Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2024; 15(3): 429-439
Published online Mar 15, 2024. doi: 10.4239/wjd.v15.i3.429
Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes
Fu-Peng Liu, Mu-Jie Guo, Qing Yang, Yan-Ying Li, Yan-Gang Wang, Mei Zhang
Fu-Peng Liu, The Affiliated Hospital of Medical College Qingdao University, Qingdao University, Qingdao 266071, Shandong Province, China
Fu-Peng Liu, Yan-Ying Li, Mei Zhang, Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
Mu-Jie Guo, Department of Medical Imaging, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
Qing Yang, Department of Clinical Nutrition, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
Yan-Gang Wang, Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Co-corresponding authors: Yan-Gang Wang and Mei Zhang.
Author contributions: Zhang M and Wang YG designed research; Zhang M, Wang YG and Liu FP contributed to study protocols and analysis plans; Liu FP, Guo MJ, Yang Q, and Li YY interpreted the data; Liu FP and Yang Q drafted the manuscript; Liu FP, Yang Q, and Guo MJ were the guarantors of this work, thereby having full access to all the data in the study and taking responsibility for the data’s integrity and accuracy of the analysis; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Zhang M and Wang YG were designated as co-corresponding authors. First, the research was performed as a collaborative effort, and the designation of co-corresponding authors accurately reflected the distribution of responsibilities and efforts involved in completing the study and the resulting paper. Second, the research team encompassed authors with a variety of expertise and skills from different fields, making the designation of co-corresponding authors the most suitable choice to reflect this diversity. Third, Zhang M and Wang YG made substantial and equal contributions throughout the research process. Selecting these researchers as co-corresponding authors acknowledged and respected their equal contributions while recognizing the spirit of teamwork and collaboration in this study. In summary, we believe that designating Zhang M and Wang YG as co-corresponding authors is appropriate for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Research Fund for Lin He’s Academician Workstation of New Medicine and Clinical Translation in Jining Medical University, No. JYHL2021FMS11; and Jining Key Research and Development Projects, No. 2022YXNS009.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Jining Medical University Institutional Review Board.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: All data generated or analyzed during this study are included in this published article. Further inquiries can be directed to the corresponding authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei Zhang, MD, Doctor, Department of Endocrinology, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Road, Jining 272029, Shandong Province, China. zhangmeijn@163.com
Received: November 2, 2023
Peer-review started: November 2, 2023
First decision: December 6, 2023
Revised: December 19, 2023
Accepted: February 20, 2024
Article in press: February 20, 2024
Published online: March 15, 2024
Processing time: 134 Days and 4.3 Hours
Abstract
BACKGROUND

Myosteatosis, rather than low muscle mass, is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Myosteatosis may lead to a series of metabolic dysfunctions, such as insulin resistance, systematic inflammation, and oxidative stress, and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis.

AIM

To investigate the association between myosteatosis and coronary artery calcification (CAC) in patients with T2DM.

METHODS

Patients with T2DM, who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography (CT) scans, were included. The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level. The CAC score was determined from thoracic CT images using the Agatston scoring method. Myosteatosis was diagnosed according to Martin’s criteria. Severe CAC (SCAC) was defined when the CAC score exceeded 300. Logistic regression and decision tree analyses were performed.

RESULTS

A total of 652 patients with T2DM were enrolled. Among them, 167 (25.6%) patients had SCAC. Logistic regression analysis demonstrated that myosteatosis, age, duration of diabetes, cigarette smoking, and alcohol consumption were independent risk factors of SCAC. Myosteatosis was significantly associated with an increased risk of SCAC (OR = 2.381, P = 0.003). The association between myosteatosis and SCAC was significant in the younger patients (OR = 2.672, 95%CI: 1.477-4.834, P = 0.002), but not the older patients (OR = 1.456, 95%CI: 0.863-2.455, P = 0.188), and was more prominent in the population with lower risks of atherosclerosis. The decision tree analyses prioritized older age as the primary variable for SCAC. In older patients, cigarette smoking was the main contributing factor for SCAC, while in younger patients, it was myosteatosis.

CONCLUSION

Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM, especially in the population with younger ages and fewer traditional risk factors.

Keywords: Type 2 diabetes; Myosteatosis; Muscle quality; Coronary artery calcification; Atherosclerosis; Cardiovascular diseases

Core Tip: Myosteatosis, rather than low muscle mass, is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Myosteatosis may lead to a series of metabolic dysfunctions that are closely associated with the acceleration of T2DM and atherosclerosis. This study demonstrated that myosteatosis was a novel risk factor for atherosclerosis in patients with T2DM, especially in the population with younger ages and fewer traditional risk factors. Therefore, this indicates the potential benefit of initiating muscle-strengthening exercises and improving muscle quality at a younger age.