Abstract
Disorders of carbohydrate metabolism are highly prevalent in patients with spinal cord injury (SCI). Intramuscular (IM) fat in the thigh has been shown to be negatively correlated with glucose tolerance in able-bodied (AB) populations. PURPOSE To examine the distribution of fat in the thighs of SCI and AB individuals, and to determine the relationship between these fat stores and oral glucose tolerance. METHODS Twelve complete SCI (2 female, 42 ± 12 years, 177.8 ± 12.7 cm, 79.4 ± 8.8 kg, injury level C3–C7, 8 ± 5 years post injury, mean ± SD) and nine AB controls (6 female, 29 ± 9 years, 169.1 ± 9.4 cm, 68.8 ± 17.2 kg) underwent oral glucose tolerance tests and MR imaging of the left thigh. Images were analyzed for IM fat cross-sectional area (CSA), and the resulting areas and percentages were correlated with fasting, 60, 90, and 120-minute glucose and insulin levels. Independent t-tests and simple linear regression were performed to detect between group differences and relationships between variables, respectively. RESULTS Persons with SCI had significantly more IM fat CSA (14.5 ± 6.0; 4.7 ± 2.5 cm2) significantly less muscle CSA (58.6 ± 21.6; 94.1 ± 32.5 cm2), and thus significantly greater IM fat percentages than AB (17.3 ± 4.4; 4.6 ± 2.6 %). The SCI group had significantly greater 90 (148.2 ± 36.5; 97.8 ± 14.7 mg/dL) and 120-minute blood glucose (142.0 ± 19.7; 97.2 ± 15.7 mg/dL), as well as significantly greater 90 (93.1 ± 68.6; 34.5 ± 8.5 μIU/mL) and 120-minute insulin levels (106.8 ± 54.7; 37.7 ± 15.6 μIU/mL). Strong positive correlations were found between blood glucose levels and percent IM fat at both 90 (r2 = .52) and 120- minutes (r2 = .71) after ingestion of glucose. CONCLUSION There is a strong relationship between IM fat of the thigh and impaired glucose tolerance in individuals with SCI. These data emphasize the importance of continued contractile activity and diet management following rehabilitation to aid in the prevention of disorders of carbohydrate metabolism. Supported by The Shepherd Center and NIH grant HD 39676(GAD)
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