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Anthropometric Cutoffs and Associations with Visceral Adiposity University of Birmingham Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury Sumrell, Ryan; Nightingale, Tom; McCauley, Liron; Gorgey, Ashraf DOI: 10.1371/journal.pone.0203049 License: Creative Commons: Public Domain Dedication Document Version Publisher's PDF, also known as Version of record Citation for published version (Harvard): Sumrell, R, Nightingale, T, McCauley, L & Gorgey, A 2018, 'Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury', PLoS ONE, vol. 13, no. 8, e0203049. https://doi.org/10.1371/journal.pone.0203049 Link to publication on Research at Birmingham portal General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication. •Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. •User may use extracts from the document in line with the concept of ‘fair dealing’ under the Copyright, Designs and Patents Act 1988 (?) •Users may not further distribute the material nor use it for the purposes of commercial gain. Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive. If you believe that this is the case for this document, please contact [email protected] providing details and we will remove access to the work immediately and investigate. Download date: 14. Jun. 2020 RESEARCH ARTICLE Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury Ryan M. Sumrell1☯, Thomas E. Nightingale1,2☯, Liron S. McCauley1, Ashraf S. Gorgey1,2* 1 Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America, 2 Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America a1111111111 ☯ These authors contributed equally to this work. a1111111111 * [email protected] a1111111111 a1111111111 a1111111111 Abstract Background/Objectives To examine associations of different anthropometric measurements of central adiposity to OPEN ACCESS visceral adipose tissue (measured via multi-axial magnetic resonance imaging; MRI) and Citation: Sumrell RM, Nightingale TE, McCauley cardiometabolic disease risk factors in men with spinal cord injury (SCI). Additionally, to LS, Gorgey AS (2018) Anthropometric cutoffs and determine population-specific seated/supine waist and abdominal circumference cutoffs, associations with visceral adiposity and metabolic which may identify men at increased risk of cardiometabolic disease. biomarkers after spinal cord injury. PLoS ONE 13 (8): e0203049. https://doi.org/10.1371/journal. pone.0203049 Participants/Methods Editor: Chelsea Pelletier, University of Northern Twenty-two men with chronic SCI underwent MRI scans, anthropometric measurements British Columbia, CANADA along with assessments of various cardiometabolic risk biomarkers. Pearson/part (account- Received: December 1, 2017 ing for age as a covariate) correlation coefficients were calculated to determine the associa- Accepted: August 10, 2018 tions between study variables. Abdominal and waist circumference cutoffs were extrapolated using the slope of linear regression equations. Published: August 31, 2018 Copyright: This is an open access article, free of all Results copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or Seated/supine abdominal and waist circumferences were (P < 0.01) associated with MRI otherwise used by anyone for any lawful purpose. visceral fat cross-sectional area (VATCSA), VAT volume and CSA:TotalCSA. Low density The work is made available under the Creative lipoprotein, non-high-density lipoprotein and total cholesterol were positively associated Commons CC0 public domain dedication. with seated/supine abdominal and waist circumferences after controlling for age; r = 0.50± Data Availability Statement: The authors do not 0.61, r = 0.46±0.58, r = 0.52±0.58, P < 0.05, respectively. Tumor necrosis factor alpha was have the right or permission to make any data available; access to all VA data is controlled by VA associated with seated/supine abdominal and waist circumferences after accounting for data security policies. The source data from which age; r = 0.49±0.51 and r = 0.48±0.56, P < 0.05 respectively. The population-specific cutoffs the study were derived are available for individuals were 86.5cm and 88.3cm for supine waist and abdominal circumferences, respectively, as who meet the criteria for access, and de-identified well as 89cm and 101cm for seated waist and abdominal circumferences, respectively. data may be requested from ashraf.gorgey@va. 2 gov. After dichotomizing VATCSA (< or 100cm ), peak oxygen uptake, triglycerides, insulin sen- sitivity and glycated hemoglobin were different (P < 0.05) between groups. After dichotomiz- Funding: Funded by Ashraf S. Gorgey received a VA-RRD CDA2: B7867-W grant Veteran Affairs, ing (< or 86.5cm) supine waist circumference, VATCSA, triglycerides and insulin sensitivity Veteran Health Administration, Rehabilitation were different (P < 0.05) between groups. PLOS ONE | https://doi.org/10.1371/journal.pone.0203049 August 31, 2018 1 / 18 Anthropometrics cutoffs and spinal cord injury Research and Development Service. The funders Conclusions had no role in study design, data collection and analysis, decision to publish, or preparation of the Seated/supine circumferences are associated with both central adiposity and biomarkers of manuscript. cardiometabolic disease risk in persons with SCI. Population-specific cutoffs are proposed Competing interests: The authors have declared herein to identify central adiposity and potential cardiometabolic disease risk after SCI. that no competing interests exist. Introduction Obesity is rapidly becoming a serious problem in persons that have physical disabilities, with a 1.2 to 3.9-fold increase in prevalence compared to the general population [1]. Specifically, in persons with spinal cord injury (SCI), the best data available would suggest that two in every three persons with SCI are likely to be obese [2]. The mechanisms by which obesity occurs in persons with SCI are multifactorial and these physiological processes have been eloquently described previously by the conceptual model of Disability-Associated Low Energy Expendi- ture Deconditioning Syndrome [3]. Following SCI, significant atrophy of paralyzed skeletal muscle and mobility impairments lead to a reduction in basal metabolic rate (BMR) and physi- cal activity energy expenditure (PAEE), respectively [4,5]. Alterations in these key components of energy expenditure contributes to an energy surplus, which if maintained, favors the devel- opment of obesity. It has also been suggested that social factors (e.g. comfort food provided by family/friends), functional challenges (e.g. problems encountered when preparing food), phys- ical barriers (e.g. transport to shops and supermarket store shelving) and environment (e.g. hospital food) also contribute to an `obesogenic environment' in this population [6]. Obesity has been addressed as one of the key modifiable risk factors for the development of type II dia- betes mellitus and cardiovascular disease (CVD) in persons with SCI [7] and, likely drives the increased prevalence of these chronic diseases compared to able-bodied individuals [8]. The accumulation of adipose tissue in different depots is altered in persons with SCI. In comparison to able-bodied controls, visceral adipose tissue (VAT) quantified by single slice computed tomography (CT) at the umbilical and L4-L5 levels have been shown to be 34% [9] and 45% (58% after adjusting for weight differences) [10] greater in persons with SCI. VATCSA, measured by single-slice CT scan, has shown to be positively correlated with homeo- stasis model assessment of insulin resistance (HOMA-IR) and fasting insulin concentrations in persons with SCI [9, 10]. Gorgey et al, [11], demonstrated that VAT cross-sectional area (VATCSA) quantified across multi-axial slices compared to a single-axial CSA is adequately describing the true associations between central adiposity and metabolic profile. These authors also demonstrated that VATCSA was positively and negatively associated with fasting plasma glucose (FPG) and insulin concentrations, respectively, but not post-load indices of insulin resistance measured during an oral glucose tolerance test. As FPG concentrations have been shown to correlate with basal rates of hepatic glucose output [12] and HOMA-IR predomi- nantly reflects hepatic insulin sensitivity [13], the associations between VAT and peripheral insulin resistance in persons with SCI remains to be assessed using a more sensitive measure of skeletal muscle/adipose tissue insulin sensitivity (i.e. intravenous
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