Park Seungweon, Widmer Annaliese, Swartz Alison Z, Koethe John R, Silver Heidi J
Vanderbilt University, School of Medicine, Nashville, TN, USA.
Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Nashville, TN, USA.
Nutr Diabetes. 2025 Jun 18;15(1):28. doi: 10.1038/s41387-025-00381-y.
HIV and obesity are conditions of impaired lipid storage where ectopic lipid accumulates in organs and tissues, promoting glucose intolerance and insulin resistance. Persons with HIV (PWH) are at high risk for diabetes, and one indicator of risk is the density of organs and tissues involved in glucose metabolism, which reflects ectopic lipid content and can be quantified using CT-tissue attenuation. We investigated relationships between subcutaneous adipose (SAT), visceral adipose (VAT), liver, pancreas, and skeletal muscle densities with biomarkers of glycemic/insulinemic status.
Demographic, anthropometric, and clinical data were utilized with automated segmentation of CT morphometric data from images acquired at the 3rd lumbar vertebra level in PWH who had normoglycemia, prediabetes, and T2DM.
Of 217 PWH, 29.0% had prediabetes and 30.4% had T2DM. Liver, pancreas, and skeletal muscle densities were lower, and SAT density was higher, in PWH with T2DM. No differences were observed for VAT density. Receiver operating curves adjusted for age, sex and BMI showed tissue densities had similar ability to discriminate glycemic/insulinemic status. Adjusted multivariable logistic regression showed higher SAT density associated with higher glucose (p = 0.002), HbA1c (p < 0.001), and diabetes status (p < 0.001). Lower liver density is associated with diabetes status (p = 0.007) and higher HbA1c (p = 0.03), whereas lower skeletal muscle density is associated with higher glucose (p = 0.03) and insulin (p = 0.04).
Tissue densities, which differed significantly among the three groups, were robustly associated with various biomarkers of glycemic/insulinemic status. CT-morphometrics may enhance the detection of metabolic perturbations and diabetes risk, possibly earlier than some clinical biomarkers.
HIV感染和肥胖均为脂质储存受损的病症，异位脂质在器官和组织中蓄积，进而引发葡萄糖耐受不良和胰岛素抵抗。HIV感染者（PWH）患糖尿病的风险较高，风险指标之一是参与葡萄糖代谢的器官和组织密度，其反映了异位脂质含量，可通过CT组织衰减进行量化。我们研究了皮下脂肪（SAT）、内脏脂肪（VAT）、肝脏、胰腺和骨骼肌密度与血糖/胰岛素水平生物标志物之间的关系。
利用人口统计学、人体测量学和临床数据，对血糖正常、糖尿病前期和2型糖尿病（T2DM）的PWH在第三腰椎水平获取的CT图像进行形态学数据自动分割。
在217名PWH中，29.0%患有糖尿病前期，30.4%患有T2DM。T2DM的PWH肝脏、胰腺和骨骼肌密度较低，SAT密度较高。VAT密度未观察到差异。调整年龄、性别和BMI后的受试者工作曲线显示，组织密度在区分血糖/胰岛素水平方面具有相似能力。调整后的多变量逻辑回归显示，较高的SAT密度与较高的血糖（p = 0.002）、糖化血红蛋白（HbA1c，p < 0.001）和糖尿病状态（p < 0.001）相关。较低的肝脏密度与糖尿病状态（p = 0.007）和较高的HbA1c（p = 0.03）相关，而较低的骨骼肌密度与较高的血糖（p = 0.03）和胰岛素（p = 0.04）相关。
三组之间组织密度存在显著差异，且与血糖/胰岛素水平的各种生物标志物密切相关。CT形态测量学可能比某些临床生物标志物更早地增强对代谢紊乱和糖尿病风险的检测。
