Clinical Rheumatology

, Volume 26, Issue 9, pp 1427–1432 | Cite as

Body composition, insulin, and leptin levels in patients with ankylosing spondylitis

  • Ismail Sari
  • Tevfik Demir
  • Leyla Didem Kozaci
  • Servet Akar
  • Tulay Kavak
  • Merih Birlik
  • Fatos Onen
  • Nurullah Akkoc
Original Article

Abstract

The aim of this study was to compare the effect of chronic inflammation on insulin resistance, serum leptin levels, and body composition (BC) in patients with ankylosing spondylitis (AS) and healthy controls. Twenty-eight AS patients and 17 healthy controls were included in this study. Subjects with hypertension, diabetes, hyperlipidemia, and obesity were excluded. Acute phase reactants and serum levels of glucose, insulin, lipids, and leptin were studied. BC was determined anthropometrically and by foot-to-foot body fat analyzer (BIA, bioelectrical impedance analysis). Quantitative insulin-sensitivity check index, homeostasis model assessment for insulin resistance, and McAuley indices were calculated. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI). Patients were also evaluated with the Bath Ankylosing Spondylitis Functional Index and the Bath Ankylosing Spondylitis Disease Activity Index. Age, sex distribution, smoking status, serum lipids, insulin concentrations, and insulin resistance indices were comparable between AS patients and controls (p > 0.05). However, acute phase reactants were significantly higher and leptin levels were significantly lower in the AS patients than in controls (p < 0.05). Fat percent assessed by both BIA and anthropometrical methods was lower in the male and female AS patients than in controls, and this reduced fat level reached statistical significance for men (p < 0.05). There were significant correlations between percent body fat, body mass index, leptin, age, and BASMI (p < 0.05; r = 0.6, 0.75, 0.35, −0.41, respectively). On the other hand, body fat percent, waist-to-hip ratio, C-reactive protein, and BASMI were significantly correlated with serum leptin levels (p < 0.05; r = 0.75, −0.42, −0.52, −0.47, respectively). Chronic inflammatory condition in AS may be responsible for the reduced body fat content and lower circulating leptin concentrations. Insulin levels and insulin resistance indices seem similar in patients and controls in the absence of classic vascular risk factors.

Keywords

Ankylosing spondylitis Body composition Insulin resistance Leptin 

References

  1. 1.
    Akkoc N, Khan MA (2006) Epidemiology of ankylosing spondylitis and related spondyloarthropathies. In: Weisman MH, Reveille JD, van der Heijde D (eds) Ankylosing spondylitis and the spondyloarthropathies. Mosby, St. Louis, pp 117–131Google Scholar
  2. 2.
    Radford EP, Doll R, Smith PG (1977) Mortality among patients with ankylosing spondylitis not given X-ray therapy. N Engl J Med 297(11):572–576 (Sep 15)PubMedCrossRefGoogle Scholar
  3. 3.
    Lehtinen K (1993) Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis 52(3):174–176 (Mar)PubMedCrossRefGoogle Scholar
  4. 4.
    Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT (2004) Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 34(3):585–592 (Dec)CrossRefGoogle Scholar
  5. 5.
    Haffner SM (1999) Epidemiology of insulin resistance and its relation to coronary artery disease. Am J Cardiol 84(1A):11J–14J (Jul 8)PubMedCrossRefGoogle Scholar
  6. 6.
    Svenson KL, Lundqvist G, Wide L, Hallgren R (1987) Impaired glucose handling in active rheumatoid arthritis: relationship to the secretion of insulin and counter-regulatory hormones. Metabolism 36(10):940–943 (Oct)PubMedCrossRefGoogle Scholar
  7. 7.
    Svenson KL, Pollare T, Lithell H, Hallgren R (1988) Impaired glucose handling in active rheumatoid arthritis: relationship to peripheral insulin resistance. Metabolism 37(2):125–130 (Feb)PubMedCrossRefGoogle Scholar
  8. 8.
    Svenson KL, Lundqvist G, Wide L, Hallgren R (1987) Impaired glucose handling in active rheumatoid arthritis: effects of corticosteroids and antirheumatic treatment. Metabolism 36(10):944–948 (Oct)PubMedCrossRefGoogle Scholar
  9. 9.
    Westhovens R, Nijs J, Taelman V, Dequeker J (1997) Body composition in rheumatoid arthritis. Br J Rheumatol 36(4):444–448 (Apr)PubMedCrossRefGoogle Scholar
  10. 10.
    Roubenoff R, Roubenoff RA, Ward LM, Holland SM, Hellmann DB (1992) Rheumatoid cachexia: depletion of lean body mass in rheumatoid arthritis. Possible association with tumor necrosis factor. J Rheumatol 19(10):1505–1510 (Oct)PubMedGoogle Scholar
  11. 11.
    Dos Santos FP, Constantin A, Laroche M, Destombes F, Bernard J, Mazieres B et al (2001) Whole body and regional bone mineral density in ankylosing spondylitis. J Rheumatol 28(3):547–549 (Mar)PubMedGoogle Scholar
  12. 12.
    Toussirot E, Michel F, Wendling D (2001) Bone density, ultrasound measurements and body composition in early ankylosing spondylitis. Rheumatology (Oxford) 40(8):882–888 (Aug)CrossRefGoogle Scholar
  13. 13.
    Matarese G, Moschos S, Mantzoros CS (2005) Leptin in immunology. J Immunol 174(6):3137–3142 (Mar 15)PubMedGoogle Scholar
  14. 14.
    Palmer G, Gabay C (2003) A role for leptin in rheumatic diseases? Ann Rheum Dis 62(10):913–915 (Oct)PubMedCrossRefGoogle Scholar
  15. 15.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368 (Apr)PubMedCrossRefGoogle Scholar
  16. 16.
    Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G et al (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85(7):2402–2410 (Jul)PubMedCrossRefGoogle Scholar
  17. 17.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419 (Jul)PubMedCrossRefGoogle Scholar
  18. 18.
    McAuley KA, Williams SM, Mann JI, Walker RJ, Lewis-Barned NJ, Temple LA et al (2001) Diagnosing insulin resistance in the general population. Diabetes Care 24(3):460–464 (Mar)PubMedCrossRefGoogle Scholar
  19. 19.
    Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32(1):77–97 (Jul)PubMedCrossRefGoogle Scholar
  20. 20.
    Siri NE (1956) Advances in biological and medical physics. Academic, London and New YorkGoogle Scholar
  21. 21.
    Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21(9):1694–1698 (Sep)PubMedGoogle Scholar
  22. 22.
    Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285 (Dec)PubMedGoogle Scholar
  23. 23.
    Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291 (Dec)PubMedGoogle Scholar
  24. 24.
    Gallagher D, Song MY (2003) Evaluation of body composition: practical guidelines. Prim Care 30(2):249–265 (Jun)PubMedGoogle Scholar
  25. 25.
    Ellis KJ (2000) Human body composition: in vivo methods. Physiol Rev 80(2):649–680 (Apr)PubMedGoogle Scholar
  26. 26.
    Vasudev S, Mohan A, Mohan D, Farooq S, Raj D, Mohan V (2004) Validation of body fat measurement by skinfolds and two bioelectric impedance methods with DEXA—the Chennai Urban Rural Epidemiology Study [CURES-3]. J Assoc Phys India 52:877–881 (Nov)Google Scholar
  27. 27.
    Fogelholm M, van Marken Lichtenbelt W (1997) Comparison of body composition methods: a literature analysis. Eur J Clin Nutr 51(8):495–503 (Aug)PubMedCrossRefGoogle Scholar
  28. 28.
    La Cava A, Matarese G (2004) The weight of leptin in immunity. Nat Rev Immunol 4(5):371–399 (May)PubMedCrossRefGoogle Scholar
  29. 29.
    van Crevel R, Karyadi E, Netea MG, Verhoef H, Nelwan RH, West CE et al (2002) Decreased plasma leptin concentrations in tuberculosis patients are associated with wasting and inflammation. J Clin Endocrinol Metab 87(2):758–763 (Feb)PubMedCrossRefGoogle Scholar
  30. 30.
    Perfetto F, Tarquini R, Simonini G, Bindi G, Mancuso F, Guiducci S et al (2005) Circulating leptin levels in juvenile idiopathic arthritis: a marker of nutritional status? Ann Rheum Dis 64(1):149–152 (Jan)PubMedCrossRefGoogle Scholar
  31. 31.
    Popa C, Netea MG, Radstake TR, van Riel PL, Barrera P, van der Meer JW (2005) Markers of inflammation are negatively correlated with serum leptin in rheumatoid arthritis. Ann Rheum Dis 64(8):1195–1198 (Aug)PubMedCrossRefGoogle Scholar
  32. 32.
    Otero M, Lago R, Gomez R, Dieguez C, Lago F, Gomez-Reino J et al (2006) Towards a pro-inflammatory and immunomodulatory emerging role of leptin. Rheumatology (Oxford) 45(8):944–950 (Aug)CrossRefGoogle Scholar
  33. 33.
    Thomas T, Burguera B, Melton LJ III, Atkinson EJ, O’Fallon WM, Riggs BL et al (2000) Relationship of serum leptin levels with body composition and sex steroid and insulin levels in men and women. Metabolism 49(10):1278–1284 (Oct)PubMedCrossRefGoogle Scholar
  34. 34.
    Radikova Z (2003) Assessment of insulin sensitivity/resistance in epidemiological studies. Endocr Regul 37(3):189–194 (Sep)PubMedGoogle Scholar
  35. 35.
    Wallace TM, Matthews DR (2002) The assessment of insulin resistance in man. Diabet Med 19(7):527–534 (Jul)PubMedCrossRefGoogle Scholar
  36. 36.
    Penesova A, Rovensky J, Zlnay M, Dedik L, Radikova Z, Koska J et al (2005) Attenuated insulin response and normal insulin sensitivity in lean patients with ankylosing spondylitis. Int J Clin Pharmacol Res 25(3):107–114PubMedGoogle Scholar
  37. 37.
    Jimenez-Balderas FJ, Solis JL, Mintz G (1991) Immunoreactive insulin levels in ankylosing spondylitis. Arch Invest Méd 22(2):121–125 (Apr–Jun)Google Scholar
  38. 38.
    Toussirot E, Nguyen NU, Dumoulin G, Regnard J, Wendling D (1998) Insulin-like growth factor-I and insulin-like growth factor binding protein-3 serum levels in ankylosing spondylitis. Br J Rheumatol 37(11):1172–1176 (Nov)PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Ismail Sari
    • 1
    • 4
  • Tevfik Demir
    • 2
  • Leyla Didem Kozaci
    • 3
  • Servet Akar
    • 1
  • Tulay Kavak
    • 3
  • Merih Birlik
    • 1
  • Fatos Onen
    • 1
  • Nurullah Akkoc
    • 1
  1. 1.Division of Rheumatology, Department of Internal MedicineDokuz Eylul University School of MedicineIzmirTurkey
  2. 2.Division of Endocrinology, Department of Internal MedicineDokuz Eylul University School of MedicineIzmirTurkey
  3. 3.Department of BiochemistryAdnan Menderes University School of MedicineAydinTurkey
  4. 4.Immunoloji-Romatoloji BDDokuz Eylul Universitesi Tip Fakultesi, Ic hastaliklari ABDIzmirTurkey

Personalised recommendations