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Causal mediation analysis. We evaluated the role of changes in MRI biomarkers of thigh muscle degeneration (baseline to 4th year) as the mediatory variables of the association between DM and KOA worsening. KOA-related symptoms worsening was assessed using NASS incidence. DM: diabetes mellitus, KOA: knee osteoarthritis, NASS: non-acceptable symptomatic state
