Polio Place

Post-Polio Health, Volume 27, Number 3, Summer 2011
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: My physiatrist says that paraplegics have a lot more diabetes, so I started wondering how post-polio and spinal cord injury compare with regard to the disease.

Answer: You are right that people with chronic spinal cord injury paralysis do develop glucose metabolism abnormalities and diabetes (by criteria) more often than their age cohorts. I attended a 90-minute course on this topic and obesity among people with spinal cord injury at a recent meeting of the American Academy of Physical Medicine and Rehabilitation. The new information reminded physicians how important muscle is to insulin utilization and, therefore, to serum glucose levels.

During the lecture, I was thinking about people who had polio, with their extensive muscle atrophy, because I expect the same issues exist for them. Not only are people with extensive muscle paralysis (paraparesis and quadriparesis, independent of causation) predisposed to obesity because they cannot move and exercise as much to burn up calories, they also are predisposed to store fat because the relative lack of muscle mass (as a proportion of the body) leaves high circulating levels of insulin which combines with serum glucose to store fat.

A recent study of body composition among polio survivors in Taiwan found a higher proportion of fat, independent of body weight as considered from the standard of Body Mass Index (BMI). Normally a BMI (calculated from height and weight) of 25 to 27 is considered “overweight” and over 30 as “obese.” Almost all polio survivors studied, even those not overweight/obese by BMI, had an increased proportion of fat by body composition measurements, a proportion that would typically be expected only in overweight/obese individuals.

I would expect there is a correlation between glucose metabolism abnormalities and increased fat proportion of body composition.