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Nutritional Intervention on Diabetes and Muscle: From the Assessment to Treatment

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Diabetes".

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 13829

Special Issue Editor


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Guest Editor
1. Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
2. Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
Interests: malnutrition in geriatrics; hospital malnutrition; muscle ultrasound; dysphagia

Special Issue Information

Dear Colleagues,

Diabetes seems to behave as an independent factor in the loss of skeletal muscle mass. Diabetes accelerates this decline in both muscle mass and strength loss. A higher prevalence of dynapenia, which causes muscle weakness, is observed in patients with DM2, regardless of the maintenance of their muscle mass. There are several proposed pathophysiological mechanisms, but insulin resistance in type 2 diabetes appears to result in a reduction in the body’s overall protein synthesis. On the other hand, pharmacological treatments used in patients with diabetes seem to alter the balance between protein synthesis and degradation through several mechanisms in the regulation of skeletal muscle. There are many comorbidities associated with diabetes, mainly of vascular origin, duly included in the diabetes mellitus management guidelines for proper screening, prevention, and treatment.

However, there are few references in these international guidelines to diabetes-associated sarcopenia in its assessment, diagnosis, and control, despite the impact of this disease and its treatments on muscle mass. In addition, type 2 diabetes is often associated with obesity. This can make the diagnosis of sarcopenia difficult, especially when the definition of sarcopenic obesity is not well defined. It has been proposed that the cut-off points for total muscle mass in kilograms for the diagnosis of sarcopenia should not be the same for obese patients. The aim of this Special Issue is to update our knowledge on the current best practices in sarcopenia and diabetes, from its diagnosis, nutritional intervention, diet and treatment, including both well established and newer novel approaches. We welcome different types of manuscript submissions, including original research articles and up-to-date reviews (systematic reviews and meta-analyses).

Dr. Alejandro Sanz
Guest Editor

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Keywords

  • sarcopenia
  • diabetes
  • diet
  • body composition
  • malnutrition

Published Papers (5 papers)

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Research

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12 pages, 1817 KiB  
Article
Prevalence of Sarcopenia and Dynapenia and Related Clinical Outcomes in Patients with Type 1 Diabetes Mellitus
by María Carmen Andreo-López, María Teresa Zarco-Martín, Victoria Contreras-Bolívar and María Luisa Fernández-Soto
Nutrients 2023, 15(23), 4914; https://doi.org/10.3390/nu15234914 - 24 Nov 2023
Viewed by 1798
Abstract
Background: Sarcopenia has recently been recognized as a complication of diabetes. However, there are few results about the prevalence of sarcopenia and dynapenia and the related clinical outcomes in type 1 diabetes mellitus (T1DM). Our objectives were to evaluate the prevalence of sarcopenia [...] Read more.
Background: Sarcopenia has recently been recognized as a complication of diabetes. However, there are few results about the prevalence of sarcopenia and dynapenia and the related clinical outcomes in type 1 diabetes mellitus (T1DM). Our objectives were to evaluate the prevalence of sarcopenia and dynapenia and to determine whether there are any associations with disease-related factors in people with T1DM. Methods: A cross-sectional study was conducted in people with T1DM. We assessed appendicular skeletal mass index (ASMI) using bioimpedance 50 Hz (Nutrilab Akern). Muscle function was assessed through handgrip strength (HGS) using a Jamar dynamometer. Sarcopenia was defined as a low HGS with low ASMI, whereas dynapenia was defined as low HGS with a normal ASMI. We used HGS data from the Spanish population percentile table and a cut-off point at p5 as dynapenia. The association of clinical, metabolic, and lifestyle variables with sarcopenia and dynapenia was studied. Results: This study included 62 T1DM patients (66% females, mean age of 38 ± 14 years, body mass index (BMI) of 24.9 ± 4.7 kg/m2). The prevalence of sarcopenia and dynapenia was 8% and 23%, respectively. In our sample, there were more men in the sarcopenic and dynapenic groups. The sarcopenic group showed a significantly higher mean HbA1c value. Lower diabetes duration, PREDIMED score, BMI, and muscle mass measures (fat-free mass index (FFMI), ASMI, and body cell mass index (BCMI)) were significantly associated with sarcopenia. Decreased diabetes duration, PREDIMED score, phase angle (PhA), and HGS values showed a significant association with dynapenia. Conclusions: The prevalence of sarcopenia and dynapenia was high in people with T1DM in our study. Specifically, the proportion of dynapenia was quite high. HGS and ASMI are practical tools for the assessment of muscle health status in T1DM, and low values are associated with poor glycemic control, underweight, and low adherence to the Mediterranean diet. Thus, dynapenia may predict accelerated muscle aging in T1DM. Full article
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19 pages, 2719 KiB  
Article
Arginine and Lysine Supplementation Potentiates the Beneficial β-Hydroxy ß-Methyl Butyrate (HMB) Effects on Skeletal Muscle in a Rat Model of Diabetes
by Manuel Manzano, María D. Girón, Rafael Salto, Chiara Burgio, Antonio Reinoso, Elena Cabrera, Ricardo Rueda and Jose M. López-Pedrosa
Nutrients 2023, 15(22), 4706; https://doi.org/10.3390/nu15224706 - 7 Nov 2023
Cited by 3 | Viewed by 2678
Abstract
Skeletal muscle is the key tissue for maintaining protein and glucose homeostasis, having a profound impact on the development of diabetes. Diabetes causes deleterious changes in terms of loss of muscle mass, which will contribute to reduced glucose uptake and therefore progression of [...] Read more.
Skeletal muscle is the key tissue for maintaining protein and glucose homeostasis, having a profound impact on the development of diabetes. Diabetes causes deleterious changes in terms of loss of muscle mass, which will contribute to reduced glucose uptake and therefore progression of the disease. Nutritional approaches in diabetes have been directed to increase muscle glucose uptake, and improving protein turnover has been at least partially an oversight. In muscle, β-hydroxy β-methyl butyrate (HMB) promotes net protein synthesis, while arginine and lysine increase glucose uptake, albeit their effects on promoting protein synthesis are limited. This study evaluates if the combination of HMB, lysine, and arginine could prevent the loss of muscle mass and function, reducing the progression of diabetes. Therefore, the combination of these ingredients was tested in vitro and in vivo. In muscle cell cultures, the supplementation enhances glucose uptake and net protein synthesis due to an increase in the amount of GLUT4 transporter and stimulation of the insulin-dependent signaling pathway involving IRS-1 and Akt. In vivo, using a rat model of diabetes, the supplementation increases lean body mass and insulin sensitivity and decreases blood glucose and serum glycosylated hemoglobin. In treated animals, an increase in GLUT4, creatine kinase, and Akt phosphorylation was detected, demonstrating the synergic effects of the three ingredients. Our findings showed that nutritional formulations based on the combination of HMB, lysine, and arginine are effective, not only to control blood glucose levels but also to prevent skeletal muscle atrophy associated with the progression of diabetes. Full article
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12 pages, 627 KiB  
Article
Pilot Study on the Relationship between Malnutrition and Grip Strength with Prognosis in Diabetic Foot
by Magali González-Colaço Harmand, Alicia Tejera Concepción, Francisco José Farráis Expósito, Jennifer Domínguez González and Yolanda Ramallo-Fariña
Nutrients 2023, 15(17), 3710; https://doi.org/10.3390/nu15173710 - 24 Aug 2023
Cited by 1 | Viewed by 1307
Abstract
Sarcopenia and malnutrition have been associated in the elderly population with a poor prognosis in wound healing and with other adverse events, such as institutionalization or functional impairment. However, it is not known how these factors influence the prognosis of diabetic foot in [...] Read more.
Sarcopenia and malnutrition have been associated in the elderly population with a poor prognosis in wound healing and with other adverse events, such as institutionalization or functional impairment. However, it is not known how these factors influence the prognosis of diabetic foot in the elderly. To answer this question, a prospective observational study of 45 patients over 65 years of age admitted with diagnoses of diabetic foot in a tertiary hospital has been conducted. All patients were assessed at admission and at 3 months after returning home to determine quality of life, pain, mobility and healing, overall hospital stay in relation to the presence of malnutrition (measured by BMI, CIPA scale and analytical parameters at admission of serum proteins and albumin), and sarcopenia measured by grip force, among other geriatric syndromes. The results found a relationship between altered sarcopenia and more pain and poorer quality of life, and altered BMI was related to a lower cure rate and worse mobility at follow-up. This study seems to indicate that, in the elderly population with diabetic foot, malnutrition and sarcopenia should be managed at the same time as the treatment of the diabetic foot itself. Full article
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14 pages, 1087 KiB  
Article
Low Muscle Mass Is Associated with Poorer Glycemic Control and Higher Oxidative Stress in Older Patients with Type 2 Diabetes
by Blanca Alabadi, Miguel Civera, Adrián De la Rosa, Sergio Martinez-Hervas, Mari Carmen Gomez-Cabrera and José T. Real
Nutrients 2023, 15(14), 3167; https://doi.org/10.3390/nu15143167 - 17 Jul 2023
Cited by 5 | Viewed by 2612
Abstract
Body composition changes that occur during aging, such as loss of lean mass, are unfavorable at metabolic level and they can explain, in part, the appearance of certain age-associated diseases such as type 2 diabetes (T2D). Separately, T2D is associated with an increase [...] Read more.
Body composition changes that occur during aging, such as loss of lean mass, are unfavorable at metabolic level and they can explain, in part, the appearance of certain age-associated diseases such as type 2 diabetes (T2D). Separately, T2D is associated with an increase in oxidative stress (OS) which negatively affects skeletal muscle. Our aim was to study the differences in clinical and nutritional parameters, disease control, and OS in a cohort of older patients with T2D classified according to the amount of lean mass they had. We included 100 adults older than 65 years with T2D. We found that women with low fat-free mass and muscle mass have worse T2D metabolic control. Moreover, the patients with a low percentile of muscle mass present a high value of OS. The study shows that the presence of low lean mass (LM) in the geriatric population diagnosed with T2D is associated with poorer glycemic control and greater OS. Full article
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Review

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18 pages, 4564 KiB  
Review
The Vicious Cycle of Type 2 Diabetes Mellitus and Skeletal Muscle Atrophy: Clinical, Biochemical, and Nutritional Bases
by Jose M. Lopez-Pedrosa, Maria Camprubi-Robles, German Guzman-Rolo, Andres Lopez-Gonzalez, Jose Manuel Garcia-Almeida, Alejandro Sanz-Paris and Ricardo Rueda
Nutrients 2024, 16(1), 172; https://doi.org/10.3390/nu16010172 - 4 Jan 2024
Cited by 4 | Viewed by 4703
Abstract
Today, type 2 diabetes mellitus (T2DM) and skeletal muscle atrophy (SMA) have become increasingly common occurrences. Whether the onset of T2DM increases the risk of SMA or vice versa has long been under investigation. Both conditions are associated with negative changes in skeletal [...] Read more.
Today, type 2 diabetes mellitus (T2DM) and skeletal muscle atrophy (SMA) have become increasingly common occurrences. Whether the onset of T2DM increases the risk of SMA or vice versa has long been under investigation. Both conditions are associated with negative changes in skeletal muscle health, which can, in turn, lead to impaired physical function, a lowered quality of life, and an increased risk of mortality. Poor nutrition can exacerbate both T2DM and SMA. T2DM and SMA are linked by a vicious cycle of events that reinforce and worsen each other. Muscle insulin resistance appears to be the pathophysiological link between T2DM and SMA. To explore this association, our review (i) compiles evidence on the clinical association between T2DM and SMA, (ii) reviews mechanisms underlying biochemical changes in the muscles of people with or at risk of T2DM and SMA, and (iii) examines how nutritional therapy and increased physical activity as muscle-targeted treatments benefit this population. Based on the evidence, we conclude that effective treatment of patients with T2DM-SMA depends on the restoration and maintenance of muscle mass. We thus propose that regular intake of key functional nutrients, along with guidance for physical activity, can help maintain euglycemia and improve muscle status in all patients with T2DM and SMA. Full article
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