Background/Purpose: In general population, a higher trunk fat and the ratio of trunk fat to leg fat (trunk-leg ratio) increase the risk for a cardiovascular event, and a higher leg fat decreases this risk. The purpose of this study is to determine if level of disease cumulative damage in Systemic Lupus Erythematosus (SLE) as measured by the SLICC/ACR damage index (SDI) is independently associated with body fat distribution in female patients with SLE.

Methods: In a cross-sectional single center study, we evaluated 101 consecutives SLE female patients who were seen at the Rheumatology department of our hospital. SLE was defined using the ACR criteria; body composition analysis was assessed by dual energy X-ray absorptiometry (DXA). A chart review, clinical evaluation and laboratory exams were performed. We defined damage using SDI. Disease activity was measured using SLEDAI. Body fat percentage and fat distribution was reported as trunk fat percentage, leg fat percentage and trunk-to-leg fat ratio. For the univariate analysis we performed a simple linear regression model, after that, we performed a logistic regression model adjusted to disease activity, metabolic syndrome, body mass index, age, disease duration, time of exposure to prednisone  and current dose of prednisone.

Results: One hundred and one SLE patients with an average age of 42.64 (SD: 12.77) years were evaluated. Almost all of them were mestizo, only one was African Latin-American. Disease duration was 8.32 (SD: 7.20) years. Percent total body fat was 36.4% (SD: 7.0%), percent trunk fat 36.4% (SD: 8.1%), percent leg fat 37.8% (SD: 7.4%), trunk-to-leg ratio 1.72 (SD: 0.68). SDI was 0.86 (SD: 1.27), SLEDAI was 5.82 (SD: 4.26). Body mass index was 27.11 (SD: 5.20) kg/m2. Forty-four (43.6%) patients had metabolic syndrome. Current dose of prednisone was 8.43 (SD: 5.18) mg/d and the time of exposure to prednisone was 8.11 (SD: 6.79) years. SDI correlate with trunk-to-leg fat ratio (β: 0.41, p<0.001) and percent leg fat (β: -0.22, p: 0.03), but not with percent total body fat (β: -0.10, p: 0.31) or percent trunk fat (β: -0.04, p: 0.71). After adjustment for disease activity, metabolic syndrome, body mass index, age, disease duration, time of exposure to prednisone  and current dose of prednisone,  SDI remained associated with trunk-to-leg fat ratio (β: 0.50, p<0.001) and leg fat (β: -0.25, p:0.009).

Conclusion: In SLE female patients, a higher level of disease damage is associated with a higher trunk-to-leg fat ratio and a lower leg fat, independently of disease activity, metabolic syndrome, body mass index, age, disease duration, time of exposure to prednisone and current dose of prednisone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/regional-fat-distribution-is-independently-associated-with-damage-accrual-in-systemic-lupus-erythematosus-female-patients/