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Bone marrow fat fraction assessment in regard to physical activity: KORA FF4–3-T MR imaging in a population-based cohort

  • Musculoskeletal
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Abstract

Objectives

To establish the effect of different degrees and kinds of physical activity on bone marrow fat (BMAT) content at different anatomical locations in a population-based cohort study undergoing whole-body MR imaging.

Methods

Subjects of the KORA FF4 study without known cardiovascular disease underwent BMAT fat fraction (FF) quantification in L1 and L2 vertebrae and femoral heads/necks (hip) via a 2-point T1-weighted VIBE Dixon sequence. BMAT-FF was calculated as mean value (fat image) divided by mean value (fat + water image). Physical activity was determined by self-assessment questionnaire regarding time spent exercising, non-exercise walking, non-exercise cycling, and job-related physical activity.

Results

A total of 385 subjects (96% of 400 available; 56 ± 9.1 years; 58% male) were included in the analysis. Exercise was distributed quite evenly (29% > 2 h/week; 31% ~ 1 h/week (regularly); 15% ~ 1 h/week (irregularly); 26% no physical activity). BMAT-FF was 52.6 ± 10.2% in L1, 56.2 ± 10.3% in L2, 87.4 ± 5.9% in the right hip, and 87.2 ± 5.9% in the left hip (all p < 0.001). Correlation of BMAT-FF between spine and hip was only moderate (r 0.42 to 0.46). Spinal BMAT-FF, but not hip BMAT-FF, was inversely associated with exercise > 2 h/week (p ≤ 0.02 vs. p ≥ 0.35, respectively). These associations remained significant after adjusting for age, gender, waist circumference, and glucose tolerance. No coherent association was found between BMAT-FF and physical activity in the less active groups.

Conclusions

In our study, exercise was inversely correlated with vertebral BMAT-FF, but not hip BMAT-FF, when exercising for more than 2 h per week. Physical activity seems to affect the spine at least preferentially compared to the hip.

Key Points

• In our population-based cohort, at least 2 h of physical activity per week were required to show lower levels of bone marrow adipose tissue fat fraction in MRI.

• Physical activity seems to affect bone marrow adipose tissue at least preferentially at the spine in contrast to the proximal femur.

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Abbreviations

BMAT:

Bone marrow adipose tissue

BMD:

Bone mineral density

BMI:

Body mass index

CI:

Confidence interval

FF:

Fat fraction

L1:

Lumbar vertebra 1

L2:

Lumbar vertebra 2

LH:

Left hip = left proximal femur

PDFF:

Proton density fat fraction

RH:

Right hip = right proximal femur

ROI:

Region of interest

SD:

Standard deviation

WC:

Waist circumference

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Acknowledgments

The KORA study was initiated and financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The MRI study and in part this analysis were funded by the German Research Foundation (DFG, Bonn, Germany), the German Centre for Diabetes Research (DZD, Neuherberg Germany), and the German Centre for Cardiovascular Disease Research (DZHK, Berlin, Germany).

Funding

The KORA study was initiated and financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The MRI study and in part this analysis were funded by the German Research Foundation (DFG, Bonn, Germany), the German Centre for Diabetes Research (DZD, Neuherberg Germany), and the German Centre for Cardiovascular Disease Research (DZHK, Berlin, Germany).

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Authors and Affiliations

  1. Department of Radiology, Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany

    Robert C. Bertheau, Johanna Nattenmüller & Christopher L. Schlett

  2. Department of Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany

    Roberto Lorbeer

  3. Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tuebingen, Tuebingen, Germany

    Elke Wintermeyer

  4. Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tuebingen, Tuebingen, Germany

    Jürgen Machann

  5. Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tuebingen, Tuebingen, Germany

    Jürgen Machann

  6. Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany

    Jürgen Machann & Annette Peters

  7. German Center for Diabetes Research (DZD), Neuherberg, Germany

    Birgit Linkohr & Annette Peters

  8. German Center for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany

    Annette Peters

  9. Institute for Cardiovascular Prevention, Ludwig-Maximilian-University-Hospital, Munich, Germany

    Annette Peters

  10. Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany

    Fabian Bamberg & Christopher L. Schlett

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  1. Robert C. Bertheau
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  2. Roberto Lorbeer
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Corresponding author

Correspondence to Christopher L. Schlett.

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Guarantor

The scientific guarantor of this publication is Christopher L. Schlett, MD MPH, Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in several studies, however not in relation to bone marrow adipose tissue, so there is no overlap.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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ESM 1

(DOCX 38 kb)

Fig. 4

Scatter plots of the correlation between different BMAT-FF measurements. Top row: spine vs. spine and hip vs. hip. Bottom rows: spine vs. hip. All p < 0.001 (PNG 102 kb)

ESM 2

(EPS 4.01 mb)

Fig. 5

Change of BMAT-FF associated with active exercise. The reported changes were absolute numbers and adjusted for age and gender. Subjects with high active exercise (“≥ 2h per week, regularly”) were compared to subjects with low exercise (“no or nearly no exercise”) (PNG 111 kb)

ESM 2

(EPS 3.23 mb)

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Bertheau, R.C., Lorbeer, R., Nattenmüller, J. et al. Bone marrow fat fraction assessment in regard to physical activity: KORA FF4–3-T MR imaging in a population-based cohort. Eur Radiol 30, 3417–3428 (2020). https://doi.org/10.1007/s00330-019-06612-y

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