Reciprocal Relations Of Visceral Adipose Tissue To Spinal Bone Mineral Density In Patients With Type 2 Diabetes Mellitus

Objective: Diabetes is a kind of Endocrine metabolic disease,which can not only influence the metabolism of carbohydrate, protein, and fat,but also the metabolism of bone.Patients with type 2 diabetes mellitus(T2DM) often have obesity,especially abdominal obesity.Although obesity has been proved to be a protective factor to osteoporosis in the past,more and more researches have shown an opposite result.Quantitative CT(QCT) can not only measure lumbar spine bone mineral density(BMD),but also visceral adipose tissue(VAT) and subcutaneous adipose tissue(SAT),which is fast and accurate. Adiponectin(ADN) is a kind of protien secreted by fat tissue,which has anti-inflammatory properties.ADN can decrease in patients with obesity,type 2 diabetes mellitus and coronary artery disease,while it is positively related to BMD and negatively related to inflammation and visceral fat.It has been shown that obesity is a kind of chronic inflammation,while high-sensitivity C-reactive protein( hs-CRP) can reflect it,which also can increased the risk of fracture.This article mainly talks about Reciprocal relations of abdomin- al obesity,especially VAT, to osteoporosis in both type 2 diabetes mellitus patients and normal people,and the influence of ADN and hs-CRP to BMD.Methods: This cross-sectional study involved 100 people,who were randomly sampled from the department of endocrinology and physical examination of the Third Hospital affiliated to Hebei Medical University. We divided them into 2 groups,while type 2 diabetes mellitus patients were in DM group with 49 people,mean age 63.88 years(45~83 years), and normal people were in NC group with 51 people,mean age 61.98 years(43~81 years).We collected clinical data in detail,including Sex,Age,Age diabetes onset Height, Weight, body mass index(BMI), waist circumference(WC), hip circumference(HC), WHR,FBG,TC,TG, HDL-C, LDL-C, Ca, P, ALP, AST, ALT, GGT, hs-CRP, FINS and Hb A1 c. ADN was determined by enzyme-linked immuno sorbent assay(ELISA). Insulin resistance index was assessed by homeostasis model(HOMA-IR)(formula,HOMA-IR=FPG×FINS/22.5).QCT was perform- ed to BMD and SAT,VAT and total adipose tissue(TAT) of the fourth lumbar level.Statistical analysis:SPSS 20.0 software was used for statistical analyses.Pearson correlations were used to examine associations between clinical variables(Age,Weight,BMI,FINS,HOMA-IR,hs-CRP,ADN,etc) and BMD in this 2 groups, respectively.Ruled out the influence of other factors(BMI,WC and SAT) to the correlating of BMD and VAT.Build the BMD of multivariate linear regression model by Logistic regression analyses. After normality test,normal distribution one uses t-test to compare this two groups,while Non-normal distribution one selected rank sum test.Results:1 Correlation analysisBivariate correlations between clinical features and BMD in T2 DM patients:Age,HDL-C,VAT,SAT,TAT and hs-CRP were significantly and negatively correlated to BMD,and ADN was significantly and positively correlated to BMD.(P<0.05) Bivariate correlations between clinical features and BMD in healthy people:Age,WHR,VAT,SAT,TAT and hs-CRP were significantly and negatively correlated to BMD,and HDL-C,ADN were significantly and positively correlated to BMD.(P < 0.05) Bivariate correlations between clinical features and VAT in T2 DM patients:weight,BMI,WC,WHR and hs-CRP were significantly and positively correlated to VAT,AND were significantly and negatively correlated to VAT.(P<0.05) Bivariate correlations between clinical features and VAT in healthy people:age,weight,BMI,WC,WHR and hs-CRP were significantly and positi- vely correlated to VAT,AND were significantly and negatively correlated to VAT.(P<0.05) VAT were significantly and positively correlated to BMD after adjusted for BMI,WC and SAT in both T2 DM patients and normal people. The multiple regression fit, modeling by enter method, indicated that the variation of the predictors(Age,hs-CRP,HDL-C,VAT,SAT, ADN) explained 47.7% of the variation in BMD between subjects respectively in T2 DM patients and 37.3% in normal people.(P<0.01)2 The comparison of T2 DM patients and healthy peopleThere is no difference in BMD,SAT,TAT and VAT/SAT between these 2 groups,while VAT,hs-CRP and HOMA-IR were larger in T2 DM patients and ADN was smaller.Conclusions:1 In T2 DM patients, visceral adipose tissue increases, adiponectin decreases and hs-CRP increases significantly.2 Bone mineral density is significantly and positively related to adiponectin,but negatively related to hs-CRP, which probably means adiponectin is a protective factor and chronic inflammation is a risk factor to osteoporosis.3 Visceral adipose tissue is significantly and negatively related to bone mineral density,and visceral adipose tissue is an independent risk factor of bone mineral density.