Predictive Value of Muscle-to-Fat Ratio in Type 2 Diabetes Mellitus among Non-overweight/Obese People

doi:10.12114/j.issn.1007-9572.2024.0624

Abstract

Abstract:

Background

Type 2 diabetes mellitus (T2DM) onset is insidious in non-overweight/obese individuals, making early identification of risk factors for T2DM critically important. Muscle-to-fat ratio (MFR) is widely used in predicting metabolic diseases, but less analyzed in T2DM, especially in non-overweight/obese people with T2DM.

Objective:

To investigate the correlation of MFR with T2DM in non-overweight/obese individuals, and its predictive value.

Methods

This study enrolled non-overweight/obese adults who underwent health examinations in Xiyuan Hospital of China Academy of Chinese Medical Sciences from 2021 to 2024. Participants were stratified based on the T2DM status, and baseline levels were compared. Logistic regression and linear regression were used to analyze the correlation of MFR with T2DM risk and fasting plasma glucose (FPG) levels in non-overweight/obese individuals. To assess the robustness of findings, subgroup analyses were conducted based on gender, age, smoking status, alcohol consumption, and hypertension status. A receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of MFR in T2DM risk among non-overweight/obese individuals.

Results

A total of 1 021 non-overweight/obese participants were enrolled, including 113 T2DM patients. Logistic regression and linear regression results showed that in Model 1 (unadjusted for covariates), each 1-unit increase in MFR among non-overweight/obese individuals was associated with a 36% reduction in T2DM risk (OR=0.36, 95%CI=0.22 to 0.60, P<0.001), and a 0.26-unit decrease in FPG (β=-0.26, 95%CI=-0.39 to -0.14, P<0.001). In Model 3 with adjustments for all covariates, each 1-unit increase in MFR was associated with a 29% reduction in T2DM risk (OR=0.29, 95%CI=0.12 to 0.69, P=0.005) and a 0.28-unit decrease in FPG (β=-0.28, 95%CI=-0.49 to -0.08, P=0.007). When MFR was treated as a categorical variable in Model 3, the risk of T2DM in the MFR Q4 group was 0.34 times that in the MFR Q1 group (OR=0.34, 95%CI=0.12 to 0.93, P=0.036), and FPG levels decreased by 0.36 units (β=-0.36, 95%CI=-0.63 to -0.09, P=0.009). Subgroup analysis revealed the correlation between MFR and FPG levels was more pronounced among smokers and individuals with hypertension. The area under the curve (AUC) of MFR in predicting T2DM risk among non-overweight/obese individuals was 0.635 4 (95%CI=0.578 6 to 0.687 4), with an optimal cutoff of 1.080 1, a sensitivity of 46.90% and a specificity of 75.44%.

Conclusion

Among non-overweight/obese individuals, MFR exhibits a nonlinear negative correlation with T2DM risk and FPG levels. MFR demonstrates good predictive efficacy and can be used for early prediction of T2DM risk in non-overweight/obese populations.

Key words: Diabetes mellitus, tpye 2, Blood glucose, Muscle-to-fat ratio, Correlation studies, Predictive modeling

摘要：

背景

非超重/肥胖人群的2型糖尿病（T2DM）发病隐匿，早期识别T2DM的危险因素，具有重要意义。肌肉与脂肪比值（MFR）在代谢性疾病预测中的应用广泛，但在T2DM领域，尤其在非超重/肥胖T2DM中研究尚少。

目的

探究MFR与非超重/肥胖人群T2DM的相关性及其预测价值。

方法

本研究纳入2021—2024年在中国中医科学院西苑医院参加健康体检的非超重/肥胖成年人，以是否患有T2DM作为分组依据比较基线水平；运用Logistic回归和线性回归分析MFR与非超重/肥胖人群T2DM发生风险及空腹血糖（FPG）的相关性；为判断研究结果的稳健性，本研究依据性别、年龄、是否吸烟、是否饮酒、是否患有高血压进行了亚组分析；绘制受试者工作特征（ROC）曲线，评估MFR对非超重/肥胖人群T2DM发生风险的预测价值。

结果

本研究共纳入非超重/肥胖受试者1 021名，包含T2DM患者113例。Logistic回归和线性回归分析结果显示，在未经协变量调整的模型1中，非超重/肥胖个体的MFR每上升1个单位，T2DM发生风险降低为原来的0.36（OR=0.36，95%CI=0.22~0.60，P<0.001），FPG降低0.26个单位（β=-0.26，95%CI=-0.39~-0.14，P<0.001）。在完全调整协变量的模型3中，MFR每上升1个单位，T2DM发生风险降低为原来的0.29（OR=0.29，95%CI=0.12~0.69，P=0.005），FPG降低0.28个单位（β=-0.28，95%CI=-0.49~-0.08，P=0.007）。当MFR作为分类变量时，在模型3中，MFR Q4组的T2DM发生风险降低为MFR Q1组的0.34（OR=0.34，95%CI=0.12~0.93，P=0.036），且FPG降低0.36个单位（β=-0.36，95%CI=-0.63~-0.09，P=0.009）。亚组分析显示，MFR与FPG水平的相关性在吸烟和高血压人群中更为显著。MFR预测非超重/肥胖人群T2DM发生风险的ROC曲线下面积（AUC）为0.635 4（95%CI=0.578 6~0.687 4），最佳临界值为1.080 1，灵敏度为46.90%，特异度为75.44%。

结论

在非超重肥胖人群中MFR与T2DM发生风险及FPG的水平呈非线性负相关，MFR具有一定预测效能，可用于非超重/肥胖人群T2DM发生风险的早期预测。

关键词: 糖尿病，2型, 血糖, 肌肉与脂肪比值, 相关性研究, 预测模型

LI Jixin,QIU Linjie,REN Yan, et al. Predictive Value of Muscle-to-Fat Ratio in Type 2 Diabetes Mellitus among Non-overweight/Obese People[J]. Chinese General Practice, 2026, 29(06): 726-732. DOI: 10.12114/j.issn.1007-9572.2024.0624.
李纪新,邱林杰,任燕等. 肌肉与脂肪比值对非超重/肥胖2型糖尿病的预测价值研究[J]. 中国全科医学, 2026, 29(06): 726-732. DOI: 10.12114/j.issn.1007-9572.2024.0624.

Figures/Tables 8

References 36

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项目	未患T2DM组（n=908）	患有T2DM组（n=113）	t（χ²）值	P值
年龄（±s，岁）	43±15	59±12	-12.22	<0.001
体质量（±s，kg）	57.11±7.23	58.41±7.52	-1.74	0.036
身高（±s，cm）	163.46±7.65	163.06±8.23	0.48	0.517
MFR（±s）	1.47±0.52	1.27±0.42	4.78	<0.001
BMI（±s，kg/m²）	21.3±1.7	21.9±1.5	-3.76	<0.001
收缩压（±s，mmHg）	118±16	130±18	-6.63	<0.001
舒张压（±s，mmHg）	69±11	72±9	-3.02	0.003
FPG（±s，mmol/L）	5.14±0.39	7.47±1.95	-12.65	<0.001
HDL-C（±s，mmol/L）	1.48±0.32	1.46±0.38	0.48	0.411
LDL-C（±s，mmol/L）	2.90±0.84	3.21±0.87	-3.46	0.001
TG（±s，mmol/L）	1.03±0.62	1.31±1.34	-2.15	<0.001
性别[例（%）]			0.06^a	0.718
男	219（24.12）	29（25.66）
女	689（75.88）	84（74.34）
饮酒史[例（%）]			51.22^a	<0.001
是	12（1.32）	15（13.27）
否	896（98.68）	98（86.73）
吸烟史[例（%）]			40.36^a	<0.001
是	14（1.54）	14（12.39）
否	894（98.46）	99（87.61）
高血压病史[例（%）]			40.42^a	<0.001
是	48（5.29）	25（22.12）
否	860（94.71）	88（77.88）
MFR四分位组[例（%）]			43.12^a	<0.001
Q1组	206（22.69）	49（43.36）
Q2组	227（25.00）	28（24.78）
Q3组	239（26.32）	16（14.16）
Q4组	236（25.99）	20（17.70）

项目	未患T2DM组（n=908）	患有T2DM组（n=113）	t（χ²）值	P值
年龄（±s，岁）	43±15	59±12	-12.22	<0.001
体质量（±s，kg）	57.11±7.23	58.41±7.52	-1.74	0.036
身高（±s，cm）	163.46±7.65	163.06±8.23	0.48	0.517
MFR（±s）	1.47±0.52	1.27±0.42	4.78	<0.001
BMI（±s，kg/m²）	21.3±1.7	21.9±1.5	-3.76	<0.001
收缩压（±s，mmHg）	118±16	130±18	-6.63	<0.001
舒张压（±s，mmHg）	69±11	72±9	-3.02	0.003
FPG（±s，mmol/L）	5.14±0.39	7.47±1.95	-12.65	<0.001
HDL-C（±s，mmol/L）	1.48±0.32	1.46±0.38	0.48	0.411
LDL-C（±s，mmol/L）	2.90±0.84	3.21±0.87	-3.46	0.001
TG（±s，mmol/L）	1.03±0.62	1.31±1.34	-2.15	<0.001
性别[例（%）]			0.06^a	0.718
男	219（24.12）	29（25.66）
女	689（75.88）	84（74.34）
饮酒史[例（%）]			51.22^a	<0.001
是	12（1.32）	15（13.27）
否	896（98.68）	98（86.73）
吸烟史[例（%）]			40.36^a	<0.001
是	14（1.54）	14（12.39）
否	894（98.46）	99（87.61）
高血压病史[例（%）]			40.42^a	<0.001
是	48（5.29）	25（22.12）
否	860（94.71）	88（77.88）
MFR四分位组[例（%）]			43.12^a	<0.001
Q1组	206（22.69）	49（43.36）
Q2组	227（25.00）	28（24.78）
Q3组	239（26.32）	16（14.16）
Q4组	236（25.99）	20（17.70）

因素	模型1		模型2		模型3
因素	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
MFR（连续性变量）	0.36（0.22~0.60）	<0.001	0.39（0.20~0.77）	0.007	0.29（0.12~0.69）	0.005
MFR（以Q1组为参照）
Q2组	0.52（0.31~0.86）	0.010	0.66（0.39~1.14）	0.137	0.62（0.34~1.15）	0.128
Q3组	0.28（0.16~0.51）	<0.001	0.41（0.21~0.78）	0.007	0.41（0.19~0.89）	0.023
Q4组	0.36（0.21~0.62）	<0.001	0.48（0.21~1.06）	0.070	0.34（0.12~0.93）	0.036

因素	模型1		模型2		模型3
因素	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
MFR（连续性变量）	0.36（0.22~0.60）	<0.001	0.39（0.20~0.77）	0.007	0.29（0.12~0.69）	0.005
MFR（以Q1组为参照）
Q2组	0.52（0.31~0.86）	0.010	0.66（0.39~1.14）	0.137	0.62（0.34~1.15）	0.128
Q3组	0.28（0.16~0.51）	<0.001	0.41（0.21~0.78）	0.007	0.41（0.19~0.89）	0.023
Q4组	0.36（0.21~0.62）	<0.001	0.48（0.21~1.06）	0.070	0.34（0.12~0.93）	0.036

因素	模型1		模型2		模型3
因素	β（95%CI）	P值	β（95%CI）	P值	β（95%CI）	P值
MFR（连续性变量）	-0.26（-0.39~-0.14）	<0.001	-0.31（-0.47~-0.16）	<0.001	-0.28（-0.49~-0.08）	0.007
MFR（以Q1为参照）
Q2组	-0.51（-0.69~-0.33）	<0.001	-0.38（-0.55~-0.21）	<0.001	-0.36（-0.55~-0.18）	<0.001
Q3组	-0.57（-0.75~-0.40）	<0.001	-0.42（-0.59~-0.25）	<0.001	-0.37（-0.58~-0.16）	<0.001
Q4组	-0.47（-0.64~-0.29）	<0.001	-0.44（-0.65~-0.22）	<0.001	-0.36（-0.63~-0.09）	0.009