Abstract
Purpose
To evaluate the long-term consequences of TNFα inhibitors on body composition and fat distribution, as well as changes in serum adipokines in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS).
Methods
Eight patients with RA and twelve with AS requiring a TNFα inhibitor were prospectively followed for 2 years. Body composition was evaluated by dual X-ray absorptiometry and included measurements of total fat mass, lean mass, fat in the gynoid and android regions, and visceral fat. Serum leptin, total and high molecular weight (HMW) adiponectin, resistin, and ghrelin were also assessed.
Results
There was a significant gain in body mass index (p = 0.05) and a tendency for weight (p = 0.07), android fat (p = 0.07), and visceral fat (p = 0.059) increase in patients with RA, while in AS, total fat mass significantly increased (p = 0.02) with a parallel weight gain (p = 0.07). When examining the whole population of patients, we observed after 2 years a significant increase in body weight (+1.9 %; p = 0.003), body mass index (+2.5 %; p = 0.004), total fat mass (+11.1 %; p = 0.007), and fat in the android region (+18.3 %; p = 0.02). There was a substantial, albeit nonsignificant gain in visceral fat (+24.3 %; p = 0.088). Lean mass and gynoid fat were not modified. No major changes were observed for serum leptin, total adiponectin, and ghrelin, while HMW adiponectin and the HMW/total adiponectin ratio tended to decrease (−15.2 %, p = 0.057 and −9.3 %, p = 0.067, respectively). Resistin decreased significantly (−22.4 %, p = 0.01).
Conclusions
Long-term TNFα inhibition in RA and AS is associated with a significant gain in fat mass, with a shift to the android (visceral) region. This fat redistribution raises questions about its influence on the cardiovascular profile of patients receiving these treatments.
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Acknowledgments
The authors are indebted to Nhu Uyen Nguyen MD, PhD, Department of Physiology, University Hospital of Besançon, France, for participating in the study design and to Mrs Fiona Ecarnot, MSc, EA3920, Department of Cardiology, University Hospital Besançon, France, for her help in preparing the manuscript. We would like to thank the following financial supports: the Association Franc Comtoise pour la recherché et l’Enseignement en Rhumatologie, the Agence Nationale de la Recherche (Labex LipSTIC, ANR-11-LABX-0021), and the Conseil Régional de Franche-Comté (“soutien au LabEX LipSTiC” 2012, for Lunar CoreScan software).
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The authors have no conflict of interest to declare.
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The study was conducted on behalf of CBT-506.
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Toussirot, É., Mourot, L., Dehecq, B. et al. TNFα blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: a 2-year prospective study. Eur J Nutr 53, 951–961 (2014). https://doi.org/10.1007/s00394-013-0599-2
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DOI: https://doi.org/10.1007/s00394-013-0599-2