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. 2025 Jun 14;17(1):213.
doi: 10.1186/s13098-025-01766-w.

From muscle quality to metabolic health: investigating the association between muscle quality index and metabolic syndrome in adults

Wen Chen #  1 , Debin Chen #  2 , Yizhou Zhuang #  3   4 , Liying Xu  5   6 , Yaojie Wang  7 , Youlan Chen  8 , Yining Li  9 , Jianhui Zhao  10   11
Affiliations

From muscle quality to metabolic health: investigating the association between muscle quality index and metabolic syndrome in adults

Wen Chen et al. Diabetol Metab Syndr. .

Abstract

Objective: Metabolic syndrome (MetS) has a high prevalence in the United States (US); however, limited research comprehensively evaluates the relationship between muscle quality index (MQI) and MetS. This study aims to investigate the association between MQI and MetS.

Methods: Adults aged 20-60 years from the 2011-2014 National Health and Nutrition Examination Survey were included. Handgrip strength (HGS) was measured using a dynamometer, and appendicular skeletal muscle mass (ASM) was assessed via dual-energy X-ray absorptiometry. MQI_total was calculated as the sum of HGS from both hands divided by ASM. Weighted multivariable logistic regression models and restricted cubic splines (RCS) were used to explore the association between MQI_total and MetS, and subgroup, interaction, and sensitivity analyses were conducted.

Results: A total of 4,503 US residents were included in the study, with 1,165 diagnosed with MetS, yielding a prevalence of 25.9% (1,165/4,503). The weighted multivariable logistic regression model indicated that after adjusting for multiple covariates, MQI was negatively associated with the risk of MetS (odds ratio [OR] = 0.49, 95%CI: 0.32-0.73). Among the different components of MetS, MQI was negatively associated with elevated waist circumference (OR = 0.19, 95%CI: 0.12-0.28), elevated high-density lipoprotein cholesterol (OR = 0.66, 95%CI: 0.51-0.85), and elevated serum triglycerides (OR = 0.66, 95%CI: 0.51-0.85). RCS revealed a negative linear relationship between MQI and MetS (P < 0.001, Pnon-linear = 0.98).

Conclusion: Low MQI is associated with an increased risk of MetS, exhibiting a linear relationship. These findings suggest that improving muscle quality may be an effective strategy for the prevention of MetS.

Keywords: Metabolic syndrome; Muscle quality index; Odds ratio; Prevalence.

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Conflict of interest statement

Declarations. Ethical approval: The NHANES protocol was approved by the National Center for Health Statistics Research Ethics Review Board, and all NHANES participants had signed informed consent. Therefore, access to NHANES database does not require any ethical or administrative permission. More information is available at the website ( www.cdc.gov/nchs/nhanes/ accessed on 31 December 2024). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of this study. Abbreviations: NHANES, National Health and Nutrition Examination Survey; MetS, Metabolic Syndrome
Fig. 2
Fig. 2
The relationships between muscle quality index and the risk of metabolic syndrome (A), as well as its components—elevated waist circumference (B), elevated TGs (C), hypertension (D), elevated fasting glucose (E), and reduced HDL-C (F) using restricted cubic splines. The restricted cubic splines model was adjusted for age, gender, ethnicity, educational level, marital status, PIR, smoking status, drinking status, METs, energy intake, uric acid levels, AST levels, ALT levels. Abbreviations: MQI, muscle quality index; MetS, metabolic syndrome; HDL-C, high density lipoprotein cholesterol; TGs, triglycerides; PIR, poverty income ratio; METs, metabolic equivalent of tasks; AST, aspartate aminotransferase; ALT, alanine aminotransferase
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