Relationship Between Body Composition And Metabolic Syndrome And Diabetes In Cushing’s Syndrome Patients

Objective:This study analyzed the body composition of Cushing’s syndrome(CS)patients,and explored the influence of body composition on metabolic syndrome(MS)and Diabetes mellitus(DM),and explored the risk factors of visceral fat accumulation in patients with CS.Methods:From January 2014 to June 2020,135 patients diagnosed as CS were hospitalized in Qingdao University Affiliated Hospital,including 54 Cushing’s disease,66 adrenal tumors and 15 ectopic ACTH syndrome,and 135 healthy physical examinees were collected as control group.Patients with CS were divided into metabolic syndrome group(MS group,n=93)and non-metabolic syndrome group(NMS group,n=42),and diabetes group(DM group,n=71)and non-diabetic group(NDM,n=64).The body composition indexes such as Visceral fat area(VFA),Subcutaneous fat area(SFA)and skeletal muscle area(SMA)of the third lumbar vertebra were measured quantitatively by CT,and the Total fat area(TFA)=VFA+SFA,ratio of visceral fat area to subcutaneous fat area(VFA/TFA),skeletal muscle index(SMI,cm~2/m~2)=SMA/height~2.Compare the clinical data and abdominal body composition of each group,analyze the correlation between body composition and general clinical data and glucose and lipid metabolism of CS patients,analyze the risk factors of MS and DM in CS patients by binary logistic regression,and analyze the risk factors of visceral fat accumulation in CS patients by multiple stepwise regression.Results:1.Comparison of general data and body composition between CS patients and control groupSystolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),triglyceride(TG),hypertension,the prevalence of dyslipidemia and sarcopenia,VFA,TFA,VFA/TFA,VFA/SFA in CS group were significantly higher than those in control group(P<0.05)2.Comparison of general data and body composition among Cushing’s disease group,adrenal tumor group and ectopic ACTH groupThe age,Hb A1c,total cholesterol(TC),number of metabolic syndrome components,VFA/TFA,VFA/SFA in ectopic ACTH group were higher than those in Cushing’s disease group and adrenal tumor group,while HDL-C was lower than those in Cushing’s disease group and adrenal tumor group.The course of disease,the number of metabolic syndrome components,VFA,VFA/TFA,VFA/SFA in adrenal tumor group were all smaller than Cushing’s disease group and ectopic ACTH group,while HDL-C was larger than Cushing’s disease group and ectopic ACTH group,and the differences were statistically significant(P<0.05).3.Correlation analysis of body composition,general data and glucose and lipid metabolism indexes of CS patientsThe relationship between VFA and course of disease,systolic blood pressure,diastolic blood pressure,FPG,Hb A1c,fasting insulin(FINS),HOMA-IR,triglyceride(TG),low density lipoprotein cholesterol(LDL-C)was positively correlated(P<0.05)with high density lipoprotein cholesterol(HDL-C)was negatively correlated(P<0.05).SFA was positively correlated with systolic blood pressure,diastolic blood pressure,FINS and HOMA-IR,and negatively correlated with age(P<0.05).TFA was positively correlated with course of disease,systolic blood pressure,diastolic blood pressure,Hb A1c,FINS and HOMA-IR(P<0.05).The VFA/TFA and VFA/SFA were positively correlated with age,course of disease,FPG,Hb A1C and TG(P<0.05),but negatively correlated with HDL-C(P<0.05).SMA was positively correlated with FINS and HOMA-IR(P<0.05),and negatively correlated with TG,TC and LDL-C(P<0.05).SMI was negatively correlated with TC and LDL-C(P<0.05).Metabolic syndrome components in CS patients were positively correlated with VFA,TFA,VFA/TFA and VFA/SFA(P<0.05),but not with SFA,SMA and SMI(P>0.05)4.Comparison of general data and body composition between CS patients with MS and patients without MSThe age,BMI,VFA,TFA,VFA/TFA and VFA/SFA in MS group were all higher than those in NMS group(P<0.05),while SFA,SMA and SMI had no statistical significance(P>0.05).5.The risk factors of MS in CS patients were analyzed by binary logistic regressionAge and VFA were screened out as risk factors for MS by univariate logistic regression analysis,and age(OR:1.130,95%CI:1.075-1.187,P=0.000)and VFA(OR:1.017,95%CI:1.009-1.020)were found by multivariate logistic regression analysis6.Comparison of general data and body composition between CS patients with DM and non-DM patientsAge,BMI,TG,blood cortisol level at 16 o’clock,VFA,TFA,VFA/TFA,VFA/SFA,hypertension and dyslipidemia in DM group were all higher than those in NDM group,while HDL-C was lower than that in NDM group(P<0.05).7.The risk factors of DM in CS patients were analyzed by logistic regressionAge,cortisol level at 16 o’clock and VFA were selected as risk factors for DM by univariate logistic regression analysis,and age(OR=1.151,95%CI:1.095-1.210,P=0.000)and VFA(OR=1.013,95%CI:1.006-1.019,P=0.001)were found by multivariate logistic regression analysis.8.Factors influencing VFA accumulation in CS patients were analyzed by multiple stepwise regressionUsing VFA as dependent variables,age,sex,BMI,course of disease,cortisol level at 0:00 and SMI as independent variables were included in stepwise multiple linear regression analysis,the results showed that course of disease(β=0.260,P=0.010),SMI(β=-0.368,P=0.001)were independent of VFA after adjusting for sex and BMI.Conclusion1.CS patients have visceral fat accumulation,muscle mass reduction,glucose and lipid metabolism disorder,prone to metabolic syndrome.2.Compared with Cushing’s disease and adrenal tumor,ectopic ACTH patients have more serious visceral fat accumulation,glucose and lipid metabolism disorder and metabolic syndrome.3.Visceral fat accumulation in patients with CS is related to blood pressure,blood glucose,insulin resistance,blood lipid level and the severity of metabolic syndrome.4.Age and visceral fat accumulation are independent risk factors for MS and DM in patients with CS.5.Course of disease and SMI are risk factors of visceral fat accumulation in patients with CS.