People with peripheral arterial disease and diabetes are associated with clinically significant weakness and mobility impairment

Abstract

INTRODUCTION: Low lean mass is associated with weakness, limited mobility, and increased risk of mortality. In the recent effort of Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, an appendicular lean mass (ALM) cutpoints for clinically significant weakness were derived. Peripheral arterial diseases (PAD) and diabetes have been shown to be associated with reduced lean mass. However, whether these diseases are associated with clinically significant weakness remain unknown. In the current study, we aimed to investigate whether PAD and diabetes are associated with clinically significant weakness and mobility impairment as defined by the FNIH Sarcopenia Project. METHODS: Data on 4841 participants aged ≥40 years of the National Health and Nutrition Examination Survey 1999-2004 were examined. ALM was measured using dual-energy X-ray absorptiometry. Logistic regression was used to assess the association of diabetes and PAD with low lean mass. Low lean mass was defined as ALM of < 19.75 kg in men and ALM of < 15.02 kg in women. RESULTS: In the simple model adjusted for age, sex, body mass index, and race/ethnicity, participants with PAD alone and both PAD and diabetes were associated with low lean mass with an odds ratio (OR) of 1.65 (95% confidence interval [CI], 1.07-2.56) and 2.07 (95% CI, 1.10-3.89), respectively. No association was observed between diabetes and low lean mass. After further adjustment for smoking, drinking, exercise, hypertension, estimated glomerular filtration rate, microalbuminuria, serum biomarkers of liver function, and cardiometabolic biomarkers, participants with both PAD and diabetes remained significantly associated with low lean mass (OR=2.08; 95% CI, 1.03-4.19). No association was observed for diabetes only and PAD only with low lean mass. CONCLUSIONS: People with both diabetes and PAD had a higher likelihood of low lean mass and hence clinically significant weakness. Intervention to improve muscle mass and strength may be useful to improve mobility and reduce risk of mortality in these people.