXA scan of 745 Japanese adults with type 2 diabetes and calculated skeletal muscle index and android and gynoid fat mass, among other factors. The researchers also evaluated eGFR each year.

Participants who had less than 7 kg/m2 (men) or 5.4 kg/m2 (women) in skeletal muscle index were considered to have sarcopenia. In addition, participants with an android to gynoid fat mass ratio of more than 0.8 (men) or 0.62 (women) were considered to have a high ratio and meet the threshold for obesity.

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Among adults with type 2 diabetes, estimated glomerular filtration rate may fall to a greater degree if a patient also has sarcopenia and obesity.

According to the researchers, participants with obesity and sarcopenia experienced a mean 4 mL/min/1.73 m2 eGFR reduction each year compared with reductions of 1.9 mL/min/1.73 m2 among those with obesity but no sarcopenia, 2.4 mL/min/1.73 m2 among those with sarcopenia but not obesity, and 1.3 mL/min/1.73 m2 among participants with neither condition (P < .001).

The researchers noted that “sarcopenic obesity was consistently and significantly associated with a high annual rate of decline in eGFR” and that “the sarcopenic low android to gynoid fat ratio group showed a consistent association with a high annual rate of decline in eGFR.”

Among those with obesity and sarcopenia, 33.3% experienced a more than 30% eGFR reduction over 4 years, which was a higher proportion than those without both conditions (5.9%), those with sarcopenia but no obesity (19.2%) and those with obesity but no sarcopenia (15.1%; P < .001). In addition, the researchers noted that the risk for experiencing a more than 30% eGFR reduction was 4.52 times greater for those with sarcopenia and obesity vs. those with neither condition (HR = 4.52; 95% CI, 2.16-9.47). The risk was also higher for those with sarcopenia but no obesity (HR = 2.15; 95% CI, 1.13-4.08) and those with obesity but no sarcopenia (HR = 2.67; 95% CI, 1.23-5.49).

“We clearly showed that visceral adiposity (android to gynoid fat ratio) is more suitable for the diagnosis of sarcopenic obesity than general adiposity (BMI) in people with type 2 diabetes,” the researchers wrote. “Present results suggest that evaluation of sarcopenic obesity may be important in assessing the risk of end-stage renal disease, as well as cardiovascular disease and mortality in people with type 2 diabetes.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.