Article
Association of the bioelectrical phase angle with incident type 2 diabetes and glycaemic deterioration: Results from the MONICA/KORA studies
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Authors
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Feiling Ai
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
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Marie-Theres Huemer
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Wolfgang Rathmann
- Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, Neuherberg, Germany
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Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
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Jana Nano
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Michael Drey
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
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Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany; German Center for Diabetes Research (DZD), Partner München-Neuherberg, Neuherberg, Germany
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Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany; German Center for Diabetes Research (DZD), Partner München-Neuherberg, Neuherberg, Germany
| Published: | September 6, 2024 |
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Outline
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Background and aims: Higher values of the bioelectrical impedance analysis (BIA)-derived phase angle (PhA) have been suggested to reflect higher cell integrity and are considered to be a marker of a good general health status. Along these lines, cross-sectional studies have suggested that persons with type 2 diabetes (T2D) have lower PhA values. However, the relationship between the PhA and incident T2D remains largely unknown. Therefore, we examined the association of the PhA with changes in glucose- and insulin-related traits and the development of T2D.
Methods: The present analysis included 7,031 men and women without diabetes aged 25–74 years from the Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) Augsburg S3 study (n=3,372) conducted in 1994–1995 and the Cooperative Health Research in the Region of Augsburg (KORA) S4 study (n=3,659) conducted in 1999–2001. Participants were followed-up for the development of T2D until 2016. Additionally, participants aged 55–74 years from the S4 study who were followed up in 2006–2008 (F4) and 2013–2014 (FF4) were included in the analysis of changes in glucose- and insulin-related traits (n=792–804, depending on the outcomes). Measurement of the PhA was performed at baseline using BIA (50 kHz and 800 μA). Incident T2D was initially assessed by self-report at several time points throughout the follow-up period and later validated by contacting the treating physician or medical chart review. At S4, F4 and FF4, fasting glucose, 2-h glucose, HOMA2-IR, HOMA2-B, and HbA1c were measured. The association of the baseline PhA with incident T2D in the MONICA/KORA S3/S4 studies was assessed using multivariable Cox regression models adjusted for age, sex, waist circumference, clinical and lifestyle factors. In addition, multivariable adjusted two-level growth models were used to assess associations of the PhA with changes in fasting glucose, 2-h glucose, HOMA2-IR, HOMA2-B, and HbA1c in the KORA S4/F4/FF4 studies.
Results: Over a median follow-up period of 15.7 years, 711 of the 7,031 participants developed T2D. Contrary to our hypothesis based on cross-sectional data, the baseline PhA was positively associated with incident T2D (HR [95% CI] per degree increase: 1.37 [1.22–1.55]) after multivariable adjustment. In the two-level growth models, the baseline PhA was also positively associated with fasting glucose and HOMA2-IR (cross-sectional between-participant effect) and with 10-year changes in 2-h glucose (longitudinal within-participant effect) with increases of 1.2% [0.1%–2.2%], 7.0% [2.3%–11.7%], and 4.5% [2.3%–6.7%] per degree increase of the baseline PhA, respectively.
Conclusion: The PhA was positively associated with the development of T2D and adverse changes in glucose- and insulin-related traits, while these associations were independent of other T2D risk factors including markers of obesity and body fat distribution. Future research needs to further elucidate the exact mechanisms explaining the observed positive links and to assess the potential utility of the PhA as a marker for T2D development.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
