{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:03:31Z","timestamp":1792699411511,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Longitudinal associations between age\u2010related changes in body composition, physical performance and incident diabetes mellitus (DM) in older adults and the mediating role of branched\u2010chain amino acids (BCAAs) remain understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 4000 community\u2010dwelling older adults at baseline. Longitudinal analysis of incident DM involved 3421 participants without baseline DM. Incident DM was identified through self\u2010reported diagnosis, medication use, hospital records or fasting glucose \u2265\u20097.0\u2009mmol\/L. Body composition (PBF [percent body fat], FMI [fat mass index], ASM [appendicular skeletal muscle mass]) was measured using DXA. Associations of baseline body composition with incident DM were assessed using Cox regression in the full cohort, with sensitivity analysis accounting for competing risk of death. Associations in long\u2010term subgroups and analysis of 14\u2010year and prediabetes changes were evaluated using multivariable logistic regression. Serum BCAAs were quantified by LC\u2013MS for mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3421 participants (median age 72\u2009years [IQR 68\u201376]; 50.1% female) without baseline DM, higher baseline adiposity (PBF: HR 1.613; FMI: HR 1.684; waist: 1.587) and ASM\/ht\n                      <jats:sup>2<\/jats:sup>\n                      (HR 1.561) were consistently associated with increased DM risk in adjusted Cox models (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Conversely, higher relative muscle mass (ASM\/weight: HR 0.603; ASM\/BMI: HR 0.631; both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) was associated with a lower risk. Faster gait speed was also linked to lower DM risk (HR 0.748,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Sensitivity analysis accounting for competing mortality demonstrated consistent results. In the complete 14\u2010year follow\u2010up subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009937, 130 incident DM cases), key baseline associations were confirmed using logistic regression (e.g., ASM\/weight: OR 0.633,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Analysis of 14\u2010year changes showed that attenuated loss of relative muscle mass (\u0394ASM\/weight: OR 0.657;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) was correlated with lower DM risk, whereas increased adiposity was correlated with higher risk (\u2206PBF: OR 1.509,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019). Pre\u2010DM changes over 0\u20134\u2009years also revealed that early increases in waist (OR 1.428,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and declines in ASM\/weight (OR 0.745,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013) were associated with subsequent DM. Serum BCAAs mediated 18.6%\u201338.2% of associations between baseline body composition and incident DM (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). No significant correlation was found between dietary protein intake and serum BCAAs after adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In older adults, higher baseline adiposity and lower relative muscle mass were associated with long\u2010term DM risk, while preserved muscle mass and faster gait speed were linked to a lower risk. These associations, partially mediated by BCAAs, advance the understanding of DM risk pathways and highlight the potential clinical relevance of weight\u2010 or BMI\u2010adjusted relative muscle mass assessment in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70297","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T11:23:52Z","timestamp":1776684232000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Associations of Body Composition and Physical Function With Incident Diabetes in Older Adults: A 14\u2010Year Prospective Cohort Study"],"prefix":"10.1002","volume":"17","author":[{"given":"Ting","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Geriatrics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yafei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Leung","sequence":"additional","affiliation":[{"name":"Jockey Club Centre for Osteoporosis Care and Control The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Pik\u2010Shan","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong China"},{"name":"Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital The Chinese University of Hong Kong  Shatin Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany K.","family":"Elshorbagy","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of Oxford  Oxford UK"},{"name":"Department of Physiology, Faculty of Medicine University of Alexandria  Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. W.","family":"Auyeung","sequence":"additional","affiliation":[{"name":"Jockey Club Institute of Ageing The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Kwok","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong China"},{"name":"Jockey Club Centre for Osteoporosis Care and Control The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Global Health and Ageing","author":"Organization 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