Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury

Abstract

Study Design: Cross-sectional comparison. Objective: The mortality rate is higher in individuals with spinal cord injury (SCI), and one major cause is cardiovascular disease (CVD). In the general population, the metabolic syndrome (MetS) is associated with an increased risk of CVD, and abdominal obesity is a major feature. Adipokines, secreted by adipose tissue, contribute to obesity-linked metabolic diseases. The aim of this study is to evaluate the prevalence of MetS, the components of this syndrome, especially body composition, and the relations between adipokines and body composition, in SCI individuals. Setting: Kanagawa Rehabilitation Hospital, Kanagawa, Japan. Methods: Forty-four male SCI individuals (57±13 years and 28 paraplegia) and age-matched ablebodied controls were studied. Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and anthropometry (waist circumference). The visceral fat area (VFA) was measured by computed tomography (CT). Plasma adipokine levels, including that of leptin, adiponectin and plasminogen activator inhibitor-1 (PAI-1), were measured. Results: Overall, 43% of SCI individuals met the criteria for MetS. Total and regional fat mass (FM), as well as VFA, were higher, whereas total and regional lean mass, except for arm, were lower than ablebodied controls. In the SCI, leptin and PAI-1 levels were positively associated and adiponectin levels were negatively associated with waist circumference, VFA and trunk FM. In multiple regression models, only leptin level was independently associated with waist circumference, VFA and trunk FM. Conclusion: SCI individuals were predisposed to excessive abdominal obesity, and higher leptin levels were strongly associated with higher prevalence of abdominal obesity in this population.

Changes of Leptin concentration in plasma in patients with spinal cord injury: A Meta-analysis

“…Although BMI seems to be a poor representative marker for obesity in SCI population, 14 still the existence of a strong correlation between BMI and fat mass allows the mentioned comparison between Maıïmoun and Huang results. However a positive association with plasma leptin level and BMI has been frequently reported in patients with SCI 9,20 which is in line with our outcomes. By considering this fact that body composition after spinal cord injury undergoes some massive changes 21,22 including decreased total lean mass along with increased total fat mass and visceral fat area, the higher level of leptin in SCI patients was justified ( Table 3).…”

“…Huang et al 9 reported that although leptin concentration is higher in patients with SCI than control group with matched BMI, body mass index was positively related with leptin level in both groups separately which is in line with Maïmoun results. Maruyama and et al 20 also showed that total lean mass is decreased in spinal cord injured patients along with increased total fat mass and visceral fat area. Although BMI seems to be a poor representative marker for obesity in SCI population, 14 still the existence of a strong correlation between BMI and fat mass allows the mentioned comparison between Maıïmoun and Huang results.…”

Spinal Cord Injury Causes Chronic Liver Pathology in Rats

“…This is important because liver pathology, including inflammation and fatty infiltration, is associated with metabolic syndrome, which occurs at increased incidence in the SCI population. [7][8][9] Indeed, SCI patients commonly have many features of metabolic syndrome, including insulin resistance, increased abdominal adiposity, altered cholesterol levels, and abnormal metabolic hormone levels. 8,10,11 In fact, one study reported evidence of metabolic syndrome in 43% of persons with SCI examined.…”

“…[7][8][9] Indeed, SCI patients commonly have many features of metabolic syndrome, including insulin resistance, increased abdominal adiposity, altered cholesterol levels, and abnormal metabolic hormone levels. 8,10,11 In fact, one study reported evidence of metabolic syndrome in 43% of persons with SCI examined. 8 The occurrence of metabolic syndrome and its hepatic manifestation termed nonalcoholic fatty liver disease (NAFLD) predict future cardiovascular disease, morbidity, and mortality, contusion injury after which clinical markers of liver pathology were assessed, including hepatic lipid accumulation, macrophage activation, cytokine expression, and serum levels of alanine transaminase (ALT).…”

Weight after SCI: the good, the bad and the ugly

“…10 For studies that have reported both BMI and % BF, an average BMI of 25 kg/m 2 (considered normal weight in able-bodied populations) usually translates to >30%BF in persons with SCI. [11][12][13][14][15][16][17][18][19][20][21] To put this in perspective, one study reported that persons with SCI are ∼13% fatter than age, height and ethnicity-matched able-bodied controls at the same BMI. 19 In fact, recent recommendations are to consider people with chronic SCI and BMI values >22 kg/m 2 as being at high risk for obesity and obesity-related chronic diseases.…”