Waist-to-Body Mass Index Ratio and Risk of Musculoskeletal Disease in Type 2 Diabetes: A Cohort and PhIP-Seq Analysis.

Authors

Yongze Zhang, Luxi Lin, Lifeng Zheng, Xiaohuang Lin, Zhaowei Xu, Ximei Shen, Lingning Huang, Fengying Zhao, Sunjie Yan

Published in

Journal of cachexia, sarcopenia and muscle. Volume 17. Issue 4. Pages e70336.

Abstract

Musculoskeletal complications in type 2 diabetes (T2DM) are inadequately captured by body mass index (BMI). Waist-to-BMI ratio (WBR) may better reflect adverse body composition. We examined cross-sectional and longitudinal associations between WBR and musculoskeletal disorders in T2DM.
This two-phase study was conducted within an ongoing hospital-based cohort at the First Affiliated Hospital of Fujian Medical University (Fuzhou, China). The cross-sectional analysis included 4157 adults with T2DM recruited between March 2012 and August 2023 (54.3% men; mean age 59.4 ± 10.3 years), using data from their first assessment. Associations of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), BMI and WBR with osteopenia, sarcopenia, sarcopenic osteopenia (SOs), sarcopenic obesity (SOb) and fractures were evaluated. The prospective cohort comprised a longitudinal subset enrolled between March 2012 and June 2022, ensuring at least 1 year of follow-up prior to administrative censoring in August 2023. A total of 440 individuals (57.0% men; mean age 59.7 ± 9.7 years) were followed for a median of 34.0 months (20.0-57.0). Associations between time-dependent WBR and incident outcomes were assessed using Cox models. A nested exploratory analysis was conducted within the cohort. Thirty participants with extreme annualised WBR change (ΔWBR/yr) were selected. Baseline serum samples collected at enrolment, prior to outcome occurrence, were analysed using phage immunoprecipitation sequencing (PhIP-Seq).
Cross-sectionally, WBR was negatively correlated with bone mineral density and appendicular skeletal muscle mass index and positively correlated with osteopenia, sarcopenia, SOs, SOb and fractures (all p < 0.01), whereas BMI, WC, WHtR and WHR showed weaker associations. After adjustment, higher WBR was independently associated with osteopenia (men: OR 1.723, 95% CI 1.614-1.840; women: OR 1.420, 1.348-1.495), sarcopenia (men: OR 4.779, 4.165-5.484; women: OR 2.991, 2.683-3.334), SOs (men: OR 6.261, 5.314-7.377; women: OR 4.336, 3.753-5.010), SOb (men: OR 4.737, 3.975-5.646; women: OR 4.652, 3.715-5.825) and fractures (men: OR 1.236, 1.093-1.397; women: OR 1.103, 1.003-1.213; all p < 0.05). Prospectively, higher time-dependent WBR predicted incident osteopenia (HR 1.365, 95% CI 1.024-1.820), sarcopenia (HR 1.282, 1.086-1.512), SOs (HR 1.408, 1.176-1.686), SOb (HR 1.634, 1.262-2.116) and fractures (HR 1.369, 1.029-1.821). PhIP-Seq analysis identified differential autoantibody reactivity related to muscle structural organisation and cytoskeletal regulation, while bone-related differences were enriched in Wnt signalling and hormone-related pathways.
Higher WBR and longitudinal increases were independently associated with osteopenia, sarcopenia, sarcopenic phenotypes and fractures in individuals with T2DM.

PMID:
42563592
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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