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Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus.

ABSTRACT: BACKGROUND:Previous studies have found that predicted fat mass and lean body mass may act differently on adverse events. However, the cardiovascular prognostic value of lean body mass and fat mass in patients with type 2 diabetes mellitus (T2DM) has not yet been investigated. We sought to investigate the relation between predicted lean body mass or fat mass and the risk of cardiovascular disease in patients with T2DM. METHODS:We conducted a post hoc analysis of data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study to investigate the relation between the predicted lean body mass or fat mass and major adverse cardiovascular events in patients with T2DM. We used sex-specific quartiles of predicted lean body mass index (BMI; kg/m2) and fat mass index (kg/m2). We defined a major adverse cardiovascular event as a composite of nonfatal myocardial infarction, nonfatal stroke or death from cardiovascular causes. RESULTS:After a mean follow-up period of 8.8 years, we found that a major cardiovascular event occurred in 1801 of 10 251 patients (17.8%). Predicted lean BMI was not associated with major cardiovascular events (p = 0.34). Compared with patients in the first quartile (incidence rate 16.4%; 17.2%, 17.5% and 19.8% for the second, third and four quartiles, respectively) of predicted fat mass index, those in the fourth quartile had a hazard ratio of 1.53 (95% confidence interval 1.23-1.91). INTERPRETATION:In patients with T2DM, we found that predicted fat mass had a strong positive association with a higher risk of a major adverse cardiovascular event. Increasing lean body mass did not have a protective role. Trial registration: ClinicalTrials.gov., no. NCT00000620.

SUBMITTER: Xing Z

PROVIDER: S-EPMC6763326 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus.

Xing Zhenhua Z Tang Liang L Chen Jian J Pei Junyu J Chen Pengfei P Fang Zhenfei Z Zhou Shenghua S Hu Xinqun X

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20190901 38

<h4>Background</h4>Previous studies have found that predicted fat mass and lean body mass may act differently on adverse events. However, the cardiovascular prognostic value of lean body mass and fat mass in patients with type 2 diabetes mellitus (T2DM) has not yet been investigated. We sought to investigate the relation between predicted lean body mass or fat mass and the risk of cardiovascular disease in patients with T2DM.<h4>Methods</h4>We conducted a post hoc analysis of data from the Actio ...[more]

PMID: 31548190

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Project description:BackgroundLittle is known about the association of changes in two body components, muscle and fat mass, with the risk of cardiovascular disease (CVD) among young adults. We investigated the association of changes in predicted lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), and body fat mass index (BFMI) with the development of CVD among young adults.MethodsThis nationwide, population-based cohort study included 3 727 738 young adults [2 406 046 (64.5%) men and 1 321 692 (35.5%) women] aged 20-39 years without a previous history of CVD who underwent two health screening examinations during 2009-2010 and 2011-2012. Using validated and robust prediction equations, we calculated the changes in predicted LBMI, ASMI, and BFMI from the first to the second examinations.ResultsThe mean (SD) age was 32.2 (4.9) years, and 2 406 046 (64.5%) of the participants were men. A total of 23 344 CVD events were detected during 22 257 632 person-years of follow-up. Each 1 kg/m2 increase in predicted LBMI and ASMI change was associated with a reduced risk of CVD among men [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI) 0.82-0.91; aHR: 0.76, 95% CI 0.69-0.82, respectively] and women (aHR: 0.77, 95% CI 0.63-0.95; aHR: 0.75, 95% CI 0.59-0.96). Each 1 kg/m2 increase in predicted BFMI change was associated with an increased risk of CVD among men (aHR: 1.16, 95% CI 1.10-1.22) and women (aHR: 1.32, 95% CI 1.06-1.65). In both sexes, decreases in predicted LBMI and ASMI were associated with greater CVD risk, and decreased predicted BFMI was associated with a reduced CVD risk. Those who maintained their BMI between -1 and +1 kg/m2 also had a decreased risk of CVD per 1 kg/m2 increase in predicted LBMI and ASMI change among men (aHR: 0.86, 95% CI 0.80-0.92; aHR: 0.85, 95% CI 0.76-0.95) and women (aHR: 0.62, 95% CI 0.47-0.83; aHR: 0.59, 95% CI 0.44-0.80) and had a greater risk of CVD per 1 kg/m2 increase in predicted BFMI change among men (aHR: 1.17, 95% CI 1.10-1.25) and women (aHR: 1.64, 95% CI 1.20-2.23). Regardless of changes in weight, such as from normal to obese or vice versa, these results were consistent.ConclusionsAmong young adults, increased predicted muscle mass or decreased predicted fat mass were associated with a reduced risk of development of CVD. Decreased predicted muscle mass or increased predicted fat mass were associated with an elevated risk of development of CVD.

Project description:OBJECTIVE:To investigate the association of predicted lean body mass, fat mass, and body mass index (BMI) with all cause and cause specific mortality in men. DESIGN:Prospective cohort study. SETTING:Health professionals in the United States PARTICIPANTS: 38?006 men (aged 40-75 years) from the Health Professionals Follow-up Study, followed up for death (1987-2012). MAIN OUTCOME MEASURES:All cause and cause specific mortality. RESULTS:Using validated anthropometric prediction equations previously developed from the National Health and Nutrition Examination Survey, lean body mass and fat mass were estimated for all participants. During a mean of 21.4 years of follow-up, 12?356 deaths were identified. A J shaped association was consistently observed between BMI and all cause mortality. Multivariable adjusted Cox models including predicted fat mass and lean body mass showed a strong positive monotonic association between predicted fat mass and all cause mortality. Compared with those in the lowest fifth of predicted fat mass, men in the highest fifth had a hazard ratio of 1.35 (95% confidence interval 1.26 to 1.46) for mortality from all causes. In contrast, a U shaped association was found between predicted lean body mass and all cause mortality. Compared with those in the lowest fifth of predicted lean body mass, men in the second to fourth fifths had 8-10% lower risk of mortality from all causes. In the restricted cubic spline models, the risk of all cause mortality was relatively flat until 21 kg of predicted fat mass and increased rapidly afterwards, with a hazard ratio of 1.22 (1.18 to 1.26) per standard deviation. For predicted lean body mass, a large reduction of the risk was seen within the lower range until 56 kg, with a hazard ratio of 0.87 (0.82 to 0.92) per standard deviation, which increased thereafter (P for non-linearity <0.001). For cause specific mortality, men in the highest fifth of predicted fat mass had hazard ratios of 1.67 (1.47 to 1.89) for cardiovascular disease, 1.24 (1.09 to 1.43) for cancer, and 1.26 (0.97 to 1.64) for respiratory disease. On the other hand, a U shaped association was found between predicted lean body mass and mortality from cardiovascular disease and cancer. However, a strong inverse association existed between predicted lean body mass and mortality from respiratory disease (P for trend <0.001). CONCLUSIONS:The shape of the association between BMI and mortality was determined by the relation between two body components (lean body mass and fat mass) and mortality. This finding suggests that the "obesity paradox" controversy may be largely explained by low lean body mass, rather than low fat mass, in the lower range of BMI.

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Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus.

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Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus.

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