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Body Fat Levels Affect Physical Function in Biologic-Treated Axial Spondyloarthritis
TOPLINE:
Higher levels of body fat and visceral adipose tissue are associated with increased functional disability and reduced spinal mobility in patients with axial spondyloarthritis (axSpA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs).
METHODOLOGY:
- Research showed that patients with axSpA respond poorly to tumor necrosis factor inhibitors if they have a high body mass index (BMI) or obesity; however, studies delving into the association between biologic therapy and body composition are limited.
- Researchers investigated the association between body composition evaluated by bioimpedance analysis and disease activity, physical function, and mobility in 74 patients with axSpA (mean age, 36.5; 71.6% men) at 6 months and 1 year after initiating bDMARDs.
- These participants from the German Spondyloarthritis Inception Cohort presented with high disease activity despite previous treatment with nonsteroidal anti-inflammatory drugs and initiated bDMARD therapy between 2015 and 2019.
- Bath Ankylosing Spondylitis Disease Activity Index and Axial Spondyloarthritis Disease Activity Score were used to measure disease activity, while Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Mobility Index assessed physical function and spinal mobility, respectively.
- BMI, fat mass, fat mass index, and visceral adipose tissue (VAT) were used to determine body composition along with other parameters.
TAKEAWAY:
- Higher BMI (parameter estimates [β], 0.081; 95% CI, 0.016-0.145), fat mass (β, 0.037; 95% CI, 0.004-0.070), and fat mass index (β, 0.125; 95% CI, 0.031-0.219) were associated with worse physical function in the overall population.
- VAT was positively associated with reduced spinal mobility (β, 0.201; 95% CI, 0.071-0.332), particularly in men.
- In women, an increase in VAT was linked to worse disease activity and functional disability.
- Treatment with bDMARDs reduced all disease activity parameters but led to an increase in BMI and fat-related parameters, indicating that lifestyle modifications are also necessary to achieve the desired outcomes with bDMARD therapy.
IN PRACTICE:
“Overall, our findings highlight the importance of maintaining a healthy body weight and body composition — characterized by adequate lean mass and reduced FM [fat mass] — to improve physical function and quality of life in patients with SpA,” the authors wrote.
SOURCE:
The study was led by Valeria Rios Rodriguez, MD, department of gastroenterology, infectiology and rheumatology, Charité Universitätsmedizin Berlin, Germany. It was published online March 20, 2024, in Rheumatology (Oxford).
LIMITATIONS:
This study lacked a control group of patients with axSpA who did not receive biologics. It also did not include dietary habits and comorbidities such as hypertension or diabetes. Additionally, bioimpedance analysis was chosen as the method to assess body composition instead of dual-energy x-ray absorptiometry.
DISCLOSURES:
The study was funded by the German Federal Ministry of Education and Research and the Berlin Institute of Health. Some of the authors declared receiving personal fees, grants, and consulting fees from various pharmaceutical companies.
A version of this article appeared on Medscape.com.
TOPLINE:
Higher levels of body fat and visceral adipose tissue are associated with increased functional disability and reduced spinal mobility in patients with axial spondyloarthritis (axSpA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs).
METHODOLOGY:
- Research showed that patients with axSpA respond poorly to tumor necrosis factor inhibitors if they have a high body mass index (BMI) or obesity; however, studies delving into the association between biologic therapy and body composition are limited.
- Researchers investigated the association between body composition evaluated by bioimpedance analysis and disease activity, physical function, and mobility in 74 patients with axSpA (mean age, 36.5; 71.6% men) at 6 months and 1 year after initiating bDMARDs.
- These participants from the German Spondyloarthritis Inception Cohort presented with high disease activity despite previous treatment with nonsteroidal anti-inflammatory drugs and initiated bDMARD therapy between 2015 and 2019.
- Bath Ankylosing Spondylitis Disease Activity Index and Axial Spondyloarthritis Disease Activity Score were used to measure disease activity, while Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Mobility Index assessed physical function and spinal mobility, respectively.
- BMI, fat mass, fat mass index, and visceral adipose tissue (VAT) were used to determine body composition along with other parameters.
TAKEAWAY:
- Higher BMI (parameter estimates [β], 0.081; 95% CI, 0.016-0.145), fat mass (β, 0.037; 95% CI, 0.004-0.070), and fat mass index (β, 0.125; 95% CI, 0.031-0.219) were associated with worse physical function in the overall population.
- VAT was positively associated with reduced spinal mobility (β, 0.201; 95% CI, 0.071-0.332), particularly in men.
- In women, an increase in VAT was linked to worse disease activity and functional disability.
- Treatment with bDMARDs reduced all disease activity parameters but led to an increase in BMI and fat-related parameters, indicating that lifestyle modifications are also necessary to achieve the desired outcomes with bDMARD therapy.
IN PRACTICE:
“Overall, our findings highlight the importance of maintaining a healthy body weight and body composition — characterized by adequate lean mass and reduced FM [fat mass] — to improve physical function and quality of life in patients with SpA,” the authors wrote.
SOURCE:
The study was led by Valeria Rios Rodriguez, MD, department of gastroenterology, infectiology and rheumatology, Charité Universitätsmedizin Berlin, Germany. It was published online March 20, 2024, in Rheumatology (Oxford).
LIMITATIONS:
This study lacked a control group of patients with axSpA who did not receive biologics. It also did not include dietary habits and comorbidities such as hypertension or diabetes. Additionally, bioimpedance analysis was chosen as the method to assess body composition instead of dual-energy x-ray absorptiometry.
DISCLOSURES:
The study was funded by the German Federal Ministry of Education and Research and the Berlin Institute of Health. Some of the authors declared receiving personal fees, grants, and consulting fees from various pharmaceutical companies.
A version of this article appeared on Medscape.com.
TOPLINE:
Higher levels of body fat and visceral adipose tissue are associated with increased functional disability and reduced spinal mobility in patients with axial spondyloarthritis (axSpA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs).
METHODOLOGY:
- Research showed that patients with axSpA respond poorly to tumor necrosis factor inhibitors if they have a high body mass index (BMI) or obesity; however, studies delving into the association between biologic therapy and body composition are limited.
- Researchers investigated the association between body composition evaluated by bioimpedance analysis and disease activity, physical function, and mobility in 74 patients with axSpA (mean age, 36.5; 71.6% men) at 6 months and 1 year after initiating bDMARDs.
- These participants from the German Spondyloarthritis Inception Cohort presented with high disease activity despite previous treatment with nonsteroidal anti-inflammatory drugs and initiated bDMARD therapy between 2015 and 2019.
- Bath Ankylosing Spondylitis Disease Activity Index and Axial Spondyloarthritis Disease Activity Score were used to measure disease activity, while Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Mobility Index assessed physical function and spinal mobility, respectively.
- BMI, fat mass, fat mass index, and visceral adipose tissue (VAT) were used to determine body composition along with other parameters.
TAKEAWAY:
- Higher BMI (parameter estimates [β], 0.081; 95% CI, 0.016-0.145), fat mass (β, 0.037; 95% CI, 0.004-0.070), and fat mass index (β, 0.125; 95% CI, 0.031-0.219) were associated with worse physical function in the overall population.
- VAT was positively associated with reduced spinal mobility (β, 0.201; 95% CI, 0.071-0.332), particularly in men.
- In women, an increase in VAT was linked to worse disease activity and functional disability.
- Treatment with bDMARDs reduced all disease activity parameters but led to an increase in BMI and fat-related parameters, indicating that lifestyle modifications are also necessary to achieve the desired outcomes with bDMARD therapy.
IN PRACTICE:
“Overall, our findings highlight the importance of maintaining a healthy body weight and body composition — characterized by adequate lean mass and reduced FM [fat mass] — to improve physical function and quality of life in patients with SpA,” the authors wrote.
SOURCE:
The study was led by Valeria Rios Rodriguez, MD, department of gastroenterology, infectiology and rheumatology, Charité Universitätsmedizin Berlin, Germany. It was published online March 20, 2024, in Rheumatology (Oxford).
LIMITATIONS:
This study lacked a control group of patients with axSpA who did not receive biologics. It also did not include dietary habits and comorbidities such as hypertension or diabetes. Additionally, bioimpedance analysis was chosen as the method to assess body composition instead of dual-energy x-ray absorptiometry.
DISCLOSURES:
The study was funded by the German Federal Ministry of Education and Research and the Berlin Institute of Health. Some of the authors declared receiving personal fees, grants, and consulting fees from various pharmaceutical companies.
A version of this article appeared on Medscape.com.
Arm Fat Raises CVD Risk in People With Type 2 Diabetes
TOPLINE:
In people with type 2 diabetes (T2D), higher levels of arm and trunk fat are associated with an increased risk for cardiovascular disease (CVD) and mortality, while higher levels of leg fat are associated with a reduced risk for these conditions.
METHODOLOGY:
- People with T2D have a twofold to fourfold higher risk for CVD and mortality, and evidence shows obesity management helps delay complications and premature death, but an elevated body mass index (BMI) may be insufficient to measure obesity.
- In the “obesity paradox,” people with elevated BMI may have a lower CVD risk than people of normal weight.
- Researchers prospectively investigated how regional body fat accumulation was associated with CVD risk in 21,472 people with T2D (mean age, 58.9 years; 60.7% men; BMI about 29-33) from the UK Biobank (2006-2010), followed up for a median of 7.7 years.
- The regional body fat distribution in arms, trunk, and legs was assessed using bioelectrical impedance analysis.
- The primary outcomes were the incidence of CVD, all-cause mortality, and CVD mortality.
TAKEAWAY:
- However, participants in the highest quartile of leg fat percentage had a lower risk for CVD than those in the lowest quartile (HR, 0.72; 95% CI, 0.58-0.90).
- A nonlinear relationship was observed between higher leg fat percentage and lower CVD risk and between higher trunk fat percentage and higher CVD risk, whereas a linear relationship was noted between higher arm fat percentage and higher CVD risk.
- The patterns of association were similar for both all-cause mortality and CVD mortality. Overall patterns were similar for men and women.
IN PRACTICE:
“Our findings add to the understanding of body fat distribution in patients with T2D, which highlights the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among patients with T2D,” wrote the authors.
SOURCE:
The study led by Zixin Qiu, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
As body fat was measured only once at the beginning of the study, its changing association over time could not be assessed. Moreover, the findings were primarily based on predominantly White UK adults, potentially restricting their generalizability to other population groups. Furthermore, diabetes was diagnosed using self-reported medical history, medication, and hemoglobin A1c levels, implying that some cases may have gone undetected at baseline.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Hubei Province Science Fund for Distinguished Young Scholars, and Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
In people with type 2 diabetes (T2D), higher levels of arm and trunk fat are associated with an increased risk for cardiovascular disease (CVD) and mortality, while higher levels of leg fat are associated with a reduced risk for these conditions.
METHODOLOGY:
- People with T2D have a twofold to fourfold higher risk for CVD and mortality, and evidence shows obesity management helps delay complications and premature death, but an elevated body mass index (BMI) may be insufficient to measure obesity.
- In the “obesity paradox,” people with elevated BMI may have a lower CVD risk than people of normal weight.
- Researchers prospectively investigated how regional body fat accumulation was associated with CVD risk in 21,472 people with T2D (mean age, 58.9 years; 60.7% men; BMI about 29-33) from the UK Biobank (2006-2010), followed up for a median of 7.7 years.
- The regional body fat distribution in arms, trunk, and legs was assessed using bioelectrical impedance analysis.
- The primary outcomes were the incidence of CVD, all-cause mortality, and CVD mortality.
TAKEAWAY:
- However, participants in the highest quartile of leg fat percentage had a lower risk for CVD than those in the lowest quartile (HR, 0.72; 95% CI, 0.58-0.90).
- A nonlinear relationship was observed between higher leg fat percentage and lower CVD risk and between higher trunk fat percentage and higher CVD risk, whereas a linear relationship was noted between higher arm fat percentage and higher CVD risk.
- The patterns of association were similar for both all-cause mortality and CVD mortality. Overall patterns were similar for men and women.
IN PRACTICE:
“Our findings add to the understanding of body fat distribution in patients with T2D, which highlights the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among patients with T2D,” wrote the authors.
SOURCE:
The study led by Zixin Qiu, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
As body fat was measured only once at the beginning of the study, its changing association over time could not be assessed. Moreover, the findings were primarily based on predominantly White UK adults, potentially restricting their generalizability to other population groups. Furthermore, diabetes was diagnosed using self-reported medical history, medication, and hemoglobin A1c levels, implying that some cases may have gone undetected at baseline.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Hubei Province Science Fund for Distinguished Young Scholars, and Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
In people with type 2 diabetes (T2D), higher levels of arm and trunk fat are associated with an increased risk for cardiovascular disease (CVD) and mortality, while higher levels of leg fat are associated with a reduced risk for these conditions.
METHODOLOGY:
- People with T2D have a twofold to fourfold higher risk for CVD and mortality, and evidence shows obesity management helps delay complications and premature death, but an elevated body mass index (BMI) may be insufficient to measure obesity.
- In the “obesity paradox,” people with elevated BMI may have a lower CVD risk than people of normal weight.
- Researchers prospectively investigated how regional body fat accumulation was associated with CVD risk in 21,472 people with T2D (mean age, 58.9 years; 60.7% men; BMI about 29-33) from the UK Biobank (2006-2010), followed up for a median of 7.7 years.
- The regional body fat distribution in arms, trunk, and legs was assessed using bioelectrical impedance analysis.
- The primary outcomes were the incidence of CVD, all-cause mortality, and CVD mortality.
TAKEAWAY:
- However, participants in the highest quartile of leg fat percentage had a lower risk for CVD than those in the lowest quartile (HR, 0.72; 95% CI, 0.58-0.90).
- A nonlinear relationship was observed between higher leg fat percentage and lower CVD risk and between higher trunk fat percentage and higher CVD risk, whereas a linear relationship was noted between higher arm fat percentage and higher CVD risk.
- The patterns of association were similar for both all-cause mortality and CVD mortality. Overall patterns were similar for men and women.
IN PRACTICE:
“Our findings add to the understanding of body fat distribution in patients with T2D, which highlights the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among patients with T2D,” wrote the authors.
SOURCE:
The study led by Zixin Qiu, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
As body fat was measured only once at the beginning of the study, its changing association over time could not be assessed. Moreover, the findings were primarily based on predominantly White UK adults, potentially restricting their generalizability to other population groups. Furthermore, diabetes was diagnosed using self-reported medical history, medication, and hemoglobin A1c levels, implying that some cases may have gone undetected at baseline.
DISCLOSURES:
This study was funded by grants from the National Natural Science Foundation of China, Hubei Province Science Fund for Distinguished Young Scholars, and Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.