{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:20:08Z","timestamp":1787746808339,"version":"build-2784847793"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82300984"],"award-info":[{"award-number":["82300984"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371601"],"award-info":[{"award-number":["82371601"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Musculoskeletal complications in type 2 diabetes (T2DM) are inadequately captured by body mass index (BMI). Waist\u2010to\u2010BMI ratio (WBR) may better reflect adverse body composition. We examined cross\u2010sectional and longitudinal associations between WBR and musculoskeletal disorders in T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This two\u2010phase study was conducted within an ongoing hospital\u2010based cohort at the First Affiliated Hospital of Fujian Medical University (Fuzhou, China). The cross\u2010sectional analysis included 4157 adults with T2DM recruited between March 2012 and August 2023 (54.3% men; mean age 59.4\u2009\u00b1\u200910.3\u2009years), using data from their first assessment. Associations of waist circumference (WC), waist\u2010to\u2010height ratio (WHtR), waist\u2010to\u2010hip ratio (WHR), BMI and WBR with osteopenia, sarcopenia, sarcopenic osteopenia (SOs), sarcopenic obesity (SOb) and fractures were evaluated. The prospective cohort comprised a longitudinal subset enrolled between March 2012 and June 2022, ensuring at least 1\u2009year of follow\u2010up prior to administrative censoring in August 2023. A total of 440 individuals (57.0% men; mean age 59.7\u2009\u00b1\u20099.7\u2009years) were followed for a median of 34.0\u2009months (20.0\u201357.0). Associations between time\u2010dependent WBR and incident outcomes were assessed using Cox models. A nested exploratory analysis was conducted within the cohort. Thirty participants with extreme annualised WBR change (\u0394WBR\/yr) were selected. Baseline serum samples collected at enrolment, prior to outcome occurrence, were analysed using phage immunoprecipitation sequencing (PhIP\u2010Seq).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cross\u2010sectionally, WBR was negatively correlated with bone mineral density and appendicular skeletal muscle mass index and positively correlated with osteopenia, sarcopenia, SOs, SOb and fractures (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), whereas BMI, WC, WHtR and WHR showed weaker associations. After adjustment, higher WBR was independently associated with osteopenia (men: OR 1.723, 95% CI 1.614\u20131.840; women: OR 1.420, 1.348\u20131.495), sarcopenia (men: OR 4.779, 4.165\u20135.484; women: OR 2.991, 2.683\u20133.334), SOs (men: OR 6.261, 5.314\u20137.377; women: OR 4.336, 3.753\u20135.010), SOb (men: OR 4.737, 3.975\u20135.646; women: OR 4.652, 3.715\u20135.825) and fractures (men: OR 1.236, 1.093\u20131.397; women: OR 1.103, 1.003\u20131.213; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Prospectively, higher time\u2010dependent WBR predicted incident osteopenia (HR 1.365, 95% CI 1.024\u20131.820), sarcopenia (HR 1.282, 1.086\u20131.512), SOs (HR 1.408, 1.176\u20131.686), SOb (HR 1.634, 1.262\u20132.116) and fractures (HR 1.369, 1.029\u20131.821). PhIP\u2010Seq analysis identified differential autoantibody reactivity related to muscle structural organisation and cytoskeletal regulation, while bone\u2010related differences were enriched in Wnt signalling and hormone\u2010related pathways.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher WBR and longitudinal increases were independently associated with osteopenia, sarcopenia, sarcopenic phenotypes and fractures in individuals with T2DM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70336","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:56:14Z","timestamp":1786089374000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Waist\u2010to\u2010Body Mass Index Ratio and Risk of Musculoskeletal Disease in Type 2 Diabetes: A Cohort and PhIP\u2010Seq Analysis"],"prefix":"10.1002","volume":"17","author":[{"given":"Yongze","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Clinical Research Center for Metabolic Diseases of Fujian Province, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Diabetes Research Institute of Fujian Province, the First Affiliated Hospital Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luxi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Clinical Research Center for Metabolic Diseases of Fujian Province, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, the First Affiliated Hospital Fujian Medical University  Fuzhou China"},{"name":"Diabetes Research Institute of Fujian Province, the First Affiliated Hospital Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Zheng","sequence":"additional","affiliation":[{"name":"Orthopedics Department the First Affiliated Hospital of Fujian Medical University  Fuzhou Fujian 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