Relationship between diabetes diet-related quality of life and dietary fiber intake among people with type 2 diabetes: a cross-sectional study.

Diet therapy is one of the most important treatments for people with type 2 diabetes (T2D). However, dietary restrictions due to diet therapy may reduce quality of life (QOL). This cross-sectional study aimed to investigate the association between diabetes diet-related QOL and dietary fiber intake in 238 people with T2D. The Diabetes Diet-related Quality of Life-Revised version (DDRQOL-9-R) and the brief-type self-administered diet history questionnaire were used to evaluate diabetes diet-related QOL and nutritional intake, respectively. Higher scores of each DDRQOL-9-R subscale means greater satisfaction with diet, perceived merits of diet therapy, and lower burden of diet therapy, which indicates good QOL. The median scores for perceived merits of diet therapy, satisfaction with diet, and burden of diet therapy were 58.3 [41.7-75.0], 75.0 [66.7-91.7], and 66.7 [50.0-75.0] points, respectively. HbA1c levels in people with high perceived merits of diet therapy (7.3 [6.7-7.8] vs. 7.5 [7.1-8.2] %, p = 0.007) and people with high satisfaction with diet (7.3 [6.8-7.8] vs. 7.5 [7.1-8.4] %, p = 0.010) were lower than those without. Dietary fiber intake was higher in people with high perceived merits of diet therapy (11.6 [8.8-16.7] vs. 10.0 [7.9-13.8] g/day, p = 0.010), high satisfaction with diet (11.4 [8.8-16.1] vs. 9.7 [7.8-13.2] g/day, p = 0.007), and low burden of diet therapy (11.8 [8.7-16.5] vs. 9.7 [7.8-12.6] g/day, p = 0.004) than in those without. Dietary fiber intake was related to perceived merits of diet therapy (Odds ratio [OR]1.07 [95%CI: 1.00-1.15], p = 0.049), burden of diet therapy (OR 0.90 [95%CI: 0.82-0.98], p = 0.022), and satisfaction with diet (OR 1.18 [95%CI: 1.09-1.27], p < 0.001) after adjusting for covariates. Dietary fiber intake is associated with diabetes diet-related QOL in people with T2D.

Comparison of Diet, Sleep, and Stress During the Emergency Coronavirus Disease Curfew in Men and Women with Hemodialysis.

OBJECTIVE: To investigate the effect of coronavirus disease 2019 (COVID-19) on diet, stress, and sleep in Japanese patients with hemodialysis. METHODS: Data on nutritional intake, frequency of food intake by cuisine, dietary behavior, and frequency of food use before and during the declaration of the state of emergency due to COVID-19, were collected. RESULTS: For the 81 participants (47 men), changes were observed in the following diet-related items: nutrition and nutrient content (one item for men, three for women), eating behavior, and frequency of food use (1 item for men, six for women), and the total number of items was two for men and nine for women. Nine out of 12 questions addressed stress and six out of eight questions addressed sleep, with a higher percentage of women adversely affected and no item with a higher percentage of men adversely affected. The mean score for stress was 25.3 ± 5.1 for men and 29.5 ± 5.0 for women, P < .001, and for sleep disturbance was 11.6 ± 3.0 for men and 14.4 ± 4.4 for women, P < .001. CONCLUSIONS: In patients with hemodialysis, the effect of refraining from going out due to the spread of COVID-19 on diet, sleep, and stress was suggested to be more significant in women than in men.

Leucine and Glutamic Acid as a Biomarker of Sarcopenic Risk in Japanese People with Type 2 Diabetes.

This study aimed to identify the serum metabolites associated with sarcopenic risk in Japanese patients with type 2 diabetes, determine the effect of dietary protein intake on the serum metabolic profile, and examine its association with sarcopenia. Ninety-nine Japanese patients with type 2 diabetes were included, and sarcopenic risk was defined as low muscle mass or strength. Seventeen serum metabolites were quantified after gas chromatography-mass spectrometry analysis. The relationship between dietary protein intake and the metabolites concerning sarcopenia was analyzed, and the factors affecting sarcopenic risk were clarified. Twenty-seven patients were classified as being at risk of sarcopenia, the same as the general risk, which was associated with older age, a longer duration of the disease, and a lower body mass index. Low levels of leucine and glutamic acid were significantly associated with low muscle strength (p = 0.002 and p < 0.001, respectively), and leucine was also associated with muscle mass (p = 0.001). Lower levels of glutamic acid had higher odds of sarcopenic risk after being adjusted for age and HbA1c (adjusted OR 4.27, 95% CI 1.07-17.11, p = 0.041), but not for leucine. Leucine and glutamic acid can serve as useful biomarkers for sarcopenia, highlighting potential targets for its prevention.

Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes.

Diabetes prevalence is increasing rapidly in older people, and sarcopenia is prevalent as a novel complication, particularly in patients with type 2 diabetes mellitus (T2DM). Therefore, sarcopenia prevention and treatment in these people is necessary. Diabetes accelerates sarcopenia through several mechanisms, such as hyperglycemia, chronic inflammation and oxidative stress. The effects of diet, exercise, and pharmacotherapy on sarcopenia in patients with T2DM need to be considered. In diet, low intake of energy, protein, vitamin D, and ω-3 fatty acid are associated with sarcopenia risk. In exercises, although intervention studies in people, especially older and non-obese patients with diabetes, are few, accumulating evidence shows the usefulness of exercise, particularly resistance exercise for muscle mass and strength, and aerobic exercise for physical performance in sarcopenia. In pharmacotherapy, certain classes of anti-diabetes compounds have possibility of preventing sarcopenia. However, much data on diet, exercise, and pharmacotherapy were obtained in obese and non-elderly patients with T2DM, demanding actual clinical data on non-obese and older patients with diabetes.

Dental care and oral conditions are associated with the prevalence of sarcopenia in people with type 2 diabetes: a cross-sectional study.

BACKGROUND: Insulin resistance, which is closely associated with type 2 diabetes mellitus (T2DM), is a cause of sarcopenia and people with T2DM have a high risk of sarcopenia. Keeping good oral condition by dental care is important for people with T2DM. Keeping good oral condition by dental care is important for people with T2DM. This study has investigated the association between dental care or oral conditions and sarcopenia in people with T2DM. METHODS: Dental care and oral conditions were evaluated based on a self-reported questionnaire. Individuals with both low handgrip strength and low skeletal muscle mass index were diagnosed with sarcopenia. RESULTS: Among 266 people with T2DM, the proportions of sarcopenia, not having a family dentist, not having a toothbrushing behavior, poor chewing ability, and use of complete dentures were 18.0%, 30.5%, 33.1%, 25.2%, and 14.3%, respectively. The proportions of sarcopenia in people not having a family dentist (27.2% vs. 14.1%, p = 0.017), those with poor chewing ability (26.9% vs. 15.1%, p = 0.047), and use of complete dentures (36.8% vs. 14.9%, p = 0.002) were higher than those in people without. The proportion of sarcopenia in people without toothbrushing behavior tended to be higher than that in people with toothbrushing behavior (25.0% vs. 14.6%, p = 0.057). Not having a family dentist (adjusted odds ratio [OR] 2.48 [95% confidence interval (CI): 1.21-5.09], p = 0.013), poor chewing ability (adjusted OR 2.12 [95% CI: 1.01-4.46], p = 0.048), and use of complete dentures (adjusted OR 2.38 [95% CI: 1.01-5.99], p = 0.046) were related to the prevalence of sarcopenia. CONCLUSIONS: This study revealed that dental care and oral conditions were associated with the prevalence of sarcopenia.

The Association of Salt Intake and Non-alcoholic Fatty Liver Disease in People With Type 2 Diabetes: A Cross-Sectional Study.

Objectives: Non-alcoholic fatty liver disease (NAFLD), which has a close relationship with type 2 diabetes (T2D), is related to salt intake in the general population. In contrast, the relationship between salt intake and the presence of NAFLD in patients with T2D has not been clarified. Methods: Salt intake (g/day) was assessed using urinary sodium excretion, and a high salt intake was defined as an intake greater than the median amount of 9.5 g/day. Hepatic steatosis index (HSI) ≥ 36 points was used to diagnosed NAFLD. Odds ratios of high salt intake to the presence of NAFLD were evaluated by logistic regression analysis. Results: The frequency of NAFLD was 36.5% in 310 patients with T2D (66.7 ± 10.7 years old and 148 men). The patients with high salt intake had a higher body mass index (25.0 ± 4.0 vs. 23.4 ± 3.8 kg/m2, p < 0.001) than those with low salt intake. HSI in patients with high salt intake was higher than that in patients with low salt intake (36.2 ± 6.2 vs. 34.3 ± 5.5 points, p = 0.005). In addition, the presence of NALFD in patients with high salt intake was higher than that in patients with low salt intake (44.5% vs. 28.4%, p = 0.005). High salt intake was associated with the prevalence of NAFLD [adjusted odds ratio, 1.76 (95% confidence interval: 1.02-3.03), p = 0.043]. Conclusion: This cross-sectional study revealed that salt intake is related to the prevalence of NAFLD in patients with T2D.

Household Income Is Related to Dietary Fiber Intake and Dietary Acid Load in People with Type 2 Diabetes: A Cross-Sectional Study.

Household income was related to habitual dietary intake in general Japanese people. This cross-sectional study investigated the relationship between household income and habitual dietary intake in people with type 2 diabetes mellitus (T2DM). Household income was evaluated using a self-reported questionnaire and categorized into high and low household income. Nutritional status was assessed using a brief-type self-administered diet history questionnaire. Among 128 men and 73 women, the proportions of participants with low household income were 67.2% (n = 86/128) in men and 83.6% (n = 61/73) in women. Dietary fiber intake (11.3 ± 4.2 vs. 13.8 ± 6.0 g/day, p = 0.006) was lower, and dietary acid load, net endogenous aid production score (NEAP) (51.7 ± 10.5 vs. 46.8 ± 10.4 mEq/day, p = 0.014) and potential renal acid load score (PRAL) (9.5 ± 10.7 vs. 3.7 ± 14.1 mEq/day, p = 0.011) were higher in men with low household income than in those without. Multivariable linear regression analyses demonstrated that log (dietary fiber intake) in men with low household income was lower than that in those with high household income after adjusting for covariates (2.35 [2.26−2.44] vs. 2.52 [2.41−2.62], p = 0.010). Furthermore, NEAP (54.6 [51.7−57.4] vs. 45.8 [42.5−49.2], p <0.001) in men with low household income were higher than in those with high household income after adjusting for covariates. Contrastingly, household income was not related to diet quality in women. This study showed that household income was related to dietary fiber intake and dietary acid load in men but not in women.

Impact of Eating Speed on Muscle Mass in Older Patients With Type 2 Diabetes: A Prospective Study of KAMOGAWA-DM Cohort.

Background and Aims: Maintenance of muscle mass is important for sarcopenia prevention. However, the effect of eating speed, especially fast, normal, or slow speed, on muscle mass changes remains unclear. Therefore, the purpose of this prospective study was to investigate the effect of eating speed on muscle mass changes in patients with type 2 diabetes (T2DM). Methods: This study included 284 patients with T2DM. Based on a self-reported questionnaire, participants were classified into three groups: fast-, normal-, and slow-speed eating. Muscle mass was assessed using a multifrequency impedance body composition analyzer, and skeletal muscle mass (SMI) decrease (kg/m2/year) was defined as [baseline SMI (kg/m2)-follow-up SMI (kg/m2)] ÷ follow-up duration (year). The rate of SMI decrease (%) was defined as [SMI decrease (kg/m2/year) ÷ baseline SMI (kg/m2)] × 100. Results: The proportions of patients with fast-, normal-, and slow-speed eating were, respectively, 50.5%, 42.9%, and 6.6% among those aged <65 years and 40.4%, 38.3%, and 21.3% among those aged ≥65 years. In patients aged ≥65 years, the rate of SMI decrease in the normal (0.85 [95% confidence interval, CI: -0.66 to 2.35]) and slow (0.93 [95% CI -0.61 to 2.46]) speed eating groups was higher than that in the fast speed eating group (-1.08 [95% CI -2.52 to 0.36]). On the contrary, there was no difference in the rate of SMI decrease among the groups in patients aged <65 years. Compared with slow speed eating, the adjusted odds ratios of incident muscle loss [defined as rate of SMI decrease (%) ≥0.5%] due to fast- and normal-speed eating were 0.42 (95% CI 0.18 to 0.98) and 0.82 (95% CI 0.36 to 2.03), respectively. Conclusion: Slow-speed eating is associated with a higher risk of muscle mass loss in older patients with T2DM.

Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes.

INTRODUCTION: Sarcopenia index (SI), calculated by (serum creatinine/cystatin C)×100, is reported to be associated with sarcopenia. Few studies reported the association between SI and subclinical atherosclerosis. We evaluated the association between SI and subclinical atherosclerosis, assessed by brachial-ankle pulse wave velocity (baPWV). RESEARCH DESIGN AND METHODS: One hundred seventy-four patients with type 2 diabetes were included in this cross-sectional study. The relationship between SI and baPWV was assessed by Pearson's correlation coefficient. To calculate area under the receiver operator characteristic (ROC) curve (AUC) of SI for the presence of subclinical atherosclerosis, which was defined as baPWV >1800 cm/s, ROC analysis was performed. Logistic regression analyses were performed to assess the effect of SI on the prevalence of subclinical atherosclerosis adjusting for covariates. RESULTS: Mean age, duration of diabetes, baPWV, and SI were 66.9 (10.1) years, 17.7 (11.6) years, 1802 (372) cm/s, and 77.6 (15.8), respectively. There was an association between SI and baPWV (men; r=-0.25, p=0.001, and women; r=-0.37, p=0.015). The optimal cut-off point of SI for the presence of subclinical atherosclerosis was 77.4 (sensitivity=0.72, specificity=0.58, p<0.001, AUC 0.66 (95% CI: 0.57 to 0.74)). In addition, SI was associated with the prevalence of subclinical atherosclerosis (adjusted OR 0.95, 95% CI: 0.91 to 0.99, p=0.015). CONCLUSIONS: SI is associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes.

Dietary Fiber Intake Is Related to Skeletal Muscle Mass, Body Fat Mass, and Muscle-to-Fat Ratio Among People With Type 2 Diabetes: A Cross-Sectional Study.

Objectives: To investigate the relationship between dietary fiber intake and skeletal muscle mass, body fat mass, and muscle-to-fat ratio (MFR) among men and women with type 2 diabetes (T2D). Methods: This cross-sectional study involved 260 men and 200 women with T2D. Percent skeletal muscle mass (%) or percent body fat mass (%) was calculated as (appendicular muscle mass [kg] or body fat mass [kg]/body weight [kg]) × 100. MFR was calculated as appendicular muscle mass divided by body fat mass. Information about dietary fiber intake (g/day) was obtained from a brief-type self-administered diet history questionnaire. Results: Dietary fiber intake was correlated with percent body fat mass (r = -0.163, p = 0.021), percent skeletal muscle mass (r = 0.176, p = 0.013), and MFR (r = 0.157, p = 0.026) in women. However, dietary fiber intake was not correlated with percent body fat mass (r = -0.100, p = 0.108), percent skeletal muscle mass (r = 0.055, p = 0.376), and MFR (r = 0.065, p = 0.295) in men. After adjusting for covariates, dietary fiber intake was correlated with percent body fat mass (ß = 0.229, p = 0.009), percent skeletal muscle mass (ß = 0.364, p < 0.001), and MFR (ß = 0.245, p = 0.006) in women. Further, dietary fiber intake was related to percent skeletal muscle mass (ß = 0.221, p = 0.008) and tended to be correlated with percent body fat mass (ß = 0.148, p = 0.071) in men. Conclusion: Dietary fiber intake was correlated with skeletal muscle mass, body fat mass, and MFR among women with T2D.

Eating Speed Is Associated with the Presence of Sarcopenia in Older Patients with Type 2 Diabetes: A Cross-Sectional Study of the KAMOGAWA-DM Cohort.

To determine the relationship between eating speed and the presence of sarcopenia in older patients with type 2 diabetes (T2D), in this cross-sectional study, patient eating speeds were classified as "fast-", "normal-" and "slow-speed eating." A multifrequency impedance analyzer was used to evaluate patient body compositions. Sarcopenia was defined as having both low muscle strength, a handgrip strength <28 kg for men and <18 kg for women, and low skeletal muscle mass as a skeletal muscle mass index <7.0 kg/m2 for men and <5.7 kg/m2 for women. Among 239 individuals, the frequencies of fast-, normal-, and slow-speed eating were 47.3%, 32.2%, and 20.5%, respectively; and the prevalence of sarcopenia was 15.9%. Patients with a slow eating speed had greater prevalence of low skeletal muscle mass, low muscle strength, and sarcopenia than those with a fast or normal eating speed. After adjusting for covariates, compared to slow eaters, the odds ratio of having sarcopenia among fast- and normal-speed eaters was 0.31 [95% CI: 0.12-0.80] and 0.18 [95% CI: 0.06-0.53], respectively. Having a slow eating speed is associated with a heightened risk of sarcopenia in older patients with T2D.

The effect of COVID-19 pandemic on the lifestyle and glycemic control in patients with type 1 diabetes: a retrospective cohort study.

Background: To investigate the acute effects of coronavirus disease (COVID-19) on lifestyle and metabolic parameters in patients with type 1 diabetes (T1D). Methods: This retrospective cohort study included 34 patients who were admitted to our hospital from April 16 to May 1, 2020. Data on stress levels, sleep duration, exercise, total diet, snacks, and prepared food intake were obtained from the questionnaires. Changes in the values of hemoglobin A1c (HbA1c) and body weight from 3 months before the administration of the questionnaire to the time the study questionnaire was administered (pandemic year), and those from 15 months before to 12 months before the administration of the questionnaire (pre-pandemic year) were evaluated. Results: Increased stress levels and decreased exercise volumes were observed in approximately 60% and 50% of participants during the COVID-19 pandemic, respectively. Decreased sleep duration was associated with changes in the body weight for 3 months during pandemic year (r = - 0.40, p = 0.043). Furthermore, compared with changes in HbA1c for 3 months during pre-pandemic year, changes in HbA1c during the pandemic year were worse (0.12% [0.33] % during pandemic year vs. - 0.09 [0.39] % during pre-pandemic year, p = 0.027). Conclusions: Many patients experienced stress and exercised less due to the COVID-19 pandemic. Glycemic control in patients with T1D was worse than that in the previous year. Since the pandemic is currently ongoing, more attention should be paid to stress and lifestyle factor management in patients with T1D. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-021-00507-4.

Sarcopenia Is Associated With a Risk of Mortality in People With Type 2 Diabetes Mellitus.

Background: Sarcopenia has reportedly been associated with increased risk of mortality in general populations. However, few studies have investigated the association between sarcopenia and mortality in older people with type 2 diabetes mellitus (T2D). This study aimed to investigate the effect of sarcopenia on incident all-cause mortality in older people with T2D. Methods: Low muscle strength were set at handgrip strength <28 kg for men and <18 kg for women, and low skeletal muscle mass index (SMI), evaluated using the impedance body composition analyzer, were set at SMI <7.0 kg/m2 for men and <5.7 kg/m2 for women. People who had both low muscle strength and low SMI were diagnosed with sarcopenia. Due to a low incidence of all-cause mortality, the propensity score was used. The propensity score was evaluated using multivariable logistic regression models with the following parameters: age, sex, duration of diabetes, history of heart disease, history of cancer, smoking, exercise, alcohol, sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1 receptor agonist, insulin, corticosteroid, hypertension, body mass index, glycosylated hemoglobin A1c, triglycerides, and creatinine, and the C-statistic was 0.89. Results: In this prospective cohort study, 396 people with an average age and duration of diabetes of 71.3 (6.3) years and 16.3 (11.3) years, respectively, were included. Of those included, 14.6% had sarcopenia. During the average 40.5 (16.5) months of follow-up, 13 people (6 out of the 338 without sarcopenia and 7 out of the 58 with sarcopenia) died. Incident rate were 5.1/1000 person years of follow-up in people without sarcopenia and 41.3/1000 person years of follow-up in people with sarcopenia. According to Cox regression analysis, sarcopenia was associated with all-cause mortality (adjusted hazard ratio: 6.12, 95% confidence interval: 1.52-24.7, p = 0.011). Conclusion: Sarcopenia is associated with incident all-cause mortality in older outpatients with T2D.

Association between Geriatric Nutrition Risk Index and The Presence of Sarcopenia in People with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

The aim of this cross-sectional study was to examine the association between the geriatric nutritional risk index (GNRI) and the prevalence of sarcopenia in people with type 2 diabetes (T2DM). Having both low handgrip strength (<28 kg for men and <18 kg for women) and low skeletal muscle mass index (<7.0 kg/m2 for men and <5.7 kg/m2 for women) was diagnosed as sarcopenia. GNRI was estimated by the formula as below: GNRI = (1.489 × serum albumin level [g/L]) + (41.7 × [current body weight (kg)/ideal body weight (kg)]). Participants were dichotomized on the basis of their GNRI scores (GNRI < 98, low; or GNRI ≥ 98, high). Among 526 people (301 men and 225 women) with T2DM, the proportions of participants with sarcopenia and low GNRI were 12.7% (n = 67/526) and 5.1% (n = 27/526), respectively. The proportion of sarcopenia in participants with low-GNRI was higher than that with high GNRI (44.4% [n = 12/27] vs. 11.0% [n = 55/499], p < 0.001). The GNRI showed positive correlations with handgrip strength (r = 0.232, p < 0.001) and skeletal muscle mass index (r = 0.514, p < 0.001). Moreover, low GNRI was related to the prevalence of sarcopenia (adjusted odds ratio, 4.88 [95% confidence interval: 1.88-12.7], p = 0.001). The GNRI, as a continuous variable, was also related to the prevalence of sarcopenia (adjusted odds ratio, 0.89 [95% confidence interval: 0.86-0.93], p < 0.001). The present study revealed that low GNRI was related to the prevalence of sarcopenia.

Association of Estimated Salt and Miso Intake with the Prevalence of Obesity in People with Type 2 Diabetes: A Cross-Sectional Study.

Salt intake is often estimated by the amount of sodium excreted in urine, and miso has been reported to increase it. This cross-sectional study investigated the relationship between obesity and high estimated salt intake with and without habitual miso consumption. Estimates of salt intake (g/day) were calculated using urinary sodium excretion, and a high estimated intake was defined as greater than the median amount of 9.5 g/day. Participants were divided into four groups based on estimated salt intake and miso consumption. Among 300 people, the proportions of obesity were 77.8% (n = 14/18), 40.2% (n = 53/132), 26.0% (n = 33/127), and 34.8% (n = 8/23) in the (+/-), (+/+), (-/+), and (-/-) groups of high estimated salt intake/habitual miso consumption, respectively. Compared with the (+/-) group, the adjusted odds ratios for obesity were 0.07 (95% confidence interval (CI): 0.02-0.26, p < 0.001), 0.16 (95% CI: 0.03-0.76, p = 0.022), and 0.14 (95% CI: 0.04-0.51, p = 0.003) in the (-/+), (-/-), and (+/+) groups, respectively. The presence of obesity was not much higher in people with high estimated salt intake with habitual miso consumption than that in people without. Clinicians should be aware that miso consumption promotes salt excretion, which may lead to an apparently higher estimated salt intake than actual.

Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort.

The aim of this prospective cohort study was to examine the relationships between the intakes of various vitamins and the loss of muscle mass in older people with type 2 diabetes (T2DM). The change in skeletal muscle mass index (SMI, kg/m2) (kg/m2/year) was defined as follows: (SMI at baseline (kg/m2) - SMI at follow-up (kg/m2))/follow-up period (year). The rate of SMI reduction (%) was calculated as follows (the change in SMI (kg/m2/year)/SMI at baseline (kg/m2)) × 100. The rate of SMI reduction ≥ 1.2% was considered as the loss of muscle mass. Among 197 people with T2DM, 47.2% of them experienced the loss of muscle mass at the 13.7 ± 5.2 month follow-up. Vitamin B1 (0.8 ± 0.3 vs. 0.8 ± 0.3 mg/day, p = 0.031), vitamin B12 (11.2 ± 8.3 vs. 13.4 ± 7.5 µg/day, p = 0.049), and vitamin D (16.5 ± 12.2 vs. 21.6 ± 13.0 µg/day, p = 0.004) intakes in people with the loss of muscle mass were significantly lower than those without. Vitamin D intake was related to the loss of muscle mass after adjusting for sex, age, exercise, alcohol, smoking, body mass index, SMI, glucagon-like peptide-1 agonist, sodium glucose cotransporter-2 inhibitor, insulin, HbA1c, creatinine, energy intake, and protein intake (adjusted odds ratio 0.93, 95% confidence interval: 0.88-0.97, p = 0.003). This study showed that vitamin D intake was related to the loss of muscle mass in older people with T2DM. Vitamin B12 intake tended to be related to the loss of muscle mass, although vitamin A, vitamin B2, vitamin B6, vitamin C, and vitamin E intake were not related.

Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study.

Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m2) was calculated as appendicular muscle mass (kg) divided by height squared (m2). Change in SMI (kg/m2/year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m2 before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m2 after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m2/year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m2/year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m2/year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m2, p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.

Habitual Miso (Fermented Soybean Paste) Consumption Is Associated with Glycemic Variability in Patients with Type 2 Diabetes: A Cross-Sectional Study.

Glycemic control, including glycemic variability, is important for the prevention of diabetic vascular complications in patients with type 2 diabetes mellitus (T2DM). There was an association between miso soup intake and insulin resistance. However, the relationship between habitual miso consumption and glycemic control, including glycemic variability, in patients with T2DM remains unknown. We defined people without habitual miso consumption if they did not consume miso soup at all in a day. The average, standard deviation (SD), and coefficient of variation (CV), calculated as CV = (SD/average HbA1c) × 100 (%), of hemoglobin (Hb) A1c levels were evaluated. The proportions of habitual miso consumption of male and female were 88.1% and 82.3%, respectively. The average (7.0 [6.4-7.5] vs. 7.3 [6.8-8.4] %, p = 0.009), SD (0.21 [0.12-0.32] vs. 0.37 [0.20-0.72], p = 0.004), and CV (0.03 [0.02-0.04] vs. 0.05 [0.03-0.09], p = 0.005) of HbA1c levels in female with habitual miso consumption were lower than those of female without. Moreover, habitual miso consumption correlated with average (ß = -0.251, p = 0.009), SD (ß = -0.175, p = 0.016), and CV (ß = -0.185, p = 0.022) of HbA1c levels after adjusting for covariates. However, no association between habitual miso consumption and any glycemic parameters was shown among male. This study clarified the association between habitual miso consumption and good glycemic control, including glycemic variability, in female, but not in male.

Short energy intake is associated with muscle mass loss in older patients with type 2 diabetes: A prospective study of the KAMOGAWA-DM cohort.

BACKGROUND & AIM: Past studies reported that the intake of adequate energy is more important than protein intake; however, the relationship between energy intake and muscle mass loss remains unclear thus far. This study therefore explored the association between energy intake and muscle mass loss in people with type 2 diabetes (T2D). METHODS: In this prospective cohort study, impedance body composition and a brief-type self-administered diet history questionnaire were used for analyzing body composition and habitual diet intake, respectively. Skeletal muscle mass index (SMI, kg/m2) was defined as appendicular muscle mass (kg) ÷ height-squared (m2). Rate of SMI change (%) was calculated as ([SMI at baseline - SMI at follow-up]/[follow-up duration (years) × baseline SMI (kg/m2)]) × 100, and muscle mass loss was defined as rate of SMI change ≥0.5%. Energy intake was defined as total energy intake (kcal/day) divided by ideal body weight (kg), defined as 22 × patient height-squared (m2). RESULTS: Among non-older and older participants, 54.8% (n = 51/93) and 58.9% (n = 116/197) experienced muscle mass loss at 16.3 (6.4) and 18.1 (7.1) months' follow-up, respectively. Logistic regression analyses showed that energy intake was associated with incident muscle mass loss after adjusting for age, sex, insulin, sodium glucose cotransporter-2 inhibitor, glucagon-like peptide-1 agonist, steroids, smoking, exercise, alcohol intake, body mass index, SMI, presence of renal failure, and protein intake (g/actual body weight/day) in the older people (odds ratio [OR] 0.94 [95% confidence interval [CI] 0.88-0.996], p = 0.037), whereas energy intake was not associated with incident muscle mass loss in the non-older people (OR 0.96 [95% CI 0.86-1.06], p = 0.423). CONCLUSIONS: Insufficient energy intake is associated with muscle mass loss in older people with T2D. Therefore, it is recommended to consume enough energy for older people with T2D to keep muscle mass.

Sarcopenic obesity is associated with macroalbuminuria in patients with type 2 diabetes: a cross-sectional study.

Sarcopenia is associated with the risk of albuminuria in patients with type 2 diabetes mellitus (T2DM), and obesity is a risk factor for proteinuria. However, the association between sarcopenic obesity and diabetic nephropathy, including albuminuria, in patients with T2DM has not been reported. The study included 206 men and 163 women with T2DM who participated in the KAMOGAWA-DM cohort, which investigating the natural history of diabetes since 2014. Sarcopenia was defined as having both low skeletal muscle mass index (SMI, kg/m2) (<7.0 kg/m2 for men and <5.7 kg/m2 for women) and low handgrip strength (<28 kg for men and <18 kg for women). Obesity was diagnosed by the percentage of body fat (>30% for men and >35% for women). The patient was said to have sarcopenic obesity if he/she had both sarcopenia and obesity. Urinary albumin excretion of patients with sarcopenic obesity was higher than that of patients without sarcopenic obesity (median [interquartile range]: 342.0 [41.8-467.5] vs. 21.0 [9.0-75.4] mg/g Cr, p = 0.016). Additionally, sarcopenic obesity was associated with the presence of macroalbuminuria, compared with non-sarcopenic obesity (adjusted odds ratio 6.92 [95% confidence interval:1.63-29.4], p = 0.009). Adjusted odds ratios of sarcopenic obesity, sarcopenia only, and obesity only for the presence of macroalbuminuria were 6.52 (1.47-28.8, p = 0.014), 1.29 (0.45-3.71, p = 0.638), and 0.78 (0.38-1.58, p = 0.482), respectively, compared with neither sarcopenia nor obesity. This study indicated that sarcopenic obesity is associated with albuminuria, especially macroalbuminuria, in Japanese patients with T2DM.