Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21-82 years

Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial

Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.

Both lean and fat body mass associate with blood pressure

High body mass index (BMI) is known to be associated with elevated blood pressure (BP). The present study aims to determine the relative importance of the two components of BMI, fat mass and lean body mass index, on BP levels. We assessed body composition with bioimpedance and performed 24 hour ambulatory BP measurements in 534 individuals (mean age 61 ± 3 years) who had no cardiovascular medication. Fat mass index and lean mass index were calculated analogously to BMI as fat mass or lean body mass (kg) divided by the square of height (m²). Both fat mass index and lean mass index showed a positive, small to moderate relationship with all 24 hour BP components independently of age, sex, smoking, and leisure-time physical activity. There were no interaction effects between fat mass index and lean mass index on the mean BP levels. Adult lean body mass is a significant determinant of BP levels with an equal, albeit small to moderate magnitude as fat mass. Relatively high amount of muscle mass may not be beneficial to cardiovascular health.

[Clinical guidelines «Obesity in children»]

Childhood obesity is an urgent problem of pediatric endocrinology due to the widespread occurrence, the development of metabolic complications and their steady tracking into adulthood. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of obesity, methods of its diagnosis and treatment based on the principles of evidence-based medicine.

Association between skeletal muscle mass and mammographic breast density

Mammographic density (MD) of the breast and body mass index (BMI) are inversely associated with each other, but have inconsistent associations with respect to the risk of breast cancer. Skeletal muscle mass index (SMI) has been considered to reflect a relatively accurate fat and muscle percentage in the body. So, we evaluated the relation between SMI and MD. A cross-sectional study was performed in 143,456 women who underwent comprehensive examinations from 2012 to 2016. BMI was adjusted to analyze whether SMI is an independent factor predicting dense breast. After adjustment for confounding factors including BMI, the odds ratios for MD for the dense breasts was between the highest and lowest quartiles of SMI at 2.65 for premenopausal women and at 2.39 for postmenopausal women. SMI was a significant predictor for MD, which could be due to the similar growth mechanism of the skeletal muscle and breast parenchymal tissue. Further studies are needed to understand the causal link between muscularity, MD and breast cancer risk.

Body Fat Mass, Percent Body Fat, Fat-Free Mass, and Skeletal Muscle Mass Reference Curves for Czech Children Aged 6-11 Years

BACKGROUND

Negative lifestyle trends are reflected in overweight and obese children, in which their lack of physical activity results in decreased muscle mass. This study aimed to define age- and sex-specific reference curves for body fat mass (BFM), skeletal muscle mass (SMM), fat-free mass (FFM), and percent body fat (%BF) in Czech children.

METHODS

Body composition was measured by segmental bioelectrical impedance (BIA, InBody 720). The research sample included 2093 children aged 6-11 years (1008 boys and 1085 girls). Only children whose parents provided informed consent were included. Statistical analysis was performed using SPSS v. 22. The statistical analysis was performed separately by age and sex. Anthropometric data were summarized as means and standard deviation. The percentile curves (P3, P10, P25, P50, P75, P90, and P97) of BFM, FFM, %BF, and SMM were calculated using the gamlss package in R 3.4.2 (R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

This study developed age- and gender-specific percentile curves of SMM, FFM, BFM, and %BF for Czech children aged 6-11 years. During childhood, BFM and %BF increased in boys, peaking at approximately 11 years of age. Girls displayed a different pattern of age-related changes in BFM and %BF compared to that in boys. These parameters gradually increased during childhood. This pattern was also observed for SMM and FFM in both sexes.

CONCLUSIONS

The purpose of this study was to serve as a reference to improve methods to evaluate body composition in Czech children and for comparison with studies worldwide.

Novel Phototherapy Kiosk Shows Promise as a Treatment Option for Low Vitamin D

INTRODUCTION

The purpose of this study was to demonstrate the feasibility of a phototherapy kiosk (PK) to engage community adults in health promotion and to stimulate production of circulating 25-hydroxyvitamin (OH)D as effectively as a vitamin D3 oral supplement (OS). Although optimal production of vitamin D comes from sun exposure, ultraviolet B radiation with a wavelength of 290 to 320 nm penetrates exposed skin and may produce vitamin D3 using a PK.

MATERIALS AND METHODS

A prospective study was conducted with adults randomized to either six PK treatments or D3 OS for 10 weeks. Serum 25(OH)D was drawn at baseline, 10 weeks, and 14 weeks. Primary outcome was serum 25(OH)D level. Mann-Whitney test was used to assess continuous data and Chi squared test for pairwise comparisons of categorical data. Significance was set at P < .05.

RESULTS

With 18% attrition, final sample size was 88; OS, n = 45, PK, n = 43. Sample was mostly female (60%), median age 35 years, with no differences observed between groups for age, race/ethnicity, marital status, military affiliation, or season of enrollment. Median daily intake of calcium and vitamin D was well below the recommended daily allowance for each nutrient, and group. Baseline median serum 25(OH)D levels were similar. By 10 weeks, PK median level was 30 ng/mL (interquartile range [IQR] 25.8-37.0) and OS was 26 ng/mL (IQR 21.5-30.5), P = .02. The difference in 25(OH)D levels persisted at 14 weeks; the PK group returned to baseline, 27 ng/mL (IQR 22.0-32.5), and OS group declined to 21 ng/mL (IQR 17.0-30.0), P = .02.

CONCLUSION

Programmed ultraviolet B phototherapy appears to be an efficacious alternative to oral vitamin D supplementation with consistent use.

Low muscle mass is associated with progression of chronic kidney disease and albuminuria - An 8-year longitudinal study in Asians with Type 2 Diabetes

AIMS

We examined the longitudinal relationship between baseline skeletal muscle mass and its change over time with eGFR decline and albuminuria progression among Asians with type 2 diabetes(T2D).

METHODS

This was a prospective cohort study of 1272 T2D patients. Skeletal muscle mass was estimated using tetra-polar multi-frequency bio-impedance analysis and Skeletal Muscle Mass Index(SMI) was defined as skeletal muscle mass/weight * 100.

RESULTS

After up to 8 years of follow-up, 33.3% of participants had CKD progression and 28.3% albuminuria progression. Every 1-SD above baseline SMI was associated with 18% lower risk of CKD progression[Hazards Ratio(HR)0.82; 95%CI 0.70-0.97; p = 0.018] and 17% lower risk of albuminuria progression [HR 0.83 (95%CI 0.71-0.97; p = 0.017)]. The largest decrease in SMI over time was associated with 67% higher risk of CKD progression, compared to those with the smallest change from baseline SMI tertile 2[HR 1.67 (95%CI 1.10-2.55); p = 0.016]. Pigment epithelium-derived factor(PEDF) and plasma leucine-rich α-2-glycoprotein (LRG1) accounted for 40.1% of the association between SMI and CKD progression.

CONCLUSIONS

Low baseline skeletal muscle mass and its reduction over time is associated with increased risk of progression of CKD among Asians with T2D. PEDF and LRG1 mediated the inverse relationship between SMI and CKD progression.

Variants in NEB and RIF1 genes on chr2q23 are associated with skeletal muscle index in Koreans: genome-wide association study

Although skeletal muscle plays a crucial role in metabolism and influences aging and chronic diseases, little is known about the genetic variations with skeletal muscle, especially in the Asian population. We performed a genome-wide association study in 2,046 participants drawn from a population-based study. Appendicular skeletal muscle mass was estimated based on appendicular lean soft tissue measured with a multi-frequency bioelectrical impedance analyzer and divided by height squared to derive the skeletal muscle index (SMI). After conducting quality control and imputing the genotypes, we analyzed 6,391,983 autosomal SNPs. A genome-wide significant association was found for the intronic variant rs138684936 in the NEB and RIF1 genes (β = 0.217, p = 6.83 × 10^–9). These two genes are next to each other and are partially overlapped on chr2q23. We conducted extensive functional annotations to gain insight into the directional biological implication of significant genetic variants. A gene-based analysis identified the significant TNFSF9 gene and confirmed the suggestive association of the NEB gene. Pathway analyses showed the significant association of regulation of multicellular organism growth gene-set and the suggestive associations of pathways related to skeletal system development or skeleton morphogenesis with SMI. In conclusion, we identified a new genetic locus on chromosome 2 for SMI with genome-wide significance. These results enhance the biological understanding of skeletal muscle mass and provide specific leads for functional experiments.

The prospective relationship between low muscle mass and thyroid hormones among 198 069 euthyroid men and women; comparing different definitions of low muscle mass

OBJECTIVE

The impact of thyroid hormones within normal range on muscle mass remains unknown. We examined the association between new onset of low muscle mass (LMM) and thyroid hormones among euthyroid men and women with three different definitions of LMM in prospective cohort study.

METHODS

We performed a cohort study of 198 069 Korean adults (mean age of 39.2 years), free of LMM at baseline, who participated in a repeated screening examination and were followed up annually or biennially for up to 6.3 years. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by an electrochemiluminescent immunoassay. Muscle mass was assessed using a bioelectrical impedance analyser. LMM was defined as the appendicular skeletal muscle mass (ASM) by body weight (ASM/weight, LMM-W), height squared (ASM/height² , LMM-H) and BMI (ASM/BMI, LMM-B) of one standard deviation below the sex-specific mean for young reference group.

RESULTS

During a median follow-up of 3.1 years (interquartile range, 2.0-4.1 years), new-onset LMM-W, LMM-H and LMM-B occurred in 17 856 (incident rate, 27.8 per 1000 person-years), 8307 (incident rate, 13.4 per 1000 person-years) and 13 990 participants (incident rate, 24.5 per 1000 person-years) in each. In euthyroid men, FT4 was inversely and FT3 positively associated with incident LMM-W in a dose-response manner. TSH and FT4 had inverse dose-response relationship with incident LMM-B. Incident LMM-H of euthyroid men has no apparent associations with any thyroid hormones. Euthyroid women had no dose-response relationship between thyroid hormones and any definition of LMM.

CONCLUSIONS

Among euthyroid men, FT4 had inverse dose-response association with new onset of LMM defined with weight (LMM-W) and BMI (LMM-B). Height squared LMM (LMM-H) had no apparent relationship with any thyroid hormones. Euthyroid women had no dose-responsive association between thyroid hormones and incident LMM.

Is active commuting associated with sedentary behaviour and physical activity in women with fibromyalgia? The al-Ándalus project

PURPOSE

This study aimed to examine the association between active commuting and sedentary time (ST) and physical activity (PA) in women with fibromyalgia.

MATERIALS AND METHODS

This cross-sectional study included 420 women with fibromyalgia (aged 30 to 74 years old) from Spain. The participants wore an accelerometer during seven days to record ST and PA. They also self-reported patterns of active commuting. Linear regression analyses were conducted to examine the relationships between commuting and accelerometer outcomes. Age, pressure pain threshold, and accelerometer wear time were used as confounders.

RESULTS

There was a negative association between active commuting and ST whereas active commuting was positively associated with moderate PA, moderate-to-vigorous PA, total PA, and step count (all p ≤ 0.01). No associations were observed in the older group.

CONCLUSION

Younger women with fibromyalgia who were active commuters spent less ST and were involved in greater PA than passive commuters. This study highlights the importance of promoting active commuting to increase PA among young women with fibromyalgia, while other sources of PA might be recommended for older patients if levels of active commuting are not increased.Implications for rehabilitationActive commuting is a source to increase PA in women with fibromyalgia.Active commuting alone does not seem to be enough to increase PA levels in older women with fibromyalgia and additional PA strategies should be implemented.Promotion of active commuting in young women with fibromyalgia is recommended.

Associations of Fat and Lean Body Mass with Circulating Amino Acids in Older Men and Women

Circulating amino acids are potential markers of body composition. Previous studies are mainly limited to middle age and focus on either fat or lean mass, thereby ignoring overall body composition. We investigated the associations of fat and lean body mass with circulating amino acids in older men and women. We studied 594 women and 476 men from the Helsinki Birth Cohort Study (age 62-74 years). Bioelectrical impedance analysis was used to indicate two main body compartments by fat (fat mass/height2) and lean mass indices (lean mass/height2), dichotomized based on sex-specific medians. Eight serum amino acids were quantified using nuclear magnetic resonance spectroscopy. General linear models were adjusted for age, smoking, and fasting glucose. Higher lean mass index (LMI) was associated with higher concentrations of branched-chain amino acids in both sexes (p ≤ .001). In men, LMI was also positively associated with tyrosine (p = .006) and inversely with glycine (p < .001). Higher fat mass index was associated with higher concentrations of all branched-chain amino acids, aromatic amino acids (phenylalanine and tyrosine), and alanine in both sexes (p ≤ .008). Associations between body composition and amino acids are largely similar in older men and women. The associations are largely similar to those previously observed in younger adults.

Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study

INTRODUCTION/OBJECTIVES

To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA).

METHODS

We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted.

RESULTS

Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15-5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32-3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13-10.19 points).

CONCLUSIONS

Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA. Key Points • Higher extracellular-to-intracellular water (ECW/ICW) ratios are associated with greater functional disability levels in patients with knee osteoarthritis (OA). • ECW/ICW ratios are useful clinical signs as a biomarker for poor functional abilities in patients with knee OA.

A high lean body mass is not protecting from type 2 diabetes in the presence of a high body fat mass

AIM

Most studies examining the associations between body composition and type 2 diabetes have been cross-sectional with prevalent diabetes diagnosis or they have analyzed only fat or lean body mass. Hence, the combined effect of fat and lean body mass on the risk of developing type 2 diabetes remains unclear. We investigated whether baseline lean and fat body mass taken simultaneously into account are associated with incidence of type 2 diabetes over a 15-year follow-up in older adults.

METHODS

We studied 704 men (n = 297) and women (n = 407) from the Helsinki Birth Cohort Study (mean age 61 years at baseline) without diabetes at baseline. Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height²) and lean mass index (LMI, lean mass/height²), dichotomized at sex-specific medians. Incident diabetes was defined as the composite of fasting plasma glucose (FPG) ≥ 7.0 mmol/l, haemoglobin A_1c (HbA_1C) ≥ 6.5% (48 mmol/mol) or physician-based diagnosis.

RESULTS

After a median 14.8 (range 12.5-16.8) years of follow-up, 110 incident diabetes cases occurred (15.6%). Participants with high FMI and LMI at baseline had higher composite incidence of type 2 diabetes (P < 0.001), and significantly increased risk of type 2 diabetes after adjustment for potential confounding factors (sex, physical activity, education and body mass index) compared to the other participants.

CONCLUSION

Contrary to a general belief greater muscle mass is not protective against type 2 diabetes. High LMI accompanied with high FMI seem to predict subsequent development of type 2 diabetes.

Adaptations to Swimming Training in Athletes with Down's Syndrome

Swimming training programs may help to limit declines in cardiovascular conditioning, muscle strength, mobility and social functioning in individuals with Down’s Syndrome (DS): (1) Background: This study aims to analyze the effects of a periodized swimming training program on swimming speed, lower body force and power and body composition in a group of swimmers with DS; (2) Methods: Nine swimmers with DS (2 men and 7 women; aged 21–30 years-old) completed an 18-week periodized swimming program. The swimmers were assessed, pre and post-training, for 25 m, 50 m and 100 m freestyle swim performance, countermovement jump performance and body composition; (3) Results: Significant and large improvements in 25 m (mean −6.39%, p < 0.05, d = 1.51), 50 m (mean −4.95%, p < 0.01, d = 2.08) and 100 m (mean −3.08%, p < 0.05, d = 1.44) freestyle performance were observed following training, with no significant changes in body composition or consistent changes in jump performance (although a large mean 14.6% decrease in relative peak force, p < 0.05, d = 1.23) (4) Conclusions: A periodized 18-week training intervention may improve swimming performance in a small group of trained swimmers with DS, with less clear changes in jump performance or body composition. This program provides a training profile for coaches working with swimmers with DS and a platform for further research into the benefits of swimming training with this under-represented population.

Lifestyle and glycemic health 5 years postpartum in obese and non-obese high diabetes risk women

AIM

Women with prior gestational diabetes (GDM) are at increased diabetes risk. This study aimed to assess whether lifestyle is associated with glycemic health of high-risk women 5 years postpartum, taking into account the pre-pregnancy BMI.

METHODS

The RADIEL study enrolled before or in early pregnancy 720 women with pre-pregnancy BMI ≥ 30 kg/m2 and/or prior GDM. The follow-up visit 5 years postpartum included questionnaires and measurements of anthropometrics, blood pressure, and physical activity (PA) as well as analyses of glucose metabolism, lipids, and inflammatory markers. We measured body composition (Inbody) and calculated a Healthy Food Intake Index (HFII) from Food Frequency Questionnaires (FFQ). ArmBand measured PA, sedentary time, and sleep. To take into account the diverse risk groups of GDM, we divided the women based on pre-pregnancy BMI over/under 30 kg/m2.

RESULTS

Altogether 348 women attended the follow-up. The obese and non-obese women showed similar prevalence of glycemic abnormalities, 13% and 19% (p = 0.139). PA levels were higher among the non-obese women (p < 0.05), except for step count, and their HFII was higher compared to the obese women (p = 0.033). After adjusting for age, education, and GDM history, PA and HFII were associated with glycemic health only among obese women. When both lifestyle factors were in the same model, only PA remained significant. PA associated with other markers of metabolic health also among the non-obese women, excluding HbA1c.

CONCLUSION

Lifestyle 5 years postpartum was associated with better glycemic health only among the obese high-risk women. PA, however, is essential for the metabolic health of all high-risk women.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, http://www.clinicaltrials.com , NCT01698385.

Skeletal muscle mass and risk of advanced adenoma in surveillance colonoscopy

BACKGROUND AND AIM

Sarcopenia has been suggested to be associated with chronic inflammation and insulin resistance. This study aimed to evaluate whether low muscle mass is associated with the incidence and recurrence of advanced colorectal adenoma.

METHODS

We conducted a cohort study including 14 701 participants who underwent first-time screening colonoscopy between 2003 and 2012 and follow-up colonoscopy until 2017. Skeletal muscle mass was measured using a bioelectrical impedance analyzer and divided by body weight to calculate the skeletal muscle mass index (SMI).

RESULTS

During a median 47 (interquartile range, 35-58) months of follow-up, overall and advanced adenoma developed in 2988 (20.3%) and 207 (1.41%) participants, respectively. In multivariate analysis using models adjusted for baseline adenoma risk, lifestyle factors, markers for insulin resistance and chronic inflammation, and metabolic syndrome, decreasing SMI quartiles were associated with increased risk of occurrence of advanced adenoma and overall adenoma. The adjusted hazard ratios (95% confidence intervals) comparing SMI quartiles 3, 2, and 1 to quartile 4 were 1.57 (1.03-2.41), 1.22 (0.78-1.92), and 1.77 (1.13-2.76), respectively, for advanced adenoma (P for trend = 0.049) and 1.05 (0.95-1.17), 1.09 (0.98-1.21), and 1.26 (1.13-1.41), respectively, for overall adenoma (P for trend < 0.001).

CONCLUSIONS

In this large cohort with long-term colonoscopy follow-up, low relative muscle mass was associated with increased risk of occurrence of advanced adenoma and overall adenoma at follow-up colonoscopy, independent of metabolic and inflammatory markers. Timely and thorough surveillance colonoscopy may be emphasized in such populations.

Lean body mass is not beneficial, but may be detrimental for glucose tolerance - Splitting body mass index according to body composition

AIMS

To study the combined effect of lean mass index (LMI) and fat mass index (FMI) on glucose regulation based upon findings in an oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR).

METHODS

We conducted a population-based, cross-sectional study including 1617 participants without diabetes born in Helsinki from 1934 through 1944. LMI and FMI were calculated as lean and fat mass (kg)/height (m²). For analysis of the association between interaction of LMI and FMI and glucose regulation the participants were divided into tertiles of FMI and LMI.

RESULTS

In men LMI correlated positively with (fasting plasma glucose) FPG and HOMA-IR in the middle and high FMI level with a significant interaction between FMI and LMI on HOMA-IR. In women LMI was not associated with glucose regulation. In both men and women increased FMI was associated with increased FPG and 2-h plasma glucose concentrations and HOMA-IR.

CONCLUSIONS

In men high lean mass accompanied with fatness may be detrimental for glucose tolerance, whereas in women lean mass seemed to have little effect on glucose regulation. Fatness is the major determinant of glucose intolerance.

Fatty liver is an independent risk factor for gallbladder polyps

BACKGROUND

Gallbladder polyps (GBPs) are known to be associated with obesity and metabolic diseases. However, to date, the relationship between GBPs and abnormal body fat distribution, such as fatty liver, visceral obesity, or sarcopenia, has not yet been established.

AIM

To evaluate whether GBPs are associated with fatty liver, visceral obesity, or sarcopenia.

METHODS

We retrospectively reviewed the medical records of subjects who underwent various laboratory tests, body composition measurement with a non-invasive body composition analyzer, and abdominal ultrasonography during health checkups. A total of 1405 subjects with GBPs were compared with 2810 age- and sex-matched controls.

RESULTS

The mean age of the subjects was 46.8 ± 11.7 years, and 63.8% were male. According to multiple logistic regression analysis, the presence of fatty liver [odds ratio (OR) 1.413; 95% confidence interval (CI) 1.218-1.638; P < 0.001] was an independent risk factor for GBP, together with low levels of alanine aminotransferase (OR 0.993; 95%CI 0.989-0.996; P < 0.001). Additionally, fatty liver showed both independent (OR 1.629; 95%CI, 1.335-1.988; P < 0.001) and dose-dependent (moderate to severe fatty liver; OR 2.137; 95%CI, 1.662-2.749; P < 0.001) relationship with large GBPs (≥ 5 mm). The presence of sarcopenia and high visceral fat area were not significantly associated with GBPs.

CONCLUSION

Fatty liver was found to be closely associated with GBPs irrespective of sarcopenia and visceral obesity.

Initial Acute Decline in Estimated Glomerular Filtration Rate After Sodium-Glucose Cotransporter-2 Inhibitor in Patients With Chronic Kidney Disease

Background

Renal function deterioration accompanied by an acute decrease in estimated glomerular filtration rate (eGFR) was observed early after starting sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy. It is unclear how much and how frequently the initial acute decline in eGFR (IAD-eGFR) would occur after SGLT2i administration, and the effects of IAD-eGFR on subsequent renal function are unknown in type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD).

Methods

We retrospectively recruited T2DM patients with CKD (stage 3b; 30 ≤ eGFR < 45 mL/min/1.73 m²) and who were newly treated with add-on SGLT2i. We further investigated the effects of SGLT2i therapy on eGFR early after starting treatment (1 - 3 months) and after 6 months of treatment. We examined the factors associated with a large IAD-eGFR (≥ 10%) using logistic regression analyses.

Results

Eighty-seven patients (male, 74.7%; mean age, 69.8 years; median hemoglobin A1c, 7.3%; mean eGFR, 37.8 mL/min/1.73 m²) were analyzed. The mean minimum eGFR early after SGLT2i administration was 34.9 mL/min/1.73 m², which was significantly lower than before treatment (mean, -7.7%). Seventy patients (80.5%) had IAD-eGFR, and 36 patients (41.4%) had a large IAD-eGFR (≥ 10%). Overall, the mean eGFR was 38.2 at 6 months after starting SGLT2i administration. In patients with a large IAD-eGFR (≥ 10%), the eGFR decreased by 72.2% at 6 months to 35.5 mL/min/1.73 m², showing a significant decline from the pretreatment value. In patients without a large IAD-eGFR, eGFR increased by 66.7% at 6 months to 40.0 mL/min/1.73 m². Multiple logistic regression analysis showed that patients with a large IAD-eGFR had a significant association with a high estimated daily salt intake.

Conclusions

SGLT2i treatment frequently induced a significant decrease in eGFR early after starting therapy, but eGFR tended to recover after 6 months in T2DM patients with CKD stage 3b. A large IAD-eGFR (≥ 10%) caused by SGLT2i may lead to subsequent deterioration in renal function, and it was significantly associated with a higher estimated daily salt intake. These results suggest that a more effective renoprotective therapeutic strategy using SGLT2i may be implemented by avoiding the occurrence of a large IAD-eGFR. Further prospective studies are warranted.

The Comparison of Segmental Multifrequency Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry for Estimating Fat Free Mass and Percentage Body Fat in an Ambulatory Population

BACKGROUND

Despite malnutrition being associated with increased mortality and morbidity, there continues to be great difficulty in defining criteria and implementing widespread screening. Tools used to diagnose decreased fat-free mass (FFM [sarcopenia]) should be easy to use, relatively inexpensive, and safe. Bioelectrical impedance analysis (BIA) has the potential to meet these criteria, but reliability across body mass index (BMI) classes is a concern.

METHODS

A total of 176 healthy ambulatory participants (aged 18-65 years) were recruited equally (n = 44) in 4 BMI categories: (1) 18.5-24.9, (2) 25.0-29.9, (3) 30-34.9, and (4) ≥35.0. Participants were fasting overnight and had S-MFBIA (InBody 770) measurements the next morning, with DXA being performed subsequently within 30 minutes.

RESULTS

The measurement (mean ± SD) for FFM with DXA was 52.8 ± 11.0, and BIA was 53.6 ± 11.0. Delta (S-MFBIA vs DXA) was 0.8 ± 2.2 (5% limits of agreement -3.5 to +5.2), and concordance correlation coefficient (CCC) was 0.98 (95% CI, 0.97-0.98). The measurements (mean ± SD) for PBF with DXA was 37.5 ± 10.6% and S-MFBIA was 36.6 ± 11.3%. Delta (S-MFBIA vs DXA) was -0.9 ± 2.6 (5% limits of agreement 6.0 to +4.2), and CCC was 0.97 (95% CI, 0.96-0.98). The CCC according to the 4 BMI groups for FFM and PBF was between 0.96-0.98 and 0.90-0.94, respectively.

CONCLUSIONS

FFM and PBF measured by S-MFBIA had good agreement with DXA across all BMI categories measured in the current study of ambulatory participants.

Physical activity is favorably associated with arterial stiffness in patients with obesity and elevated metabolic risk

OBJECTIVES

Physical activity and cardiorespiratory fitness (CRF) are relevant modifiers of cardiovascular risk. Their independent effects on arterial stiffness have not been assessed in people with obesity. This study aimed to assess the independent effects of light (LPA) and moderate-to-vigorous (MVPA) physical activity and CRF on Pulse wave velocity (PWV).

METHODS

Brachial-ankle PWV (baPWV) was measured cross-sectionally in 55 subjects (43.0 ± 13.8 years; 66% women) with moderate cardiovascular risk. Body composition was assessed with bioelectrical impedance-analysis. Daily minutes of LPA and MVPA were measured by accelerometry and CRF (peak oxygen uptake [VO₂ peak]) with spiroergometry. Independent effects of LPA, MVPA, and VO₂ peak on baPWV were analyzed in an age-, sex-, body fat mass-, and blood pressure-adjusted ANOVA.

RESULTS

Every 10 minutes increase of daily MVPA was associated with a 2.8% (0.32m/s [-0.64 to 0.001 m/s], P = .05) reduction of baPWV, whereas LPA and VO₂ peak had only a little or no relevant effects on baPWV.

CONCLUSIONS

Higher MVPA is associated with lower composite arterial stiffness independent of CRF and the number of metabolic risk factors in patients with obesity and further metabolic risk factors. Thus, lifestyle interventions should aim for an increase in MVPA. BaPWV may improve the monitoring of favorable effects of MVPA, even if an improvement of VO₂ peak cannot be obtained.

Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study

INTRODUCTION

Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD.

OBJECTIVES

To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects.

MATERIALS AND METHODS

109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance).

RESULTS

BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14).

CONCLUSION

In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.

Menopausal Transition, Body Mass Index, and Prevalence of Mammographic Dense Breasts in Middle-Aged Women

The interrelationship between menopausal stage, excessive adiposity and dense breasts remains unclear. We aimed to investigate the relationship between menopausal stage and dense-breast prevalence in midlife women while considering a possible effect modification of being overweight. The present cross-sectional study comprised 82,677 Korean women, aged 35–65 years, who attended a screening exam. Menopausal stages were categorized based on the Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Mammographic breast density was categorized according to Breast Imaging Reporting and Data System (BI-RADS). Dense breasts were defined as BI-RADS Breast Density category D (extremely dense). The prevalence of dense breasts decreased as menopausal stage increased (p-trend < 0.001), and this pattern was pronounced in overweight women than non-overweight women (p-interaction = 0.016). Compared with pre-menopause, the multivariable-adjusted prevalence ratios (and 95% confidence intervals) for dense breasts were 0.98 (0.96–1.00) in early transition, 0.89 (0.86–0.92) in late transition, and 0.55 (0.52–0.59) in post-menopause, among non-overweight women, while corresponding prevalence ratios were 0.92 (0.87–0.98), 0.83 (0.77–0.90) and 0.36 (0.31–0.41) among overweight women. The prevalence of dense breasts was inversely associated with increasing menopausal stages and significantly decreased from the late menopausal transition, with stronger declines among overweight women.

Measuring maternal body composition by biomedical impedance can predict risk for gestational diabetes mellitus: a retrospective study among 22,223 women

OBJECTIVES

This study aimed to identify which element of body composition measurements taken before 17th week gestation was the strongest risk factor for gestational diabetes mellitus (GDM) in Chinese pregnant women.

DESIGN AND SETTING

A retrospective study was performed using data retrieved from the Electronic Medical Record database of Chongqing Health Center for Women and Children (China) from January 2014 to December 2015.

PARTICIPANTS

A total of 22,223 women were included with singleton pregnancies and no preexisting diabetes who underwent bioelectrical impedance analysis (BIA) before 17 gestational weeks and 75-g OGTT at 24-28 gestational weeks.

RESULTS

The prevalence of GDM from 2014 to 2015 was 27.13% (IADPSG). All indicators of BIA (total body water, fat mass, fat-free mass, percent body fat, muscle mass, visceral fat levels, proteins, bone minerals, basal metabolic rate, lean trunk mass), age, weight and body mass index (BMI) were risk factors that significantly increased the occurrence of GDM (p < .001 for all). Women older than 30 years or with a BMI more than 23, had a significantly higher GDM prevalence (34.89% and 34.77%). After adjusted covariates, visceral fat levels at the third quartile, the ORs of GDM were 1.142 (95% CI 1.032-1.263) in model I and 1.419 (95% CI 1.274-1.581) in model II used the first quartile as reference (p < .05 for both); bone minerals at the third quartile, the ORs of GDM were 1.124 (95% CI 1.020-1.238) in model I and 1.311 (95% CI 1.192-1.442) in model II (p < .05 for both). After adjusted for age, visceral fat levels and bone minerals, OR of GDM for percent body fat more than 28.77% at the third quartile was 1.334 (95% CI 1.201-1.482) in model II (p < .05 for both).

CONCLUSIONS

Visceral fat levels, bone minerals and percent body fat were significantly associated with an increased risk of GDM, providing the reference ranges of visceral fat levels, bone minerals and percent body fat as predictive factors for Chinese women to estimate the risk of GDM by BIA during pregnancy.

Physical Function and Cardio-Ankle Vascular Index in Elderly Heart Failure Patients

The number of heart failure patients is increasing rapidly in Japan because of its large elderly population. As age increases, arterial stiffness and physical dysfunction progress. This study aimed to evaluate the association between the physical function and arterial stiffness in elderly heart failure patients.This retrospective, observational study includes data from 100 heart failure patients aged ≥ 65 years who were admitted to our hospital and underwent cardiac rehabilitation. The Cardio-Ankle Vascular Index (CAVI) was measured as an indicator of arterial stiffness. Body composition was assessed by bioelectrical impedance analysis. To determine the degree of physical function, we assessed handgrip strength, five-meter walk speed (5MWS), five-repetition sit-to-stand time (5RSST) and six-minute walk distance (6MWD). Sarcopenia was defined using Asian guidelines based on physical function and body composition.Among 100 patients, 47.0% of patients had sarcopenia. After adjustments for age, sex, atrial fibrillation, and ischemic cardiomyopathy, CAVI was significantly higher in with sarcopenia patients than those without sarcopenia. Age, handgrip strength, 5MWS, 5RSST, and 6MWD were associated with CAVI, and 6MWD was as an independent determinant factor of CAVI.6MWD was recognized as an accurate physical function indicator. These findings suggested that physical function and arterial stiffness complement each other. To restore cardiac dysfunction, improving both arterial stiffness and physical function might be useful.

Low relative skeletal muscle mass predicts incident hypertension in Korean men: a prospective cohort study

OBJECTIVE

Previous cross-sectional studies suggest an association between low muscle mass and hypertension. However, whether low muscle mass predicts the development of hypertension is unknown. The aim of this study is to investigate the relationship between relative muscle mass and incident hypertension in a large prospective cohort of Korean adults.

METHODS

In this prospective cohort study, we analyzed 132 324 participants without hypertension at baseline who underwent two health check-ups in 2012 and 2016 or in 2013 and 2017 with a 4-year interval. The participants were divided according to skeletal muscle mass index quartiles (Q1--Q4) according to their baseline skeletal muscle mass index [skeletal muscle mass index (%) = total skeletal muscle mass (kg)/body weight (kg) × 100). Multivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for the development of hypertension after 4 years.

RESULTS

After 4 years, 7180 (5.43%) participants developed hypertension. The incidence rates of hypertension were 12.11, 8.58, 6.93, and 4.37% in men and 4.02, 2.29, 1.73, and 1.18% in women in Q1, Q2, Q3, and Q4, respectively. The multivariate adjusted odds ratios (95% confidence intervals) for incident hypertension in Q1, Q2, and Q3, in comparison with Q4, were 1.46 (1.3-1.63), 1.31 (1.19-1.46), and 1.26 (1.14-1.40) in men and 0.97 (0.76-1.23), 1.12 (0.90-1.38), and 1.14 (0.92-1.42) in women, respectively.

CONCLUSION

Low relative skeletal muscle mass was independently and significantly associated with the incidence of hypertension only in Korean men. Further research is required to understand the underlying mechanisms of this relationship.

Prevalence and factors associated with motoric cognitive risk syndrome in community-dwelling older Chinese: a cross-sectional study

BACKGROUND AND PURPOSE

A recently proposed pre-dementia syndrome, motoric cognitive risk (MCR) syndrome, is characterized by cognitive complaints and slow gait, and increases the risk of dementia and mortality. The aim of the present study was to explore the prevalence of and factors associated with MCR syndrome in elderly community-dwelling Chinese subjects.

METHODS

The Ningbo Community Study on Aging recruited 953 Chinese community-dwelling participants aged ≥ 65 years from November 2016 to March 2017. Handgrip, Five-Times-Sit-to-Stand (FTSS) test time and body composition, as well as comprehensive geriatric evaluation, were measured as potentially independent factors associated with MCR syndrome.

RESULTS

The prevalence of MCR syndrome was 12.8% in men and 12.6% in women, and high prevalence of MCR syndrome was not associated with age or sex. Multiple logistic regression analysis by sex showed that a 1-SD increase in FTSS test time in males and females was associated with 45% (95% confidence intervals, 19-76; P < 0.01) and 20% (95% confidence intervals, 9-33; P < 0.01) higher risk of having MCR syndrome, respectively, whereas handgrip strength was inversely correlated with MCR syndrome in males [odds ratio (OR), 0.91; P = 0.02] but not females (P = 0.06). Moreover, the relationship of arm fat mass and MCR syndrome was statistically significant in both sexes (OR, 1.69-1.77), but leg fat mass was only associated with MCR syndrome (OR, 1.56; P = 0.02) in men.

CONCLUSIONS

Handgrip, FTSS test time and body composition were associated in a sex-specific manner with MCR syndrome in elderly community-dwelling Chinese subjects. Our results on MCR syndrome are novel and should be considered as important information in future studies.

Thyroid Function and Sarcopenia: Results from the ELSA-Brasil Study

OBJECTIVES

We aimed to investigate the association of subclinical thyroid disease and thyroid hormone levels with sarcopenia and its defining components in community-dwelling middle-aged and older adults without overt thyroid dysfunction.

DESIGN

Cross-sectional study.

SETTING

Active and retired employees from public institutions located in six Brazilian cities.

PARTICIPANTS

A total of 6974 participants from the ELSA-Brasil study's second wave, aged 50 years and older, without overt thyroid dysfunction and with complete data for exposure, outcome, and covariates.

METHODS

Serum levels of thyrotropin (TSH), free thyroxine, and free triiodothyronine (FT3) were measured and divided in quintiles for the analyses. Participants were classified with euthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism. Muscle mass was assessed by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Possible confounders included sociodemographic characteristics, clinical conditions, and lifestyle. Analyses were performed separately for middle-aged and older adults (≥65 y).

RESULTS

The frequencies of sarcopenia, low muscle mass, low muscle strength, subclinical hypothyroidism, and subclinical hyperthyroidism were 1.5%, 20.8%, 3.8%, 9.1%, and .9%, respectively. Subclinical thyroid dysfunction was not associated with sarcopenia and its defining components. Among older adults, TSH had a U-shaped association with sarcopenia and low muscle strength. The odds ratios (ORs) (95% confidence intervals [CIs]) for the associations of the first, second, fourth, and fifth quintile with sarcopenia, respectively, were 5.18 (1.47-18.28), 6.28 (1.82-21.73), 4.12 (1.15-14.76), and 4.81 (1.35-17.10), and with low muscle strength was (OR (95% CI) for the first, second, and fifth quintiles, respectively: 1.43 (1.16-5.07), 2.07 (1.24-4.70), and 2.18 (1.03-4.60). Additionally, FT3 had a negative association with muscle mass in both age strata.

CONCLUSION

Subtle thyroid hormone alterations are associated with sarcopenia or its defining components in middle-aged and older adults without overt thyroid dysfunction. J Am Geriatr Soc 68:1545-1553, 2020.

Sedentary Time Accumulated in Bouts is Positively Associated with Disease Severity in Fibromyalgia: The Al-Ándalus Project

To examine the associations of prolonged sedentary time (ST) with disease severity in women with fibromyalgia, and to analyse the combined association of total ST and prolonged ST with the disease severity in this population. Women (n = 451; 51.3 ± 7.6 years old) with fibromyalgia participated. Sedentary time and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometry and ST was processed into 30- and 60-min bouts. Dimensions of fibromyalgia (function, overall, symptoms) and the overall disease impact were assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Body fat percentage was assessed using a bio-impedance analyser, and physical fitness was assessed with the Senior Fitness Tests Battery. Greater percentage of ST in 30-min bouts and 60-min bouts were associated with worse function, overall, symptoms and the overall impact of the disease (all, P < 0.05). Overall, these associations were statistically significant when additionally controlling for MVPA and overall physical fitness. Participants with low levels of total ST and prolonged ST (>60-min bouts) presented lower overall impact compared to participants with high levels of total ST and prolonged ST (mean difference = 6.56; 95% confidence interval (CI) = 1.83 to 11.29, P = 0.002). Greater percentage of ST accumulated in 30- and 60-min bouts and a combination of high levels of total and prolonged ST are related to worse disease severity. Although unable to conclude on causality, results suggest it might be advisable to motivate women with fibromyalgia to break prolonged ST and reduce their total daily ST.

Body composition and changes in health-related quality of life in older age: a 10-year follow-up of the Helsinki Birth Cohort Study

Purpose

Most studies examining the associations between body composition and health-related quality of life (HRQoL) in older age have been cross-sectional and analyzed only fat or lean mass. Hence, it is poorly known whether fat and lean mass are independently associated with subsequent changes in HRQoL. We investigated whether baseline lean and fat mass are associated with changes in HRQoL over a 10-year period in older adults.

Methods

We studied 1044 men and women from the Helsinki Birth Cohort Study (age 57–70 years at baseline). Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height²) and lean mass index (lean mass/height²), dichotomized at sex-specific medians. HRQoL was assessed using RAND 36-item Health Survey at baseline and follow-up 10 years later.

Results

When controlled for lean mass and adjusted for potential confounders, high baseline FMI was associated with a greater decline in general health (standardized regression coefficient [β] = − 0.13, p = 0.001), physical functioning (β = − 0.11, p = 0.002), role physical (β = − 0.13, p = 0.003), vitality (β = − 0.08, p = 0.027), role emotional (β = − 0.12, p = 0.007), and physical component score (β = − 0.14, p < 0.001). High baseline FMI was also associated with low HRQoL in all physical domains at baseline (β: from − 0.38 to − 0.10). Lean mass was not strongly associated with HRQoL at baseline or change in HRQoL.

Conclusion

In older community-dwelling adults, higher fat mass is, independent of lean mass, associated with lower physical HRQoL and greater decline in HRQoL. Prevention of adiposity may contribute to preservation of a good quality of life in older age.

Effects of volume status on body composition in incident peritoneal dialysis patients

BACKGROUND

Inadequate fluid removal or high water intake leads to overhydration, which results in malnutrition. The aim of the present study was to evaluate the effects of volume status on body composition in incident peritoneal dialysis (PD) patients.

METHODS

All incident PD patients who survived ≥1 year after PD initiation were considered eligible. A total of 366 incident PD patients were finally included and divided into three tertiles according to the time-averaged-edema index (TA-EI). The body composition parameters measured using bioimpedance analysis included the EI, fat mass index (FMI, kg/m²), and appendicular muscle mass index (AMMI, kg/m²). dFMI and dAMMI were defined as delta values for each variable. The cutoff value for sarcopenia (SP) was defined as previously reported. Patients with AMMI below the cutoff values were defined as having SP.

RESULTS

The number of participants in the low, middle, and high tertiles was 126, 100, and 140, respectively. A high volume status was associated with high solute clearance, albumin loss, and glucose absorption through the peritoneal membrane, which led to high dialysate glucose. In addition, volume status was inversely associated with increases in AMMI, but was not associated with changes in FMI. SP as a categorical variable was positively associated with a high volume status. On subgroup analyses, TA-EI had the greatest negative correlation coefficients for dAMMI.

CONCLUSION

Overhydration in PD patients was associated with decrease in muscle mass indices and the development of SP.

Resistance training using different elastic components offers similar gains on muscle strength to weight machine equipment in Individuals with COPD: A randomized controlled trial

Purpose: To compare the effects of three modalities of resistance training, two using elastic components and one using conventional weight machine on peripheral muscle strength in Individuals with chronic obstructive pulmonary disease (COPD). Effects on exercise capacity, impact of disease on health status, body composition and daily level of physical activity were investigated as secondary endpoints.Methods: Forty-eight participants were randomly allocated (Trials Registry #RBR-6V9SJJ) into Elastic band group (Theraband®) (EBG), Elastic tubes training using Lemgruber® (ETG), and Conventional training with weight machine equipment (CG). Participants were evaluated before and after 12 weeks of training regarding peripheral muscle strength by dynamometry; impact of disease on health status via COPD Assessment Test, CAT; exercise capacity by 6-min walk test, 6MWT; body composition by bioelectrical impedance; and daily level of physical activities via accelerometry.Results: Inter-group comparison of training effects did not elucidate significant differences between the modalities in muscle strength (p ≥ .2). Likewise, all training modalities showed similar effects on CAT, body composition and daily physical activity variables with no statistical significance observed (p ≥ .15).Conclusions: Modalities of resistance training using elastic components presented similar effects on muscle strength, health status, exercise capacity, body composition and daily level of physical activity in individuals with COPD. The effects of elastic resistance were similar to conventional resistance training.

Capacidade de avaliação de testes de desempenho físico para identificar baixa massa muscular em mulheres de meia-idade e idosas

Resumo Objetivo Verificar a capacidade de avaliação de testes de desempenho físico na identificação da baixa massa muscular (MM) em mulheres de meia-idade e idosas. Método Estudo transversal realizado com 540 mulheres de meia-idade (40-59 anos) e idosas (≥60 anos), nos municípios de Parnamirim e Santa Cruz, no Rio Grande do Norte, Brasil. Foram avaliadas MM, força de preensão palmar, extensão de joelho e velocidade da marcha. A baixa MM foi definida pelo índice de massa muscular esquelética menor que os 20% mais baixos para cada grupo de idade. Foram utilizados os testes: t de Student, qui-quadrado, análise de curva ROC para calcular a área sob a curva e ponto de corte de cada teste na discriminação das participantes com baixa MM. Foi considerado p<0,05 e IC de 95%. Resultados Para o grupo de meia-idade, as forças de preensão palmar e de extensão do joelho apresentaram sensibilidade (71,6% e 72,5%, respectivamente) e especificidade (59,4% e 56,0%, respectivamente) moderadas na identificação de baixa MM. Para as idosas, a velocidade da marcha e a força de preensão manual apresentaram boa sensibilidade (77,8% e 81,6%, respectivamente) e especificidade moderada (51,4% e 64,5%, respectivamente). A capacidade discriminatória da velocidade da marcha para as mulheres de meia-idade e da força de extensão do joelho para as mulheres idosas foi insatisfatória. Conclusão As medidas de força muscular são úteis para a triagem de baixa MM em mulheres de meia-idade, enquanto os testes de força de preensão manual e velocidade de marcha são úteis para idosas.

Transgenerational effects of maternal obesity and gestational diabetes on offspring body composition and left ventricle mass: the Finnish Gestational Diabetes Prevention Study (RADIEL) 6-year follow-up

AIM

To investigate the influence of maternal adiposity and gestational diabetes on offspring body composition and left ventricle mass in early childhood.

METHODS

The observational follow-up study included 201 mother-child pairs, a sub-cohort from the Finnish Gestational Diabetes Prevention Study, who were recruited 6.1 ± 0.5 (mean ± SD) years postpartum, aiming for an equal number of mothers with and without gestational diabetes.

RESULTS

Maternal pre-pregnancy BMI (mean ± SD; 30.5 ± 5.6 kg/m² ) was associated with child body fat percentage [0.26 (95% CI; 0.08, 0.44)% increase in child body fat per 1 kg/m² increase in pre-pregnancy BMI of mothers with obesity] and was reflected in child BMI Z-score (mean ± SD; 0.45 ± 0.93). Left ventricle mass, left ventricle mass index and left ventricle mass Z-score were not associated with gestational diabetes, pre-pregnancy BMI or child body fat percentage. After adjusting for child sex, body fat percentage, systolic blood pressure, pre-pregnancy BMI and maternal lean body mass, left ventricle mass increased by 3.08 (95% CI; 2.25, 3.91) g for each 1 kg in child lean body mass.

CONCLUSIONS

Left ventricle mass at 6 years of age is determined predominantly by lean body mass. Maternal pre-gestational adiposity is reflected in child, but no direct association between left ventricle mass and child adiposity or evidence of left ventricle mass foetal programming related to gestational diabetes and maternal adiposity was observed in early childhood.

High-Risk Human Papillomavirus Infection and the Risk of Cardiovascular Disease in Korean Women

RATIONALE

Until now, no cohort studies have evaluated the relationship between high-risk human papillomavirus (HPV) infection and new-onset cardiovascular diseases (CVD).

OBJECTIVE

We investigated an association between high-risk HPV infection and the development of CVD.

METHODS AND RESULTS

We conducted a cohort study of 63 411 women aged 30 or older without CVD at baseline who underwent a high-risk HPV test and were followed annually or biennially from 2011 to 2016. CVD was ascertained through the linkage to the Health Insurance and Review Agency database. A Cox-proportional hazards regression model was used to estimate adjusted hazard ratios (HRs) with 95% CIs of incident CVD. The prevalence of high-risk HPV infection was 7.6%. During 261 598.9 person-years of follow-up, 1122 cases of new-onset CVD were identified (incidence rate of 4.3 per 10³ person-years). High-risk HPV infection was significantly associated with incident CVD. After adjustment for possible confounders, and high sensitivity C-reactive protein, a significant association between high-risk HPV infection and incident CVD was still observed, with a corresponding HR (95% CI) of 1.25 (1.03-1.52). This association was stronger among individuals with obesity and those with metabolic syndrome. Multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.10 (0.87-1.39) in the nonobese, whereas corresponding HR (95% CI) was 1.73 (1.19-2.51) in those with obesity ( P for interaction by obesity=0.02). Similarly, multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.09 (0.87-1.36) in those without metabolic syndrome and 1.99 (1.28-3.08) in those with MetS ( P for interaction=0.05).

CONCLUSION

In this large cohort, high-risk HPV infection was significantly associated with an increased risk of developing CVD, especially in obese individuals and those with MetS, indicating that high-risk HPV might affect CVD risk with possible effect modification by obesity and MetS.

Equation models developed with bioelectric impedance analysis tools to assess muscle mass: A systematic review

BACKGROUND & AIMS

This systematic review aims to systematically assess and summarize the equation models developed to estimate muscle mass with bioelectric impedance analysis (BIA) instruments against a reference instrument (DXA, MRI, CT-scan, Ultrasonography), in order to help researchers and clinicians choose the most adapted equation, depending on the device and the population in question.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. Medline (via Ovid) and Scopus were searched in January 2019 for observational (transversal, longitudinal, retrospective) studies developing an equation prediction model to validate BIA against another reference method for the assessment of muscle mass. Study selection and data extraction was performed independently by two researchers. Methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

RESULTS

25 studies matched the inclusion criteria and were included in the present systematic review. Among them, 10 studies proposed an equation for subjects aged 65 years and older, 9 for adults, 4 for infants and 2 did not report the age of the population. A large heterogeneity was observed regarding the brand and type of BIA as well as the administration protocol (mode, frequency, number of electrodes, administration position and empty bladder/stomach or not). Most of the studies used DXA as the reference instrument, except 4 that used MRI. In each of the included papers authors provided, through simple or multiple regression, a predictive equation for muscle mass. BIA resistance index, sex, weight, age, BIA reactance and height were most frequently included as predictive variables. The majority of the equations developed explained more than 80% of the variance between both instruments. Out of the 25 equations available, only 9 were also validated in another population within the same paper.

CONCLUSION

This systematic review of the literature offers clinicians and researchers the opportunity to verify the existence of a prediction equation when using a BIA device for estimating muscle mass. This will help them to obtain a valid estimation of muscle mass in a specific population and with a specific instrument. If the equation exists and has been validated by a study free of high risk of bias, it's use is recommended because the development of a new equation in the same context seems redundant and undesirable. If a validation has not been carried out for a specific brand of BIA, reference method or population, we recommend the development and cross-validation of a new equation.

Consumption of dietary supplements to support weight reduction in adults according to sociodemographic background, body mass index, waist-hip ratio, body fat and physical activity

BACKGROUND

The aim of this study was to analyse the use of dietary supplements to support weight reduction (DSSWR) in adults according to sociodemographic background, body mass index (BMI), waist-hip ratio (WHR), body fat percentage (%BF) and level of physical activity (PA).

METHOD

Participants (n = 1130) were recruited from a region of Poland with a high rate of adult overweight and obesity. Based on anthropometric data, BMI and WHR were calculated. %BF was assessed using a bioimpedance method. To examine the association between DSSWR use and sociodemographic factors, BMI, WHR, %BF and PA multiple logistic regression were conducted.

RESULTS

The rate of DSSWR use in the group studied was high (69.5%). A higher proportion of women, individuals aged 18-35 years, those who had completed higher education, those who did not report financial status as "poor", with a BMI < 18.5, normal %BF and individuals with a high level of PA used DSSWR. In complete case analysis (n = 1108), primarily financial status reported as "good" (OR = 2.18, 95% CI: 1.69, 2.81) or "hard to say" (OR = 2.41, 95% CI: 1.86, 3.12) (vs. "poor") and female sex (OR = 2.59, 95% CI: 2.17, 3.08) were associated with DSSWR intake.

CONCLUSION

It seems that primarily financial status and sex, but also age, education, and level of PA, have significance in DSSWR use in adults and may be considered when developing appropriate strategies for body weight management and health promotion.

Association Between Peritonitis and Low Muscle Mass in Peritoneal Dialysis Patients

OBJECTIVE

Peritoneal dialysis (PD) peritonitis is a common complication in PD patients. The remission of peritonitis is easily achieved, but its presence is associated with local/systemic inflammation in PD patients, which would lead to decreases in muscle mass. Here, we hypothesized that the history of PD peritonitis is associated with low muscle mass (LMM) in PD patients.

METHODS

We identified incident PD patients for whom body composition measurements at baseline and 1 year after PD initiation were available. Finally, we analyzed 230 incident PD patients. The PDP group was defined as patients with a PD peritonitis event during the period and the Non-PDP group was defined as patients without a PD peritonitis event during the period. Body compositions were calculated using bioimpedance and includes regional lean mass (LM), fat mass (FM), and sarcopenia index.

RESULTS

There were no significant intergroup differences in baseline limb LM, total LM, or total FM. Total FM and body mass index at follow-up (FU) increased in both groups compared to that at baseline. There was no significant difference in total LM between baseline and FU in either group. Limb LM at FU increased in only the Non-PDP group compared to that at baseline. Sarcopenia index at FU decreased in only the PDP group compared to that at baseline. The prevalence of LMM at FU was higher in the PDP group than in the Non-PDP group. Among the participants without LMM at baseline, those in the PDP group had a higher prevalence of LMM at FU. Logistic regression showed that the PDP group was associated with a higher odds ratio for LMM at FU in the multivariate analyses.

CONCLUSION

LMM was found to be associated with the presence of PD peritonitis in incident PD patients.

Assessment of Skin Properties in Chronic Lymphedema: Measurement of Skin Stiffness, Percentage Water Content, and Transepidermal Water Loss

Background: Lymphedema (LE) is a chronic progressive protein-rich edema of the soft tissues. Measurement of extracellular fluid of the affected limbs is widely used in detecting LE; however, quantification of the skin alterations and early tissue changes in LE lacks approaches. Methods and Results: Ninety-one patients with LE were assessed. Measurement of transepidermal water loss (TEWL), skin stiffness (SF), and percentage water content (PWC) was assessed on five predetermined skin sites. The value of TEWL, SF, and PWC increased significantly in lymphedematous skin compare with controls, indicating damaged function and texture of the affected skin. Both PWC ratio and SF ratio strongly correlated with LE stage. High correlations were found among instruments assessing tissue fluid. Conclusions: Assessment of the skin parameters has contributed new information about the functional and structural alterations in chronic lymphedematous skin. Quantification of skin properties changes could be a valuable supplement to diagnosis and evaluation of chronic LE.

Association of Serum Amino Acid Concentration With Loss of Skeletal Muscle Mass After 1 Year in Cardiac Rehabilitation Center Patients

Background: Decreased skeletal muscle mass index (SMI) is a major complication of severe chronic heart failure (HF), but no appropriate indices have been developed to predict decreased SMI.

Methods and Results: We enrolled patients with a structural heart disease or history of HF and collected body composition and blood sample data, including serum amino acid concentration. On multivariate logistic regression analysis and receiver operating characteristic curve analysis, serum branched-chain amino acid (BCAA) concentration was a significant predictor of decreased SMI at 1-year follow-up.

Conclusions: Serum BCAA concentration at baseline was significantly associated with decreased SMI at 1-year follow-up.

Lean body mass and risk of type 2 diabetes - a Danish cohort study

Purpose

Excess body fat is a commonly known risk factor for type 2 diabetes. However, whether lean body mass, or fat free mass, could have a protective effect against type 2 diabetes, remains unclear. The aim of this study was to explore the association between lean body mass, fat mass and type 2 diabetes.

Methods

This study used data from the Danish Diet, Cancer and Health cohort of 37,053 men and women, aged 50-64 years at baseline (1993-1997). The exposure was measurements of body composition using bioelectrical impedance analysis. Incident diabetes during follow-up was determined through linkage to the Danish National Diabetes Register. Cox proportional hazards regression analysis was used to estimate HR and 95%CI for the association between lean body mass and incident type 2 diabetes, with and without adjustment for fat mass. A sensitivity analysis was performed, excluding cases of incident type 2 diabetes within the first 2 years of follow-up.

Results

When adjusted for fat mass, the main analysis showed non-linear inverse association between lean body mass and risk of diabetes for men, but not for women. However, the sensitivity analysis found no association for either men or women.

Conclusions

Lean body mass was not associated with incident type 2 diabetes when excluding cases that may have been subclinical at baseline. The results imply that public health should focus on reduction of fat mass for diabetes prevention.

Associations between Skeletal Muscle and Myocardium in Aging: A Syndrome of "Cardio-Sarcopenia"?

OBJECTIVES

The link between skeletal muscle and heart disease remains intriguing. It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function, particularly in the presence of aging-related sarcopenia. We hypothesize that among aging adults with sarcopenia, alterations in myocardial structure and/or function may exist, resulting in a syndrome of "cardio-sarcopenia."

METHODS

Participants derived from a community cohort study underwent same-day bioimpedance body composition analysis that measured skeletal muscle in sites such as the trunk, upper limb, and lower limb, and echocardiography for assessment of myocardial structure and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria.

RESULTS

We studied a total of 378 participants, of whom 88 (23.3%) had sarcopenia. Participants with sarcopenia had smaller left ventricular (LV) sizes (lower LV internal diameter end diastole (4.1 ± .7 vs 4.5 ± .6 cm; P < .0001), lower LV internal diameter end systole (2.3 ± .5 vs 2.5 ± .4 cm; P = .010), lower LV posterior wall end diastole (.7 ± .1 vs .8 ± .1 cm; P = .0036), and lower LV posterior wall end systole (1.4 ± .3 vs 1.5 ± .2 cm; P = .0031). Sarcopenic participants also had lower LV mass (106 ± 35 vs 126 ± 53; P = .0014) and lower left atrial (LA) volume (33 ± 13 vs 36 ± 13; P = .033). Adjusting for age and diabetes mellitus, skeletal muscle mass was associated with LV diameter (β = .06; 95% confidence interval [CI] = .03-.09; P < .0001), LV mass (β = 4.04; 95% CI = 1.78-6.29; P = .001), LA diameter (β = .05; 95% CI = .01-.09; P = .007), and LA volume (β = 1.26; 95% CI = .38-2.13; P = .005). A positive linear correlation was observed between LV mass and handgrip strength (r = .25; P < .0001).

CONCLUSION

Among a community sample of older adults with preserved heart function, sarcopenia is associated with reductions in LV and LA sizes. Skeletal muscle mass was independently associated with specific indices of myocardial structure. J Am Geriatr Soc 67:2568-2573, 2019.

A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings

PURPOSE

To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy.

BACKGROUND

Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear.

METHODS

This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2).

RESULTS

Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01.

CONCLUSIONS

Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.

Dry Electrode-Based Body Fat Estimation System with Anthropometric Data for Use in a Wearable Device

The bioelectrical impedance analysis (BIA) method is widely used to predict percent body fat (PBF). However, it requires four to eight electrodes, and it takes a few minutes to accurately obtain the measurement results. In this study, we propose a faster and more accurate method that utilizes a small dry electrode-based wearable device, which predicts whole-body impedance using only upper-body impedance values. Such a small electrode-based device typically needs a long measurement time due to increased parasitic resistance, and its accuracy varies by measurement posture. To minimize these variations, we designed a sensing system that only utilizes contact with the wrist and index fingers. The measurement time was also reduced to five seconds by an effective parameter calibration network. Finally, we implemented a deep neural network-based algorithm to predict the PBF value by the measurement of the upper-body impedance and lower-body anthropometric data as auxiliary input features. The experiments were performed with 163 amateur athletes who exercised regularly. The performance of the proposed system was compared with those of two commercial systems that were designed to measure body composition using either a whole-body or upper-body impedance value. The results showed that the correlation coefficient (r2) value was improved by about 9%, and the standard error of estimate (SEE) was reduced by 28%.

Association of Sarcopenia With Performance on Multiple Cognitive Domains: Results From the ELSA-Brasil Study

Background

Sarcopenia and cognitive impairment share pathophysiological paths and risk factors. Our aim was to investigate the association of sarcopenia and its defining components with cognitive performance in middle-aged and older adults.

Methods

This cross-sectional analysis included 5,038 participants from the ELSA-Brasil Study, aged ≥ 55 years. Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health. Cognition was evaluated using delayed word recall test, semantic verbal fluency test, and trail making test version B. Possible confounders included sociodemographic characteristics, lifestyle, and clinical comorbidities.

Results

The frequencies of sarcopenia, low muscle mass, and low muscle strength were 1.8%, 23.3%, and 4.4%, respectively. After adjustment for possible confounders, poorer performance on the verbal fluency test was associated with sarcopenia (β = −0.20, 95% confidence interval [CI] = −0.38; −0.01, p = .03) and low muscle mass (β = −0.08, 95% CI = −0.14; −0.01, p = .02). Low muscle strength was associated with poorer performance in the delayed word recall test (β = −0.14, 95% CI = −0.27; −0.02, p = .02), verbal fluency test (β = −0.14, 95% CI = −0.26; −0.02, p = .03), and trail making test (β = −0.15, 95% CI = −0.27; −0.03, p = .01).

Conclusions

Sarcopenia was associated with poorer performance on the verbal fluency test, and low muscle strength was associated with poorer performance in all cognitive tests in middle-aged and older adults.

Association of objectively measured physical activity and sedentary time with health-related quality of life in women with fibromyalgia: The al-Ándalus project

PURPOSE

To examine the association of physical activity (PA) intensity levels and sedentary time with health-related quality of life (HRQoL) in women with fibromyalgia and whether patients meeting the current PA guidelines present better HRQoL.

METHODS

This cross-sectional study included 407 women with fibromyalgia aged 51.4 ± 7.6 years. The time spent (min/day) in different PA intensity levels (light, moderate, and moderate-to-vigorous physical activity (MVPA) and sedentary time were measured with triaxial accelerometry. The proportion of women meeting the American PA recommendations (≥150 min/week of MVPA in bouts ≥10 min) was also calculated. HRQoL domains (physical function, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health), as well as physical and mental components, were assessed using the 36-item Short-Form Health Survey.

RESULTS

All PA intensity levels were positively correlated with different HRQoL dimensions (r partial between 0.10 and 0.23, all p < 0.05). MVPA was independently associated with social functioning (p < 0.05). Sedentary time was independently associated with physical function, physical role, bodily pain, vitality, social functioning, and both the physical and mental component summary score (all p < 0.05). Patients meeting the PA recommendations presented better scores for bodily pain (mean = 24.2 (95%CI: 21.3-27.2) vs. mean = 20.4 (95%CI: 18.9-21.9), p = 0.023) and better scores for social functioning (mean = 48.7 (95%CI: 43.9-44.8) vs. mean = 42.3 (95%CI: 39.8-44.8), p = 0.024).

CONCLUSION

MVPA (positively) and sedentary time (negatively) are independently associated with HRQoL in women with fibromyalgia. Meeting the current PA recommendations is significantly associated with better scores for bodily pain and social functioning. These results highlight the importance of being physically active and avoiding sedentary behaviors in this population.