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Differences in Glucose Metabolism Among Women With Spinal Cord Injury May Not Be Fully Explained by Variations in Body Composition

  • Jia Li
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
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  • Gary R. Hunter
    Affiliations
    Department of Nutrition, University of Alabama at Birmingham, Birmingham, AL

    Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
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  • Yuying Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL

    Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
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  • Amie McLain
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL

    Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
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  • Daniel L. Smith
    Affiliations
    Department of Nutrition, University of Alabama at Birmingham, Birmingham, AL

    Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
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  • Ceren Yarar-Fisher
    Correspondence
    Corresponding author Ceren Yarar-Fisher, PT, PhD, Department of Physical Medicine and Rehabilitation, Shelby Building 503, 1825 University Blvd, University of Alabama at Birmingham, Birmingham, AL 35233.
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL

    Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
    Search for articles by this author
Published:October 11, 2018DOI:https://doi.org/10.1016/j.apmr.2018.08.191

      Abstract

      Objective

      To investigate the differences in glucose metabolism among women with paraplegic, and tetraplegic spinal cord injury (SCI) in comparison to their able-bodied (AB) counterparts after adjusting for differences in body composition.

      Design

      Cross-sectional study. After an overnight fast, each participant consumed a 75-g glucose solution for oral glucose tolerance test (OGTT). Blood glucose, insulin, and C-peptide concentrations were analyzed before and 30, 60, 90, and 120 minutes after ingesting glucose solution. Insulin sensitivity index (ISI) was estimated using the Matsuda index. Percentage fat mass (%FM) and total body lean mass (TBLM) were estimated using data from dual-energy x-ray absorptiometry. Visceral fat (VF) was quantified using computed tomography. Outcome measures were compared among groups using analysis of covariance with %FM (or VF) and TBLM as covariates.

      Setting

      Research university.

      Participants

      Women (N=42) with SCI (tetraplegia: n=8; paraplegia: n=14) and their race-, body mass index-, and age-matched AB counterparts (n=20).

      Interventions

      Not applicable.

      Results

      At fasting, there was no difference in glucose homeostasis (glucose, insulin, C-peptide concentrations) among 3 groups of women. In contrast, glucose, insulin, and C-peptide concentrations at minute 120 during OGTT were higher in women with tetraplegia versus women with paraplegia and AB women (P<.05, adjusted for TBLM and %FM). In addition, women with tetraplegia had lower ISI (P<.05, adjusted for TBLM and %FM) versus AB women. These differences remained after adjusting for VF and TBLM.

      Conclusion

      Our study confirms that impaired glucose metabolism among women with tetraplegia may not be fully explained by changes in their body composition. Future studies exploring additional factors involved in glucose metabolism are warranted.

      Keywords

      List of abbreviations:

      AB (able-bodied), ANCOVA (analysis of covariance), BMI (body mass index), CT (computed tomography), DXA (dual-energy x-ray absorptiometry), FM (fat mass), IMF (intramuscular fat), ISI (insulin sensitivity index), OGTT (oral glucose tolerance test), SCI (spinal cord injury), TBLM (total body lean mass), TBLMI (total body lean mass index), UAB (University of Alabama at Birmingham), VF (visceral fat), Wt (weight)
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      References

        • Bauman W.A.
        • Spungen A.M.
        Coronary heart disease in individuals with spinal cord injury: assessment of risk factors.
        Spinal Cord. 2008; 46: 466-476
        • Kressler J.
        • Cowan R.E.
        • Bigford G.E.
        • Nash M.S.
        Reducing cardiometabolic disease in spinal cord injury.
        Phys Med Rehabil Clin N Am. 2014; 25 (viii): 573-604
        • Bauman W.A.
        • Spungen A.M.
        Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging.
        Metabolism. 1994; 43: 749-756
        • Bauman W.A.
        • Spungen A.M.
        Carbohydrate and lipid metabolism in chronic spinal cord injury.
        J Spinal Cord Med. 2001; 24: 266-277
      1. National Spinal Cord Injury Statistical Center. 2016 SCIMS annual report – complete public version. Available at: https://www.nscisc.uab.edu. Accessed December 1, 2017.

        • Gorgey A.S.
        • Dolbow D.R.
        • Dolbow J.D.
        • Khalil R.K.
        • Castillo C.
        • Gater D.R.
        Effects of spinal cord injury on body composition and metabolic profile - part I.
        J Spinal Cord Med. 2014; 37: 693-702
        • Bauman W.A.
        • Spungen A.M.
        Metabolic changes in persons after spinal cord injury.
        Phys Med Rehabil Clin N Am. 2000; 11: 109-140
        • Spungen A.M.
        • Adkins R.H.
        • Stewart C.A.
        • et al.
        Factors influencing body composition in persons with spinal cord injury: a cross-sectional study.
        J Appl Physiol (1985). 2003; 95: 2398-2407
        • DeFronzo R.A.
        • Jacot E.
        • Jequier E.
        • Maeder E.
        • Wahren J.
        • Felber J.P.
        The effect of insulin on the disposal of intravenous glucose. Results from indirect calorimetry and hepatic and femoral venous catheterization.
        Diabetes. 1981; 30: 1000-1007
        • Buchholz A.C.
        • Pencharz P.B.
        Energy expenditure in chronic spinal cord injury.
        Curr Opin Clin Nutr Metab Care. 2004; 7: 635-639
        • Monroe M.B.
        • Tataranni P.A.
        • Pratley R.
        • Manore M.M.
        • Skinner J.S.
        • Ravussin E.
        Lower daily energy expenditure as measured by a respiratory chamber in subjects with spinal cord injury compared with control subjects.
        Am J Clin Nutr. 1998; 68: 1223-1227
        • Aksnes A.K.
        • Hjeltnes N.
        • Wahlstrom E.O.
        • Katz A.
        • Zierath J.R.
        • Wallberg-Henriksson H.
        Intact glucose transport in morphologically altered denervated skeletal muscle from quadriplegic patients.
        Am J Physiol. 1996; 271: E593-E600
        • Bauman W.A.
        • Adkins R.H.
        • Spungen A.M.
        • Waters R.L.
        The effect of residual neurological deficit on oral glucose tolerance in persons with chronic spinal cord injury.
        Spinal Cord. 1999; 37: 765-771
        • Farkas G.J.
        • Gorgey A.S.
        • Dolbow D.R.
        • Berg A.S.
        • Gater D.R.
        The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles.
        J Spinal Cord Med. 2018; 41: 407-415
        • Schmid A.
        • Halle M.
        • Stutzle C.
        • et al.
        Lipoproteins and free plasma catecholamines in spinal cord injured men with different injury levels.
        Clin Physiol. 2000; 20: 304-310
        • Groah S.L.
        • Nash M.S.
        • Ward E.A.
        • et al.
        Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury.
        J Cardiopulm Rehabil Prev. 2011; 31: 73-80
        • Gorgey A.S.
        • Farkas G.J.
        • Dolbow D.R.
        • Khalil R.E.
        • Gater D.R.
        Gender dimorphism in central adiposity may explain metabolic dysfunction after spinal cord injury.
        PM R. 2018; 10: 338-348
        • Szlachcic Y.
        • Adkins R.H.
        • Govindarajan S.
        • Cao Y.
        • Krause J.S.
        Cardiometabolic changes and disparities among persons with spinal cord injury: a 17-year cohort study.
        Top Spinal Cord Inj Rehabil. 2014; 20: 96-104
        • Matsuda M.
        • DeFronzo R.A.
        Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.
        Diabetes Care. 1999; 22: 1462-1470
        • Kvist H.
        • Chowdhury B.
        • Grangard U.
        • Tylen U.
        • Sjostrom 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
        • Hunter G.R.
        • Brock D.W.
        • Byrne N.M.
        • Chandler-Laney P.C.
        • Del Corral P.
        • Gower B.A.
        Exercise training prevents regain of visceral fat for 1 year following weight loss.
        Obesity (Silver Spring). 2010; 18: 690-695
        • American Diabetes Association
        Classification and diagnosis of diabetes.
        Diabetes Care. 2015; 38: S8-S16
        • Roberts T.T.
        • Leonard G.R.
        • Cepela D.J.
        Classifications in brief: American Spinal Injury Association (ASIA) Impairment Scale.
        Clin Orthop Relat Res. 2017; 475: 1499-1504
        • Buchholz A.C.
        • McGillivray C.F.
        • Pencharz P.B.
        Differences in resting metabolic rate between paraplegic and able-bodied subjects are explained by differences in body composition.
        Am J Clin Nutr. 2003; 77: 371-378
        • Inskip J.
        • Plunet W.
        • Ramer L.
        • et al.
        Cardiometabolic risk factors in experimental spinal cord injury.
        J Neurotrauma. 2010; 27: 275-285
        • Duckworth W.C.
        • Solomon S.S.
        • Jallepalli P.
        • Heckemeyer C.
        • Finnern J.
        • Powers A.
        Glucose intolerance due to insulin resistance in patients with spinal cord injuries.
        Diabetes. 1980; 29: 906-910
        • Rankin K.C.
        • O'Brien L.C.
        • Segal L.
        • Khan M.R.
        • Gorgey A.S.
        Liver adiposity and metabolic profile in individuals with chronic spinal cord injury.
        Biomed Res Int. 2017; 2017: 1364818
        • Buse M.G.
        • Buse J.
        Glucose uptake and response to insulin of the isolated rat diaphragm: the effect of denervation.
        Diabetes. 1959; 8: 218-225
        • Elder C.P.
        • Apple D.F.
        • Bickel C.S.
        • Meyer R.A.
        • Dudley G.A.
        Intramuscular fat and glucose tolerance after spinal cord injury--a cross-sectional study.
        Spinal Cord. 2004; 42: 711-716
        • Gorgey A.S.
        • Dudley G.A.
        Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury.
        Spinal Cord. 2007; 45: 304-309
        • Yarar-Fisher C.
        • Bickel C.S.
        • Windham S.T.
        • McLain A.B.
        • Bamman M.M.
        Skeletal muscle signaling associated with impaired glucose tolerance in spinal cord-injured men and the effects of contractile activity.
        J Appl Physiol (1985). 2013; 115: 756-764
        • O'Brien L.C.
        • Chen Q.
        • Savas J.
        • Lesnefsky E.J.
        • Gorgey A.S.
        Skeletal muscle mitochondrial mass is linked to lipid and metabolic profile in individuals with spinal cord injury.
        Eur J Appl Physiol. 2017; 117: 2137-2147
        • O'Brien L.C.
        • Wade R.C.
        • Segal L.
        • et al.
        Mitochondrial mass and activity as a function of body composition in individuals with spinal cord injury.
        Physiol Rep. 2017; 5
        • Gorgey A.S.
        • Mather K.J.
        • Gater D.R.
        Central adiposity associations to carbohydrate and lipid metabolism in individuals with complete motor spinal cord injury.
        Metabolism. 2011; 60: 843-851
        • Hunter G.R.
        • Chandler-Laney P.C.
        • Brock D.W.
        • Lara-Castro C.
        • Fernandez J.R.
        • Gower B.A.
        Fat distribution, aerobic fitness, blood lipids, and insulin sensitivity in African-American and European-American women.
        Obesity (Silver Spring). 2010; 18: 274-281
        • Williams M.J.
        • Hunter G.R.
        • Kekes-Szabo T.
        • Snyder S.
        • Treuth M.S.
        Regional fat distribution in women and risk of cardiovascular disease.
        Am J Clin Nutr. 1997; 65: 855-860
        • Gorgey A.S.
        • Gater D.R.
        A preliminary report on the effects of the level of spinal cord injury on the association between central adiposity and metabolic profile.
        PM R. 2011; 3: 440-446