Association between extracellular-to-intracellular water ratio and type 2 diabetes mellitus in Korean males aged 19-80 years: analysis of KNHANES 2022-2023.

PURPOSE: The extracellular-to-intracellular water (ECW/ICW) ratio is a known indicator of metabolic health; however, few studies have examined its association with type 2 diabetes mellitus (T2DM). This study investigated the relationship between the ECW/ICW ratio and T2DM prevalence using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We analyzed the data of 2,281 Korean males aged 19-80 years who participated in the 9th KNHANES (2022-2023) and had no history of kidney disease. The participants were classified as normal, prediabetic, or diabetic based on their fasting glucose levels, Hemoglobin A1c levels, and physician diagnosis. The ECW/ICW ratio was divided into tertiles. One-way analysis of variance (ANOVA) with Bonferroni post hoc tests was used to compare group differences in general and body composition characteristics. Logistic regression analyses were used to assess the association between ECW/ICW tertiles and T2DM prevalence.

RESULTS

The diabetes group had significantly higher age, body mass index (BMI), waist circumference, and body fat percentage, and lower fat-free mass and grip strength than the other groups (p <.001). They had lower ICW values and higher ECW/total body water (TBW) and ECW/ICW ratios. Compared to the lowest tertile group, the middle tertile group showed a significantly higher risk of diabetes (OR = 1.661, 95% CI, 1.104-2.499), whereas the highest tertile did not reach statistical significance (OR = 1.417, 95% CI: 0.880-2.280) in the model adjusted for age, BMI, and grip strength.

CONCLUSION

This study identified a significant association between a higher ECW/ICW ratio and the prevalence of T2DM in Korean males, independent of age, BMI, and muscle strength. The ECW/ICW ratio reflects both metabolic and musculoskeletal characteristics and may be useful in describing diabetes-related body composition profiles.