Gender Differences in Adiposity and its Relationship to Cardiometabolic Profiles and Proinflammatory Adipokines in Spinal Cord Injury
Authors: Farkas Gary J , Gorgey Ashraf S , Dolbow David , Berg Arthur S , Gater David R 
Published: November 2023

IntroductionChanges in body composition have been vastly reported following spinal cord injury (SCI) and linked to metabolic dysfunction. The distribution‐ and gender‐dependent differences of adipose tissue (AT) and proinflammatory adipokine secretion are thought to contribute to adiposity‐related comorbidities in the able‐bodied population. Despite emerging research, gender differences in adiposity and its relationship to cardiometabolic and proinflammatory adipokines in SCI are not well understood.MethodsIn this IRB approved study, 71 participants with chronic motor complete SCI (international standards for neurological classifications for SCI A and B) were included (Table 1). All participants completed informed consent and underwent dual‐energy x‐ray absorptiometry to quantify total percent body fat (%BF) and noncontrast magnetic resonance imaging to measure visceral (VAT) and subcutaneous (SAT) AT. Images were separated into VAT and SAT and volume and a VAT:SAT ratio were calculated. Cardiometabolic and inflammatory profiles were assessed according to stand procedures and an intravenous glucose tolerance test was administered to calculate glucose effectiveness (Sg) and insulin sensitivity (Si). Mann‐Whitney U test and spearman correlations were used to evaluate gender based differences.ResultsFemales had a significantly greater amount of total %BF and SAT compared to males who had significantly greater VAT, VAT:SAT ratio, high‐density lipoprotein‐cholesterol (HDL), and total cholesterol: HDL ratio (TC:HDL, p < 0.05, Tables 1 & 2). The majority of the cardiometabolic and inflammatory variables did not show significant differences between genders; however, males frequently experienced unfavorable profiles vs. females (Table 2). In both genders, body fat significantly correlated with HDL and TC:HDL (M: ρ = −0.42, 0.33 and F: ρ = −0.57, 0.78, respectively, p < 0.05), while in males it related to high‐sensitivity c‐reactive protein (hsCRP; ρ = 0.39, p < 0.05). SAT correlated to systolic blood pressure (BP) and plasminogen activator inhibitor‐1 (PAI1; ρ = 0.84, 0.74, respectively, p < 0.05) in females and diastolic BP (DBP) in both genders (M: ρ = −0.31, F: ρ = 0.74, p < 0.05). In males VAT significantly correlated with triglycerides (TG), fasting glucose (FG), and tumor necrosis factor‐α (TNFα; ρ = 0.38–0.69, while in females VAT significantly correlated with hsCRP (ρ = 0.69, p < 0.05). %SAT significantly correlated with DBP and FG (ρ = 0.83, −0.71, respectively, p < 0.05) in females. In males %VAT significantly correlated with TG (ρ = 0.40, p < 0.05). VAT:SAT ratio significantly related with total cholesterol, HDL, insulin sensitivity, and hsCRP (ρ = [−0.75]–[0.77], p < 0.05) in females; however, this ratio only correlated to TG (ρ = 0.40, P < 0.05) in males. All other correlations were not significant.ConclusionWe have elucidated gender‐specific differences suggesting AT may uniquely contribute to cardiometabolic dysfunction in both SCI males and females potentially through proinflammatory adipokines. A better understanding of these relationships can optimize pharmaceutical and rehabilitative interventions following SCI.Support or Funding InformationVHA RR&D B6757R and NIH UL1RR031990
Demographic and Body Composition Profiles by Gender

Males (n=58)
Females (n=13)

Age (y)
44.9±10.9
42±13.5

BMI (kg/m2)
27.1±5.8
27.8±6.6

Level of Injury
C4‐L1
C4‐T11

Time Since Injury (y)
15.2±11.0
10.9±11.1

Body Fat (kg)
31.9±12.8
34.1±13.7

%Body Fat*
37.7±8.9
45.1±9.4

Males (n=38)
Females (n=9)

MRI SAT Volume (L)*
3517.7±1538.7
6064.5±2800.0

MRI VAT Volume (L)*
2541.3±1323.2
1053.5±762.4

%SAT*
10.7±2.9
16.0±6.2

%VAT*
7.5±3.2
2.6±1.4

VAT:SAT Ratio*
0.75±0.39
0.17±0.10

Significant difference between males and females, p < 0.05

Cardiometabolic and Proinflammatory Adipokine Profiles by Gender

Males (n=58)
Females (n=13)

Systolic BP (BPM)
115.2±14.1
109.8±14.2

Diastolic BP (BPM)
70.1±10.3
67.46±13.0

Total Cholesterol (mg/dL)
155.9±32.4
153.8±19.8

LDL‐C (mg/dL)
95.2±30.0
89.2±14.0

HDL‐C (mg/dL)*
43.2±7.6
34.3±8.0

TC:HDL Ratio*
4.7±1.3
3.6±0.4

Triglycerides (mg/dL)
120.9±65.5
97.8±79.5

Fasting Glucose (mg/dL)
99.2±28.1
93.7±12.1

Glucose Effectiveness
0.02±0.01
0.02±0.01

Insulin Effectiveness
7.8±23.1
3.9±3.4

TNF‐α (pg/mL)
17.8±36.8
8.7±0.9

Interleukin‐6 (pg/mL)
7.8±11.0
4.2±3.2

PAI‐1 (ng/mL)
92.1±66.9
62.8±60.6

hs‐CRP (mg/mL)
8.6±7.9
6.0±4.7

Significant difference between males and females, p < 0.05
BP, blood pressure; HDL‐C, High‐Density Lipoprotein‐C; High‐sensitivity C‐reactive Protein; LDL‐C, Low‐Density Lipoprotein‐C; PAI‐1, Plasminogen activator inhibitor‐1; TNF‐α, Tumor Necrosis Factor‐α