title: Influences of nutrition and adiposity on bone mineral density in individuals with chronic spinal cord injury: A cross-sectional, observational study.
abstract: Dietary inadequacy and adiposity, both prevalent in the chronic spinal cord injury (SCI) population, are known to influence bone turnover and may be potential modifiable risk factors for the development of sublesional osteoporosis following SCI. This pilot study in an SCI cohort aimed to assess measures of nutrition and obesity, to determine if these measures were associated with bone mineral density (BMD), and to compare these measures to a non-SCI control cohort.
  
  
  
  In a cross-sectional observational study, volunteers with chronic SCI (> 1 year post-injury, lesions from C1 to T12 and severity category A-D by the American Spinal Injury Association Impairment Scale) were assessed, and 8 non-SCI individuals were recruited as a comparison group. BMD at the femoral neck (FN) and lumbar spine (LS), and an estimate of visceral adipose tissue (VAT) from lumbar vertebrae 1 through 4 were measured using dual energy X-ray absorptiometry (DXA); nutrient intake of calcium, vitamins D & K, and protein were estimated using a food frequency questionnaire; plasma 25-hydroxyvitamin D (25(OH)D) was analyzed using ultra-high performance liquid chromatography/tandem mass spectroscopy; and serum leptin, adiponectin and insulin were analyzed using a multiplex assay.
  
  
  
  A total of 34 individuals with SCI (n = 22 tetraplegic; n = 12 paraplegic; 94% male) who averaged 12.7 (9.0) years post-injury, age 40.0 (10.9) years and % body fat of 28.4 (7.3) were assessed. Multiple linear regression analyses in the SCI cohort showed significant associations between BMD at the FN and LS with leptin (FN: r = 0.529, p = 0.005; LS: r = 0.392, p = 0.05), insulin (FN: r = 0.544, p = 0.003; LS: r = 0.388, p = 0.05), and VAT percent (FN: r = 0.444, p = 0.02; LS: r = 0.381, p = 0.05). Adiponectin was only correlated with LS BMD (r = 0.429, p = 0.03). No significant relationships were found between BMD and serum 25(OH)D, or intakes of calcium, vitamins D & K, and protein. Intake of vitamin D was adequate in 69% of participants with SCI, where 91% of those persons consumed either vitamin D and/or multivitamin supplements. Vitamin D status was similar between SCI and non-SCI groups as was sub-optimal status (25(OH)D < 75 nmol/L) (60% of SCI compared to 50% of non-SCI). Participants with SCI had significantly lower FN BMD in comparison to non-SCI controls (p = 0.001).
  
  
  
  Compromised BMD among individuals with SCI was not associated with a deficiency of vitamin D or other bone nutrients. The observed positive associations between BMD and leptin, insulin, adiponectin and VAT provide a framework to evaluate links between adiposity and bone health in a larger SCI cohort.
authors.affiliation: Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
authors.forename: Irena
authors.initials: I
authors.lastname: Doubelt
authors.affiliation: Department of Kinesiology, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Totosy de Zepetnek
authors.affiliation: Department of Kinesiology, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: MacDonald
authors.affiliation: Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Atkinson
keywords: AIS, American Spinal Injury Association Impairment Scale; Adiposity; Bone mineral density; DRI, dietary reference intakes; EAR, estimated average requirement; FFQ, food frequency questionnaire; IOM, Institute of Medicine; Nutritional status; SCI, spinal cord injury; SLOP, sublesional osteoporosis; Spinal cord injury; Sublesional osteoporosis; UPLC/MS–MS, ultra high performance liquid chromatography tandem mass spectrometry; VAT, visceral adipose tissue; WC, waist circumference.