Association of phase angle versus skeletal muscle mass profiling with body fat mass in relation to glycemic control in type 2 diabetes: a cross-sectional study
Abstract
While preserving skeletal muscle mass (SMM) is advocated in type 2 diabetes mellitus (T2DM), mass-based assessments often overlook muscle quality. This study aimed to investigate whether the balance between cellular integrity (phase angle [PhA]) and metabolic load (body fat mass [BFM]) is more clinically relevant to glycemic control than SMM-based profiling in patients with T2DM. In this cross-sectional study of 622 patients, participants were stratified into four groups based on sex-specific medians of PhA and BFM, and similarly for SMM and BFM. Multivariate logistic regression evaluated associations with glycemic targets (HbA1c <8.0% and <7.0%), adjusting for confounders. Sensitivity analyses utilized continuous Z-scores and interaction terms. High-PhA/High-BFM and High-PhA/Low-BFM groups showed significantly higher odds of HbA1c <8.0% compared with the Low-PhA/High-BFM reference group (adjusted odds ratio [OR] 2.05, 95% confidence interval [CI] 1.22-3.44; OR 2.10, 95% CI 1.21-3.64, respectively). Conversely, SMM/BFM combinations showed no significant associations. Neither profile was significantly associated with the stricter HbA1c <7.0% target. In continuous models, the PhA × BFM interaction was significantly associated with achievement of HbA1c <8.0% (p = 0.025), whereas SMM × BFM interaction was not. In conclusion, the PhA/BFM interplay shows a clearer association with glycemic control than SMM/BFM profiling in T2DM. Higher PhA may reflect a more favorable metabolic phenotype against adiposity and is associated with a lower likelihood of severe hyperglycemia (HbA1c ≥8.0%). PhA/BFM profiling offers a novel approach to identify high-risk patients overlooked by conventional mass-based assessments.
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BibTeX
@article{nakanishi2026association,
title = {{Association of phase angle versus skeletal muscle mass profiling with body fat mass in relation to glycemic control in type 2 diabetes: a cross-sectional study}},
author = {Shuhei Nakanishi and Masashi Shimoda and Tomohiko Kimura and Junpei Sanada and Yoshiro Fushimi and Yuichiro Iwamoto and Masato Kubo and Ryo Inaba and Yui Okamoto and Hideyuki Iwamoto and Kohei Kaku and Hideaki Kaneto},
journal = {Endocrine Journal},
year = {2026},
month = aug,
doi = {10.1507/endocrj.ej26-0238},
url = {https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0238/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of phase angle versus skeletal muscle mass profiling with body fat mass in relation to glycemic control in type 2 diabetes: a cross-sectional study
AU - Shuhei Nakanishi
AU - Masashi Shimoda
AU - Tomohiko Kimura
AU - Junpei Sanada
AU - Yoshiro Fushimi
AU - Yuichiro Iwamoto
AU - Masato Kubo
AU - Ryo Inaba
AU - Yui Okamoto
AU - Hideyuki Iwamoto
AU - Kohei Kaku
AU - Hideaki Kaneto
PY - 2026
DA - 2026/08/26
JO - Endocrine Journal
DO - 10.1507/endocrj.ej26-0238
UR - https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0238/_article
AB - While preserving skeletal muscle mass (SMM) is advocated in type 2 diabetes mellitus (T2DM), mass-based assessments often overlook muscle quality. This study aimed to investigate whether the balance between cellular integrity (phase angle [PhA]) and metabolic load (body fat mass [BFM]) is more clinically relevant to glycemic control than SMM-based profiling in patients with T2DM. In this cross-sectional study of 622 patients, participants were stratified into four groups based on sex-specific medians of PhA and BFM, and similarly for SMM and BFM. Multivariate logistic regression evaluated associations with glycemic targets (HbA1c <8.0% and <7.0%), adjusting for confounders. Sensitivity analyses utilized continuous Z-scores and interaction terms. High-PhA/High-BFM and High-PhA/Low-BFM groups showed significantly higher odds of HbA1c <8.0% compared with the Low-PhA/High-BFM reference group (adjusted odds ratio [OR] 2.05, 95% confidence interval [CI] 1.22-3.44; OR 2.10, 95% CI 1.21-3.64, respectively). Conversely, SMM/BFM combinations showed no significant associations. Neither profile was significantly associated with the stricter HbA1c <7.0% target. In continuous models, the PhA × BFM interaction was significantly associated with achievement of HbA1c <8.0% (p = 0.025), whereas SMM × BFM interaction was not. In conclusion, the PhA/BFM interplay shows a clearer association with glycemic control than SMM/BFM profiling in T2DM. Higher PhA may reflect a more favorable metabolic phenotype against adiposity and is associated with a lower likelihood of severe hyperglycemia (HbA1c ≥8.0%). PhA/BFM profiling offers a novel approach to identify high-risk patients overlooked by conventional mass-based assessments.
SN - 1348-4540
SN - 0918-8959
ER -