Association of the muscle/fat mass ratio with insulin resistance in gestational diabetes mellitus

Abstract

This study assessed the association of muscle mass with insulin resistance, evaluated from the insulin sensitivity index (ISI), in Japanese patients with gestational diabetes mellitus (GDM). Consecutive patients with GDM (n = 96) admitted to St. Marianna University Hospital between October 2015 and March 2018 for initial education and glycemic control were enrolled in a prospective observational study. Insulin resistance was evaluated by measuring the ISI and body composition was assessed by bioelectrical impedance analysis. The subjects were aged 34.4 ± 4.8 years (mean ± SD) and their body mass index (BMI) before pregnancy was 22.3 ± 4.0 kg/m 2. Fifty-three patients (55.2%) had a history of diabetes in first-degree relatives. The ISI was 7.2 ± 3.3, appendicular skeletal muscle mass (ASM) was 17.0 ± 2.1 kg, and fat mass (FM) was 18.8 ± 8.2 kg. The ASM/FM ratio was 1.02 ± 0.34. There was a positive correlation between FM and ASM (r = 0.734, p < 0.001). To adjust for confounders when evaluating the association of ASM with ISI, multivariate analysis was conducted using age, family history of diabetes, and BMI as variables. In this analysis, the ASM/FM ratio showed a significant positive correlation with ISI (β = 0.303, p = 0.020). These findings suggest that inadequate ASM/FM ratio is important for the development of insulin resistance in Japanese patients with GDM. Excessive emphasis on dieting rather than health might increase the risk of GDM by reducing the muscle mass below the level that maintains normal glucose metabolism.

<p>The Body Composition in Early Pregnancy is Associated with the Risk of Development of Gestational Diabetes Mellitus Late During the Second Trimester</p>

“…[26][27][28] However, previous studies have shown that the Chinese population, like other Asian populations, has a lower BMI but a higher percentage of body fat than Caucasians of similar age and gender. 29 BMI does not differentiate between bone, muscle, and fat mass, so a simple and inexpensive method of assessing fat mass may be better for predicting the development of GDM. Methods such as bioelectrical impedance analysis for the assessment of fat mass and fat-free mass in pregnant women in the body composition studies have been described.…”

“…According to a study conducted by Kawanabe et al, inadequate appendicular skeletal muscle mass/fat mass ratio is a risk for the development of insulin resistance in Japanese patients with GDM. 29 Unfortunately, we did not evaluate the relationship between SMMP and insulin resistance since insulin test is not included in the routine Figure 2 Correlation between pre-BMI and FMI and receiver-operating characteristic (ROC) curve to predict GDM. (A) Correlation between Pre-BMI and FMI.…”

Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes?

“…Several studies have demonstrated that high muscle mass, high muscle/fat mass ratio and high muscle strength are associated with lower insulin resistance in a variety of populations (36)(37)(38)(39). On top of this, it has been demonstrated in several studies that low muscle strength is associated with a higher prevalence and severity of type 2 diabetes in a broad range of ethnicities (40-45).…”

Cdc42: A Novel Regulator of Insulin Secretion and Diabetes-Associated Diseases

“…Diabetes is characterized by multiple mutagenic events that affect the secretion and sensitivity of insulin. Moreover, diabetes is known to be associated with various diseases in different tissues and organs, including kidney, skeleton muscle, eyes, lung, heart, liver, and even brain [142,143,144,145,146,147,148]. The protein Cdc42 is a member of the Rho family of small GTPases.…”