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Grilo EC, Cunha TA, Costa ÁDS, Araújo BGM, Lopes MMGD, Maciel BLL, Alves CX, Vermeulen-Serpa KM, Dourado-Júnior MET, Leite-Lais L, Brandão-Neto J, Vale SHL. Validity of bioelectrical impedance to estimate fat-free mass in boys with Duchenne muscular dystrophy. PLoS One 2020; 15:e0241722. [PMID: 33216757 PMCID: PMC7679022 DOI: 10.1371/journal.pone.0241722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022] Open
Abstract
The evaluation of fat-free mass (FFM) in patients with Duchenne muscular dystrophy (DMD) is useful to investigate disease progression and therapeutic efficacy. This study aimed to validate the Bioelectrical impedance (BIA) method compared with the dual-energy X-ray absorptiometry (DXA) for estimating the %FFM in boys with DMD. This is a cross-sectional study performed with children and adolescents diagnosed with DMD. Resistance and reactance were measured with a BIA analyzer, from which eight predictive equations estimated the %FFM. The %FFM was also determined by DXA and its used as a reference method. Pearson correlation test, coefficient of determination, the root-mean-square error, the interclass correlation coefficient, and linear regression analysis were performed between %FFM values obtained by BIA and DXA. The agreement between these values was verified with the Bland-Altman plot analysis. Forty-six boys aged from 5 to 20 years were enrolled in the study. All the equations showed a correlation between the %FFM estimated by BIA and determined by DXA (p < 0.05). The Bland-Altman method indicated that two equations have a significant bias (p < 0.05) and six equations showed no significant bias of %FFM (p > 0.05). However, one of them has high variation and wide limits of agreement. Five of eight %FFM predictive equations tested in DMD were accurate when compared with the DXA. It can be concluded that BIA is a validity method to evaluate patients with DMD.
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Affiliation(s)
- Evellyn C. Grilo
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Thais A. Cunha
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ádila Danielly S. Costa
- Postgraduate Nutrition Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Bárbara G. M. Araújo
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Bruna L. L. Maciel
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Camila X. Alves
- Neurology outpatient facility, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Karina M. Vermeulen-Serpa
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Lucia Leite-Lais
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Brandão-Neto
- Department of Internal Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sancha Helena L. Vale
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Doulgeraki AE, Athanasopoulou HI, Katsalouli MS, Petrocheilou GM, Paspati IN, Monopolis IK. Body composition of patients with Duchenne muscular dystrophy: the Greek experience. Acta Neurol Belg 2016; 116:565-572. [PMID: 26680652 DOI: 10.1007/s13760-015-0582-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Abstract
Greece ranks among the first countries suffering from the obesity epidemic globally. The aim of the study was to evaluate body composition in Greek patients with Duchenne muscular dystrophy (DMD). We hypothesized that able-bodied patients would not differ from controls, in terms of adiposity, based on clinical observations during everyday practice. STUDY DESIGN Cross-sectional study of steroid-dependent DMD subjects, who underwent dual-energy X-ray absorptiometry and laboratory metabolic bone profile evaluation. Forty-two patients and thirty-one controls were studied. Overall, DMD subjects were shorter (height Z-score = -1.4, p = 0.01). Their bone mineral density (BMD) was low (lumbar spine BMD Z-score = -1.2, p < 0.01, subcranial total body BMD Z-score = -1.8, p < 0.01). Lean tissue mass (LTM) was also decreased (LTM Z-score = -2.2, p < 0.01). The above findings were more pronounced in adolescence. Regarding adiposity, increased fat mass (FM) was found only in pubertal DMD patients (FM Z-score = 1.4, p < 0.01), whereas prepubertal, able-bodied patients did not differ from controls, thus confirming the initial hypothesis. Finally, 65 % of DMD subjects had increased bone resorption markers and 57 % had suboptimal vitamin D levels. The importance of using native population as controls for body composition analysis is highlighted. In Greece, abnormal body composition in DMD patients is more striking when loss of ambulation occurs and not during the prepubertal period, due to the concurrent presence of obesity in the pediatric population. Thus, adolescents with this neuromuscular disorder should be targeted toward prompt lifestyle interventions.
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Affiliation(s)
- Artemis E Doulgeraki
- Department of Bone and Mineral Metabolism, Institute of Child Health, "Agia Sophia" Children's Hospital, 115 27, Goudi, Athens, Greece.
| | - Helen I Athanasopoulou
- Department of Bone and Mineral Metabolism, Institute of Child Health, "Agia Sophia" Children's Hospital, 115 27, Goudi, Athens, Greece
| | | | - Glykeria M Petrocheilou
- Department of Bone and Mineral Metabolism, Institute of Child Health, "Agia Sophia" Children's Hospital, 115 27, Goudi, Athens, Greece
| | - Ioanna N Paspati
- Department of Orthopedics, "Penteli" Children's Hospital, Athens, Greece
| | - Ioannis K Monopolis
- Department of Statistics, Institute of Child Health, "Agia Sophia" Children's Hospital, Athens, Greece
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Ishizaki M, Kedoin C, Ueyama H, Maeda Y, Yamashita S, Ando Y. Utility of skinfold thickness measurement in non-ambulatory patients with Duchenne muscular dystrophy. Neuromuscul Disord 2016; 27:24-28. [PMID: 27793470 DOI: 10.1016/j.nmd.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/23/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
Nutritional disorders in Duchenne muscular dystrophy (DMD) worsen the medical condition. In particular, obesity is a serious problem that increases the risk of cardiomyopathy and affects nursing care. However, it is often difficult to evaluate body fatness in the advanced stages of DMD. Skinfold thickness measurement is a classical method to evaluate body fatness and is easily performed, even for bed-bound patients at home. We aimed to investigate the utility of skinfold thickness measurement in non-ambulatory DMD patients. Twenty-two patients with non-ambulatory, steroid-naive DMD ranging in age of 12-47 years were evaluated by body mass index (BMI), blood tests, measurement of triceps skinfold thickness (TSF), and abdominal computed tomography (CT) measurement of the areas of both subcutaneous and visceral fat. TSF showed good correlation with BMI (r = 0.80; p < 0.001), serum triglycerides (r = 0.67; p < 0.01), area of subcutaneous fat (r = 0.85; p < 0.0001), and area of visceral fat (r = 0.76; p < 0.0001). These results indicate the skinfold thickness measurement may be applicable as a screening tool in clinical practice where CT and magnetic resonance imaging assessment is often difficult in patients with advanced DMD.
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Affiliation(s)
- Masatoshi Ishizaki
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan; Department of Neurology, National Hospital Organization, Kumamoto Minami Hospital, Kumamoto, Japan.
| | - Chika Kedoin
- Department of Nutrition, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Hidetsugu Ueyama
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Yasushi Maeda
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Satoshi Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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