Lipodystrophy: Watch Out For Lost Pounds

Obesity is a condition characterized by abnormal accumulation of fat tissues in the body. It often leads to insulin resistance (diabetes). The reverse is also quite possible, that is diabetes can also lead to some conditions characterized by fat tissue disorders. They are called the syndromes of lipodystrophy.

Lipodystrophies

People with lipodystrophy, typically, lose weight in their faces, arms, and legs, giving them a gaunt appearance. Later they regain fat in their bellies (dubbed protease paunch) and odd fat deposits in the neck and elsewhere, termed buffalo humps.

Lipodystrophy is an abnormality of adipose tissue (fat) marked by selective loss of fat tissue from different parts of the body. There are different types of lipodystrophies and the extent of fat loss may differ from small-depressed areas to near complete absence of fat. Some patients have just cosmetic problems while others have severe metabolic complications. The extent of fat loss determines the severity of metabolic complications related to insulin resistance, such as diabetes mellitus.

The diagnosis is easily possible at birth, as the affected infants appear muscular due to the absence of fat. This is an important criterion for its diagnosis. Other indicators are accelerated growth, advanced bone age during their childhood and have a voracious appetite. The onset of diabetes is usually during the pubertal years and requires high dose of insulin to control the blood glucose levels.

These disorders can either be inherited (familial or genetic lipodystrophies) or can occur secondary to various types of illnesses or drugs (acquired lipodystrophies).

1. Inherited lipodystrophies:

These are caused by changes in gene. Several genes responsible for different types of inherited lipodystrophies have been identified. Several other candidate genes are currently under investigation for other varieties of inherited lipodystrophies.

2. Acquired lipodystrophies:

Acquired lipodystrophies do not have a direct genetic basis. Rather, many mechanisms may be involved. One such mechanism under investigation is an autoimmune response that destroys normal fat cells. This type of lipodystrophies are associated with HIV and similar other severe infections affecting the human immune system. It could result from the side effect of the drugs used to treat such infection.

So, what do we do about it?

Present treatments are mainly based on specific symptoms. Encouraging patients to exercise, adhere to a low-fat diet and to take lipid-lowering agents and anti-diabetic drugs are among the most prescribed norms of treatment. If these are taken care of, the danger of diabetes can be avoided to some extend in non-diabetic patients.

Disfigurement caused by fat loss is a serious cause of concern for some patients. Apart from fat loss and excessive muscular appearance and hirsutism (increased body hair), dark color pigmentation and thickening of the skin in the neck, armpits, groin and the trunk may pose cosmetic problems. Severe diabetes might produce complications like kidney disease, retinal (eye) problems, heart disease and neuropathy (nerve damage). Hyper-triglyceridemia (high levels of blood fats) can result in serious pancreatic injury with severe abdominal pain and can potentially trigger off coronary heart diseases.

Surgical Intervention

Quite a few surgical methods are available to treat the after-effects of lipodystrophy. They include facial reconstruction with transplanted tissue, transposition of facial muscles, facial implants and collagen injections in the cheeks, however the results are variable. Liposuction and lipectomy for removal of excessive facial or neck fat have been done on many patients with familial partial lipodystrophies.