Lean mass is the strongest predictor of bone mineral content in type-2 diabetes and normal individuals: an eastern India perspective

Journal of Diabetes & Metabolic Disorders

Subhankar Chowdhury¹  Satinath Mukhopadhyay¹  Deep Dutta¹  Indira Maisnam¹ 

[1] Department of Endocrinology & Metabolism, Institute of Post-Graduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, 244 AJC Bose Road, Calcutta 700020, India

关键词: Fat mass;    Lean mass;    Type-2 diabetes;    Bone mineral content,bone mineral density;   

Others  :  1136140
DOI  :  10.1186/s40200-014-0090-5

 received in 2013-10-11, accepted in 2014-08-17,  发布年份 2014

【 摘 要 】

Background

Impact of body fat distribution on bone mineral content (BMC) and density (BMD) at different sites has not been studied in type-2 diabetes (T2DM). This study aimed to compare BMC and BMD in normal (BMI < 25 kg/m²) and increased BMI (BMI ≥ 25 kg/m²) T2DM patients with age and BMI matched normal controls, and evaluate the impact of lean mass and body fat distribution parameters on them.

Methods

Seventy-six T2DM patients and 56 normal controls underwent anthropometric assessment, blood sampling and estimation of BMC, BMD, body fat and lean mass distribution by dual energy X-ray absorptiometry (DXA).

Results

Increased BMI individuals (n = 63) had significantly higher BMD, BMC, fat mass and significantly lower 25-hydroxy-vitamin-D (25OHD), as compared to normal BMI individuals (n = 69). Lean mass had stronger positive correlation with BMC and BMD, compared to fat mass. BMI, sagittal abdominal diameter (SAD) and Android/Gynoid (A/G) ratio had positive correlation with BMC and BMD. Percent body fat had negative correlation with BMC and BMD. T2DM patients had higher central obesity (A/G ratio). WC was the best predictor of A/G ratio. Regression analysis revealed lean mass to be the strongest predictor of BMC after adjusting for age, sex, BMI and 25OHD, in normal individuals and patients with diabetes, followed by fat mass. BMD right femur, BMC, lean mass and A/G ratios were significantly higher in males (n = 74). Fat mass and percent body fat were significantly higher in females (n = 58). Fat mass was the best predictor of BMC in males where as lean mass was the best predictor of BMC in females.

Conclusion

Increased BMI and T2DM are associated with increased BMC and BMD at different sites, with lean mass having the strongest impact on BMC in normal individuals and patients with diabetes. Males have higher BMC and BMD as compared to females, likely due to a greater lean mass, A/G ratio, along with lesser fat mass and percent body fat.

【 授权许可】

   
2014 Maisnam et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, Johnson KC, Margolis KL: Risk of fracture in women with type 2 diabetes mellitus: the women’s health initiative observational study. J Clin Endocrinol Metab 2006, 91:3404-3410.
• [2]Janghorbani M, Feskanich D, Willett WC, Hu F: Prospective study of diabetes and risk of hip fracture: the nurses’ health study. Diabetes Care 2006, 29:1573-1578.
• [3]Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Bauer DC, Tylavsky FA, de Rekeneire N, Harris TB, Newman AB: Non-traumatic fracture risk in type 2 diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging and body composition study. Arch Intern Med 2005, 165:1612-1617.
• [4]De Liefde II, der KliftM V, De Laet CE, van Daele PL, Hofman A, Pols HA: Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam study. Osteoporos Int 2005, 16:1713-1720.
• [5]Ma L, Oei L, Jiang L, Estrada K, Chen H, Wang Z, Yu Q, Zillikens MC, Gao X, Rivadeneira F: Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol 2012, 27:319-332.
• [6]Dutta MK, Pakhetra R, Garg MK: Evaluation of BMD in type 2 diabetes mellitus before and after treatment. Med J Armed Forces India 2012, 68:48-52.
• [7]Zhao N, Tang XL, Zhen DH, Liu HH: Higher calcaneal bone mineral density in men with metabolic syndrome in a Chinese population. J Diabetes 2013, 5:7-9.
• [8]Blum M, Dolnikowski G, Seyoum E, Harris SS, Booth SL, Peterson J, Saltzman E, Dawson-Hughes B: Vitamin D3 in fat tissue. Endocrine 2008, 33:90-94.
• [9]Russell M, Mendes N, Miller KK, Rosen CJ, Lee H, Klibanski A, Misra M: Visceral fat is a negative predictor of bone density measures in obese adolescent girls. J Clin Endocrinol Metab 2010, 95:1247-1255.
• [10]Taaffe DR, Villa ML, Holloway L, Marcus R: Bone mineral density in older non-Hispanic Caucasian and Mexican-American women: relationship to lean and fat mass. Ann Hum Biol 2000, 27:331-344.
• [11]Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X: Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 2006, 83:146-154.
• [12]El Hage R, Jacob C, Moussa E, Baddoura R: Relative importance of lean mass and fat mass on bone mineral density in a group of Lebanese postmenopausal women. J Clin Densitom 2011, 14:326-331.
• [13]Dytfeld J, Ignaszak-Szczepaniak M, Gowin E, Michalak M, Horst-Sikorska W: Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis. Arch Gerontol Geriatr 2011, 53:237-242.
• [14]Liu S, Li J, Sheng Z, Liao E: Relationship between body composition and age, menopause and its effects on bone mineral density at segmental regions in Central Southern Chinese postmenopausal elderly women with and without osteoporosis. Arch Gerontol Geriatr 2011, 53:192-197.
• [15]Yoo HJ, Park MS, Yang SJ, Kim TN, Lim KI, Kang HJ, Song W, Baik SH, Choi DS, Choi KM: The differential relationship between fat mass and bone mineral density by gender and menopausal status. J Bone Miner Metab 2012, 30:47-53.
• [16]Kvist H, Chowdhury B, Grangård U, Tylén U, Sjöström L: Total and visceral adipose tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988, 48:1351-1361.
• [17]Risérus U, Arnlöv J, Brismar K, Zethelius B, Berglund L, Vessby B: Sagittal abdominal diameter is a strong anthropometric marker of insulin resistance hyperproinsulinemia in obese men. Diabetes Care 2004, 27:2041-2046.
• [18]Guzzaloni G, Minocci A, Marzullo P, Liuzzi A: Sagittal abdominal diameter is more predictive of cardiovascular risk than abdominal fat compartments in severe obesity. Int J Obes 2009, 33:233-238.
• [19]Adams JS, Hewison M: Update in vitamin D. J Clin Endocrinol Metab 2010, 95:471-478.
• [20]Klein S, Fabrini E, Romijn JA: Obesity. In Williams textbook of endocrinology. 12th edition. Edited by Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Elsevier Saunders, ■■■; 2011:1605-1631.
• [21]Kemink SA, Hermus AR, Swinkels LM, Lutterman JA, Smals AG: Osteopenia in insulin-dependent diabetes mellitus; prevalence and aspects of pathophysiology. J Endocrinol Invest 2000, 23:295-303.
• [22]Le Roith D: Beta-cell dysfunction and insulin resistance in type 2 diabetes: role of metabolic and genetic abnormalities. Am J Med 2002, 113:3S-11S.
• [23]Mc Carty MF, Thomas CA: PTH excess may promote weight gain by impending catecholamine-induced lipolysis-implications for the impact of calcium, vitamin D and alcohol on body weight. Med Hypotheses 2003, 61:535-542.
• [24]Iyengar S, Hamman RF, Marshall JA, Majumder PP, Ferrell RE: On the role of Vitamin D binding globulin in glucose homeostasis: results from the San Luis Valley diabetes study. Genet Epidemiol 1989, 6:691-698.
• [25]Baier LJ, Dobberfuhl AM, Pratley RE, Hanson RL, Bogardus C: Variations in the vitamin D-binding protein (Gc locus) are associated with oral glucose tolerance in non-diabetic Pima Indians. J Clin Endocrinol Metab 1998, 83:2993-2996.
• [26]Hitman GA, Mannan N, McDermott MF, Aganna E, Ogunkolade BW, Hales CN, Boucher BJ: Vitamin D receptor gene polymorphisms influence insulin secretion in Bangladeshi Asians. Diabetes 1998, 47:688-690.
• [27]Barrett-Connor E, Holbrook TL: Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 1992, 268:3333-3337.
• [28]De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A: Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 2005, 16:1330-1338.
• [29]Bavenholm PN, Kuhl J, Pigon J, Saha AK, Ruderman NB: EfedicS. Insulin resistance in type 2 diabetes: association with truncal obesity, impaired fitness, and atypical malonyl coenzyme A regulation. J Clin Endocrinol Metab 2003, 88:82-87.
• [30]Heiss CJ, Sanborn CF, Nichols DL, Bonnick SL, Alford BB: Associations of body fat distribution, circulating sex hormones, and bone density in postmenopausal women. J Clin Endocrinol Metab 1995, 80:1591-1596.
• [31]Marwaha RK, Garg MK, Tandon N, Mehan N, Sastry A, Bhadra K: Relationship of body fat and its distribution with bone mineral density in Indian population. J Clin Densitom 2013, 16:353-359.
• [32]Zillikens MC, Uitterlinden AG, van Leeuwen JP, Berends AL, Henneman P, van Dijk KW, Oostra BA, van Duijn CM, Pols HA, Rivadeneira F: The role of body mass index, insulin, and adiponectin in the relation between fat distribution and bone mineral density. Calcif Tissue Int 2010, 86:116-125.
• [33]Kim CJ, Oh KW, Rhee EJ, Kim KH, Jo SK, Jung CH, Won JC, Park CY, Lee WY, Park SW, Kim SW: Relationship between body composition and bone mineral density (BMD) in perimenopausal Korean women. Clin Endocrinol (Oxf) 2009, 71:18-26.
• [34]Lanyon LE, Rubin CT: Static vs. dynamic loads has an influence on bone remodeling. J Biomech 1984, 17:897-905.