Systemic inflammatory biomarkers and their partial role in the association between diabetes and sarcopenia: A population-based study using NHANES data

The mediating role of inflammatory biomarkers in the association between diabetes and sarcopenia remains poorly quantified in general populations. This study aims to investigate this relationship and quantify the mediating effects of systemic inflammatory indicators. This cross-sectional study included 11,190 adults from the National Health and Nutrition Examination Survey 2011 to 2018. Weighted logistic regression and subgroup analyses were used to assess the association between diabetes and sarcopenia, defined by the Foundation for the National Institutes of Health criteria (appendicular skeletal muscle mass/body mass index). Mediation analysis with bootstrapping was performed to evaluate the mediating roles of white blood cells, neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, and Systemic Immune-Inflammation Index. Diabetes was significantly associated with an increased risk of sarcopenia (odds ratio = 1.48, 95% confidence interval: 1.03–2.13, P = .042) after full adjustment. Mediation analysis revealed that white blood cells, neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, and Systemic Immune-Inflammation Index mediated 28.48%, 26.58%, 7.36%, 6.54%, and 10.17% of this association, respectively (all P < .05). Diabetes is positively associated with sarcopenia risk, partially mediated by systemic inflammation. Readily available inflammatory biomarkers may aid in identifying high-risk diabetic patients for sarcopenia prevention.