Low Handgrip Strength (Possible Sarcopenia) With Insulin Resistance Is Associated With Type 2 Diabetes Mellitus

Association of triglyceride-glucose index and its combinations with sarcopenia among community-dwelling older adults: based on the Chongqing Aging and Sarcopenia Evaluation (CHASE) cohort

BACKGROUND

The triglyceride-glucose (TyG) index serves as an alternative index for assessing insulin resistance (IR). The relationship between the TyG index and its combined indicators and sarcopenia remains insufficiently explored.

AIM

To investigate the association between the TyG index and its combined parameters and sarcopenia.

METHODS

This cross-sectional study encompassed 792 community-dwelling older adults from the Chongqing Aging and Sarcopenia Evaluation (CHASE) cohort. The multivariate logistic regression model was used to analyze the relationship between the TyG index and its combined parameters, which include the triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-calf girth (TyG-CG), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist-to-hip ratio (TyG-WHR). The receiver operator characteristic (ROC) curve was utilized to assess the diagnostic effect of each index. The integrated discrimination improvement index (IDI) and net reclassification improvement (NRI) were applied to compare the diagnostic efficacy among the indices.

RESULTS

The TyG index and its combined parameters demonstrated a significant correlation with the risk of sarcopenia (P < 0.05). The area under the ROC curve (AUC) for the TyG index in predicting the risk of sarcopenia was 0.623 (95% confidence interval: 0.570-0.675). Notably, composite parameters incorporating the TyG index showed enhanced predictive performance. Specifically, TyG-BMI showing the highest AUC of 0.892 (95% confidence interval: 0.860-0.924), indicating its strong predictive potential. Furthermore, the diagnostic efficacy of TyG-BMI was superior to that of all other indicators in both the IDI and NRI.

CONCLUSION

The TyG index demonstrates diagnostic potential for sarcopenia identification, with significantly enhanced accuracy when combined with other parameters. Among them, TyG-BMI is a robust sarcopenia risk predictor due to its superior predictive power.

Association between triglyceride-glucose index and sarcopenic obesity in adults: a population-based study

Background

Sarcopenic obesity is characterized by the coexistence of sarcopenia and obesity, which has been demonstrated to be linked to insulin resistance. The triglyceride-glucose (TyG) index is a novel surrogate indicator of insulin resistance. However, the relationship between sarcopenic obesity and the TyG index remains unclear. This population-based study aimed to investigate the association between TyG index and sarcopenic obesity in adults.

Methods

This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), individuals aged over 45 years were categorized into sarcopenia, obesity, sarcopenic obesity, and control groups. Baseline characteristics were analyzed across these groups. Logistic regression models were employed to explore the association between the TyG index and sarcopenic obesity, adjusting for confounding variables. Subgroup analyses were conducted to explore the potential variations in this association across different demographic and clinical variables.

Results

A total of 9,485 individuals were included in the study, with the sarcopenic obesity group exhibiting a higher TyG index (8.96 ± 0.61) compared to other groups (p < 0.001). A significant and independent association was observed between higher TyG index and increased likelihood of sarcopenic obesity, even after adjusting for confounders. Participants in the highest TyG index tertile had a 1.82-fold increase in the risk of sarcopenic obesity compared to those in the lowest tertile. Subgroup analyses revealed significant associations between TyG index and sarcopenic obesity across various demographic and clinical variables, particularly in individuals aged over 60 years, females, and those with chronic diseases.

Conclusion

The findings suggest a strong association between elevated TyG index and sarcopenic obesity in adults, independent of demographic and clinical factors. Further large-scale prospective studies are warranted to validate and expand upon these findings.

Association of Appendicular Skeletal Muscle Mass Index and Insulin Resistance With Mortality in Multi-Nationwide Cohorts

BACKGROUND

Although sarcopenia and insulin resistance are closely related, there is limited evidence regarding how they interact to influence mortality across different population groups. The purpose of this study was to examine the relationship between skeletal muscle mass and insulin resistance and its impact on mortality and cardiovascular disease risk using large-scale national data from Korea and the United States.

METHODS

We analysed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 and 2011-2018 and the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011, with mortality follow-up through to 2019. Cox regression models were used to assess the effects of muscle mass (appendicular skeletal mass index, ASMI) and insulin resistance on all-cause and major adverse cardiovascular and cerebrovascular events (MACCE)-related mortality. Mediation analysis was performed to examine direct and indirect effects.

RESULTS

The study included 8036 participants from NHANES and 14 449 from KNHANES. The sarcopenia group demonstrated a lower homeostasis model assessment for insulin resistance and better metabolic indices than the normal group despite having a higher mortality rate. Insulin resistance positively correlated with muscle mass (r = 0.203, p < 0.001 in the NHANES; r = 0.143, p < 0.001 in the KNHANES), and both insulin resistance and sarcopenia were identified as independent risk factors for all-cause and MACCE-related mortality. When the participants were categorized into four groups based on the presence or absence of insulin resistance and sarcopenia, those with both conditions exhibited the highest risk of all-cause mortality (hazard ratio [HR]: 2.30, 95% confidence interval [CI]: 1.72-3.08 in the NHANES; HR: 2.60, 95% CI: 2.14-3.16 in the KNHANES) and MACCE-related mortality among the groups (HR: 3.18, 95% CI: 1.99-5.08 in the NHANES; HR: 2.47, 95% CI: 1.66-3.69 in the KNHANES). Mediation analysis revealed that low muscle mass was associated with decreased insulin resistance but directly increased both all-cause mortality and MACCE-related mortality (NHANES: total natural direct effects [TNDE], HR: 2.08, 95% CI: 1.57-2.76; KNHANES: TNDE, HR: 1.69, 95% CI: 1.28-2.23).

CONCLUSIONS

This study found that low ASMI was inversely associated with insulin resistance and positively associated with mortality risk in both cohorts. These findings, consistent across two large national studies, highlight the complex relationships between muscle mass, insulin sensitivity and mortality. Further studies are needed to assess the underlying mechanisms and clinical implications of these associations.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT05616013.

Nutritional Approach to Diabetic Sarcopenia: A Comprehensive Review

PURPOSE OF THE REVIEW

The aim of this review is to discuss and evaluate diabetic sarcopenia (DS) and its relationship with nutrition by discussing the mechanisms of diabetic sarcopenia in detail and comprehensively reviewing the literature.

RECENT FINDINGS

Type 2 diabetes (T2DM) affects approximately 25% of people aged 50 years and over and indicates a significant the cost of health for the elderly. Nutrition is an important part of these treatment approaches, and in this review, the literature was comprehensively reviewed, focusing on understanding the mechanisms of DS and discussing its relationship with nutrition. A comprehensive search was conducted on Web of Science, Google Scholar, Scopus, Science Direct, and PubMed from inception up to July 2024. The aim of nutritional treatment for DS is to improve muscle mass, muscle strength and physical performance while improving diabetes-related metabolic risk and glucose levels. In this context, it is important to determine energy intake in individuals with DS according to calorie intake exceeding 30 kcal/kg. For these individuals, a protein intake of at least 1-1.2 g/kg/day is recommended, with an emphasis on the number and timing of meals and a nutritional pattern rich in branched chain amino acids (BCAA). In addition, it is important to adopt a diet rich in antioxidants and to choose diet patterns that contain sufficient levels of macro and micronutrients. The Mediterranean diet model can be a good diet option for individuals with DS. Comprehensive studies in this field are needed so that clinicians can make specific dietary recommendations for DS.