Association of Body Composition with Insulin Resistance in a
                    Middle-Aged Population

Ke Zhou; Mengru Chen; Yuyan Zhang; Qingfang Deng; Hao Kang; Kangping Li; Yufan Wu; Jie Zhang; Jiaojiao Zhu; Ting Zheng; Aixia Zhang; Jie Sheng; Xing Liu; Sufang Wang

doi:10.1055/a-2691-0442

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2025; 57(09): 520-528
DOI: 10.1055/a-2691-0442

Original Article: Endocrine Care

Association of Body Composition with Insulin Resistance in a Middle-Aged Population

Authors

Ke Zhou ‡

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)

²Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Hefei, China

³NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China

⁴Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
Mengru Chen

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Yuyan Zhang‡

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Qingfang Deng

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Hao Kang

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Kangping Li

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Yufan Wu

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)
Jie Zhang

⁵Hongguang Street Community Health Service Center, Hefei, China
Jiaojiao Zhu

⁵Hongguang Street Community Health Service Center, Hefei, China
Ting Zheng

⁵Hongguang Street Community Health Service Center, Hefei, China
Aixia Zhang

⁵Hongguang Street Community Health Service Center, Hefei, China
Jie Sheng

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)

²Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Hefei, China

³NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China

⁴Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
Xing Liu

⁵Hongguang Street Community Health Service Center, Hefei, China
Sufang Wang

¹School of Public Health, Anhui Medical University, Hefei, China (Ringgold ID: RIN12485)

²Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Hefei, China

³NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China

⁴Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China

Abstract

This study aims to clarify the relationship between body mass index, body composition indices, and the risk of insulin resistance. From November 2019 to January 2020, 573 employees aged 40–60 years from Anhui Hong Sifang Co., Ltd, underwent physical and biochemical assessments. We analyzed fasting glucose, serum insulin, and homeostasis model assessment of insulin resistance differences across body mass index and body composition, and examined associations with insulin resistance risk. Among 573 participants (mean age 48.3 years, 67.4% men), 20.8% had insulin resistance. Overweight/obesity, central obesity, high visceral adipose index, high fat mass%, limb/trunk fat%, and elevated fat-muscle-ratio were significantly associated with higher fasting serum insulin, homeostasis model assessment of insulin resistance, and insulin resistance prevalence (all p<0.05). The increase in these factors corresponded with increased insulin resistance risk, with odds ratios and 95% confidence intervals of 4.71 (2.88–7.72), 5.80 (3.60–9.35), 4.88 (3.07–7.74), 4.25 (2.71–6.69), 3.48 (2.19–5.52), 5.72 (3.45–9.47), and 4.41 (2.73–7.13). Conversely, lower muscle mass%, limb/trunk muscle%, bone mineral content%, total body water%, extracellular water%, and intracellular water% were linked to higher fasting serum insulin and homeostasis model assessment of insulin resistance, indicating a protective effect against insulin resistance with odds ratios and 95% confidence intervals of 4.34 (2.67–7.08), 3.53 (2.21–5.62), 3.49 (2.20–5.53), 5.35 (3.24–8.85), 4.73 (2.91–7.70), 4.99 (3.06–8.16), and 4.98 (3.04–8.14). The findings suggest a significant association between body composition indices and insulin resistance risk. Increased fat mass raises the risk of insulin resistance, while higher muscle mass, bone mineral content, and body water content have a protective effect. Additionally, the balance between fat and muscle influences insulin resistance levels.

Keywords

body composition - diabetes - insulin resistance - middle-aged people

Full Text

References

References
1 Khan RS, Bril F, Cusi K. et al. Modulation of insulin resistance in nonalcoholic fatty liver disease. Hepatology 2019; 70: 711-724
2 Wondmkun YT. Obesity, insulin resistance, and type 2 diabetes: associations and therapeutic implications. Diabetes Metab Syndr Obes 2020; 13: 3611-3616
3 Akatlı Kürşat Ö, Süheyl A, Aydana A. et al. Obesity- insulin resistance and diabetes. Turk J Fam Med. Primary Care 2015; 9: 36
4 Ioannou GN, Bryson CL, Boyko EJ. Prevalence and trends of insulin resistance, impaired fasting glucose, and diabetes. J Diabetes Complicat 2007; 21: 363-370
5 Wang X, Xian T, Jia X. et al. A cross-sectional study on the associations of insulin resistance with sex hormone, abnormal lipid metabolism in T2DM and IGT patients. Medicine (Baltimore) 2017; 96: e7378
6 Park MH, Kim DH, Lee EK. et al. Age-related inflammation and insulin resistance: a review of their intricate interdependency. Arch Pharm Res 2014; 37: 1507-1514
7 Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med 2009; 6 (Suppl. 01) 60-75
8 Shakil-Ur-Rehman S, Karimi H, Gillani SA. Effects of supervised structured aerobic exercise training program on fasting blood glucose level, plasma insulin level, glycemic control, and insulin resistance in type 2 diabetes mellitus. Pak J Med Sci 2017; 33: 576-580
9 Kim SB, Shin TM, Lee YH. Development and evaluation of a bio-ion measurement system on acupoints for meridian diagnosis. J Acupunct Meridian Stud 2013; 6: 110-118
10 Mundi MS, Karpyak MV, Koutsari C. et al. Body fat distribution, adipocyte size, and metabolic characteristics of nondiabetic adults. J Clin Endocrinol Metab 2010; 95: 67-73
11 World Health Organization. Guidelines for controlling and monitoring the tobacco epidemic. World Health Organization 1998
12 Matthews DR, Hosker JP, Rudenski AS. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
13 Xing XY, Yang WY, Yang ZJ. The diagnostic significance of homeostasis model assessment of insulin resistance in metabolic syndrome among subjects with different glucose tolerance. Chin J Diabetes 2004; 12: 182-186
14 Yin XY, Zheng FP, Zhou JQ. et al. Central obesity and metabolic risk factors in middle-aged Chinese. Biomed Environ Sci 2014; 27: 343-352
15 Baker JF, Davis M, Alexander R. et al. Associations between body composition and bone density and structure in men and women across the adult age spectrum. Bone 2013; 53: 34-41
16 Seo YG, Song HJ, Song YR. Fat-to-muscle ratio as a predictor of insulin resistance and metabolic syndrome in Korean adults. J Cachexia Sarcopenia Muscle 2020; 11: 710-725
17 Xu K, Zhu HJ, Chen S. et al. Fat-to-muscle Ratio: a new anthropometric indicator for predicting metabolic syndrome in the Han and Bouyei populations from Guizhou Province, China. Biomed Environ Sci 2018; 31: 261-271
18 Park J, Kim S. Validity of muscle-to-fat ratio as a predictor of adult metabolic syndrome. J Phys Ther Sci 2016; 28: 1036-1045
19 Gamboa-Gómez CI, Simental-Mendía LE, Rodríguez-Morán M. et al. The fat-to-lean mass ratio, a novel anthropometric index, is associated to glucose metabolic disorders. Eur J Intern Med 2019; 63: 74-78
20 Chen YY, Fang WH, Wang CC. et al. Fat-to-muscle ratio is a useful index for cardiometabolic risks: A population-based observational study. PLoS One 2019; 14: e0214994
21 Kurinami N, Sugiyama S, Yoshida A. et al. Correlation of body muscle/fat ratio with insulin sensitivity using hyperinsulinemic-euglycemic clamp in treatment-naïve type 2 diabetes mellitus. Diabetes Res Clin Pract 2016; 120: 65-72
22 Tsai PF, Wang CH, Hunt CW. et al. Relative importance of physical activity and body composition on insulin resistance in older adult population. Top Geriatr Rehab 2022; 38: 165-174
23 Clarke SL, Reaven GM, Leonard D. et al. Cardiorespiratory fitness, body mass index, and markers of insulin resistance in apparently healthy women and men. Am J Med 2020; 133: 825-830.e2
24 Dev R, Bruera E, Dalal S. Insulin resistance and body composition in cancer patients. Ann Oncol. 2018. 29. (Suppl 2): ii18-ii26
25 Tian X, Chen S, Wang P. et al. Insulin resistance mediates obesity-related risk of cardiovascular disease: a prospective cohort study. Cardiovasc Diabetol 2022; 21: 289
26 Lee S, Bacha F, Gungor N. et al. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006; 148: 188-194
27 Chen S, Miki T, Fukunaga A. et al. Associations of serum amino acids with insulin resistance among people with and without overweight or obesity: a prospective study in Japan. Clin Nutr 2022; 41: 1827-1833
28 Misra A, Madhavan M, Vikram NK. et al. Simple anthropometric measures identify fasting hyperinsulinemia and clustering of cardiovascular risk factors in Asian Indian adolescents. Metabolism 2006; 55: 1569-1573
29 Kotlyarevska K, Wolfgram P, Lee JM. Is waist circumference a better predictor of insulin resistance than body mass index in U.S. adolescents?. J Adolesc Health 2011; 49: 330-333
30 Deusdará R, de Moura Souza A, Szklo M. Obesity, overweight, elevated waist circumference and Insulin differ in their associations with insulin resistance markers- the ERICA study. Metabolism 2022; 128: 155103-155103
31 Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004; 79: 379-384
32 Ozturk MA. Association between cardiovascular risk factors and triglyceride to high-density lipoprotein ratio: a single-center experience. Arch Med Sci Atheroscler Dis 2019; 4: e196-e200
33 Zhan R, Liu L, Yang M. et al. Associations of 10 trace element levels in the whole blood with risk of three types of obesity in the elderly. Environ Geochem Health 2023; 45: 9787-9806
34 Reum Khang AH. 279-LB: The role of body composition phenotypes on insulin resistance in nondiabetic asians—The Korea national health and nutrition examination survey (KNHANES) 2008–2011. Diabetes 2023; 72 (Suppl. 01) 279-LB
35 Zegarra-Lizana PA, Ramos-Orosco EJ, Guarnizo-Poma M. et al. Relationship between body fat percentage and insulin resistance in adults with BMI values below 25 Kg/M2 in a private clinic. Diabetes Metab Syndr 2019; 13: 2855-2859
36 Kurniawan LB, Bahrun U, Hatta M. et al. Body Mass, Total body fat percentage, and visceral fat level predict insulin resistance better than waist circumference and body mass index in healthy young male adults in Indonesia. J Clin Med 2018; 7: 96
37 McLaughlin T, Lamendola C, Liu A. et al. Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metab 2011; 96: E1756-E1760
38 Zhang M, Hu T, Zhang S. et al. Associations of different adipose tissue depots with insulin resistance: A systematic review and meta-analysis of observational studies. Sci Rep 2015; 5: 18495
39 Vishvanath L, Gupta RK. Contribution of adipogenesis to healthy adipose tissue expansion in obesity. J Clin Invest 2019; 129: 4022-4031
40 Rader DJ. Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med 2007; 120 (Suppl. 01) S12-S18
41 Ural D, Kılıçkap M, Göksülük H. et al. Data on prevalence of obesity and waist circumference in Turkey: Systematic review, meta-analysis and meta regression of epidemiological studies on cardiovascular risk factors. Turk Kardiyol Dern Ars 2018; 46: 577-590
42 Castro AV, Kolka CM, Kim SP. et al. Obesity, insulin resistance and comorbidities? Mechanisms of association. Arq Bras Endocrinol Metabol 2014; 58: 600-609
43 Fahed G, Aoun L, Bou Zerdan M. et al. Metabolic syndrome: updates on pathophysiology and management in 2021. Int J Mol Sci 2022; 23: 786
44 Alba DL, Farooq JA, Lin MYC. et al. Subcutaneous fat fibrosis links obesity to insulin resistance in Chinese Americans. J Clin Endocrinol Metab 2018; 103: 3194-3204
45 Zhang H, Lin S, Gao T. et al. Association between sarcopenia and metabolic syndrome in middle-aged and older non-obese adults: a systematic review and meta-analysis. Nutrients 2018; 10: 364
46 Seko T, Akasaka H, Koyama M. et al. Preserved lower limb muscle mass prevents insulin resistance development in nondiabetic older adults. J Am Med Dir Assoc 2023; 24: 376-381
47 Ahn SH, Lee JH, Lee JW. Inverse association between triglyceride glucose index and muscle mass in Korean adults: 2008-2011 KNHANES. Lipids Health Dis 2020; 19: 243
48 Beaudart C, Rizzoli R, Bruyère O. et al. Sarcopenia: burden and challenges for public health. Arch Public Health 2014; 72: 45
49 DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care 2009; 32 (Suppl. 02) S157-S163
50 Wu H, Ballantyne CM. Skeletal muscle inflammation and insulin resistance in obesity. J Clin Invest 2017; 127: 43-54
51 O'Neill BT, Lauritzen HP, Hirshman MF. et al. Differential role of insulin/IGF-1 receptor signaling in muscle growth and glucose homeostasis. Cell Rep 2015; 11: 1220-1235
52 Scott D, Cumming R, Naganathan V. et al. Associations of sarcopenic obesity with the metabolic syndrome and insulin resistance over five years in older men: The Concord Health and Ageing in Men Project. Exp Gerontol 2018; 108: 99-105
53 Shin D, Kim S, Kim KH. et al. Association between insulin resistance and bone mass in men. J Clin Endocrinol Metab 2014; 99: 988-995
54 Dennison EM, Syddall HE, Aihie Sayer A. et al. Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance?. Diabetologia 2004; 47: 1963-1968
55 Avnet S, Perut F, Salerno M. et al. Insulin receptor isoforms are differently expressed during human osteoblastogenesis. Differentiation 2012; 83: 242-248
56 Brennan-Speranza TC, Conigrave AD. Osteocalcin: an osteoblast-derived polypeptide hormone that modulates whole body energy metabolism. Calcif Tissue Int 2015; 96: 1-10
57 Zoch ML, Clemens TL, Riddle RC. New insights into the biology of osteocalcin. Bone 2016; 82: 42-49
58 Zhuo M, Chen Z, Zhong ML. et al. Association of insulin resistance with bone mineral density in a nationwide health check-up population in China. Bone 2023; 170: 116703

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