Erector spinae muscle area and the ratio of the computed tomography values of the liver and spleen are associated with frailty in older patients with diabetes: A cross-sectional study

Abstract

Abstract Background Older patients with diabetes mellitus are more susceptible to frailty. Although some imaging markers of appendicular skeletal muscle mass obtained using dual-energy X-ray absorptiometry or computed tomography (CT) imaging can reflect frailty status, the association between imaging indices obtained by abdominal CT scans and frailty in older inpatients has not been reported. Methods A total of 151 older inpatients with diabetes mellitus (median age, 79 years; men, 42%) who underwent abdominal CT scans close to the admission were studied to examine the associations between abdominal CT indices and frailty. We used two frailty definitions: the modified Cardiovascular Health Study (mCHS) criteria and Kihon Checklist (KCL) criteria. Using the imaging analysis software SYNAPSE VINCENT®, we compared the areas of four truncal muscles (erector spinae, iliopsoas, rectus abdominis, and abdominal oblique muscles) and the ratio of the CT values of the liver and spleen (L/S) between frail and non-frail patients. The muscle areas that showed the strongest associations with frailty were also investigated in relation to grip strength and walking speed. Finally, we performed multivariate binominal logistic regression analysis to assess the independent associations of muscle areas and L/S with the prevalence of frailty. Results The prevalence of frailty defined by the mCHS and KCL criteria was 55% and 52%, respectively. The area of the erector spinae muscle was most significantly associated with frailty, and was significantly smaller in mCHS-defined frail patients of both sexes and in men with KCL-defined frailty. The erector spinae muscle area was also positively correlated with grip strength and walking speed. In contrast, the L/S ratio was higher in men with KCL-defined frailty. Multivariate logistic regression analyses revealed that the area of the erector spinae muscle was independently associated with mCHS-defined frailty in women, and the L/S ratio was associated with KCL-defined frailty in men. Conclusions The erector spinae muscle area and low liver fat could be indices of frailty in older patients with diabetes.