Greater adipose tissue distribution and diminished spinal musculoskeletal density in adults with cerebral palsy

Abstract

Objective

The purposes of this study were to examine differences in adipose tissue distribution, lumbar vertebral bone mineral density (BMD), and muscle attenuation in adults with and without cerebral palsy (CP), and to determine the associations between morphological characteristics.

Design

Cross-sectional, retrospective analyses of archived computed tomography (CT) scans.

Setting

Clinical treatment and rehabilitation center for persons with CP.

Participants

Adults with CP with a mean ± SD age of 38.8 ± 14.4 years; body mass: 61.3 ± 17.1 kg; Gross Motor Function Classification level of I-V, and a matched cohort of neuro-typical adults. Of the 41 adults with CP included in the study, 10 were not matchable due to low body masses.

Interventions

Not applicable

Main Outcome Measure(s)

Computed tomography scans were assessed for visceral and subcutaneous adipose tissue (VAT and SAT areas), psoas major area and attenuation in Hounsfield units (HU), and cortical and trabecular BMDs.

Results

Adults with CP had lower cortical (β=−63.41 HU, p<0.001) and trabecular (β=−42.24 HU, p<0.001) BMDs, as well as psoas major areas (β=−374.51 mm ², p<0.001) and attenuation (β=−9.21 HU, p<0.001), after controlling for age, sex, and body mass. Adults with CP had greater VAT (β=3914.81 mm ², p<0.001) and SAT (β=4615.68 mm ², p<0.001). Muscle attenuation was significantly correlated with trabecular (r=0.51, p=0.002) and cortical (r=0.46, p<0.01) BMD; whereas VAT was negatively associated with cortical BMD (β=−0.037 HU/cm ²; r ²=0.13; p=0.03).

Conclusions

Adults with CP had lower BMDs, smaller psoas major area, greater intermuscular adipose tissue, and greater trunk adiposity than neuro-typical adults. VAT and cortical BMD were inversely associated.