The Relationship Between Body Composition And Cardiovascular Diseases In Patients With Type 2 Diabetes

Background:The comorbidity of cardiovascular disease（CVD）and diabetes is very serious in China.Diabetes is an important factor leading to increased risk of cardiovascular events,and CVD is the primary cause of death in DM patients.Obesity is a crucial risk factor for CVD.Recent studies have shown that some people with normal BMI have increased the risk of CVD due to increased visceral fat and ectopic fat accumulation.Different parts of fat content have different effects on CVD.Different from abdominal fat accumulation,increased fat content in hips and thighs may be a protective factor for cardiovascular diseases.With the increase of age,due to the decrease of metabolic rate and the change of hormone levels,the increase of body fat and the decrease of muscle mass increase the risk of CVD.At present,whether the changes of body composition in middle-aged and elderly patients with type 2 diabetes mellitus（T2DM）are related to the increased risk of CVD remains to be further studied.Objective:To provide information for the prevention and treatment of T2DM patients who developed CVD in clinical practice,we investigated the relationship between body composition and CVD in middle-aged and elderly patients with T2DM,the difference of relationship between sexes,and cardiovascular risk factors in T2DM.Methods:1.A total of 419 patients with T2DM in the Endocrinology Department of the First Hospital of Jilin University from September 2020 to September 2021 were selected.After removing repeated hospitalization and excluding patients who did not meet the standards,finally,419 patients were included in the study,of which,236 are females and 183 are males.2.Medical history including the course of diabetes,cardiovascular disease history,smoking history and drinking history were carefully collected.Height,weight and blood pressure were measured.BMI was also calculated.Laboratory indexes such as blood lipid profile（TC,TG,HDL-C,LDL-C）,fasting plasma glucose（FPG）,glycosylated hemoglobin（HbA1c）,serum uric acid,ALT,AST,and creatinine were collected.3.Body components were assessed using dual-energy X-ray absorptiometry（DXA）scans.The total body muscle mass and appendicular skeletal muscle mass（ASM）were measured,and the appendicular skeletal muscle mass index（ASMI）was calculated.Body fat content and body fat percentage,android region and gynoid region fat content were measured,and android-to-gynoid fat ratio（AGR）was calculated.4.SPSS 25.0 software was used for statistical analysis.Continuous data were presented as mean ± standard deviation（SD）or median with 25th or 75th percentile（P25 to P75）.Categorical data were presented as percentage.T-test was used to compare data with normal distribution between the two groups.Non-normal distribution between the two groups were compared by Mann-Whitney test,and enumeration data were compared by chi-square test.ANOVA was used to compare data with normal distribution between the three groups.Kruskai-Wallis test was used to compare data with Non-normal distribution between the three groups.Spearman correlation was used to analyze the relationship between body composition and other indicators.Associations between body composition and CVD were examined using logistic regression models.P-values of less than 0.05 indicated a statistically significant difference.Results:1.The prevalence of T2DM with CVD in the study population was 24.8%.accounted for,while accounted for 50.9%.Female and male patients accounted for 49.1%and 50.9%,respectively.2.Spearman correlation analysis showed that there was a significant positive correlation between ASMI and BMI in elderly T2DM patients（r=0.562,P<0.001）,and a significant negative correlation between ASMI and age（r=-0.218,P<0.001）.Body fat percentage was significantly positively correlated with BMI（r=0.396,P<0.001）and age（r=0.217,P<0.001）.3.In male patients with T2DM,ASMI and total muscle mass decreased with age,and the difference between different age groups was statistically significant（P<0.05）.With age,the body fat percentage increased,and the difference between different age groups was statistically significant（P<0.05）.In female patients with T2DM,ASMI and total muscle mass decreased with age,the body fat percentage increased with age,and the difference between different age groups was statistically significant（P<0.05）.4.Multivariate logistic regression analysis suggested that in middle-aged and elderly male T2DM patients,the duration of diabetes（OR=1.068,95%CI:1.019-1.120）,BMI（OR=1.344,95%CI:1.033-1.750）,and body fat percentage（OR=1.245,95%CI:1.007-1.538）were the risk factors for CVD（P<0.05）.Fat content in gynoid region（OR=0.997,95%CI:0.994-0.999）was a protective factor for CVD（P<0.05）.In female patients,age（OR=1.075,95%CI:1.026-1.126）and duration of diabetes（OR=1.058,95%CI:1.099-1.019）were risk factors for CVD（P<0.05）.Conclusion:1.The prevalence of CVD in middle-aged and elderly patients with T2DM was 24.8%,and the prevalence in males was slightly higher than that in females.2.In middle-aged and elderly patients with T2DM,SMI decreased with age,while the body fat percentage increased with age.Therefore,we should pay much more attention to sarcopenia and obesity as an age-related disease.It is important to conduct sarcopenia screening in communities or medical institutions for middle-aged and elderly people.3.In middle-aged and elderly male patients with T2DM,duration of diabetes,BMI and body fat percentage are risk factors for CVD.The fat content in gynoid region is a protective factor for CVD.In middle-aged and elderly female patients with T2DM,age and duration of diabetes are risk factors for CVD.Paying attention to the related measures of reducing body mass index and body fat percentage in middle-aged and elderly male patients with T2DM may be beneficial to their CVD risk.