Research Article: Fat-to-muscle ratio is a useful index for cardiometabolic risks: A population-based observational study

Date Published: April 9, 2019

Publisher: Public Library of Science

Author(s): Yuan-Yuei Chen, Wen-Hui Fang, Chung-Ching Wang, Tung-Wei Kao, Hui-Fang Yang, Chen-Jung Wu, Yu-Shan Sun, Ying-Chuan Wang, Wei-Liang Chen, Ying-Mei Feng.


Metabolic disorders are prevalent worldwide and have recently become public health problems recently. Previous studies have proposed different body composition indices for predicting future cardiovascular risks. We hypothesized an association among fat-to-muscle ratio (FMR), metabolic syndrome (MetS), hypertension (HTN), prediabetes, type 2 diabetes mellitus (DM), and cardiovascular risk in an adult population. A total of 66829 eligible subjects composed of 34182 males and 32647 females aged 20 years or older were obtained from health examinations in the Tri-Service General Hospital from 2011 to 2017. The body composition indices included fat and muscle mass measured by bioelectrical impedance analysis. A multivariable regression model was performed in a large population-based cross-sectional study. FMR was significantly associated with MetS, prediabetes, DM and HTN in all models of both genders. Based on quartile analysis, higher FMR had higher predictive ability for adverse health outcomes. The association between different definitions of MetS and the Framingham risk score was analyzed, and FMR-incorporated MetS was more useful for predicting higher Framingham risk scores than traditional definitions. FMR was a useful indicator for the presence of adverse cardiometabolic risks. Compared to traditional definition of MetS, FMR-incorporated MetS had a greater ability to predict incident cardiovascular risks. FMR seemed to be a simple and effective index for the early prevention and management of cardiometabolic events.

Partial Text

The current worldwide prevalence of obesity has increased progressively. As a major public health problem in the world, an increasing number of individuals have been diagnosed with obesity and metabolic syndrome (MetS) in Taiwan with high risks for the development of diabetes mellitus (DM) and hypertension (HTN)[1]. An emerging concept called “sarcopenic obesity”, which reflect a combination of age-associated skeletal muscle loss and fat mass accumulation[2], was also recognized as a critical public health risk in the aging society. Previous studies have proposed an association between sarcopenic obesity and MetS in both sexes[3] and between sarcopenic obesity and insulin resistance in the adult population[4].

In the cross-sectional study of data from the annual health examinations of a medical center in Taiwan for the general population, a novel indicator, FMR, was suggested as an excellent body composition index for predicting the presence of MetS, prediabetes, DM and HTN. FMR was significantly associated with adverse health outcomes and a substantial dose dependent effect was noted in both genders. Furthermore, FMR-incorporated MetS had better predictive ability for the Framingham risk score than other definitions, particularly in females, indicating the possibility that FMR might have the potential capacity for predicting the incident risks of cardiovascular disease mortality.

The present study highlighted a significant association between FMR and MetS, prediabetes, DM and HTN. FMR might be incorporated in newly constructed MetS definitions, which were better able to predict the incident cardiovascular risks than traditional criteria. We provided a simple and useful body composition indicator for the early prevention and management of cardiometabolic risks and improvement of public health. Further studies should focus more effort on the underlying mechanisms of the interaction between body composition and metabolic alternation.




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