A cross-sectional study to determinate the relationship between body composition & neuropathy in patients with type 2 diabetes mellitus

Background
More information is required where the relation of diabetic neuropathy and body composition through bioimpedance is addressed. Therefore the aim of this study was to investigate the association between peripheral (PN) and autonomic neuropathy (AN) with bioimpedance in patients with type 2 diabetes mellitus (T2DM) aged 18 to 64 years.

Methods
A cross-sectional study was conducted at a private hospital in Northeastern Mexico between November 2023 and March 2024. Patients with T2DM were evaluated using the Michigan Neuropathy Screening Instrument (MNSI) for PN, Sudoscan for AN, and bioimpedance analysis (InBody) for body composition. Other variables considered included diabetes duration, hemoglobin A1C (HbA1C), and lipid profile. Chi-square, T-test, and Wilcoxon tests were used for independent variables, Cohen’s kappa for concordance, and logistic regression models for association analyses.

Results
A total of 160 patients were analyzed, with a median (IQR) age of 51 (12) years, and a majority being male (n = 81, 51%). The prevalence of PN was 30% (n = 48) and AN was 35.6% (n = 57), with a Cohen’s kappa concordance of 0.282. Patients with PN had higher median (IQR) visceral fat mass [20 (8.3) vs. 17 (10.3) kg, p = 0.010], arm fat mass [3.65 (3.35) vs. 2.70 (2.30) kg, p = 0.004], torso fat percentage [485 (166) vs. 369 (173), p < 0.001], arm circumference [40.1 (7.4) vs. 36.4 (5.7) cm, p < 0.001], arm muscle circumference [32.1 (3.8) vs. 30.7 (4.7) cm, p = 0.008], and skeletal muscle index (SMI) [8.35 (1.25) vs. 7.95 (1.55), p = 0.009]. For AN, a higher torso muscle percentage was observed [105.2 (6.2) vs. 103.3 (7), p = 0.02]. No significant differences were found in HbA1C or lipid profile. Logistic regression for PN showed associations with T2DM duration (OR = 1.111, p = 0.006), age (OR = 1.080, p = 0.004), leg fat mass (OR = 187.197, p = 0.003), and SMI (OR = 0.612, p = 0.021), with a Nagelkerke R² of 0.328. No significant predictors were found for AN.

Conclusion
A high prevalence of neuropathy was observed, with a significant association between body composition and PN, highlighting greater adiposity in limbs, torso, and visceral fat, as well as age, T2DM duration, and SMI.