Adipose tissue distribution is associated with cardio-metabolic alterations in adult patients with juvenile-onset dermatomyositis

Abstract

Objectives: Primary aims were to compare adipose tissue distribution in adult patients with juvenile-onset DM (JDM), with matched controls. Secondary aims were to explore how adipose tissue distribution is associated with cardio-metabolic status (cardiac dysfunction and metabolic syndrome) in patients.

Methods: Thirty-nine JDM patients (all aged ≥18 y, mean age 31.7 y and 51% female) were examined mean 22.7 y (s.d. 8.9 y) after disease onset and compared with 39 age/sex-matched controls. In patients, disease activity and lipodystrophy were assessed by validated tools and use of prednisolone noted. In all participants, dual-energy X-ray absorptiometry (DXA) and echocardiography were used to measure visceral adipose tissue (VAT)(g) and cardiac function, respectively. Risk factors for metabolic syndrome were measured and associations with adipose tissue distribution explored. For primary and secondary aims, respectively, P-values ≤0.05 and ≤0.01 were considered significant.

Results: Patients exhibited a 2.4-fold increase in VAT, and reduced HDL-cholesterol values compared with controls (P-values ≤ 0.05). Metabolic syndrome was found in 25.7% of the patients and none of the controls. Cardiac dysfunction (systolic and/or diastolic) was found in 23.7% of patients and 8.1% of controls (P = 0.07). In patients, VAT levels were correlated with age, disease duration and occurrence of metabolic syndrome and cardiac dysfunction. Occurrence of lipodystrophy (P = 0.02) and male sex (P = 0.04) tended to be independently associated with cardiac dysfunction.

Conclusion: Adults with JDM showed more central adiposity and cardio-metabolic alterations than controls. Further, VAT was found increased with disease duration, which was associated with development of cardio-metabolic syndrome.

Keywords: JDM; cardiac dysfunction; cardio-metabolic syndrome; lipodystrophy; metabolic syndrome; visceral adipose tissue.

Fig. 1

Occurrence (%) of cardio-metabolic risk factors, metabolic syndrome and cardiac dysfunction in patients compared with controls. (A) Occurrence (%) of the cardio-metabolic risk factors: body mass index (BMI), lipids, blood pressure and glucose at levels exposing risk for the metabolic syndrome, and occurrence of metabolic syndrome. (B) Data for systolic and diastolic dysfunction, and occurrence of cardiac dysfunction when one or both systolic and diastolic dysfunction were present. High BMI: >30 kg/m²; high TG: triglycerides ≥1.7 mmol/l; low HDL: high density lipoprotein ≤1.04 mmol/l in men and 1.29 mmol/l in women; high BP: systolic and diastolic blood pressure ≥130/85 mmHg; high glucose: blood glucose ≥5.6 mmol/l; low LAS: long axis strain ≤13.7%; low e’: early diastolic tissue velocity ≤8.2 cm/s; cardiac dysfunction: presence of low LAS and/or low e’. *P ≤ 0.05; **P ≤ 0.01.