Association of muscle mass and fat mass with insulin resistance and the prevalence of metabolic syndrome in Korean adults: a cross-sectional study

Abstract

Relationship of muscle mass and fat mass with insulin resistance and metabolic syndrome remains uncertain, especially among Asian population. We performed a cross-sectional study with 14,807 adult participants aged between 18 and 65 in the fourth and fifth Korea National Health and Nutrition Examination Survey with Dual Energy X-ray Absorptiometry (DEXA) data to investigate whether muscle mass and fat mass are associated with insulin resistance and metabolic syndrome. DEXA records were used to categorize the participants into four categories (low muscle/low fat, low muscle/high fat, high muscle/ low fat, and high muscle/high fat). Least square means and incidence rate ratios (IRR) were used to assess the associations of muscle mass and fat mass with insulin resistance and metabolic syndrome. After adjustment for potential confounders, high muscle/low fat was associated with significantly lower insulin resistance (P < 0.001) compared to low muscle/low fat. Low muscle/high fat (IRR: 1.90; 95% confidence interval [CI]:1.44-2.50, P < 0.001) and high muscle/high fat (IRR: 2.30; 95% CI:1.76-3.00, P < 0.001) were significantly associated with the prevalence of metabolic syndrome. Our study suggests that protective association of muscle mass with metabolic syndrome is attenuated by high fat mass in Korean adults.

Figure 1

Least square mean of insulin resistance (HOMA-IR) by muscle mass and fat mass. Adjusted for sociodemographic factors (age, sex, education, employment status, area of residence, household income), health behavior (smoking, alcohol consumption, sleep duration, physical activity) and health-related status (BMI, and presence of comorbidity). Abbreviations: BMI, Body Mass Index; HOMA-IR, the Homeostasis Model Assessment of Insulin Resistance *P < 0.001 (reference group is low muscle/low fat).