Kristell Le Mapihan, K. Benomar, S. Espiard
Apr 17, 2014
Journal name not available for this finding
Introduction. The diagnosis of non-HIV lipodystrophies is challenging, especially since borderline forms with type 2 diabetes have been described (Strickland Diabetes Care 2013). Aim: to identify the most specific anthropometric and biological parameters enabling to differentiate lipodystrophic from obese and control subjects. Methods. This prospective study (clin.gov 2009-AO-1169-48) included 94 patients divided in 3 groups adjusted for age and gender: 52 lipodystrophic patients (among whom 16 LMNA –mutated lipodystrophies (LDM), 16 non- LMNA mutated partial lipodystrophies (LDNM), and 20 other types of lipodystrophies), 28 obese (O; 12 diabetic (OD) and 16 non-diabetic (OND)) and 14 normal-weighed healthy subjects (C). The anthropometric (DEXA, MRI) characteristics and leptin levels of the patients were recorded. Three ratios were calculated to assess the respective part of fat and lean mass (FM/LM), intra- and whole abdominal fat (IAF/WAF) and adipose tissue function (leptin/WAF). Results. The three groups differed by the FM, LM, IAF, WAF, leptinemia, trunk FM/LM ( P <0.0001), IAF/WAF ( P <0.001) and leptin/WAF ( P <0.01). The main distinctive feature of LDM compared to C was IAF (188±38 vs 82±23 cc; P <0.01) whereas BMI, FM, LM, WAF and leptinemia were similar. The ratios ranges of the five subgroups were as follows: IAF/WAF: 0.5 in LDM vs 0.3 in all other subgroups; trunk FM/LM: 0.2 in LDM and C, increased from 0.5 to 0.7 and 0.8 respectively in LDNM, OD, OND); leptin/WAF: decreased to 2.3 and 1.6 in respectively LDM and LDNM compared to C (2.7), and increased in OD (3.7) and OND (5.6). Conclusion. Increased intra/whole abdominal fat ratio, hypoleptinemia and preserved fat/lean mass ratio characterized lipodystrophic laminopathies, in contrast with obese people who showed an increased fat/muscle mass, hyperleptinemia and preserved intra/whole abdominal fat ratio. Non-mutated lipodystrophic patients were intermediate, with decreased leptin/WAF ratio, close to LDM, and increased IAF/WAF and FM/LM ratios close to the obese population.