Association of body composition, daily physical activity and handgrip strength with mortality, cardiovascular events and cancers in Japanese patients with diabetes

Aims: Sarcopenia and sarcopenic obesity are associated with increased risks of cardiovascular (CV) disease and mortality. This study examined the associations of body composition and daily physical activity with mortality, CV events and cancer in patients with diabetes. Methods: This prospective cohort study included patients with diabetes treated at a specialised clinic in Japan between January 2018 and March 2023. Body composition, including visceral adipose tissue (VAT), was assessed by bioelectrical impedance analysis. Daily physical activity was evaluated using the non-exercise activity thermogenesis (NEAT) questionnaire, and handgrip strength (HGS) was measured by dynamometry. Cox proportional hazards models were used to assess associations with mortality, CV events, and cancer. Results: Among 2,024 patients (mean age 63.0 years, BMI 24.6 kg/m^2, HbA1c 7.8%), NEAT, HGS, and VAT were not independently associated with all-cause mortality. Higher VAT was associated with increased cancer risk (HR 1.485; 95% CI 1.101-2.003; p = 0.009). Higher HGS was inversely associated with CV event risk (HR 0.951; 95% CI 0.919-0.984; p = 0.004). NEAT was not associated with any outcome. Conclusions: Higher VAT was associated with increased cancer risk, whereas higher HGS was protective against CV events. Incorporating body composition and HGS assessments into clinical practice may improve risk stratification and management in patients with diabetes.