Fig. 1Distribution of the four types of body composition according to sex and age groups at (A, B) baseline and (C, D) their respective changes after the 5-year follow-up period.
Fig. 2(A) Transitions of each body composition phenotype from baseline to follow-up after 5 years. (B) Incidence of type 2 diabetes mellitus (T2DM) in the baseline “high muscle/low fat” group according to the transition of body composition during the follow-up period. aP<0.01 between the groups by chi-square test.
Table 1Baseline characteristics of the participants
Characteristic |
Men |
Women |
Number |
10,768 |
6,512 |
Age, yr |
48.5±8.1 |
47.5±8.6 |
Height, cm |
170.9±5.8 |
158.7±5.1 |
Weight, kg |
72±9 |
56±7 |
BMI, kg/m2
|
24.7±2.6 |
22.4±2.7 |
LBM, kg |
58±6 |
42±4 |
LBMI, kg/m2
|
19.8±1.5 |
16.6±1.2 |
Muscle mass, kg |
55±6 |
39±4 |
MMI, kg/m2
|
18.7±1.4 |
15.7±1.2 |
ASM, kg |
26±3 |
18±2 |
ASMI, kg/m2
|
9.0±0.7 |
7.3±0.6 |
Fat mass, kg |
13.9 (11.3–16.8) |
14.0 (11.4–17.0) |
FMI, kg/m2
|
4.8 (3.9–5.8) |
5.5 (4.5–6.8) |
Waist, cm |
86±7 |
75±7 |
Smoking, % |
|
|
Current |
35.3 |
2.4 |
Ex-smoker |
42.6 |
2.9 |
Alcohol use (≥2 times/wk), % |
54.3 |
12.2 |
Exercise (≥3 times/wk), % |
51.3 |
59.6 |
Hypertension, % |
24.1 |
13.8 |
SBP, mm Hg |
120±13 |
112±14 |
DBP, mm Hg |
75±9 |
70±9 |
Total cholesterol, mmol/L |
4.94±0.85 |
4.91±0.88 |
HDL-C, mmol/L |
1.34±0.31 |
1.63±0.36 |
TG, mmol/L |
1.41 (1.01–1.98) |
0.95 (0.71–1.32) |
FPG, mmol/L |
5.6±1.1 |
5.2±0.8 |
HbA1c, % (mmol/mol) |
5.5±0.7 (37±8) |
5.3±0.6 (34±7) |
Insulin, pmol/L |
45.8 (31.9–66.0) |
39.6 (28.5–55.6) |
HOMA-IR |
1.6 (1.1–2.4) |
1.3 (0.9–1.9) |
HOMA-β |
71 (50–101) |
72 (53–100) |
Table 2Comparison of baseline characteristics and incidence of type 2 diabetes mellitus according to four body composition phenotypes at baseline
Characteristic |
Men |
Women |
Low muscle/low fat |
High muscle/low fat |
Low muscle/high fat |
High muscle/high fat |
Low muscle/low fat |
High muscle/low fat |
Low muscle/high fat |
High muscle/high fat |
Number |
3,585 (33) |
1,915 (18) |
1,802 (17) |
3,466 (32) |
2,041 (31) |
1,274 (20) |
1,249 (19) |
1,948 (30) |
Age, yr |
48.8±8.2 |
46.8±7.6 |
50.7±8.1 |
47.8±7.8 |
44.5±8.5 |
46.7±7.2 |
49.7±8.9a
|
49.5±8.5a
|
Height, cm |
170.4±5.5 |
173.9±5.3 |
167.5±5.3 |
170.9±5.8 |
159.2±4.8 |
160.7±4.7 |
156.1±4.9 |
158.4±4.9 |
Weight, kg |
64.0±5.4 |
74.0±5.2 |
69.6±4.9 |
80.4±7.5 |
50.2±3.7 |
56.1±3.8 |
55.4±3.9 |
63.4±6.3 |
BMI, kg/m2
|
22.1±1.5 |
24.5±1.1 |
24.8±1.3 |
27.3±1.9 |
19.8±1.3 |
21.7±1.1 |
22.7±1.3 |
25.3±2.3 |
LBM, kg |
53.5±4.3b
|
62.0±4.3c
|
53.4±3.6b
|
62.0±5.2c
|
39.4±2.6 |
44.3±2.7c
|
39.0±2.6 |
44.6±3.4c
|
LBMI, kg/m2
|
18.4±1.0 |
20.5±0.8 |
19.1±0.7 |
21.1±1.0 |
15.6±0.8 |
17.2±0.7 |
16.0±0.7 |
17.8±1.0 |
ASM, kg |
24.3±2.2 |
28.4±2.2 |
24.0±1.9 |
28.2±2.6 |
17.4±1.4 |
19.8±1.5 |
17.0±1.4 |
20.0±1.8 |
ASMI, kg/m2
|
8.4±0.4 |
9.4±0.3 |
8.5±0.3 |
9.6±0.5 |
6.9±0.3 |
7.7±0.3 |
7.0±0.3 |
7.8±0.4 |
Fat mass, kg |
10.7 (9.0–12.2) |
12.2 (10.8–13.4) |
15.7 (14.4–17.5) |
17.7 (15.7–20.0) |
11.0 (9.4–12.4) |
12.1 (10.5–13.3) |
16.0 (14.7–17.6) |
17.7 (15.8–20.7) |
FMI, kg/m2
|
3.7 (3.1–4.2) |
4.1 (3.6–4.4) |
5.5 (5.1–6.2) |
5.9 (5.3–6.8) |
4.3 (3.7–4.9) |
4.7 (4.1–5.2) |
6.5 (6.0–7.2) |
7.0 (6.2–8.2) |
Waist, cm |
80±5 |
85±4 |
87±5 |
92±6 |
69±5 |
74±5 |
76±5 |
81±7 |
Smoking, % |
36.6b
|
38.1b
|
28.6 |
36.0b
|
3.0 |
3.8 |
1.2 |
1.8 |
Alcohol use (≥ ×2/wk), % |
50.0 |
58.6 |
52.9 |
57.5 |
12.2b
|
12.9b
|
10.7b
|
12.7b
|
Exercise (≥ ×3/wk), % |
52.6 |
56.7 |
48.6a
|
48.2a
|
56.0 |
69.7 |
55.3 |
58.6 |
Hypertension, % |
16.1b
|
17.3b
|
32.0a
|
31.5a
|
6.4 |
8.5 |
17.0 |
22.0 |
SBP, mm Hg |
117±13 |
119±12 |
122±13a
|
123±13a
|
108±13 |
109±14 |
114±15 |
116±15 |
DBP, mm Hg |
74±9b
|
74±9b
|
77±9a
|
77±9a
|
67±8b
|
68±9b |
71±9a
|
72±10a
|
HDL-C, mmol/L |
1.45±0.34 |
1.37±0.31 |
1.32±0.28 |
1.27±0.28 |
1.73±0.36 |
1.68±0.39 |
1.60±0.36 |
1.50±0.34 |
TG, mmol/L |
1.20 (0.89–1.69) |
1.27 (0.95–1.80) |
1.54 (1.14–2.12) |
1.61 (1.18–2.26) |
0.83 (0.65–1.13)b
|
0.83 (0.64–1.17)b
|
1.05 (0.80–1.46) |
1.10 (0.81–1.54) |
FPG, mmol/L |
5.5±1.1b
|
5.5±0.9b
|
5.7±1.2a
|
5.7±1.1a
|
5.1±0.7b |
5.2±0.8b |
5.3±0.7 |
5.4±0.9 |
HbA1c, % (mmol/mol) |
5.4±0.7 (36±8)b
|
5.4±0.6 (36±7)b
|
5.6±0.8 (38±9)a
|
5.6±0.8 (38±9)a
|
5.2±0.5 (33±5)b
|
5.3±0.5 (34±5)b
|
5.4±0.5 (36±5) |
5.5±0.7 (37±8) |
HOMA-IR |
1.2 (0.9–1.8) |
1.4 (1.0–2.0) |
1.9 (1.3–2.7) |
2.1 (1.5–3.1) |
1.1 (08–1.6)b
|
1.1 (0.8–1.6)b
|
1.5 (1.0–2.0) |
1.6 (1.1–2.4) |
HOMA-β |
59 (42–81) |
64 (47–90) |
79 (57–110) |
87 (63–122) |
67 (49–92)b
|
65 (46–89)b
|
75 (55–102) |
82 (61–115) |
Incident diabetes |
121 (3.4)b
|
71 (3.7)b
|
117 (6.5) |
284 (8.2) |
18 (0.9) |
25 (2.0) |
34 (2.7) |
101 (5.2) |
Table 3Comparison of changes in characteristics among four transition types of body composition in the baseline high muscle/low fat group
Characteristic |
Men |
Women |
Low muscle/low fat |
High muscle/low fat |
Low muscle/high fat |
High muscle/high fat |
Low muscle/low fat |
High muscle/low fat |
Low muscle/high fat |
High muscle/high fat |
Number |
419 (22) |
647 (34) |
318 (17) |
531 (27) |
368 (29) |
311 (24) |
357 (28) |
238 (19) |
Age, yr |
54±7a
|
52±8b
|
54±7a
|
51±7b
|
52±7a
|
51±7a
|
54±7 |
53±7a
|
Height, cm |
173.5±5.2a
|
174.0±5.3a
|
173.1±5.3a
|
174.5±5.2a
|
160.8±4.7a
|
161.5±4.7a
|
159.9±4.9a
|
160.9±4.3a
|
Weight, kg |
69.2±4.2 |
73.1±5.1b
|
73.4±4.4b
|
78.8±5.8 |
52.7±3.3 |
56.1±3.7 |
56.9±3.7 |
61.0±3.9 |
BMI, kg/m2
|
23.0±0.8 |
24.1±0.9 |
24.5±0.8 |
25.9±1.0 |
20.3±0.9 |
21.4±1.1 |
22.2±0.9 |
23.5±1.1 |
LBM, kg |
57.2±3.1 |
61.3±4.1 |
56.9±3.2 |
62.0±4.3 |
40.6±2.3a
|
44.1±2.6b
|
40.2±2.4a
|
43.9±2.6b
|
LBMI, kg/m2
|
19.0±0.5 |
20.2±0.7 |
19.0±0.5 |
20.1±0.8 |
15.7±0.5 |
16.8±0.7 |
15.7±0.6 |
17.8±0.6 |
ASM, kg |
26.3±1.6a
|
28.3±2.1b
|
26.0±1.6a
|
28.5±2.2b
|
18.3±1.2 |
20.0±1.4b
|
17.9±1.3 |
19.8±1.3b
|
∆ASM, kg |
−1.3 ± 0.8 |
−0.4 ± 0.8 |
−1.5 ± 0.8 |
0.6 ± 1.0 |
−1.2 ± 0.6 |
−0.3 ± 0.7 |
−1.4 ± 0.7 |
0.6 ± 0.7 |
ASMI, kg/m2
|
9.1±0.1a
|
9.5±0.3b
|
9.2±0.2a
|
9.6±0.4b |
7.5±0.2 |
7.8±0.3b
|
7.6±0.2 |
7.9±0.3b
|
Fat mass, kg |
12.3 (11.1 to 13.3)a
|
12.2 (10.8 to 13.3)a
|
16.2 (15 to 17.6)c
|
16.5 (15.2 to 17.9)c
|
12.3 (10.9 to 13.4)a
|
12.4 (11 to 13.5)a
|
16.4 (15.2 to 17.9) |
16.6 (15.5 to 18.4) |
∆Fat mass, kg |
0.8 (–0.3 to 2.1) |
0.5 (–0.7 to 1.9) |
3.6 (2.5 to 4.8)c
|
3.5 (2.3 to 5.0)c
|
1.3 (0.1 to 2.6) |
0.8 (–0.5 to 1.9) |
3.9 (2.8 to 5.3)c
|
3.7 (2.5 to 5.2)c
|
FMI, kg/m2
|
4.1 (3.7 to 4.5) |
4.1 (3.6 to 4.4) |
5.1 (5.4 to 5.9)c
|
5.3 (5.1 to 5.8)c
|
4.7 (4.2 to 5.2)a
|
4.8 (4.2 to 5.2)a
|
6.3 (6.0 to 6.9)c
|
6.4 (6.0 to 7.0)c
|
Waist, cm |
83.4±4.1 |
84.8±4.3 |
88.4±432.7 |
90.5±4.2 |
73.2±4.4 |
74.7±4.4 |
78.3±4.3 |
80.6±4.4 |
Smoking, % |
29a
|
28a
|
32a
|
32a
|
3a
|
3a
|
3a
|
3a
|
Alcohol use (≥ ×2/wk), % |
58.1a
|
56.9a
|
61.8a
|
62.0a
|
11.7a
|
12.5a
|
14.4a
|
12.7a
|
Exercise (≥ ×3/wk), % |
56.0a
|
60.6a
|
52.0a
|
54.9a
|
70.0a
|
72.2a
|
66.9a
|
69.9a
|
Hypertension, % |
30.9 |
31.5 |
38.6 |
40 |
10.7a
|
11.9a
|
16.2c
|
16c
|
SBP, mm Hg |
121±12 |
124±12b
|
124±12b
|
126±13 |
111±12a
|
112±12a,b
|
114±13b,c
|
115±12c
|
DBP, mm Hg |
78±10a
|
79±10a
|
80±10a,c
|
81±11c
|
70±10a
|
70±10a
|
71±10a
|
72±10a
|
HDL-C, mmol/L |
1.42±0.39a
|
1.40±0.36a
|
1.32±0.31c
|
1.27±0.31c
|
1.78±0.44a
|
1.73±0.44a
|
1.60±0.39c
|
1.60±0.36c
|
TG, mmol/L |
1.09 (0.81 to 1.58)a
|
1.11 (0.81 to 1.52)a
|
1.32 (1.02 to 1.79) |
1.46 (1.07 to 1.99) |
0.79 (0.61 to 1.10)a
|
0.77 (0.60 to 1.06)a
|
1.01 (0.73 to 1.37)c
|
0.97 (0.71 to 1.26)c
|
FPG, mmol/L |
5.6±1.2a
|
5.5±0.9a
|
5.6±1.1a
|
5.6±0.8a
|
5.1±0.6a
|
5.1±0.7a
|
5.2±0.7 |
5.2±0.8a
|
HbA1c, % (mmol/mol) |
5.6±0.6 (38±7)a
|
5.6±0.6 (38±7)a
|
5.6±0.6 (38±7)a
|
5.6±0.5 (38±5)a
|
5.4±0.4 (36±4) |
5.5±0.4 (37±4)b
|
5.5±0.4 (37±4)b
|
5.5±0.6 (37±7)b
|
HOMA-IR |
1.0 (0.6 to 1.5)a
|
1.0 (0.6 to 1.5)a
|
1.4 (1.0 to 2.0)c
|
1.4 (0.9 to 2.0)c
|
0.7 (0.4 to 1.2)a
|
0.8 (0.5 to 1.2)a
|
1.0 (0.6 to 1.5) |
1.1 (0.7 to 1.61) |
HOMA-β |
62 (46 to 85)a
|
61 (45 to 82)a
|
67 (48 to 99) |
73 (54 to 100) |
63 (45 to 88)a
|
65 (45 to 86)a
|
67 (47 to 88)a
|
72 (57 to 94) |
Incident diabetes |
20 (4.8)a
|
14 (2.2)b
|
18 (5.7)a
|
19 (3.6)a,b
|
6 (1.6)a
|
5 (1.6)a
|
10 (2.8) |
4 (1.7)a
|
Table 4ORs for incident diabetes in men and women according to obesity status
Variable |
Men |
Women |
Non-obese (n=6,084, 56.5%) |
Obese (n=4,684, 43.5%) |
Non-obese (n=5,516, 84.7%) |
Obese (n=996, 15.3%) |
OR |
95% CI |
OR |
95% CI |
OR |
95% CI |
OR |
95% CI |
Model 1 |
|
|
|
|
|
|
|
|
FMI, kg/m2
|
1.12 |
0.91–1.36 |
1.27 |
1.15–1.40 |
0.94 |
0.76–1.17 |
1.13 |
0.97–1.32 |
ASMI, kg/m2
|
0.73 |
0.56–0.95 |
0.82 |
0.70–0.96 |
1.08 |
0.66–1.80 |
1.04 |
0.63–1.72 |
Waist, cm |
1.11 |
1.05–1.15 |
1.06 |
1.02–1.09 |
1.08 |
1.02–1.14 |
1.09 |
1.03–1.14 |
Model 2 |
|
|
|
|
|
|
|
|
FMI, kg/m2
|
1.09 |
0.87–1.36 |
1.33 |
1.18–1.49 |
1.02 |
0.78–1.33 |
1.12 |
0.91–1.38 |
ASMI, kg/m2
|
0.79 |
0.65–0.96 |
0.86 |
0.76–0.97 |
1.06 |
0.74–1.52 |
0.91 |
0.78–1.06 |
Waist, cm |
1.08 |
1.02–1.13 |
1.04 |
0.98–1.10 |
1.04 |
0.98–1.10 |
1.06 |
0.97–1.15 |
Model 3 |
|
|
|
|
|
|
|
|
FMI, kg/m2
|
1.07 |
0.82–1.39 |
1.31 |
1.17–1.46 |
0.96 |
0.76–1.21 |
1.08 |
0.85–1.37 |
ASMI, kg/m2
|
0.71 |
0.52–0.97 |
0.87 |
0.77–0.98 |
1.11 |
0.76–1.62 |
0.89 |
0.74–1.07 |
Waist, cm |
1.07 |
1.01–1.13 |
0.98 |
0.93–1.03 |
1.03 |
0.97–1.09 |
1.05 |
0.94–1.17 |