Thigh Muscle Quality Predicts the Incidence of Type 2 Diabetes Mellitus.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 42660514 · doi:10.4093/dmj.2025.1239
What was done
A prospective cohort study evaluated 2,129 East Asian adults (mean age 57.4 ± 16.9 years; BMI 25.0 ± 3.9 kg/m²; 48.5% male) with at least one cardiometabolic risk factor and no diabetes at baseline. Low-density muscle (LDM) area, reflecting intramuscular fat infiltration, was quantified via non-contrast CT at the midthigh level (attenuation 0–30 Hounsfield units). Participants were followed for incident type 2 diabetes over a median of 7.4 years using adjusted Cox proportional hazards models.
What was found
Over follow-up, 201 males (19.5%) and 156 females (14.1%) developed diabetes. Those who developed diabetes had higher baseline HbA1c (6.1% ± 0.3% vs. 5.7% ± 0.4%) and larger LDM areas (48.8 ± 14.2 cm² vs. 38.1 ± 13.2 cm², both P < 0.05). In adjusted Cox models, a large LDM area was independently associated with incident diabetes in males (hazard ratio [HR], 2.36; 95% CI, 1.52–3.67) and females (HR, 2.15; 95% CI, 1.28–3.61). Adding LDM area to traditional risk factor models increased the area under the curve from 0.810 to 0.838 in males and from 0.893 to 0.908 in females.
Why it matters
Intramuscular fat infiltration in the thigh is a strong independent predictor of incident diabetes that enhances risk discrimination beyond traditional cardiometabolic factors.
Limits
The study was restricted to East Asian individuals with preexisting cardiometabolic risk factors, limiting generalizability to healthier or non-Asian populations. CT was performed only at baseline, precluding evaluation of changes in muscle quality over time. Residual confounding from unmeasured lifestyle factors such as specific diet or exercise regimens cannot be excluded.
Cited by
- supports Having high-quality skeletal muscle makes it significantly harder to develop metabolic disorders.
- partial Having high-quality skeletal muscle mass makes the occurrence of type 2 diabetes extraordinarily rare.