title: Explanators of Sarcopenia in Individuals With Diabesity: A Cross-Sectional Analysis.
abstract: OBJECTIVE
  Excess lower extremity intermuscular adipose tissue (IMAT), reduced strength, and functional limitations are common in obese individuals with and without diabetes (the former termed diabesity). Individuals with diabesity are particularly susceptible to accelerated sarcopenia, which may be underdiagnosed. The purpose of this study was to determine critical values for leg IMAT volume, plantar flexor (PF) muscle strength, and physical performance that help identify individuals with diabesity who have sarcopenia.
  
  
  METHODS
  Forty-three age- and sex-matched obese adults were studied: 12 with type 2 diabetes, 21 with diabetes and peripheral neuropathy, and 10 nondiabetic controls. Dual-energy x-ray absorptiometry-derived skeletal muscle index determined classification of sarcopenia. Leg fat (% IMAT), ankle (PF) peak torque, and power while ascending 10 steps, were used as explanators of sarcopenia. Receiver operating curves identified critical values for each explanator individually. Logistic regression models using all 3 explanators, and only PF torque and stair power, were also created. Receiver operating curve analyses identified the predicted probability that maximized each model's sensitivity and specificity. A leave-one-out cross validation was used to simulate the models' performance in an independent sample.
  
  
  CONCLUSIONS
  Thirty-two participants were sarcopenic, and 11 were not. Critical values for individual explanators were 21% IMAT, 68 Nm PF torque, and 441 watts of stair power. Predicted probabilities of .76 and .67 were chosen as the optimal cutoff probabilities for the model combining all 3 explanators, and the model combining PF torque and stair power, respectively. The cross-validation analysis produced an accuracy of 82.4%, using the cutoff probability of .5, and an accuracy of 76.5% using the cutoff of 0.76. The area under the curve for the cross validation receiver operating curve analysis was 0.82. Critical values of leg % IMAT, PF torque, and stair power can classify individuals with diabesity as sarcopenic. The results of the cross validation give us confidence that the sample used in this study was representative of the target population, and suggests models created from this sample may perform well in externally derived data sets.
  
  
  CONCLUSIONS
  Clinicians may be able to use these critical values to select interventions that specifically target sarcopenia. Measures of % IMAT, PF torque, and stair power may offer a customized alternative to traditional sarcopenic classification systems, which may not be optimally suited to the common impairments among individuals with diabesity.
authors: 1Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri. 2Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California.
authors: Adam J
authors: AJ
authors: Bittel
authors: Daniel C
authors: DC
authors: Bittel
authors: Lori J
authors: LJ
authors: Tuttle
authors: Michael J
authors: MJ
authors: Strube
authors: Michael J
authors: MJ
authors: Mueller
authors: W Todd
authors: WT
authors: Cade
authors: David R
authors: DR
authors: Sinacore
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000534:rehabilitation; D003929:Diabetic Neuropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009765:Obesity / Q000453:epidemiology* / Q000534:rehabilitation; D055948:Sarcopenia / Q000453:epidemiology* / Q000534:rehabilitation; D019415:Torque