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Role of Muscle Mass and Muscle Quality in the Association Between Diabetes and Gait Speed
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OBJECTIVE: Older people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb muscle mass and muscle quality to verify whether diabetes-related muscle impairments mediate the association between diabetes and low walking speed. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis of 835 participants (65 years old and older) enrolled in the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) population-based study. Total, muscular, and fat cross-sectional areas of the calf and relative muscle density were measured using peripheral quantitative computerized tomography. Indicators of muscle performance included knee-extension torque, ankle plantar flexion and dorsiflexion strength, lower-extremity muscle power, and ankle muscle quality (ratio of ankle strength to the muscle area [kilograms per centimeters squared]). Gait performance was assessed by 4- and 400-m walking speed. Diabetes was ascertained by standard American Diabetes Association criteria. RESULTS: Prevalence of diabetes was 11.4%. After adjustment for age and sex, participants with diabetes had lower muscle density, knee and ankle strength, and muscle power and worse muscle quality (all P < 0.05). Diabetic participants were also slower on both 4-m (β: −0.115 ± 0.024 m/s, P < 0.001) and 400-m (β:−0.053 ± 0.023 m/s, P < 0.05) walking tests. In multivariable linear regression models, lower-limb muscle characteristics accounted for 24.3 and 15.1% of walking speed difference comparing diabetic and nondiabetic subjects in the 4- and 400-m walks, respectively. CONCLUSIONS: In older persons, diabetes is associated with reduced muscle strength and worse muscle quality. These impairments are important contributors of walking limitations related to diabetes.
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![Figure 1 Percent reduction in the association between diabetes and gait speed after adjustment for all potential mediators of the association (fully adjusted), for all muscular mediators, and for individual covariates. Bars show the reduction in β coefficient (from linear regression models) for diabetes compared with basic model (age and sex): [1 − (β adjusted/β basic)]. Gray bars, 4-m gait speed; black bars, 400-m gait speed.](/paper-figures/b12c971fd3944884bf1d20de7583ee49/role-of-muscle-mass-and-muscle-quality-in-the-association-between-diabetes-and-figure-1.jpg)
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“For example, studies have suggested that impaired muscle function potentially mediates the association of diabetes with impaired gait and low walking speed in older adults (aged 65 and older).35”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [35]
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Metadata
- Authors
- Volpato, S., Bianchi, L., Lauretani, F., Lauretani, F., Bandinelli, S., Guralnik, J. M., Zuliani, G., & Ferrucci, L.
- Affiliations
- University of Ferrara (IT)
- Ospedale di Parma (IT)
- Azienda Sanitaria di Firenze (IT)
- University of Maryland, Baltimore (US)
- National Institute on Aging (US)
- Corresponding author
- Volpato, Stefano
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2012-07-14
- Volume
- 35
- Issue
- 8
- Pages
- 1672-1679
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3402248
- OpenAlex
- W2164208500
- Cited by
- 294
- References
- 33
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 22 · 2023: 22 · 2022: 23 · 2021: 26 · 2020: 20 · 2019: 15 · 2018: 26 · 2017: 21 · 2016: 22 · 2015: 17 · 2014: 16 · 2013: 14 · 2012: 4
- FWCI
- 10.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Funders
- Ministero della Salute (ICS 110.1/RF97.71, 263 MD 821336, 263 MD 9164)
- National Institute on Aging (263 MD 9164, 821336, ICS 110.1/RF97.71, 263MD821336)
- National Institute on Minority Health and Health Disparities (263MD9164, 263MD 821336, R01MD009164)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- type 2 diabetes, walking speed, muscle mass, muscle quality, muscle density, muscle strength, muscle power, lower limb muscles, older adults, mobility impairment, peripheral quantitative computed tomography, knee extension torque, ankle dorsiflexion strength, InCHIANTI cohort
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Gait, Humans, Male, Muscle, Skeletal, Muscle Strength
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