Visceral adipose tissue and the ratio of visceral to subcutaneous adipose tissue are greater in adults with than in those without spinal cord injury, despite matching waist circumferences

Abstract

Background: Abdominal obesity, particularly visceral adipose tissue (VAT), is associated with an increased risk of coronary heart disease (CHD). Despite an elevated risk of CHD mortality in persons with spinal cord injury (SCI), neither abdominal adipose tissue accumulation nor the validity of waist circumference (WC) has been determined in persons with SCI. Objectives: The objectives of this study were to compare total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the ratio of VAT to SAT (VAT:SAT) between adults with SCI and age-, sex-, and WC-matched ablebodied (AB) controls and to determine the relation between WC and VAT in both groups. Design: Thirty-one men and women (n ҃ 15 SCI and 16 AB) with a mean (ȀSD) age of 38.9 Ȁ 7.9 y participated in this cross-sectional study. Abdominal adipose tissue was quantified by computed tomography at L 4 -L 5 . WC was measured at 3 sites: lowest rib, iliac crest, and the midpoint between the lowest rib and iliac crest. Results: Persons with SCI had a 58% greater mean VAT (P ϭ 0.003), 48% greater mean VAT:SAT (P ҃ 0.034), and 26% greater mean TAT (P ҃ 0.055) than did matched AB controls after differences in weight were accounted for. Mean SAT was not significantly different between groups. WC at all sites was correlated with VAT in both groups (SCI: 0.905 ͨ r ͨ 0.925; AB: 0.838 ͨ r ͨ 0.877; both P 0.001). Conclusions: High levels of VAT exist in young people with SCI who classify themselves as active and healthy. WC may be a valid surrogate measure of VAT in this population and serve as a tool for clinicians to identify those at risk of CHD.Am J Clin Nutr 2008; 87:600 -7.

Functional disability of adult individuals with spinal cord injury and its association with socio-demographic characteristics

“…As a result of these conditions, some health problems may emerge, such as obesity, coronary disease and type 2 diabetes mellitus (5) . (6) .…”

Severe spasticity in lower extremities is associated with reduced adiposity and lower fasting plasma glucose level in persons with spinal cord injury

“…5 More importantly, WC, which is known to be a good surrogate measure of visceral adipose tissue in the persons with SCI, as well as in able-bodied population, was lower in the severe spasticity group. 14,15 Because increase in visceral adipose tissue is known to be associated with altered carbohydrate and lipid metabolism in both able-bodied and SCI populations, 16,17 severe spasticity, especially in lower extremities as presented in this study, might be regarded as to have protective effects against adverse metabolic profiles commonly seen in individuals with SCI.…”

Commentary on Comparison of Coronary Artery Calcification Scores, National Cholesterol Education Program Guidelines for Coronary Heart Disease Risk Assessment, Treatment Paradigms in Individuals with Chronic Traumatic Spinal Injury

“…As a result of the decreased lean mass, decreased sympathetic nervous system activity, and decreased physical activity, persons with SCI have decreased energy expenditure compared to able-bodied individuals [13][14][15]. Subsequently, obesity, and particularly central adiposity, is common among persons with chronic SCI and is more prevalent than in able-bodied persons [16][17][18][19][20][21][22]. The sedentary lifestyle can also result in low levels of high density lipoprotein cholesterol (HDL-C), an additional CHD risk factor [23,24].…”

“…Many other articles had previously documented CHD risk factors including diabetes mellitus [25,26], dyslipidemia [27,28], obesity [17,29] and inflammation [30,31]. Yet, a literature search of clinical trials with the search terms ("spinal cord" or tetraplegia or paraplegia or quadriplegia) AND (cardiovascular disease or coronary heart disease or diabetes) only revealed two articles [32,33] with interventions aimed to improve cardiovascular health or improve body composition.…”