Regional and relative adiposity patterns in relation to carbohydrate and lipid metabolism in men with spinal cord injury

Abstract

This study examined the relationship among regional and relative adipose tissue distribution, glucose, and lipid metabolism in men with spinal cord injury (SCI). After overnight fasting, 32 individuals with motor complete tetraplegia (Tetra) (n = 7) and paraplegia (Para) (n = 25) underwent resting energy expenditure and measurement of serum lipid profile, followed by an oral glucose tolerance test to measure plasma glucose and plasma insulin concentrations. Regional fat mass (FM) and fat-free mass were quantified using dual-energy X-ray absorptiometry. Relative adipose tissue was calculated as the ratio of leg FM/trunk FM, leg FM/whole-body FM, and trunk FM/whole-body FM. Individuals with Tetra have greater leg FM/trunk FM (45%) and leg FM/body FM (26%) and lower trunk FM/body FM (29%) ratios than individuals with Para (p < 0.05). Glucose area under the curve (AUC) was positively related to leg FM (r = 0.34, p = 0.05) but not to trunk or body FM. Strong negative relationships were noted between the ratio of trunk FM to body FM and glucose AUC (r = -0.38, p = 0.03) and low-density lipoprotein cholesterol (LDL-C) (r = -0.45, p = 0.001). Whole-body FM was negatively related to high-density lipoprotein cholesterol (r = -0.49, p = 0.007) after controlling for percentage of trunk FM. Both leg and trunk FM may play a pivotal role in determining the metabolic profile in individuals with SCI. Relative to whole-body FM and leg FM, trunk FM may induce a protective effect on glucose homeostasis and the LDL-C profile.

Adiposity and spinal cord injury

“…Studying whole and regional adiposity may need specialized body composition assessment techniques to accurately quantify adiposity after SCI. Although the prevalence of obesity may easily exceed two-thirds of the SCI population [23] ; we believe that that the SCI population suffers from excessive adiposity that exceeds 30% of the whole body mass [6,17] . This may be true in 50% of the SCI population despite having normal BMI, which leads to significant metabolic and health implications [6] .…”

“…DXA scans are commonly used in the clinical settings to measure total, regional body composition and bone mineral density or content. However, DXA is limited in distinguishing between subcutaneous adipose tissue (SAT) and ectopic adipose tissue [6] . The anatomy and distribution of adipose tissue is of particular interest to the metabolic health after SCI [5][6][7]16] .…”

“…However, DXA is limited in distinguishing between subcutaneous adipose tissue (SAT) and ectopic adipose tissue [6] . The anatomy and distribution of adipose tissue is of particular interest to the metabolic health after SCI [5][6][7]16] . Triglycerides can be either stored in subcutaneous or ectopic sites similar to the peritoneum, visceral adipose tissue (VAT), in the liver (steatosis), in the muscle such as IMF or IeMF and in the bone marrow as BMF.…”

“…The central distribution of adipose tissue may represent up to 25% of total body FM [22] . Gorgey and Gater [6] have highlighted the significance of studying regional and relative adiposity and their associations to metabolic health variables after SCI.…”

“…Additionally, adipose tissues secrete number of active peptides called adipokines [3] . Interest in studying adipose tissue physiology and anatomical distribution has stemmed from its closest association with disturbance in metabolic profile including carbohydrate, lipid, and bone metabolism [3][4][5][6][7] . Most recently the link between adipose tissue and bone health has been recognized after spinal cord injury (SCI) [7] .…”