Association Between Vitamin A Intake and Disease Severity in Early-Onset Heterotopic Ossification of the Posterior Longitudinal Ligament of the Spine

Abstract

Study Design: A sex- and age-matched case-control study and a cross-sectional study. Objective: In our previous study, patients with early-onset (<50 years of age) ossification of the posterior longitudinal ligament (OPLL) had distinct features such as morbid obesity, a high prevalence of lifestyle-related diseases, and diffuse ossified lesions mainly affecting the thoracic spine. Our goals were to determine whether early-onset OPLL patients have unbalanced dietary habits and to identify nutritional factors associated with OPLL exacerbation. Methods: In Study 1, the simple brief-type self-administered diet history questionnaire (BDHQ) was used to compare nutrient intake levels of early-onset OPLL patients (n = 13) with those of sex- and age-matched non-OPLL controls (n = 39) or with those of common OPLL (onset age ≥ 50 years, n = 62). In Study 2, serological validation was conducted for thoracic OPLL patients (n = 77) and non-OPLL controls (n = 101) in a nationwide multicenter study in Japan. Results: The BDHQ showed that the early-onset OPLL patients had significantly lower intakes of vitamins A and B6 than non-OPLL controls. These results were validated by lower serum vitamins A and B6 levels in the early-onset thoracic OPLL patients. The severity of OPLL negatively correlated with serum vitamin A levels in male early-onset OPLL patients. The multiple regression analysis revealed that the severity of thoracic OPLL had an association with onset age and serum vitamin A level. Conclusions: Vitamin A deficiency resulting from unbalanced dietary habits is associated with exacerbation of male early-onset OPLL.

Close Association Between Non-Alcoholic Fatty Liver Disease and Ossification of the Posterior Longitudinal Ligament of the Spine

“…In a single regression analysis to examine factors associated with the sum of all ossi cation indices, the L/S ratio was identi ed as the sole risk factor (P = 0.008). Multiple regression analysis using the FIB-4 index and the L/S ratio as well as the previously reported risk factors such as age of symptom onset, BMI, and diabetes mellitus as independent variables revealed that the L/S ratio was associated with the sum of all ossi cation indices (P = 0.023) (Table 3) [8,9,[13][14][15].…”

“…[17][18][19] A possible explanation for the high prevalence of NAFLD in symptomatic patients with OPLL is the multiple risk factors for NAFLD, such as obesity, physical inactivity, a sedentary lifestyle, and sarcopenia, which are accompanying symptoms of myelopathy. [8,9,[13][14][15][16] Our results suggest that fatty liver is a contributing factor in the progression of spinal ligament ossi cation. This was supported by the negative correlation between the L/S ratio and the severity of ossi cation in middle-aged patients.…”

“…This classi cation was based on our previous study showing that patients with myelopathy caused by thoracic OPLL have distinct features, such as severe obesity, early symptom onset, and diffuse ossi cation of the spinal ligaments. [8,9] Demographics, comorbidities, and OPLL distribution Demographic data were obtained from all participants. Their current body mass index (BMI), comorbidities (diabetes, hypertension, hyperlipidemia, heart disease, kidney disease, hyperuricemia, and cancer), and drinking habits were assessed.…”

“…To determine the severity of spinal ligament ossi cation, the OPLL-index, OALL-index, OLF-index, OSIL-index, and total ossi cation index (de ned as the sum of the presence or absence of ossi cation at each vertebral and intervertebral level) were calculated according to a previously described method. [5,9] The analysis was performed independently by three board-certi ed spine surgeons (TE, MT, and YH). Before reviewing the images, all readers interpreted the same images for 20 patients and an interobserver agreement was determined.…”

“…[5][6][7] Epidemiological studies have revealed that patients with thoracic OPLL have a strong tendency toward an early onset of symptoms and a high prevalence of morbid obesity, as well as co-existing ossi ed lesions of spinal ligaments over the entire spine. [8,9] This prompted us to further investigate the association between obesity-related diseases and OPLL.…”