Scleroderma and Subcutaneous Adipose Tissue
— By Andrea M. Pampaloni, Ph.D.
Scleroderma is a group of autoimmune diseases that cause skin and connective tissue to harden and tighten. Cases are rare and there is no cure, but it can affect the quality and longevity of a patient’s life — and it can be dangerous or even life-threatening if untreated.
The most outwardly noticeable characteristics are changes to the skin, but internal organ fibrosis also develops in many people with systemic scleroderma. This can affect the lungs, gastrointestinal tract, kidneys, heart, esophagus and other internal organs, as well as muscles, joints and blood vessels. People of any age can be affected by scleroderma, but it is most common in patients between 30 and 50, and women are affected at a ratio of about four-to-one.
Obesity can contribute to Scleroderma
Although the cause of scleroderma is unknown, research linked fat tissue with the pathogenesis of the disease. This is not surprising since adipose tissue is one of the largest endocrine organs in the body. While visceral adipose fat has direct links to obesity, type 2 diabetes and cardiometabolic risk, Subcutaneous Adipose Tissue (SAT) is less likely to be associated with health issues. Rather, it provides cushioning and insulation, stores energy and regulates temperature, and it also is the connective tissue that attaches the dermis to bones and muscles. However, people with obesity store too much subcutaneous fat, which does increase health risks.1
Obesity can contribute to risks associated with scleroderma in several ways:
- In patients with scleroderma, fat cells within the skin activate and become scar-forming cells.2
- Morbid obesity impairs subcutaneous adipose tissue relative resistance to dysfunctional change and promotes development of metabolic disorders.
- Adipokines are linked anatomically and functionally with systemic scleroderma:
- Leptins induce inflammation and indirectly stimulate fibrosis.
- Chemerin contributes to inflammatory processes and is associated with risk of impaired renal function.
- Resistin is correlated with obesity and metabolic syndrome and directly impacts inflammation, which triggers fibrosis. It also is correlated with a pro-fibrotic molecule, which may contribute to the higher likelihood of deep vein thrombosis and pulmonary thromboembolism.
Visceral fat is considered easier to lose than subcutaneous fat loss, though weight loss in both areas reduces health risks that can be exacerbated by scleroderma. Further, a meta-analysis in the International Journal of Obesity found that when measured by area, volume and weight (versus percentage), subcutaneous fat loss is greater than visceral fat loss, and loss of visceral fat is linked to subcutaneous fat loss.3
Reducing the Health Risks of Scleroderma
Treating patients with obesity by using a Very Low Calorie Diet (VLCD) as part of a comprehensive program addresses many of the overlapping health issues related to scleroderma and obesity. VLCDs help reduce the need for diabetes medication, improve blood pressure and increase quality of life, which also can reduce stress, another contributing factor to scleroderma.
- Subcutaneous Adipose Tissue & Visceral Adipose Tissue
- Fat Tissue May be Key to Scleroderma’s Progression
- Subcutaneous Fat Loss is Greater than Visceral Fat Loss with Diet and Exercise, Weigh-loss Promoting Drugs and Bariatric Surgery: A Critical Review and Meta-analysis
About the Author: Dr. Andrea Pampaloni has over 20 years of communication experience across corporate, academic, nonprofit and government sectors. She provides research and writing services on a range of business issues and industry-specific topics to prepare white papers, articles, proposals, presentations, technical content, and speaking points, as well as marketing-communications content such as blogs, website content, newsletters, news releases and award submissions. Dr. Pampaloni’s research findings have been presented at national and international conferences and published in peer-reviewed journals, and she is a ghostwriter for three books, a Forbes article, and several corporate blogs.