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Obesity, metabolic comorbidities common in spina bifida
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Researchers observed a high prevalence of obesity coupled with related cardiometabolic complications in a cohort of Australian patients with spina bifida, as well as an increased risk for fragility fracture, according to findings published in the Journal of the Endocrine Society.
“With increasing life expectancy, chronic diseases of adulthood, including obesity, osteoporosis, cardiovascular disease and renal failure, are also emerging as health problems in this vulnerable group,” Anne A. Trinh, MBBS, FRACP, a doctoral student in the bone and muscle health research group at Monash University in Melbourne, Australia, and colleagues wrote. “Limited literature for adults with [spina bifida] exists to guide clinical management of these conditions.”
In a retrospective, cross-sectional study, Trinh and colleagues analyzed data from 49 adults with spina bifida who underwent DXA imaging at a tertiary hospital between 2005 and 2015 (mean age, 33 years; 40.8% men; more than half non-ambulatory). The medical indications for DXA imaging included suspected low bone mineral density in the setting of immobility, fracture, renal disease, anticonvulsant use and hypogonadism. BMD was measured at the L1 vertebra, femoral neck and total body; total lean tissue mass and fat mass were derived from the whole-body scan. Adults were stratified as ambulatory or non-ambulatory and categorized into four BMI groups: underweight (BMI < 18.5 kg.m²), normal (BMI, 18.5-25 kg/m²), overweight (BMI > 25 kg/m²) or obese (BMI 30 kg/m²). Researchers used regression analysis to examine the correlation between fat mass and lean tissue mass with BMD at the L1, femoral neck and total body, adjusting for age, sex and height.
Mean BMI for the cohort was 31.7 kg/m²; only 10 patients had normal weight or underweight. According to total body fat percentage, 87.5% had obesity. Using age- and sex-matched fat centiles from National Health and Nutrition Examination Survey III, 62.5% had DXA total body fat percentage above the 95th centile. There were no between-group differences in BMI for ambulatory vs. non-ambulatory patients.
The median lumbar spine BMD z score was –1.05; median femoral neck BMD z score was –1.5. Researchers observed reduced BMD in 21.9% of patients at the L1 vertebra and in 35.1% of patients at the femoral neck. Ten of 49 patients (20.4%) experienced a fragility fracture; all involved the lower limb apart from two shoulder fractures. Fat mass was significantly positively associated with BMD after adjustment for age, sex and height, and accounted for 18.6% of the variance in BMD.
Researchers also observed a high prevalence of metabolic comorbidities, including hypertension (20.4%), obstructive sleep apnea (16.3%), deep vein thrombosis (8.2%) and type 2 diabetes requiring medication (6.1%).
“The finding of low bone density is not unexpected given that many with spina bifida have reduced mobility,” Trinh told Endocrine Today. “However, treatment needs to be tailored, as we were unable to demonstrate a relationship between low bone density and fracture. The high rate of obesity in our study was alarming; further research is required to better understand the etiology of obesity in spina bifida and to develop strategies for prevention starting from childhood.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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