Pes Giovanni Mario, Delitala Alessandro Palmerio, Delitala Giuseppe, Errigo Alessandra, Costantino Salvatore, Fanciulli Giuseppe
Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, I-07100 Sassari, Italy.
Diabetol Metab Syndr. 2014 Nov 25;6:128. doi: 10.1186/1758-5996-6-128. eCollection 2014.
In patients with Latent Autoimmune Diabetes in Adults (LADA) a lower body mass index was reported compared with classical type 2 diabetes (T2D), and was found to be associated with a faster progression to insulin-dependence. In this study we determined the body composition in a cohort of LADA patients from Sardinia, Italy, and compared it with age- and gender-matched patients diagnosed as having adult-onset type 1 diabetes (T1D) and non-autoimmune T2D.
In 210 LADA patients, 210 T2D patients and 30 adult-onset T1D patients of Sardinian origin we assessed total and segmental body composition (weight-adjusted percent fat mass and lean mass) by using Dual Energy X-rays Absorptiometry (DXA).
In the whole cohort of LADA patients total fat mass was significantly smaller compared with T2D patients (p < 0.0001), while no difference was found between LADA and T1D patients. In LADA men fat depletion involved all body segments, while in LADA women it was observed only in the truncal segment (p < 0.0001), as in the upper and lower regions fat deposits were larger compared to T2D (p < 0.0001). However, LADA women showed a significantly elevated truncal fat compared to T1D women (p < 0.004), whereas no difference was detected in the extremities.
Body composition in LADA patients shows substantial difference, in a gender-dependent way, compared to classic T2D. In women fat deposits tend to accumulate in peripheral regions rather than centrally, whereas in men the distribution is more homogeneous. In addition, central fat depletion in LADA women appears to be a significant predictor of faster progression to insulin dependence. Thus, routine assessment of body composition may help the physician identify LADA patients who require early insulin treatment in order to delay beta-cell exhaustion, as well those with increased CV risk due to excess truncal adiposity.
据报道，成人隐匿性自身免疫性糖尿病（LADA）患者的体重指数低于经典2型糖尿病（T2D）患者，且发现其与更快进展至胰岛素依赖有关。在本研究中，我们测定了来自意大利撒丁岛的一组LADA患者的身体成分，并将其与年龄和性别匹配的诊断为成人发病型1型糖尿病（T1D）和非自身免疫性T2D的患者进行比较。
我们使用双能X线吸收法（DXA）评估了210例撒丁岛裔LADA患者、210例T2D患者和30例成人发病型T1D患者的全身和分段身体成分（体重调整后的脂肪量百分比和瘦体量）。
在整个LADA患者队列中，总脂肪量显著低于T2D患者（p < 0.0001），而LADA患者与T1D患者之间未发现差异。在LADA男性中，脂肪减少累及身体所有部位，而在LADA女性中，仅在躯干部位观察到脂肪减少（p < 0.0001），因为与T2D相比，上半身和下半身的脂肪堆积更大（p < 0.0001）。然而，与T1D女性相比，LADA女性的躯干脂肪显著升高（p < 0.004），而四肢未检测到差异。
与经典T2D相比，LADA患者的身体成分存在显著差异，且具有性别依赖性。在女性中，脂肪堆积倾向于在外周区域而非中心区域，而在男性中，分布更为均匀。此外，LADA女性的中心性脂肪减少似乎是更快进展至胰岛素依赖的重要预测因素。因此，常规评估身体成分可能有助于医生识别需要早期胰岛素治疗以延缓β细胞耗竭的LADA患者，以及因躯干肥胖而心血管风险增加的患者。
