A new nationwide cohort study published in Calcified Tissue International has revealed that a higher appendicular skeletal muscle mass-to-visceral fat area ratio (SVR) is linked with a reduced risk of cardiovascular and cancer-related mortality in patients with diabetes. However, the researchers caution that SVR may offer limited clinical utility in predicting individual mortality risk compared to conventional measures like body mass index (BMI) or waist circumference (WC).

The study analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. A total of 1,439 diabetic patients with dual-energy X-ray absorptiometry (DXA) data were included. Researchers applied weighted Cox proportional hazards models and restricted cubic spline methods to assess the association between SVR and mortality outcomes. They evaluated diagnostic accuracy using weighted receiver operating characteristic (ROC) curves.

After confounder adjustment, each 0.01-unit increase in SVR corresponded to a 3% decrease in the risk of cardiovascular death and a 2% decrease in the risk of cancer-related death. Despite this linear negative association, SVR showed poor diagnostic performance (area under the ROC curve (AUC) values cardiovascular mortality: 0.520, AUC for cancer mortality: 0.527). These results suggest that SVR is not superior to simpler, widely used indicators such as BMI, WC, appendicular skeletal muscle mass (ASM), or visceral fat area (VFA) in predicting mortality risk in diabetes.

The findings emphasize the potential importance of maintaining muscle mass relative to visceral fat for long-term health outcomes in people with diabetes, but also highlight the practical limitations of SVR in clinical risk assessment.