Association between ankle–brachial index and body composition parameters measured by bioelectrical impedance analysis in patients with high-risk type 2 diabetes mellitus: a cross-sectional study

Abstract

Abstract Background Peripheral arterial disease (PAD) is a common macrovascular complication of type 2 diabetes mellitus (T2DM) associated with substantial morbidity. The ankle-brachial index (ABI) is a simple, non-invasive, and widely recommended tool for PAD screening, while alterations in body composition may influence cardiovascular risk. This study investigated the association between bioelectrical impedance analysis (BIA)-derived body composition parameters and ABI in patients with T2DM. Methods In this cross-sectional study, 100 high-risk adults with type 2 diabetes mellitus attending a tertiary diabetes clinic were consecutively recruited between December 2024 and December 2025. Peripheral arterial disease (PAD) was assessed using the ankle-brachial index (ABI), and body composition was measured by multi-frequency bioelectrical impedance analysis (BIA). Demographic, clinical, and laboratory data were also collected. Comparisons of body composition parameters across ABI categories were performed using non-parametric tests. Multivariable binary logistic regression analyses were conducted to evaluate the independent associations of representative body composition parameters with PAD after assessment of multicollinearity. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with p-Value < 0.05 considered statistically significant. All analyses were conducted using R statistical software for Windows (v 4.5.2, R Core Team 2025). Results Body composition parameters did not differ significantly across ABI categories (p-Value > 0.05). Patients with PAD had lower HDL-C and higher TSH levels than those without PAD (p-Value = 0.02 and p-Value = 0.01, respectively). In separate multivariable logistic regression models adjusted for age and hypertension, neither muscle mass nor visceral fat area showed an independent association with PAD. Conclusion Representative BIA-derived body composition parameters showed no independent association with PAD in high-risk patients with T2DM. Given the limited number of PAD events, these findings should be interpreted cautiously and confirmed in larger, adequately powered prospective studies. Clinical trial number Not applicable.