Adiposity measures as predictors of long-term physical disability

Muscle Mass Adjusted by Body Height is not Correlated with Mobility of Middle-Aged and Older Adults

Background

Low muscle mass and obesity are associated with mobility disability, cardiometabolic diseases, and loss of independence. Three skeletal muscle indices (SMIs) are proposed to adjust the body size of individuals. However, it is unknown which index is better correlated with mobility. Additionally, it remains unclear whether low muscle mass or abdominal obesity has a greater impact on the mobility and cardiometabolic health of older adults.

Objectives

This study explored the association between different SMIs {appendicular skeletal muscle mass [ASM] adjusted by body height [Ht], body weight [Wt], or body mass index [BMI (kg/m2)]} and mobility/cardiometabolic health. The roles of low muscle mass and abdominal obesity in the mobility and cardiometabolic health of individuals were also identified.

Methods

Four-hundred and twenty-seven community-dwelling middle-aged and older adults underwent body composition assessments [dual-energy x-ray absorptiometry and waist circumference (WC)], grip strength, and mobility (timed up-and-go test and chair stand test). Spearman's rank correlation coefficient and regression models were used to examine research questions. This study was registered in the Thai Clinical Trials Registry (registration number: TCTR20210521007).

Results

All SMIs were positively correlated with the grip strength (ASM/Ht2: r = 0.392; ASM/Wt: r = 0.439; ASM/BMI: r = 0.569). Regarding mobility, only ASM/Ht2 wasn't relevant. After adjusting for age, sex, and WC, ASM/BMI was the only SMI associated with grip strength (β = 0.274). When age and sex were controlled, WC, but not SMI, was associated with mobility and cardiometabolic health.

Conclusions

ASM/Ht2 did not correlate with mobility in middle-aged and older adults, whereas ASM/Wt and ASM/BMI did. Abdominal obesity has a greater impact on mobility and cardiometabolic health than low muscle mass in middle-aged and older adults. We recommend using ASM/BMI to identify the low muscle mass of individuals. In addition, clinicians should note the important role of abdominal obesity when considering mobility in middle-aged and older adults.

Maximal Oxygen Consumption Is Negatively Associated with Fat Mass in Facioscapulohumeral Dystrophy

Facioscapulohumeral dystrophy (FSHD) leads to progressive changes in body composition such as loss of muscle mass and increase in adiposity. In healthy subjects, anthropometric parameters are associated with the maximum volume of oxygen consumed per minute (VO2max), which is a health and function indicator in several populations of subjects, both healthy and pathological. Since VO2max can be difficult to test in patients with FSHD due to exercise intolerance, the identification of associated anthropometric parameters could provide new easily obtainable elements for the patients' clinical stratification. The aim of this study was to evaluate whether anthropometric and body composition parameters are associated with VO2max in patients with FSHD. A total of 22 subjects with a molecular genetics-based diagnosis of FSHD (6 females, 16 males, mean age of 35.18 years) were recruited for the study. VO2max was measured by cardiopulmonary exercise tests (CPETs) on a cycle ergometer, utilizing a step incremental technique (15 Watts (W) every 30 s). Weight (Kg) and height (m) were obtained and utilized to calculate body mass index (BMI). Body composition parameters (fat mass (FM), fat free mass (FFM), and body cell mass (BCM)) were obtained by bioelectrical impedance analysis (BIA). Significant negative associations were found between VO2max and FM (Spearman correlation coefficient (SCC) -0.712), BMI (SCC -0.673), age (SCC -0.480), and weight (SCC -0.634), unlike FFM and BCM. Our results indicate that FM, BMI, age, and body weight are negatively associated with VO2max in patients with FSHD. This evidence may help practitioners to better stratify patients with FSHD.

Recent Progress in Sarcopenia Research: a Focus on Operationalizing a Definition of Sarcopenia

PURPOSE OF REVIEW

To discuss recent progress in sarcopenia research and to highlight controversies in the field particularly around reaching consensus on a definition of sarcopenia.

RECENT FINDINGS

Accordingly, this review begins with a discussion of the increasing awareness of this condition; briefly describes evolving definitions of sarcopenia; suggests a framework for consistent terminology for sarcopenia; discusses outstanding issues in the definition of sarcopenia; and reviews the association between sarcopenia and adverse outcome in older adults. In addition, the role of sarcopenia in other diseases is discussed. The field of sarcopenia continues to hold considerable promise and work continues to resolve outstanding concerns in this field with a unifying consensus definition on the horizon.

Potential contributions of skeletal muscle contractile dysfunction to altered biomechanics in obesity

Obesity alters whole body kinematics and joint kinetics during activities of daily living which are thought to contribute to increased risk of musculoskeletal injury, development of lower extremity joint osteoarthritis (OA), and physical disability. To date, it has widely been accepted that excess adipose tissue mass is the major driver of biomechanical alterations in obesity. However, it is well established that obesity is a systemic disease affecting numerous, if not all, organ systems of the body. Indeed, obesity elicits numerous adaptations within skeletal muscle, including alterations in muscle structure (ex. myofiber size, architecture, lipid accumulation, and fiber type), recruitment patterns, and contractile function (ex. force production, power production, and fatigue) which may influence kinematics and joint kinetics. This review discusses the specific adaptations of skeletal muscle to obesity, potential mechanisms underlying these adaptations, and how these adaptations may affect biomechanics.

Validation of the Italian version of the Laval questionnaire: health-related quality of life in subjects with obesity

Background

Obesity is associated to increased risk of metabolic comorbidity as well as increased mortality. Notably, obesity is also associated to the impairment of the psychological status and of quality of life.

Only three questionnaires are available in the Italian language evaluating the health-related quality of life in subjects with obesity.

The aim of the present study was to test the validity and reliability of the Italian version of the Laval Questionnaire.

Methods

The original French version was translated into Italian and back-translated by a French native speaker. 273 subjects with obesity (Body Mass Index ≥ 30 kg/m²) were enrolled; the Italian version of the Laval Questionnaire and the O.R.Well-97 questionnaire were administered in order to assess health- related quality of life. The Laval questionnaire consists of 44 items distributed in 6 domains (symptoms, activity/mobility, personal hygiene/clothing, emotions, social interaction, sexual life). Disability and overall psychopathology levels were assessed through the TSD-OC test (SIO test for obesity correlated disabilities) and the SCL-90 (Symptom Checklist-90) questionnaire, respectively. To verify the validity of the Italian version, the analysis of internal consistency, test-retest reliability, and construct validity were performed.

Results

The observed proportion of agreement concordance of results was 50.2% with Cohen’s K = 0.336 (CI 95%: 0.267–0.404), indicating a fair agreement between the two tests.

Test-retest correlation was statistically significant (ρ = 0.82; p < 0.01); validity (standardized Chronbach’s alpha) was considered reliable (α > 0.70). The analysis of construct validity showed a statistically significant association in terms of both total score (ρ = −0.66) and scores at each single domain (p < 0.01). A high correlation (p < 0.01) was observed between Laval questionnaire total and single domain scores and other related measures (Body Mass Index, TSD-OC scores, SCL-90 global severity index), revealing a high construct validity of the test.

Conclusions

The Italian version of the Laval Questionnaire is a valid and reliable measure to assess the health-related quality of life in subjects with obesity.

Predictors of seeking financial compensation following motor vehicle trauma: inception cohort with moderate to severe musculoskeletal injuries

BACKGROUND

Compensation related factors have been repeatedly associated with poor recovery following orthopaedic trauma. There is limited research into the factors associated with seeking financial compensation. Further understanding of these factors could facilitate injury recovery by purposeful compensation scheme design. The aim of this study was to investigate the predictors of seeking financial compensation, namely making a claim and seeking legal representation, following motor vehicle related orthopaedic trauma. The study was conducted in New South Wales (NSW), Australia, in motor vehicle crash and workers' compensation schemes.

METHODS

Participants were patients admitted with upper or lower extremity factures following a motor vehicle crash to two trauma hospitals. Data were collected at baseline within two weeks of injury. Participants were followed up at six months. Analysis involved: descriptive statistics for baseline characteristics; comparison of compensable and non-compensable participants with Analysis of Variance (ANOVA) and chi-squared tests; and logistic regression for predictor models.

RESULTS

The cohort consisted of 452 participants with a mean age 40 years; 75% male; 74% working pre-injury; 30% in excellent pre-injury health; 56% sustained serious injuries with an Injury Severity Score (ISS) 9-15; 61% had a low-middle range household income; and 35% self-reported at fault in the crash. There was no significant difference in pre-injury/baseline health between compensable and non-compensable participants. Follow up data was available for 301 (67%) participants. The significant predictor of claiming compensation in the adjusted analysis was higher body mass index (BMI) (overweight Odds Ratio [OR] 3.05, 95% Confidence Interval [CI] 1.63-5.68; obese OR 1.63, 95% CI 0.83-3.20). Participants less likely to claim were: involved in a motorcycle crash (OR 0.47, 95% CI 0.28-0.82); socioeconomically less disadvantaged (OR 0.37, 95% CI 0.17-0.82) or least disadvantaged (OR 0.39, 95% CI 0.17-0.90); at risk for short term harm (injury) due to alcohol consumption (OR 0.56, 95% CI 0.32-0.97); and with fair-poor pre-injury health (OR 0.30, 95% CI 0.09-0.94). The predictors for seeking legal representation were speaking a language other than English at home (OR 2.80, 95% CI 1.2-6.52) and lower household income (OR 3.63, 95% CI 1.22-10.72). Participants less likely to seek legal representation were least socioeconomically disadvantaged (OR 0.15, 95% CI 0.04-0.50).

CONCLUSIONS

Seeking financial compensation was associated with a higher pre-injury BMI rather than injury-related factors. Seeking legal representation was solely related to socio-economic factors.

External loading alters trunk kinematics and lower extremity muscle activity in a distribution-specific manner during sitting and rising from a chair

BACKGROUND

Excess body mass alters gait biomechanics in a distribution-specific manner. The effects of adding mass centrally or peripherally on biomechanics during sitting and rising from a chair are unknown.

METHODS

Motion analysis and lower extremity EMG were measured for fifteen healthy, normal weight subjects during sit-to-stand (SitTS) and stand-to-sit (StandTS) from a chair under unloaded (UN), centrally loaded (CL), and peripherally loaded (PL) conditions.

RESULTS

Compared to UN, PL significantly increased support width (SitTS and StandTS), increased peak trunk flexion velocity (SitTS), and trended to increase peak trunk flexion angle (SitTS). During StandTS, CL significantly reduced peak trunk flexion compared to UN and PL. EMG activity of the semitendinosus, vastus lateralis and/or medialis was significantly increased in CL compared to UN during SitTS and StandTS.

CONCLUSIONS

Adding mass centrally or peripherally induces contrasting biomechanical strategies to successfully sit or rise from a chair. CL limits trunk flexion and increases knee extensor muscle activity whereas; PL increases support width and trunk flexion, thus preventing increased EMG activity.

Comparison of different measures of obesity in their association with health-related quality of life in older adults - results from the KORA-Age study

OBJECTIVE

As ageing is associated with changes in body composition, BMI may not be the appropriate obesity measure for older adults. To date, little is known about associations between obesity measures and health-related quality of life (HRQoL). Thus, we aimed to compare different obesity measures in their association with HRQoL and self-rated physical constitution (SRPC) in older adults.

DESIGN

Seven obesity measures (BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, fat mass percentage based on bioelectrical impedance analysis, hypertriglyceridaemic waist (HTGW) and sarcopenic obesity) were assessed at baseline in 2009. HRQoL, using the EQ-5D questionnaire, and SRPC, using one single question, were collected at baseline and at the 3-year follow-up in 2012. Linear and logistic regression analyses were used to examine the associations between the obesity measures and both outcomes. Model comparisons were conducted by area under the receiver-operating characteristic curve, R 2, Akaike and Schwarz Bayesian information criteria.

SETTING

KORA-Age study in Southern Germany (2009-2012).

SUBJECTS

Older adults (n 883; aged ≥65 years).

RESULTS

Nearly all obesity measures were significantly inversely associated with both outcomes in cross-sectional analyses. Concerning HRQoL, the WC model explained most of the variance and had the best model adaption, followed by the BMI model. Regarding SRPC, the HTGW and BMI models were best as rated by model quality criteria, followed closely by the WC model. Longitudinal analyses showed no significant associations.

CONCLUSIONS

These results suggest that, with regard to HRQoL/SRPC, simple anthropometric measures are sufficient to determine obesity in older adults in medical practice.

The effects of horseback riding on body mass index and gait in obese women

[Purpose] The aim of this study was to examine the effect of horseback riding on body mass index (BMI) and gait in obese women. [Subjects and Methods] Twenty-four obese women residing in Seoul and Gyeonggi-do were randomly divided into a horseback riding group and a walking group and conducted their respective exercises 3 times a week for 8 weeks. [Results] Step length increased significantly and BMI and width of the base of support significantly decreased in both groups. A comparison of BMI and width of the base of support after the intervention between the two groups revealed that the horseback riding group showed larger decreases than the walking group. [Conclusion] The result of this study indicated that the horseback riding may improve gait ability and obesity.

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

BACKGROUND

We aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop a disability risk algorithm to estimate the risk of future disability for those aged 45-65 years.

METHODS

FOS is a longitudinal study. We used examination 5 (1991-1995; 'baseline') and examination 8 (2005-2008; 'follow-up'). We included participants aged between 45-65 years at 'baseline' with complete predictor and outcome measures (n=2031; mean age 53.9 years). Predictors considered were body mass index, smoking, hypertension, diabetes and dyslipidaemia. We used multinomial logistic regression to identify predictors of disability or death.We assessed external validity using Australian data.

RESULTS

By examination 8, 156 participants had disability and 198 had died. Disability was associated with smoking (OR (95% CI) 1.81 (1.18 to 2.78)); obesity (2.95 (1.83 to 4.77)); diabetes 1.96 (1.11 to 3.45) and being female (OR 1.67 (1.13 to 2.45). The model performed moderately well in predicting disability and death in an Australian population. Based on our algorithm, a 45-year-old man/woman with the combined risk factors of obesity, diabetes and smoking has similar likelihood of surviving free of disability to a 65-year-old man/woman without any of the same risk factors.

CONCLUSIONS AND RELEVANCE

The derived risk algorithm allows, for the first time, quantification of the substantial combined impact on future disability of key modifiable risk factors in mid-life. Here we demonstrated the combined impact of obesity, diabetes and smoking to be similar to 20 years of aging.

Energy Flux and its Role in Obesity and Metabolic Disease

In order to reverse the global obesity pandemic, there is a need for an enhanced understanding of the energy dynamics that underlie the problem. To maintain a stable body weight, energy intake must, over time, match or equal energy expenditure, a concept known as energy balance. Obesity results from a positive state of energy balance (i.e. when energy intake exceeds energy expenditure). However, recent research suggests that strategies to combat obesity should focus on energy flux (the amount of calories going through a system), rather than energy balance alone. In other words, it is easier to maintain weight loss at higher levels of physical activity. Recent findings suggest that a high energy flux, maintained by increasing energy expenditure, can improve an individual's metabolic profile without changing weight. Further understanding of this concept may help in the design of interventions to achieve and maintain a healthy weight.

The impact of long-term body mass index patterns on health-related quality of life: the Doetinchem Cohort Study

Overweight is associated with a reduced health-related quality of life (QOL), but less is known about the impact of long-term body mass index (BMI, calculated as weight (kg)/height (m)(2)) patterns on QOL in adults. In the Dutch Doetinchem Cohort Study (1989-2009) that included 1,677 men and 1,731 women aged 20-66 years, 6 BMI patterns were defined by using 4 measurements over a 15-year period: 1) persistent healthy weight (18.5-24.9, reference pattern); 2) persistent overweight (25.0-29.9); 3) persistent obesity (≥30.0); 4) developing overweight; 5) developing obesity; and 6) switching between BMI categories. For each BMI pattern, adjusted QOL (measured on a 0-100 scale) was estimated at the end of this period. The lowest QOL was observed for persistent obesity of all BMI patterns. It was 5.0 points (P = 0.02) lower for 1 mental dimension in men and 6.2-11.6 points (P < 0.05) lower for 5 (mainly physical) dimensions in women. Developing overweight or obesity scored 1.8-6.3 points (P < 0.05) lower on 2-5 (mainly physical) dimensions. Persistent overweight hardly differed from a persistent healthy weight. In women, switching between BMI categories resulted in a lower QOL on the mental dimensions. Studying long-term BMI patterns over a 15-year period showed that persistent obesity, developing overweight, and developing obesity resulted in a lower QOL-particularly on the physical dimensions-compared with a persistent healthy weight.

What moves them? Active transport among inhabitants of Dutch deprived districts

BACKGROUND

Active modes of transport like walking and cycling have been shown to be valuable contributions to daily physical activity. The current study investigates associations between personal and neighbourhood environmental characteristics and active transport among inhabitants of Dutch deprived districts.

METHOD

Questionnaires about health, neighbourhoods, and physical activity behaviour were completed by 742 adults. Data was analysed by means of multivariate linear regression analyses.

RESULTS

Being younger, female, and migrant and having a normal weight were associated with more walking for active transport. Being younger, male, and native Dutch and having a normal weight were associated with more cycling for active transport. Neighbourhood characteristics were generally not correlated with active transport. Stratified analyses, based on significant person-environment interactions, showed that migrants and women walked more when cars did not exceed maximum speed in nearby streets and that younger people walked more when speed of traffic in nearby streets was perceived as low. Among migrants, more cycling was associated with the perceived attractiveness of the neighbourhood surroundings.

DISCUSSION AND CONCLUSION

Results indicated that among inhabitants of Dutch deprived districts, personal characteristics were associated with active transport, whereas neighbourhood environmental characteristics were generally not associated with active transport. Nevertheless, interaction effects showed differences among subgroups that should be considered in intervention development.