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Body Composition and Adiponectin Serum Concentrations in Adult Patients with Cystic Fibrosis

Divisions of Endocrinology, Diabetes, and Clinical Nutrition (N.M., M.K., B.M., U.K., J.J.P.) and Central Laboratory (C.P.G.N.), Division of Pulmonary Medicine (S.S., M.T.), University Hospital, CH-4031 Basel, Switzerland; and Department of Medicine (J.J.P.), Columbia University College of Physicians and Surgeons, New York, New York 10032

Address all correspondence and requests for reprints to: Jardena J. Puder, M.D., Division of Endocrinology, Diabetes, and Clinical Nutrition, Department of Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland. E-mail: puderj{at}uhbs.ch.

Context: Cystic fibrosis (CF) is a disease characterized by weight loss and chronic low-grade inflammation.

Objective: The objective of the study was to assess changes in body composition and the serum concentrations of adiponectin, a marker of negative energy balance and insulin sensitivity, in adult patients with CF.

Design: This was a cross-sectional study.

Setting: The study was conducted at an outpatient clinic of the University Hospital of Basel, Switzerland.

Participants: Twenty-four stable adult CF patients and 24 healthy controls, matched for body mass index, age, sex, and hormonal therapy in women participated in the study.

Main Outcome Measures: Changes in body composition (assessed by dual x-ray absorptiometry) and serum adiponectin levels were measured.

Results: Body mass index, percent fat mass (in percentage of body weight), and percent lean body mass were similar in patients and controls, whereas central fat accumulation was increased [trunk to extremity fat ratio 1.2 (0.99–1.51) vs. 0.99 (0.81–1.25), P = 0.01] in patients with CF, compared with controls. Decreased lean mass and increased highly sensitive C-reactive protein levels were independently associated with worse lung function in CF patients. Despite similar insulin resistance (homeostasis model assessment) and similar SHBG serum concentrations, the serum concentrations of adiponectin were higher in CF patients, compared with controls, independent of other confounders (P = 0.01).

Conclusions: Central fat accumulation is increased in patients with CF. It is postulated that the energy deficit-induced increase in serum adiponectin could explain the preservation of insulin sensitivity in these patients despite the increase in central fat and in highly sensitive C-reactive protein serum concentrations and could prevent a further deterioration of protein catabolism.