Excessive Loss of Skeletal Muscle Mass in Older Adults With Type 2 Diabetes

  1. Seok Won Park, MD, DRPH1,
  2. Bret H. Goodpaster, PHD2,
  3. Jung Sun Lee, PHD3,
  4. Lewis H. Kuller, MD, DRPH4,
  5. Robert Boudreau, PHD4,
  6. Nathalie de Rekeneire, MD5,
  7. Tamara B. Harris, MD6,
  8. Stephen Kritchevsky, PHD7,
  9. Frances A. Tylavsky, PHD8,
  10. Michael Nevitt, PHD9,
  11. Yong-wook Cho, MD, PHD1,
  12. Anne B. Newman, MD, MPH4 and
  13. for the Health, Aging, and Body Composition Study
  1. 1Department of Internal Medicine, CHA University, Sungnam, Korea;
  2. 2Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
  3. 3Department of Foods and Nutrition, University of Georgia, Athens, Georgia;
  4. 4Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania;
  5. 5Center on Disability and Disabling Disorders, Yale University School of Medicine, New Haven, Connecticut;
  6. 6Intramural Research Program, Laboratory for Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland;
  7. 7Sticht Center on Aging, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina;
  8. 8Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee;
  9. 9Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
  1. Corresponding author: Seok Won Park, spark{at}cha.ac.kr.

Abstract

OBJECTIVE A loss of skeletal muscle mass is frequently observed in older adults. The aim of the study was to investigate the impact of type 2 diabetes on the changes in body composition, with particular interest in the skeletal muscle mass.

RESEARCH DESIGN AND METHODS We examined total body composition with dual-energy X-ray absorptiometry annually for 6 years in 2,675 older adults. We also measured mid-thigh muscle cross-sectional area (CSA) with computed tomography in year 1 and year 6. At baseline, 75-g oral glucose challenge tests were performed. Diagnosed diabetes (n = 402, 15.0%) was identified by self-report or use of hypoglycemic agents. Undiagnosed diabetes (n = 226, 8.4%) was defined by fasting plasma glucose (≥7 mmol/l) or 2-h postchallenge plasma glucose (≥11.1 mmol/l). Longitudinal regression models were fit to examine the effect of diabetes on the changes in body composition variables.

RESULTS Older adults with either diagnosed or undiagnosed type 2 diabetes showed excessive loss of appendicular lean mass and trunk fat mass compared with nondiabetic subjects. Thigh muscle CSA declined two times faster in older women with diabetes than their nondiabetic counterparts. These findings remained significant after adjusting for age, sex, race, clinic site, baseline BMI, weight change intention, and actual weight changes over time.

CONCLUSIONS Type 2 diabetes is associated with excessive loss of skeletal muscle and trunk fat mass in community-dwelling older adults. Older women with type 2 diabetes are at especially high risk for loss of skeletal muscle mass.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • See accompanying editorial, p. 2136.

    • Received February 11, 2009.
    • Accepted June 17, 2009.
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  1. Published online before print June 23, 2009, doi: 10.2337/dc09-0264 Diabetes Care November 2009 vol. 32 no. 11 1993-1997
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