Diabetic Sarcopenia and Mortality in South Korean Adults: Dietary Quality as a Modifier

Background and Objectives: Diabetes and sarcopenia independently contribute to adverse health outcomes and increased mortality.When occurring together, a condition known as diabetic sarcopenia, health risks are amplified.Emerging evidence suggests that higher dietary quality may help mitigate these risks.In this study, we examined the association between diabetic sarcopenia and mortality and evaluated the modifying effect of dietary quality on this relationship.Methods: Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korean Genome and Epidemiology Study (KoGES).Sarcopenia was defined as the lowest 2 sex-specific quartiles of fat-free mass index.Diabetes was identified by fasting glucose level, medication use, or medical diagnosis.Dietary quality was quantified using the Korean Healthy Eating Index (KHEI).Cox proportional hazards models assessed associations between diabetic sarcopenia and mortality.Results: In KNHANES, individuals with both sarcopenia and diabetes had a significantly increased risk of all-cause mortality compared to those with neither condition (hazard ratio [HR], 2.44; 95% confidence interval [CI], 1.72-3.47).This association was particularly pronounced among participants with low-moderate KHEI scores (HR, 2.56; 95% CI, 1.75-3.74),but not among those with high KHEI scores.Additionally, a significant association with cancer mortality was observed.In contrast, in KoGES, significant associations were observed for both all-cause and cardiovascular mortality.Conclusions: Both sarcopenia and diabetes were independently associated with increased mortality, with the highest risk observed in individuals with both conditions.Importantly, higher dietary quality attenuated this risk, highlighting the significance of nutritional interventions in diabetic sarcopenia.