{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T14:51:44Z","timestamp":1754146304319,"version":"3.41.2"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"Background<\/jats:title>The ratio of fat-free mass (FFM) to fat mass (FM) is a key indicator of body composition. Evidence suggests that the FFM\/FM ratio is more reliable than body mass index in predicting functional outcomes in older adults with prefrailty. Individuals with type 2 diabetes mellitus (T2DM) exhibit higher FM and faster lean mass loss than do those without T2DM. In this study, we determined whether the FFM\/FM ratio can predict functional outcomes in patients with T2DM.<\/jats:p><\/jats:sec>Methods<\/jats:title>This study enrolled 166 men and 173 women aged \u226550 years who received a T2DM diagnosis at least 1 year before the initiation of this study. Participants were recruited from Taipei Veterans General Hospital, Taiwan, between April 2019 and December 2023. Based on the FFM\/FM ratio, patients were stratified into three groups: high, middle, and low tertiles. Body composition was assessed using InBody 3.0. Physical performance was evaluated through the Short Physical Performance Battery and gait speed measurement. The FFM\/FM ratio was calculated using established formulas. Stepwise multiple regression was performed to identify the predictors of the FFM\/FM ratio in patients stratified by sex.<\/jats:p><\/jats:sec>Results<\/jats:title>In both sexes, individuals in the high-tertile group exhibited superior physical performance than did the other groups, as indicated by higher Short Physical Performance Battery scores (P<\/jats:italic> &lt; 0.001 for both sexes), better performance in the 30-second chair stand test (P<\/jats:italic> &lt; 0.001), faster gait speed in the 6-m walk (P &lt;<\/jats:italic>0.001), and shorter completion time in the timed up and go test (P &lt;<\/jats:italic>0.001). In men, waist circumference, upper arm circumference, age, logarithmic transformation of alanine transaminase level, and uric acid level emerged as independent predictors of the FFM\/FM ratio. In women, waist circumference, upper arm circumference, age, and uric acid level emerged as independent predictors; notably, logarithmic transformation of alanine transaminase level was not included in the regression model.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The present study revealed that a decreased FFM\/FM ratio is associated with suboptimal physical performance in patients with T2DM, and this ratio may provide meaningful clinical benefits in targeting body composition in this population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1562870","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T04:10:40Z","timestamp":1752811840000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ratio of fat-free mass to fat mass is associated with physical performance in patients with type 2 diabetes 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