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Is fat mass index a good indicator of cardiovascular risk in diabetes patients?

A large data analysis evaluated fat mass index and lean body mass index as indicators of cardiovascular risk in diabetes patients.

Obesity is an important risk factor for several health problems, including heart disease. It is important to have an accurate method of measuring obesity, both in order to study its effects on populations and to assess health risks for individuals.

Body mass index (BMI) has some limitations as a measure of obesity

Body mass index (BMI), calculated using a person’s weight divided by their height squared, is a commonly-used measure of obesity. However, BMI has some limitations since it does not distinguish between lean muscle mass and fat mass. For example, an athlete who has a high muscle mass may be classified as obese using BMI. However, a higher muscle mass has a protective role on health, whereas fat mass is harmful. On the other hand, people who have type 2 diabetes (T2DM) have been shown to have a lower lean muscle mass compared to fat mass, so BMI may also be a less accurate measure of obesity in this group of people. Other measures may be better and measuring obesity and predicting heart disease risk in people with diabetes. Researchers analyzed data from a previous large study in T2DM patients to assess the relationship between the measures fat mass index and lean body mass index, with the risk of cardiovascular disease. They recently published their findings in the Canadian Medical Association Journal.

Fat mass index associated with heart disease risk in T2DM patients

The researchers used data collected from over 10,250 T2DM patients with or at risk of heart disease who had participated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study. This randomized controlled trial had investigated whether intensive control of blood glucose, blood pressure and lipids could reduce the incidence of CVD. From the ACCORD data, they calculated the fat mass index and lean body mass index in participating patients and evaluated the relationship between both fat mass index and lean body mass index with the risk of cardiovascular disease.

T2DM patients with a higher fat mass index were at increased risk of major cardiovascular events compared of people with lower fat mass index. Although there was a trend showing that high lean body mass was associated with fewer major adverse CV events, this did not reach statistical significance.

The researchers concluded that in T2DM patients fat mass index has a strong association with a higher risk of cardiovascular disease and major cardiovascular events. Unlike previous research, increasing lean body mass did not have a protective role in these patients.


Written by Julie McShane, MA MB BS



  1. Xing Z, Tang L, Chen J, et al. Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus. Canadian Medical Association Journal 2019;191(38):E1042-E1048.
  2. Canadian Medical Association Journal, Press release, Sept 23, 2019. Fat mass index, not BMI, associated with cardiovascular events in people with diabetes.


Image by Vidmir Raic from Pixabay


Julie Mcshane MA MB BS
Julie Mcshane MA MB BS
Julie studied medicine at the Universities of Cambridge and London, UK. Whilst in medical practice, she developed an interest in medical writing and moved to a career in medical communications. She worked with companies in London and Hong Kong on a wide variety of medical education projects. Originally from Ireland, Julie is now based in Dublin, where she is a freelance medical writer. She enjoys contributing to the Medical News Bulletin to help provide a source of accurate and clear information about the latest developments in medical research.


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