Independent and joint association of fat‐to‐muscle mass ratio and cardiorespiratory fitness with type 2 diabetes mellitus incidence: A prospective cohort study

医学 心肺适能 2型糖尿病 前瞻性队列研究 内科学 2型糖尿病 糖尿病 队列研究 队列 心理干预 物理疗法 体质指数 联想(心理学) 危险分层 瘦体质量 体脂分布 心血管健康 风险因素 接头(建筑物) 观察研究 心脏病学
作者
Haofeng Zhou,Yutong Wang,Xinyang Song,Tao Xu,Chenxi Xia,Ying Guo,Sixian Weng,Junsong Gong,Fang Wang
出处
期刊:Diabetes, Obesity and Metabolism [Wiley]
卷期号:28 (1): 463-471
标识
DOI:10.1111/dom.70217
摘要

AIM: Body mass index (BMI) might fail to distinguish between fat and muscle mass. The fat-to-muscle mass ratio (FMR) and cardiorespiratory fitness (CRF) may provide complementary insights into the risk of type 2 diabetes mellitus (T2DM). This study aimed to investigate the independent and joint associations of FMR and CRF with incident T2DM. METHODS: This prospective analysis included 60 837 adults from the UK Biobank without diabetes at baseline. FMR was assessed via bioelectrical impedance analysis, and CRF was estimated from a submaximal cycle test. Cox proportional hazards models evaluated associations with T2DM incidence. Additive and multiplicative interaction effects were further estimated. Predictive performance was evaluated using time-dependent ROC analysis. RESULTS: Over a median 14.49-year follow-up, 2439 participants developed T2DM. Higher FMR (per 1-SD) was independently associated with higher T2DM risk in women (HR = 1.17, 95%CI: 1.07-1.27) and men (HR = 1.32, 95%CI: 1.23-1.42). Higher CRF (per 1-MET increment) was associated with lower risk in women (HR = 0.84, 95%CI: 0.80-0.89) and men (HR = 0.82, 95%CI: 0.79-0.86). Participants with both high FMR and low CRF had the highest risk (HR = 1.81, 95%CI: 1.59-2.07). This association was strongest in adults <60 years. Adding FMR and CRF to the Cambridge Diabetes Risk Score significantly improved predictive accuracy at 3, 5 and 10 years. CONCLUSION: FMR and CRF were independent predictors of T2DM, with their combination identifying the highest-risk phenotype. Integrating FMR and CRF assessment enhances T2DM risk stratification and identifies high-risk individuals who may benefit from lifestyle interventions focusing on improving body composition and fitness.
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