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Ertuglu LA, Sahinoz M, Alsouqi A, Deger SM, Guide A, Pike M, Robinson‐Cohen C, Akwo E, Pridmore M, Crescenzi R, Madhur MS, Kirabo A, Harrison DG, Luft FC, Titze J, Ikizler TA, Gamboa JL. Intermuscular adipose tissue accumulation is associated with higher tissue sodium in healthy individuals. Physiol Rep 2024; 12:e16127. [PMID: 38960895 PMCID: PMC11222016 DOI: 10.14814/phy2.16127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND AND AIMS High tissue sodium accumulation and intermuscular adipose tissue (IMAT) are associated with aging, type 2 diabetes, and chronic kidney disease. In this study, we aim to investigate whether high lower-extremity tissue sodium accumulation relates to IMAT quantity and whether systemic inflammatory mediators and adipocytokines contribute to such association. METHODS Tissue sodium content and IMAT accumulation (percentage of IMAT area to muscle area) were measured in 83 healthy individuals using sodium imaging (23Na-MRI) and proton (1H-MRI) imaging of the calf. Insulin sensitivity was assessed by glucose disposal rate (GDR) measured with the hyperinsulinemic-euglycemic clamp. RESULTS Median (interquartile range) muscle and skin sodium contents were 16.6 (14.9, 19.0) and 12.6 (10.9, 16.7) mmol/L, respectively. Median IMAT was 3.69 (2.80, 5.37) %. In models adjusted for age, sex, BMI, GDR, adiponectin, and high-sensitivity C-reactive protein, increasing tissue sodium content was significantly associated with higher IMAT quantity (p = 0.018 and 0.032 for muscle and skin tissue sodium, respectively). In subgroup analysis stratified by sex, skin sodium was significantly associated with IMAT only among men. In interaction analysis, the association between skin sodium and IMAT was greater with increasing levels of high-sensitivity C-reactive protein and interleukin-6 (p for interaction = 0.022 and 0.006, respectively). CONCLUSIONS Leg muscle and skin sodium are associated with IMAT quantity among healthy individuals. The relationship between skin sodium and IMAT may be mediated by systemic inflammation.
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Affiliation(s)
- Lale A. Ertuglu
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Melis Sahinoz
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Aseel Alsouqi
- Now with Division of Hematology and Oncology, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Serpil Muge Deger
- Division of Nephrology, Department of MedicineDokuz Eylul UniversityIzmirTurkey
| | - Andrew Guide
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mindy Pike
- Division of Epidemiology, Department of MedicineVanderbilt UniversityNashvilleTennesseeUSA
| | - Cassianne Robinson‐Cohen
- Division of Nephrology and Hypertension, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Elvis Akwo
- Division of Nephrology and Hypertension, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Michael Pridmore
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTennesseeUSA
| | - Meena S. Madhur
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Molecular Physiology and BiophysicsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - David G. Harrison
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Jens Titze
- Program in Cardiovascular and Metabolic DisordersDuke NUS Medical SchoolBukit MerahSingapore
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jorge L. Gamboa
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
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Inacio M, Esser P, Li J, Xu L, Zeng H, He R, Dawes H, Liu F. Spectral parameters of gait differentiate diabetic patients from healthy individuals. Foot (Edinb) 2023; 56:102038. [PMID: 37201241 DOI: 10.1016/j.foot.2023.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a clinical condition that affects gait performance and control in millions of individuals worldwide. Contrary to basic spatiotemporal parameters, gait-based spectral analysis may provide useful insights into gait neuromotor control. Hence, this study was set to investigate the spectral content of gait at the preferred speed in patients with DM. METHODS Total 1117 individuals [658 DM and 649 healthy adults (HA)] performed a 10 m walk while wearing an inertial measurement unit over the fourth lumbar vertebra. Mann-Whitney-U test was used for between-group gait parameters comparisons. RESULTS DM group had a slower step time (1.2%, p < 0.05) and gait speed (2.4%, p < 0.05) than HA. Additionally, DM individuals showed reduced dominant frequency (DM:0.24 Hz vs HA:0.25 Hz on average, p < 0.05). Increased antero-posterior and vertical dominant frequency width (DM:1.73 Hz vs HA:1.76 Hz on average, p < 0.05) and medio-lateral relative power spectral density at the dominant frequency (DM:6.19% vs HA:5.96%, p < 0.05). CONCLUSIONS It was demonstrated for the first time that the gait spectral content, not only corroborates spatiotemporal characteristics, but also provides further insight into their neuromotor control deficits in diabetic patients. Ultimately, this type of analysis in the diabetic population can help guide the therapeutic interventions to prevent diabetic foot.
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Affiliation(s)
- Mario Inacio
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; University of Maia, Maia, Portugal; Research Center in Sport Science, Health Sciences and Human Development, Vila Real, Portugal.
| | - Patrick Esser
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Junxian Li
- Dept of Endocrinology and Metabolism of Shanghai General Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China; Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Lei Xu
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Hui Zeng
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Rui He
- Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China
| | - Helen Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; College of Medicine and Health, University of Exeter, Exeter, UK; Department of Clinical Neurology, University of Oxford, Oxford UK; Oxford Health Biomedical Research Centre, UK
| | - Fang Liu
- Dept of Endocrinology and Metabolism of Shanghai General Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China; Dept of Endocrinology and Metabolism of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao-Tong University, School of Medicine, China.
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3
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Yoshiko A, Ohta M, Kuramochi R, Mitsuyama H. Serum Adiponectin and Leptin Is Not Related to Skeletal Muscle Morphology and Function in Young Women. J Endocr Soc 2023; 7:bvad032. [PMID: 36911319 PMCID: PMC9998031 DOI: 10.1210/jendso/bvad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 03/03/2023] Open
Abstract
Adipokines secreted from adipose tissue, such as adiponectin and leptin, enhance skeletal muscle metabolism. Animal studies have shown that adipokine knockout leads to a reduction in muscle function. Muscle function is determined by muscle size and quality; therefore, it is speculated that lower adipokine levels affect skeletal muscle size and quality, eventually leading to lower muscle function. This study aimed to investigate the relationship between adipokines and skeletal muscle morphology and function in young individuals. A total of 21 young women participated in this study. Adiponectin and leptin levels were analyzed using fasting blood samples from all participants. B-mode ultrasound images of the thigh and calf were obtained, and the muscle thickness and echo intensity were measured in the vastus lateralis (VL) and medial gastrocnemius (MG). The shear modulus was measured from the VL and MG using shear wave elastography. Knee extension and plantar flexion peak torques were measured as muscle functions. Adiponectin and leptin were not related to echo intensity, shear modulus, and muscle thickness in the VL and MG (rs = -0.26-0.37, P > .05). Furthermore, no relationship was observed between adiponectin, leptin, knee extension, and dorsiflexion peak torque (rs = -0.28-0.41, P > .05). These negative results suggest that adiponectin and leptin levels in young women are not associated with muscle size and quality, nor are they related to muscle function.
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Affiliation(s)
- Akito Yoshiko
- Faculty of Liberal Arts and Sciences, Chukyo University, Toyota 470-0393, Japan
| | - Megumi Ohta
- Faculty of Liberal Arts and Sciences, Chukyo University, Toyota 470-0393, Japan
| | - Rieko Kuramochi
- School of Health and Sport Sciences, Chukyo University, Toyota 470-0393, Japan
| | - Hirohito Mitsuyama
- School of Health and Sport Sciences, Chukyo University, Toyota 470-0393, Japan
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Low thigh muscle strength in relation to myosteatosis in patients with type 2 diabetes mellitus. Sci Rep 2023; 13:1957. [PMID: 36732561 PMCID: PMC9895033 DOI: 10.1038/s41598-022-24002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023] Open
Abstract
This study aimed to investigate the association of thigh muscle fat infiltration by quantitative MRI with muscle strength in patients with type 2 diabetes mellitus (T2DM). Seventy T2DM patients and sixty control subjects (71 males; age: 52 ± 8 years) underwent 3.0T MRI and isokinetic muscle strength measurements to obtain the skeletal muscle index (SMI), intermuscular adipose tissue (IMAT) proton density fat fraction (PDFF), intramuscular fat (IMF) PDFF, peak torque (PT) and total work (TW) of knee extensors and flexors. The differences of measurements between T2DM patients and asymptomatic volunteers were compared. Multivariate regression analysis was used to determine significant predictors of thigh extension and flexion strength. The SMI, IMAT and IMF PDFF of thigh muscles in T2DM patients were higher than that in the control group (p < 0.001), while PT and TW were lower than those in the control subjects (p < 0.05). Both IMF and IMAT PDFF were negatively correlated with PT, TW in participants with T2DM (extensors: r = - 0.72, - 0.70, p < 0.001; r = - 0.62, - 0.56, p < 0.05. flexors: r = - 0.37, - 0.43, p < 0.05; r = - 0.39, - 0.46, p < 0.05). Moderate and strong correlations between HOMA-IR and muscle strength measurements, muscle PDFFs were observed in extensors and flexors. IMF PDFF and age were the statistically significant predictor of PT and TW of extensors of thigh in multivariate regression analysis. Therefore, the thigh muscle PDFF increased was associated with muscle strength decreased in T2DM patients beyond SMI. Age are also important factors influencing thigh muscle PDFF and strength in T2DM patients.
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Wong AKO, Fung HJW, Pretty SP, Laing AC, Chan AH, Mathur S, Zabjek K, Giangregorio L, Cheung AM. Ankle flexor/extensor strength and muscle density are complementary determinants of balance during dual‐task engagement: The ankle quality study. JCSM CLINICAL REPORTS 2023. [DOI: 10.1002/crt2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Andy K. O. Wong
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Division of Epidemiology, Dalla Lana School of Public Health University of Toronto ON Toronto Canada
| | - Hugo J. W. Fung
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education University of Toronto ON Toronto Canada
| | - Steven P. Pretty
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
| | - Andrew C. Laing
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
| | - Adrian H. Chan
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Temerty Faculty of Medicine University of Toronto ON Toronto Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy Queen's University ON Kingston Canada
| | - Karl Zabjek
- Department of Physical Therapy, Rehabilitation Sciences Institute University of Toronto ON Toronto Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
- Schlegel‐UW Research Institute for Aging University of Waterloo ON Waterloo Canada
| | - Angela M. Cheung
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Division of Epidemiology, Dalla Lana School of Public Health University of Toronto ON Toronto Canada
- Temerty Faculty of Medicine University of Toronto ON Toronto Canada
- Centre of Excellence in Skeletal Health Assessment University of Toronto ON Toronto Canada
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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Yu F, Fan Y, Sun H, Li T, Dong Y, Pan S. Intermuscular adipose tissue in Type 2 diabetes mellitus: Non-invasive quantitative imaging and clinical implications. Diabetes Res Clin Pract 2022; 187:109881. [PMID: 35483545 DOI: 10.1016/j.diabres.2022.109881] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022]
Abstract
Intermuscular adipose tissue (IMAT) is an ectopic fat depot found beneath the fascia and within the muscles. IMAT modulates muscle insulin sensitivity and triggers local and systemic chronic low-grade inflammation by producing cytokines and chemokines, which underlie the pathogenesis of Type 2 diabetes mellitus (T2DM). Imaging techniques have been increasingly used to non-invasively quantify IMAT in patients with diabetes in research and healthcare settings. In this study, we systematically reviewed the cell of origin and definition of IMAT, and the use of quantitative and functional imaging technology pertinent to the etiology, risk factors, lifestyle modification, and therapeutic treatment of diabetes. The purpose of this article is to provide important insight into the current understanding of IMAT and future prospects of targeting IMAT for T2DM control.
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Affiliation(s)
- Fuyao Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yiping Fan
- Department of Nuclear Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - He Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tianming Li
- Department of Gastroenterology and Medical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Orsatti FL, Nunes PRP, da Silva Carneiro MA, Orsatti CL, Souza MVC. Heterogeneity in resistance training-induced muscle strength responses is associated with training frequency and insulin resistance in postmenopausal women. Exp Gerontol 2022; 163:111807. [PMID: 35421558 DOI: 10.1016/j.exger.2022.111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In older adults, muscle strength (MS), a key component of sarcopenia, is essential to maintaining independence and physical capacity. The rate of muscle strength decline typically accelerates during the menopausal transition. Although MS has been shown to increase with resistance training (RT), the response to training is quite heterogeneous. Thus, if contributing factors to RT non-responsiveness to MS gains are identified, it may be possible to develop more effective and personalized ways to improve MS or identify individuals who may benefit from RT interventions. This study assessed potential factors that may contribute to MS response heterogeneity in postmenopausal women: training frequency, serum FSH and estrogen levels, adiposity, inflammation marker, and insulin resistance. METHODS One hundred and thirteen individuals participated in a 16-week program of supervised RT (3 sets, 8-12 repetitions, and 2-3 times/week). A control group (CTL, n = 63 - no performed the RT) was used as the comparator arm. Body composition (skinfold) and blood samples (metabolic and inflammatory indicators and hormones) were measured at baseline. Knee extensor strength (1RM) was measured at baseline, 8 weeks, and 16 weeks. RESULTS Only the RT group increased 1RM after 8 weeks (RT = 14 ± 12% vs. CTL = 6 ± 15%). Both groups increased 1RM after 16 weeks, with the RT group showing a greater increase than the CTL group (RT = 31 ± 23% vs CTL = 13 ± 25%). After 8 weeks of RT, 41 (36% of total) individuals were considered non-responders (based on control group responses) and 27 (24% of total) individuals after 16 weeks. At week 8, lower RT frequency (2 times/week vs. 3 times/week) was associated with higher odds of being non-responder (3 times, P = 0.048). At week 16, lower RT frequency (13 times, P = 0.009) and higher HOMA-IR (for every unit increase, odds increase by 40%, P = 0.022) were associated with higher odds of being non-responder. Higher QUICKI was associated with lower odds of being non-responder (for every unit increase, odds decrease by 16%, P = 0.039). Moreover, higher RT frequency (17 times, P = 0.028) and higher QUICKI (for every unit increase, odds increase by 41%, P = 0.017) were associated with higher odds of becoming a responder at week 16, being a non-responder at week 8. CONCLUSION Heterogeneity in RT-induced MS responses is associated with training frequency and insulin resistance in postmenopausal women.
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Affiliation(s)
- Fábio Lera Orsatti
- Exercise Biology Research Lab (BioEx), Department of Sport Sciences, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
| | - Paulo Ricardo Prado Nunes
- Department of Physical Education, Minas Gerais State University (UEMG), Passos, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Marcelo Augusto da Silva Carneiro
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Paraná, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Cláudio Lera Orsatti
- Department Health Science, Oeste Paulista University - UNOESTE, Jaú, SP, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Markus Vinícius Campus Souza
- Exercise Biology Research Lab (BioEx), Department of Sport Sciences, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Lazzer S, D’Alleva M, Vaccari F, Tringali G, De Micheli R, Sartorio A. Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults With Obesity. Front Nutr 2022; 9:840018. [PMID: 35433781 PMCID: PMC9008348 DOI: 10.3389/fnut.2022.840018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background The aim of the present study was to examine the short-term changes in body composition and physical capabilities in subjects with obesity during a multidisciplinary inpatient body weight reduction program (BWRP). Methods One hundred thirty-nine adolescents (56 boys and 83 girls; BMI: 37.1 ± 6.5 kg/m2; Fat Mass, FM: 45.3 ± 7.2%) and 71 adults (27 males and 44 females; BMI: 44 ± 4.7 kg/m2; FM: 51.4 ± 4.7%) followed a 3-week inpatient BWRP consisting of regular physical activity, moderate energy restriction, nutritional education and psychological counseling. Before (T0) and after the end of the BWRP (T21), body composition was assessed with an impedancemeter, lower limb muscle power with Margaria Stair Climbing Test (SCT), lower limb functionality with Short Physical Performance Battery (SPPB), and the capacity of performing activity of daily living (ADL) with Physical Performance Test (PPT). Results At T21, obese adolescents showed a 4% reduction in body mass (BM) (p < 0.001), associated with a FM reduction in boys (−10%) and girls (−6%) (p < 0.001) and with a 3% reduction in fat-free mass (FFM) recorded only in boys (p = 0.013). Obese adults showed a 5% BM reduction (p < 0.001), associated with a 2% FFM and 9% FM reduction (p < 0.001) in males, and 7% FM reduction in females (p < 0.001). Regarding physical capabilities, at T21 in obese adolescents, PPT score increased by 4% (p < 0.001), SCT decreased by −5% (boys) and −7% (girls) (p < 0.001), while SPPB score did not change significantly. In obese adults at T21, PPT score increased by 9% (p < 0.001), SCT decreased by −16% (p < 0.001) only in females, and SPPB score increased by 7% (males) and 10% (females) (p < 0.01). Conclusion In conclusion, moderate energy restriction and regular physical activity determine a 4-5% BM reduction during a 3-week inpatient BWRP, improve physical capabilities and induce beneficial changes in body composition in adolescents and adults with obesity. Trial registration This study was approved by the Ethical Committee of the Istituto Auxologico Italiano (Milan, Italy; research code: 01C124; acronym: PRORIPONATFIS). Registered 11 November 2020 - Retrospectively registered.
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Affiliation(s)
- Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Mattia D’Alleva
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
- *Correspondence: Mattia D’Alleva,
| | - Filippo Vaccari
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Scientific Institute for Hospitalization and Care (IRCCS), Piancavallo, Italy
| | - Roberta De Micheli
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Scientific Institute for Hospitalization and Care (IRCCS), Piancavallo, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Scientific Institute for Hospitalization and Care (IRCCS), Piancavallo, Italy
- Division of Auxology, Istituto Auxologico Italiano, Scientific Institute for Hospitalization and Care (IRCCS), Piancavallo, Italy
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Bille MB, Ballegaard M. Sensory nerve conduction studies in probable painful neuropathy: comparing surface and near-nerve nerve conduction techniques. BMJ Neurol Open 2022; 4:e000227. [PMID: 35265843 PMCID: PMC8860043 DOI: 10.1136/bmjno-2021-000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/27/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction We compared sensory nerve conduction studies (NCS) using surface and near-nerve recording electrodes in 53 patients with clinical probable painful neuropathy. Our aim was to validate the use of both recording techniques in that limited patient group. Methods Patients had sensory NCS using two established recording methods and quantitative sensory tests (QST). We compared normalised amplitudes of sensory sural nerve action potentials (SNAP) and sensory thresholds and used receiver operated curve (ROC) analysis of absolute SNAP amplitudes to find discriminatory levels predicting abnormal sensory thresholds. Results Mean sural SNAP z-scores differed depending on recording techniques (surface −1.0: SD 1.9; near-nerve −2.5: SD 1.7) with a numeric mean difference of −1.49 (Bland-Altman test: CI −1.872 to −1.12) with surface technique giving the z-value closest to zero. We documented a significant bias between the methods. Fifteen patients (28.3%) and 30 (56.6%) patients had abnormal results, respectively (χ2 test: p<0.001). Sural SNAP amplitudes correlated significantly with vibration thresholds using the near-nerve (p<0.02) but not using the surface technique (p=0.11). ROC analysis gave an optimal discriminative value of SNAP amplitudes for each QST measure, which were similar to our lower limit of normal values from investigating normal controls using near-nerve but not surface recording. Conclusion In patients with probable painful neuropathy, choosing sensory NCS technique introduces a bias in the diagnostic outcome. Differences in test performance suggest that using a normal sural NCS alone to delineate small fibre neuropathy from mixed neuropathy could result in poorly defined diagnostic groups.
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Affiliation(s)
- Margrethe Bastholm Bille
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Ballegaard
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
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11
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Abdelaal AA, El-Shamy SM. Effect of lower body positive pressure aerobic training on fall risk in patients with diabetic polyneuropathy: randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:33-42. [PMID: 34636527 PMCID: PMC9980519 DOI: 10.23736/s1973-9087.21.06847-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retarded task-oriented gait, balance performance and increased fall risk are among the most debilitating problems in patients with diabetic polyneuropathy (DPN). The lower body positive pressure (LBPP) training was recently introduced in the field of rehabilitation, but evaluating the effects of the LBPP on gait, balance and fall risk in patients with DPN has not been thoroughly investigated. AIM The aim of this study was to evaluate the effect of LBPP treadmill training program on task-oriented gait, balance performance and fall risk in patients with DPN. DESIGN Single-blinded, randomized-controlled trial. SETTING Rehabilitative outpatient unit. POPULATION Sixty-two patients with DPN were randomly assigned into 5-groups; group-A (100% weight-bearing; N.=12), group-B (75% weight-bearing; N.=13), group-C (50% weight-bearing; N.=13), group-D (25% weight-bearing; N.=12) and group-E (control group; N.=12). METHODS The intervention groups (A, B, C, D) received moderate intensity aerobic exercise training (AET) program (30-45 minutes, 50-70% heart rate reserve) on the AlterG (AlterG, Inc., Fremont, CA, USA) treadmill for 12-weeks. Task-oriented gait, balance performance and the fall risk were evaluated at baseline (evaluation-1), after 12-weeks (evaluation-2) and 12-weeks poststudy cessation (evaluation-3; follow-up) for all groups using the Tinetti balance assessment tool. RESULTS At evaluation-2, there were significant "within-groups" increases in the balance, gait and fall risk scores. There were significant "between-groups" differences in the same evaluated variables, with the highest increases were in group-B (P<0.05). At evaluation-3, there was a decline in the mean values of the evaluated variables, but still significant increases in the mean values of balance, gait and fall risk compared to the baseline mean values. There were significant "between-groups" differences in all variables, with the highest increases were in group-B (P<0.05). CONCLUSIONS Moderate intensity LBPP treadmill training program can effectively improve task-oriented gait, balance performance, and fall risk scores in patients with DPN. The 25% off-loading weight percentage during the LBPP treadmill training program yielded the most favorable short and long-term improvements compared to the other weight off-loading percentages in patients with DPN. CLINICAL REHABILITATION IMPACT The LBPP aerobic training program is an effective rehabilitation procedure in patients with DPN especially when utilizing the 25% off-loading weight percentage during the LBPP treadmill training program.
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Affiliation(s)
- Ashraf A Abdelaal
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia -
| | - Shamekh M El-Shamy
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
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12
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HIRASAWA Y, MATSUKI R, TANINA H. Relationship between Echo Intensity of Vastus Lateralis and Knee Extension Strength in Patients with Type 2 Diabetes Mellitus. Phys Ther Res 2022; 25:113-119. [PMID: 36819918 PMCID: PMC9910353 DOI: 10.1298/ptr.e10172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to determine the association between echo intensity (EI) of vastus lateralis and knee extension strength (KES) in patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective study included a total of 304 patients (189 males and 115 females) with T2DM who were hospitalized for treatment or care. EI and muscle thickness (MT) of the right vastus lateralis were assessed from transverse ultrasound images. Maximal isometric KES was evaluated using a dynamometer and normalized for body weight (%KES). RESULTS %KES was significantly positively correlated with MT and stages of change for exercise behavior, and significantly negatively correlated with age, T2DM duration, and EI. %KES was significantly higher in male than in female. %KES was significantly higher in non-diabetic peripheral neuropathy (DPN) than in DPN. Stepwise multiple regression analysis showed that sex, age, T2DM duration, EI, and stages of change for exercise behavior were significant determinants of %KES. CONCLUSION The study results suggest that EI is associated with %KES in patients with T2DM.
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Affiliation(s)
| | - Ryosuke MATSUKI
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Hideaki TANINA
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
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13
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Verdú E, Homs J, Boadas-Vaello P. Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413333. [PMID: 34948944 PMCID: PMC8705491 DOI: 10.3390/ijerph182413333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).
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Affiliation(s)
- Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Correspondence: (E.V.); (P.B.-V.)
| | - Judit Homs
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Department of Physical Therapy, EUSES-University of Girona, 17190 Salt, Spain
| | - Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Correspondence: (E.V.); (P.B.-V.)
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14
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The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med 2021; 10:jcm10215042. [PMID: 34768562 PMCID: PMC8584831 DOI: 10.3390/jcm10215042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes. It is associated with pain, paresthesia, sensory loss, muscle atrophy with fat infiltration, and muscular dysfunction typically starting distally in the feet and progressing proximally. Muscle deterioration within the leg and foot can lead to muscle dysfunction, reduced mobility, and increases the risk of disability, ulceration, and amputation. Exercise training is an established method for increasing the different components of physical fitness, including enhancing body composition and improving neuromuscular strength. A number of experimental studies have utilized exercise training to treat various impairments associated with DPN, such as nerve conduction velocity, pain tolerance, and balance. However, the broad spectrum of exercise training modalities implemented and differences in target outcome measurements have made it difficult to understand the efficacy of exercise training interventions or provide appropriate exercise prescription recommendations. Therefore, the aims of this review were to (1) briefly describe the pathophysiology of DPN and (2) discuss the effects of exercise training interventions on sensorimotor, metabolic, and physical functions in people with DPN.
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15
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Tuñón-Suárez M, Reyes-Ponce A, Godoy-Órdenes R, Quezada N, Flores-Opazo M. Exercise Training to Decrease Ectopic Intermuscular Adipose Tissue in Individuals With Chronic Diseases: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6309597. [PMID: 34174085 DOI: 10.1093/ptj/pzab162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of exercise training on ectopic fat within skeletal muscle (intermuscular adipose tissue [IMAT]) in adult populations with chronic diseases. METHODS A literature search was conducted in relevant databases to identify randomized controlled trials (RCTs) from inception. Selected studies examined the effect of aerobic training (AET), resistance training (RT), or combined training (COM) on IMAT as assessed by noninvasive magnetic resonance imagery or computed tomography. Eligibility was determined using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data extraction was performed using the population (P), intervention (I), comparison (C), outcome (O), timing (T), and settings (S) approach. Methodological quality was analyzed by the Cochrane risk of bias assessment. Standardized effect sizes (ES) with 95% CIs were calculated. Heterogeneity among studies was quantified using I2 statistics. Subgroup and meta-regression analyses were included. Risk of publication bias was examined by the Egger regression test. RESULTS Nineteen RCTs included 962 adults (628 women; age range = 34.8-93.4 years) with different chronic conditions that participated in 10 AET, 12 RT, and 5 COM interventions. The quality of studies was deemed moderate. Overall, the effect of exercise on IMAT was small (ES = 0.24; 95% CI = 0.10 to 0.37; heterogeneity I2 = 0.0%) compared with no exercise or control interventions. Moderate-intensity AET and COM had larger ES compared with RT regardless of intensity. This effect was associated with exercise-induced body weight and fat mass losses. Subgroup analysis revealed larger ES in studies assessing IMAT by magnetic resonance imagery compared with computed tomography in adults and middle-aged individuals compared with older adults and in participants who were HIV+ compared with other diagnoses. CONCLUSION AET and COM of moderate intensity reduce IMAT in individuals from 18 to 65 years of age who are affected by chronic diseases. This effect is associated with exercise-induced body weight and fat mass losses. In older individuals who are frail and patients at an advanced disease stage, exercise may result in a paradoxical IMAT accumulation. IMPACT In people affected by chronic conditions, IMAT accumulation induces muscle mass and strength losses, decline in physical performance, inflammation, and metabolic alterations. The present study shows that moderate-intensity AET or COM prevent or reduce IMAT in these conditions. Thus, the deleterious effect of IMAT on skeletal muscle homeostasis may be reverted by a properly prescribed exercise regime. The findings of the present systematic review are critical for physical therapists and health care professionals because they emphasize the therapeutic role of exercise and provide recommendations for exercise prescription that ultimately may have a positive impact on the course of disease, recovery of functionality, and independence. LAY SUMMARY Aerobic exercise (eg, walking/jogging, cycling) alone or combined with resistance exercise (strength training with free-weights, kettle bells, or gym equipment) is effective in reducing fat streaks that infiltrate muscles and impair muscle function and growth, particularly in adults affected by chronic diseases.
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Affiliation(s)
- Mauro Tuñón-Suárez
- Exercise Physiology and Metabolism Laboratory, School of Kinesiology, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Facultad de Ciencias de la Rehabilitación, Escuela de Kinesiología, Universidad Andres Bello, Viña del Mar, Chile
| | - Rodrigo Godoy-Órdenes
- Clinical Exercise Physiology Program, Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Nicolás Quezada
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Flores-Opazo
- Exercise Physiology and Metabolism Laboratory, School of Kinesiology, Universidad Finis Terrae, Santiago, Chile
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16
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FGF-2-dependent signaling activated in aged human skeletal muscle promotes intramuscular adipogenesis. Proc Natl Acad Sci U S A 2021; 118:2021013118. [PMID: 34493647 PMCID: PMC8449320 DOI: 10.1073/pnas.2021013118] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/23/2021] [Indexed: 01/07/2023] Open
Abstract
Aged skeletal muscle is markedly affected by fatty muscle infiltration, and strategies to reduce the occurrence of intramuscular adipocytes are urgently needed. Here, we show that fibroblast growth factor-2 (FGF-2) not only stimulates muscle growth but also promotes intramuscular adipogenesis. Using multiple screening assays upstream and downstream of microRNA (miR)-29a signaling, we located the secreted protein and adipogenic inhibitor SPARC to an FGF-2 signaling pathway that is conserved between skeletal muscle cells from mice and humans and that is activated in skeletal muscle of aged mice and humans. FGF-2 induces the miR-29a/SPARC axis through transcriptional activation of FRA-1, which binds and activates an evolutionary conserved AP-1 site element proximal in the miR-29a promoter. Genetic deletions in muscle cells and adeno-associated virus-mediated overexpression of FGF-2 or SPARC in mouse skeletal muscle revealed that this axis regulates differentiation of fibro/adipogenic progenitors in vitro and intramuscular adipose tissue (IMAT) formation in vivo. Skeletal muscle from human donors aged >75 y versus <55 y showed activation of FGF-2-dependent signaling and increased IMAT. Thus, our data highlights a disparate role of FGF-2 in adult skeletal muscle and reveals a pathway to combat fat accumulation in aged human skeletal muscle.
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17
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Zellers JA, Commean PK, Chen L, Mueller MJ, Hastings MK. A limited number of slices yields comparable results to all slices in foot intrinsic muscle deterioration ratio on computed tomography and magnetic resonance imaging. J Biomech 2021; 129:110750. [PMID: 34555631 DOI: 10.1016/j.jbiomech.2021.110750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/17/2021] [Accepted: 09/08/2021] [Indexed: 01/20/2023]
Abstract
Diagnostic imaging modalities, like computed tomography (CT) and magnetic resonance imaging (MRI), can be used to assess in vivo muscle quality. Quantitative assessment using these techniques is time-intensive and costly due in part to extensive post-processing needs. The purpose of this study was to identify whether a subset of slices on CT and MRI would yield comparable results to the full number of slices for a measure of muscle quality (muscle deterioration ratio = fat volume/muscle volume) in the foot intrinsic muscles of people with diabetes and peripheral neuropathy. CT (0.6 mm slice thickness) and MRI (3.5 mm slice thickness) scans were obtained using previously described methods. The total number of slices acquired during the scan was compared to several conditions using a portion of slices. Bland-Altman plots and Lin's concordance correlation coefficient were used to test agreement. Any condition using at least three slices yielded substantial to almost perfect agreement with the total number of slices on both CT and MRI (Range of Lin's concordance correlation coefficient: 0.947-0.999). Using a single slice in the middle of the region of interest demonstrated poor to moderate agreement with the total number of slices. The findings of this study suggest that using a limited number of slices to quantify muscle deterioration ratio on CT or MRI is a viable way to balance the combined need for measurement accuracy with feasibility in research and clinical settings.
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Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States
| | - Paul K Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, United States
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine in St. Louis, United States
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States.
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18
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Brown R, Sharafi A, Slade JM, Convit A, Davis N, Baete S, Milton H, Mroczek KJ, Kluding PM, Regatte RR, Parasoglou P, Rao S. Lower extremity MRI following 10-week supervised exercise intervention in patients with diabetic peripheral neuropathy. BMJ Open Diabetes Res Care 2021; 9:9/1/e002312. [PMID: 34518157 PMCID: PMC8438733 DOI: 10.1136/bmjdrc-2021-002312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS Twenty participants with DPN completed a longitudinal trial consisting of a 30-day control period, during which subjects made no change to their lifestyle, followed by a 10-week intervention program that included three supervised aerobic and resistance exercise sessions per week targeting the upper and lower extremities. The participants' midcalves were scanned with multinuclear MRI two times prior to intervention (baseline1 and baseline2) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters. RESULTS There were no changes between baseline1 and baseline2 MRI metrics (p>0.2). Significant changes (p<0.05) between baseline2 and postintervention MRI metrics were: gastrocnemius medialis (GM) T1 -2.3%±3.0% and soleus T2 -3.2%±3.1%. Trends toward significant changes (0.05<p<0.1) between baseline2 and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4). CONCLUSIONS The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.
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Affiliation(s)
- Ryan Brown
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Azadeh Sharafi
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Antonio Convit
- Department of Psychiatry, New York University Grossman School of Medicine, New York City, New York, USA
- Department of Psychiatry, Nathan S Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Nathan Davis
- Department of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Steven Baete
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Heather Milton
- Sports Performance Center, New York University Langone Health, New York City, New York, USA
| | - Kenneth J Mroczek
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York City, New York, USA
| | - Patricia M Kluding
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ravinder R Regatte
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Prodromos Parasoglou
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Smita Rao
- Department of Physical Therapy, New York University, New York City, New York, USA
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19
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Farsijani S, Santanasto AJ, Miljkovic I, Boudreau RM, Goodpaster BH, Kritchevsky SB, Newman AB. The Relationship Between Intermuscular Fat and Physical Performance Is Moderated by Muscle Area in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:115-122. [PMID: 32614950 DOI: 10.1093/gerona/glaa161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Age-related deposition of fat in skeletal muscle is associated with functional limitations. Skeletal muscle fat may be present in people with preserved muscle mass or accompanied by muscle wasting. However, it is not clear if the association between muscle fat deposition and physical performance is moderated by muscle mass. OBJECTIVE To determine whether the association between midthigh intermuscular fat and physical performance is moderated by muscle area. METHODS We performed a cross-sectional analysis of the Health, Aging, and, Body Composition (ABC) study data collected in 2002-2003 (n = 1897, women: 52.2%). Midthigh muscle cross-sectional area (by computed tomography) and physical performance measures were compared across quartiles of intermuscular fat absolute area. Moderation analysis was performed to determine the conditional effect of intermuscular fat on physical performance as a function of muscle area. Conditional effects were evaluated at three levels of muscle area (mean and ± 1 standard deviation [SD]; 213.2 ± 53.2 cm2). RESULTS Simple slope analysis showed that the negative association between intermuscular fat area (cm2) and leg strength (N·m) was of greater magnitude (beta coefficient [b], 95% confidence interval [CI] = -0.288 [-0.427, -0.148]) in participants with greater muscle area (ie, 1 SD above the mean) compared to those with lower muscle area (ie, at mean [b = -0.12 {-0.248, 0.008}] or 1 SD below the mean [b = 0.048 {-0.122, 0.217}]). Similarly, the negative association of intermuscular fat with 400-m walk speed (m/s) and chair stand (seconds) was greater in those with higher muscle areas (p < .001) compared to those with lower muscle areas. CONCLUSIONS The association between higher intermuscular fat area and impaired physical function in aging is moderated by muscle area.
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Affiliation(s)
- Samaneh Farsijani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, Florida.,Sanford Burnham Presby Medical Discovery Institute, La Jolla, California
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
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20
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Zheng J, Sorensen C, Li R, An H, Hildebolt CF, Zayed MA, Mueller MJ, Hastings MK. Deteriorated regional calf microcirculation measured by contrast-free MRI in patients with diabetes mellitus and relation with physical activity. Diab Vasc Dis Res 2021; 18:14791641211029002. [PMID: 34313140 PMCID: PMC8481746 DOI: 10.1177/14791641211029002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate regional calf muscle microcirculation in people with diabetes mellitus (DM) with and without foot ulcers, compared to healthy control people without DM, using contrast-free magnetic resonance imaging methods. METHODS Three groups of subjects were recruited: non-DM controls, DM, and DM with foot ulcers (DM + ulcer), all with ankle brachial index (ABI) > 0.9. Skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in calf muscle were measured at rest and during a 5-min isometric ankle plantarflexion exercise. Subjects completed the Yale physical activity survey. RESULTS The exercise SMBF (ml/min/100 g) of the medial gastrocnemius muscle were progressively impaired: 63.7 ± 18.9 for controls, 42.9 ± 6.7 for DM, and 36.2 ± 6.2 for DM + ulcer, p < 0.001. Corresponding exercise SMOEF was the lowest in DM + ulcers (0.48 ± 0.09). Exercise SMBF in the soleus muscle was correlated moderately with the Yale physical activity survey (r = 0.39, p < 0.01). CONCLUSIONS Contrast-free MR imaging identified progressively impaired regional microcirculation in medial gastrocnemius muscles of people with DM with and without foot ulcers. Exercise SMBF in the medial gastrocnemius muscle was the most sensitive index and was associated with HbA1c. Lower exercise SMBF in the soleus muscle was associated with lower Yale score.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Jie Zheng, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO 63130-4899, USA.
| | - Christopher Sorensen
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles F Hildebolt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Mueller
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary K Hastings
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
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21
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Hastings MK, Commean PK, Chen L, Zellers JA, Sinacore DR, Baker JC. Qualitative study of musculoskeletal tissues and their radiographic correlates in diabetic neuropathic foot deformity. Foot (Edinb) 2021; 47:101777. [PMID: 33957525 PMCID: PMC8212350 DOI: 10.1016/j.foot.2021.101777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/31/2020] [Accepted: 01/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) with peripheral neuropathy (PN) results in foot deformity increasing ulceration, joint dislocation, and amputation risk. This study describes the frequency and severity of foot and ankle musculoskeletal abnormalities and their relationship to radiographic alignment in people with DMPN with (DMPN + MCD) and without (DMPN - MCD) medial column deformity (MCD) compared to age- and body mass index-matched controls without DMPN or MDC. METHODS DMPN + MCD (n = 11), DMPN - MCD (n = 12), and controls (n = 12) were studied. A radiologist scored foot and ankle magnetic resonance images (MRI) for abnormalities in tendons/fascia, ligaments, muscles, joints, and bones. Higher scores represent greater abnormalities. Foot alignment was measured from lateral weightbearing radiographs. Frequency of abnormalities between groups and relationships between abnormalities and foot alignment in the combined group (n = 35) were examined. RESULTS DMPN + MCD had higher total muscle, joint, and bone scores compared to controls and higher total joint scores than DMPN - MCD. DMPN - MCD had higher total muscle scores than controls. DMPN + MCD higher bone and joint scores were driven by increased frequency of osteophytes, cartilage damage, focal bone marrow edema, new bone formation, and subchondral cysts. Significant correlations included cuboid height and total bone and joint scores (ρ = -0.37 and ρ = -0.40, respectively) and talar declination angle and total joint score (ρ = 0.38). CONCLUSION High contrast resolution MRI allowed identification of structural lesions of the foot affecting the cartilage surfaces, bone marrow, and soft tissue supports in patients with DMPN + MCD. As expected, the presence of bone and joint lesions on MRI were strongly associated with DMPN + MCD; surprisingly, although the sample is small, lesions of the soft tissue supports were not associated with MCD. While MRI is not done routinely to investigate MCD, opportunistic use of the information from MRI done for the common clinical indications may allow early identification of the structural lesions associated with MCD and facilitate early, aggressive therapy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, Campus Box 8502,4444 Forest Park Blvd, Room 1101, St. Louis, Missouri, USA 63108, United States of America.,Corresponding Author Address correspondence to: Mary K Hastings, PT, DPT, MSCI, Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO 63108,
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Division of radiological Science, Washington University School of Medicine in St. Louis, 510 South Kingshighway Blvd., St. Louis, MO 63110, United States of America
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine in St. Louis, Campus Box 8067, St. Louis, MO 63110, United States of America
| | - Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, Campus Box 8502,4444 Forest Park Blvd, Room 1101, St. Louis, Missouri, USA 63108, United States of America
| | - David R. Sinacore
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, Campus Box 8502,4444 Forest Park Blvd, Room 1101, St. Louis, Missouri, USA 63108, United States of America
| | - Jonathan C. Baker
- Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, Campus Box 8131, St. Louis, MO 63110, United States of America
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22
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Bittel DC, Bittel AJ, Varadhachary AS, Pietka T, Sinacore DR. Deficits in the Skeletal Muscle Transcriptome and Mitochondrial Coupling in Progressive Diabetes-Induced CKD Relate to Functional Decline. Diabetes 2021; 70:1130-1144. [PMID: 33526590 PMCID: PMC8173802 DOI: 10.2337/db20-0688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
Two-thirds of people with type 2 diabetes mellitus (T2DM) have or will develop chronic kidney disease (CKD), which is characterized by rapid renal decline that, together with superimposed T2DM-related metabolic sequelae, synergistically promotes early frailty and mobility deficits that increase the risk of mortality. Distinguishing the mechanisms linking renal decline to mobility deficits in CKD progression and/or increasing severity in T2DM is instrumental both in identifying those at high risk for functional decline and in formulating effective treatment strategies to prevent renal failure. While evidence suggests that skeletal muscle energetics may relate to the development of these comorbidities in advanced CKD, this has never been assessed across the spectrum of CKD progression, especially in T2DM-induced CKD. Here, using next-generation sequencing, we first report significant downregulation in transcriptional networks governing oxidative phosphorylation, coupled electron transport, electron transport chain (ETC) complex assembly, and mitochondrial organization in both middle- and late-stage CKD in T2DM. Furthermore, muscle mitochondrial coupling is impaired as early as stage 3 CKD, with additional deficits in ETC respiration, enzymatic activity, and increased redox leak. Moreover, mitochondrial ETC function and coupling strongly relate to muscle performance and physical function. Our results indicate that T2DM-induced CKD progression impairs physical function, with implications for altered metabolic transcriptional networks and mitochondrial functional deficits as primary mechanistic factors early in CKD progression in T2DM.
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Affiliation(s)
- Daniel C Bittel
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Adam J Bittel
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Arun S Varadhachary
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Terri Pietka
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
| | - David R Sinacore
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC
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23
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Farsijani S, Marron MM, Miljkovic I, Baugh ME, Kritchevsky SB, Newman AB. Metabolic Markers Demonstrate the Heterogeneity of Myosteatosis in Community-Dwelling Older Black Men from the Health ABC Study. Metabolites 2021; 11:metabo11040224. [PMID: 33917005 PMCID: PMC8067743 DOI: 10.3390/metabo11040224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022] Open
Abstract
Myosteatosis is a complex condition, associated with aging and diverse pathological conditions (e.g., diabetes), that contributes to mobility disability. Improved characterization of myosteatosis is required to develop targeted interventions to maintain muscle health in aging. We first determined the associations between plasma metabolites and intermuscular fat (IMF) in a cross-sectional analysis of 313 older Black men from Health ABC Study. Using partial correlation analysis, 34/350 metabolites were associated with IMF, the majority of which were lipids and organic acids. Next, we used Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), as an indicator of metabolic health to delineate the anthropometric, functional, and metabolic heterogeneity of myosteatosis in a case-control matching analysis. We categorized participants based on their IMF and HOMA-IR levels into: Low-IMF with Low- versus High-HOMA, as well as High-IMF with Low- versus High-HOMA. Among participants with similar levels of IMF, those who were metabolically unhealthy, i.e., with High HOMA-IR, had higher fat and lean mass, muscle strength, and had hyperglycemia, hypertriglyceridemia, hyperinsulinemia, and higher levels of plasma metabolites belonging to diacylglycerols, triacylglycerols, fatty acid and aminoacyl-tRNA biosynthesis pathways versus those with Low HOMA-IR. In summary, HOMA-IR delineates the heterogeneity of myosteatosis by distinguishing metabolically healthy versus unhealthy individuals.
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Affiliation(s)
- Samaneh Farsijani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.F.); (M.M.M.); (I.M.)
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Megan M. Marron
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.F.); (M.M.M.); (I.M.)
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.F.); (M.M.M.); (I.M.)
| | - Mary Elizabeth Baugh
- Fralin Biomedical Research Institute, Virginia Polytechnic Institute and State University, Roanoke, VA 24016, USA;
| | - Stephen B. Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.F.); (M.M.M.); (I.M.)
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Correspondence:
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24
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Zheng J, Li R, Zayed MA, Yan Y, An H, Hastings MK. Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries. Vasc Med 2021; 26:367-373. [PMID: 33749394 DOI: 10.1177/1358863x21996465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle-brachial index (ABI) (0.9-1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group (p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group (p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Yan Yan
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mary K Hastings
- Physical Therapy Program, Washington University School of Medicine, St Louis, MO, USA
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25
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Eetvelde BLV, Lapauw B, Proot P, Wyngaert KV, Helleputte S, Stautemas J, Cambier DC, Calders P. The impact of diabetic neuropathy on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 diabetes mellitus: a cross-sectional study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:464-474. [PMID: 34854385 PMCID: PMC8672402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to determine the impact of diabetic neuropathy (dNP) on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 Diabetes Mellitus (T2DM). METHODS 19 healthy male controls without neuropathy (HC) and 35 male T2DM patients, without dNP (n=8), with sensory dNP (n=13) or with sensorimotor dNP (dNPsm; n=14), were enrolled in this study. Maximal isometric (IM) and isokinetic (IK) muscle strength and IK muscle endurance of the dominant knee, ankle and elbow, and maximal IM handgrip strength were measured by means of dynamometry. RESULTS Ankle muscle endurance was lower compared to the knee, independently of dNP (p<0.001). Maximal IK ankle muscle strength was also lower compared to the knee, albeit only in dNPsm (p=0.003). No differences were found between maximal IM handgrip and elbow strength. CONCLUSIONS Our results suggest an impact of T2DM -with or without dNP- on lower limb muscle strength more distally than proximally, while this was not observed in the upper limb. The gradient of dNP seemed to be a determining factor for the maximal muscle strength, and not for muscle endurance, in the lower limb.
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Affiliation(s)
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Belgium
| | - Pascal Proot
- Department of Neurology, Ghent University Hospital, Belgium
| | | | - Simon Helleputte
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Jan Stautemas
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Dirk C. Cambier
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Belgium,Corresponding author: Prof. dr. Patrick Calders, Department of Rehabilitation Sciences, Campus UZ Gent, Corneel Heymanslaan 10, B3, Entrance 46, 9000 Ghent, Belgium E-mail:
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26
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Van Eetvelde BLM, Lapauw B, Proot P, Vanden Wyngaert K, Celie B, Cambier D, Calders P. The impact of sensory and/or sensorimotor neuropathy on lower limb muscle endurance, explosive and maximal muscle strength in patients with type 2 diabetes mellitus. J Diabetes Complications 2020; 34:107562. [PMID: 32122790 DOI: 10.1016/j.jdiacomp.2020.107562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022]
Abstract
AIMS The purpose of this study was to investigate the impact of diabetic neuropathy (dNP) on lower limb endurance, explosive and maximal muscle strength in patients with Type 2 Diabetes Mellitus (T2DM). METHODS Fifty-four participants, aged between 55 and 85, were enrolled in this observational comparative study. The patients with T2DM had an average HbA1c of 7.4% (±1.03) and diabetes duration of 13 years. Participants were classified by means of electroneuromyography as T2DM without dNP (dNP-; n = 8), T2DM with sensory dNP (dNPs; n = 13), T2DM with sensorimotor dNP (dNPsm; n = 14), and healthy controls without neuropathy (C; n = 19). Maximal muscle strength and muscle endurance of the dominant knee and ankle were measured by dynamometry, while explosive muscle strength was evaluated by mechanography. RESULTS Muscle endurance "total work" in knee extension and ankle plantar flexion was higher in the healthy controls compared to dNP-, dNPs and dNPsm, in knee flexion compared to dNPs and dNPsm, and in ankle dorsiflexion compared to dNPsm only (p<0.05). Furthermore, relative explosive muscle strength "total power/body weight" and relative maximal muscle strength "peak torque/lean body mass of the dominant leg" considering knee flexion, ankle plantar flexion and dorsiflexion, were higher in healthy controls compared to the dNPsm group, and for maximal muscle strength ankle dorsiflexion even between dNP- and dNPsm (p < 0.05). CONCLUSIONS Muscle endurance is impaired in patients with T2DM, independent of the presence of dNP. Explosive and maximal muscle strength are more likely affected by the presence and severity of dNP.
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Affiliation(s)
- Birgit L M Van Eetvelde
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Pascal Proot
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Bert Celie
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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27
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Bohnert KL, Hastings MK, Sinacore DR, Johnson JE, Klein SE, McCormick JJ, Gontarz P, Meyer GA. Skeletal Muscle Regeneration in Advanced Diabetic Peripheral Neuropathy. Foot Ankle Int 2020; 41:536-548. [PMID: 32059624 PMCID: PMC8783612 DOI: 10.1177/1071100720907035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Decreased lean muscle mass in the lower extremity in diabetic peripheral neuropathy (DPN) is thought to contribute to altered joint loading, immobility, and disability. However, the mechanism behind this loss is unknown and could derive from a reduction in size of myofibers (atrophy), destruction of myofibers (degeneration), or both. Degenerative changes require participation of muscle stem (satellite) cells to regenerate lost myofibers and restore lean mass. Determining the degenerative state and residual regenerative capacity of DPN muscle will inform the utility of regeneration-targeted therapeutic strategies. METHODS Biopsies were acquired from 2 muscles in 12 individuals with and without diabetic neuropathy undergoing below-knee amputation surgery. Biopsies were subdivided for histological analysis, transcriptional profiling, and satellite cell isolation and culture. RESULTS Histological analysis revealed evidence of ongoing degeneration and regeneration in DPN muscles. Transcriptional profiling supports these findings, indicating significant upregulation of regeneration-related pathways. However, regeneration appeared to be limited in samples exhibiting the most severe structural pathology as only extremely small, immature regenerated myofibers were found. Immunostaining for satellite cells revealed a significant decrease in their relative frequency only in the subset with severe pathology. Similarly, a reduction in fusion in cultured satellite cells in this group suggests impairment in regenerative capacity in severe DPN pathology. CONCLUSION DPN muscle exhibited features of degeneration with attempted regeneration. In the most severely pathological muscle samples, regeneration appeared to be stymied and our data suggest that this may be partly due to intrinsic dysfunction of the satellite cell pool in addition to extrinsic structural pathology (eg, nerve damage). CLINICAL RELEVANCE Restoration of DPN muscle function for improved mobility and physical activity is a goal of surgical and rehabilitation clinicians. Identifying myofiber degeneration and compromised regeneration as contributors to dysfunction suggests that adjuvant cell-based therapies may improve clinical outcomes.
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Affiliation(s)
| | - Mary K. Hastings
- Program in Physical Therapy, Washington University, St. Louis, MO, USA
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - David R. Sinacore
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Jeffrey E. Johnson
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Sandra E. Klein
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Jeremy J. McCormick
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Paul Gontarz
- Department of Developmental Biology, Washington University, St. Louis, MO, USA
| | - Gretchen A. Meyer
- Program in Physical Therapy, Washington University, St. Louis, MO, USA
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
- Departments of Neurology and Biomedical Engineering, Washington University, St. Louis, MO, USA
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28
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Mesinovic J, Scott D. Sarcopenia and diabetes mellitus: evidence for a bi-directional relationship. Eur Geriatr Med 2019; 10:677-680. [DOI: 10.1007/s41999-019-00230-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
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29
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Bryniarski AR, Meyer GA. Brown Fat Promotes Muscle Growth During Regeneration. J Orthop Res 2019; 37:1817-1826. [PMID: 31042310 PMCID: PMC6824921 DOI: 10.1002/jor.24324] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/08/2019] [Indexed: 02/04/2023]
Abstract
Accumulation of adipose tissue around and within muscles is highly correlated with reduced strength, functional limitations, and poor rehabilitative outcomes. Given the intimate physical contact between these tissues, paracrine cross-talk is a likely mediator of this association. The recent discovery that muscle-associated adipose tissue exhibits features of beige fat has suggested that this cross-talk may be modifiable, as beige fat can be stimulated to assume features of brown fat. In this work, we describe a novel intermuscular fat transplant model in the mouse rotator cuff to investigate cross-talk between muscle and adipose tissue. Specifically, we examine the role of transplanted fat phenotype on muscle regeneration by transplanting pieces of classical brown (interscapular), beige (inguinal), or white (epididymal) adipose tissue in conjunction with cardiotoxin injection to the adjacent supraspinatus muscle. Transplantation of brown fat, but not beige or white, significantly increased muscle mass, fiber cross-sectional area and contractile force production compared with sham injury. This effect was not seen when cardiotoxin was delivered to a distant muscle, or when adjacent muscles were injected with saline indicating that the effect is localized and specifically targeting the regenerative process. Thus, we conclude that local signaling between fat and muscle varies by phenotype and that brown fat supports regeneration. Clinical significance: Our findings suggest that the phenotype of muscle-associated fat could be a novel therapeutic target to modulate fat-muscle signaling. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1817-1826, 2019.
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Affiliation(s)
- Anna R. Bryniarski
- Departments of Investigation performed at the Program in Physical Therapy, Washington University in St. Louis; St. Louis, MO 63108
| | - Gretchen A. Meyer
- Departments of Investigation performed at the Program in Physical Therapy, Washington University in St. Louis; St. Louis, MO 63108,Departments of Neurology, Orthopaedic Surgery and Biomedical Engineering, Washington University in St. Louis; St. Louis, MO 63108,Corresponding Author: Dr. Gretchen A.Meyer, 4444 Forest Park Ave, Suite 1101, St. Louis, MO 63108, Tel: 314-286-1456, Fax: 314-747-0674,
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30
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Cheuy VA, Loyd BJ, Hafner W, Kittelson AJ, Waugh D, Stevens-Lapsley JE. Influence of Diabetes Mellitus on the Recovery Trajectories of Function, Strength, and Self-Report Measures After Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2019; 71:1059-1067. [PMID: 30156757 DOI: 10.1002/acr.23741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/21/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE As the proportion of individuals with diabetes mellitus (DM) in the aging population and the number of total knee arthroplasties (TKAs) both continue to grow, understanding the outcomes for these patient populations is critical. The purpose of this study was to determine whether patients with and without DM differed in the recovery of 3 physical performance measures during the first 90 days following a TKA. METHODS Data collected at ATI Physical Therapy from 169 patients (37 with DM, and 132 without) were available. Physical performance measures included the 4-meter walk test, the 30-second sit-to-stand test (30STS), and the timed-up-and-go test (TUG). A mixed-effects model was performed to determine differences in the rate of recovery and 90-day postoperative scores for all measures. RESULTS Both groups had similar baseline values for all measures. Patients with DM demonstrated a slower rate of recovery for the 4-meter walk test, and worse scores for the 4-meter walk test, 30STS, and TUG at the end of 90 days when accounting for significant covariates. CONCLUSION Our findings show a negative relationship between the presence of DM and the recovery trajectories of all physical performance measures. Clinicians should closely monitor patients with DM, knowing that they are at higher risk for sustained functional deficits and early complications.
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Affiliation(s)
| | | | | | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, South Carolina
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31
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Pagnotti GM, Styner M, Uzer G, Patel VS, Wright LE, Ness KK, Guise TA, Rubin J, Rubin CT. Combating osteoporosis and obesity with exercise: leveraging cell mechanosensitivity. Nat Rev Endocrinol 2019; 15:339-355. [PMID: 30814687 PMCID: PMC6520125 DOI: 10.1038/s41574-019-0170-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis, a condition of skeletal decline that undermines quality of life, is treated with pharmacological interventions that are associated with poor adherence and adverse effects. Complicating efforts to improve clinical outcomes, the incidence of obesity is increasing, predisposing the population to a range of musculoskeletal complications and metabolic disorders. Pharmacological management of obesity has yet to deliver notable reductions in weight and debilitating complications are rarely avoided. By contrast, exercise shows promise as a non-invasive and non-pharmacological method of regulating both osteoporosis and obesity. The principal components of exercise - mechanical signals - promote bone and muscle anabolism while limiting formation and expansion of fat mass. Mechanical regulation of bone and marrow fat might be achieved by regulating functions of differentiated cells in the skeletal tissue while biasing lineage selection of their common progenitors - mesenchymal stem cells. An inverse relationship between adipocyte versus osteoblast fate selection from stem cells is implicated in clinical conditions such as childhood obesity and increased marrow adiposity in type 2 diabetes mellitus, as well as contributing to skeletal frailty. Understanding how exercise-induced mechanical signals can be used to improve bone quality while decreasing fat mass and metabolic dysfunction should lead to new strategies to treat chronic diseases such as osteoporosis and obesity.
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Affiliation(s)
- Gabriel M Pagnotti
- School of Medicine, Division of Endocrinology, Indiana University, Indianapolis, IN, USA
| | - Maya Styner
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Gunes Uzer
- College of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Vihitaben S Patel
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Laura E Wright
- School of Medicine, Division of Endocrinology, Indiana University, Indianapolis, IN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Theresa A Guise
- School of Medicine, Division of Endocrinology, Indiana University, Indianapolis, IN, USA
| | - Janet Rubin
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Clinton T Rubin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
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Zhen Q, Yao N, Chen X, Zhang X, Wang Z, Ge Q. TOTAL BODY ADIPOSITY, TRIGLYCERIDES, AND LEG FAT ARE INDEPENDENT RISK FACTORS FOR DIABETIC PERIPHERAL NEUROPATHY IN CHINESE PATIENTS WITH TYPE 2 DIABETES MELLITUS. Endocr Pract 2019; 25:270-278. [PMID: 30913011 DOI: 10.4158/ep-2018-0459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the risk factors associated with diabetic peripheral neuropathy (DPN) in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS Between January 2014 and December 2017, 107 participants who had obesity with T2DM and 349 participants who had normal weight with T2DM, matched for age, sex, and duration of diabetes, were recruited. The clinical and biochemical parameters were measured in each patient. DPN was diagnosed based on neuropathy symptom score and neuropathy deficit score. Motor and sensory nerve conduction velocities were measured by electromyography. Body fat mass was estimated by dual-energy X-ray absorptiometry, while hepatic steatosis was evaluated by ultrasonography. RESULTS The group with obesity had a significant higher prevalence of DPN (66.62%) than that (46.99%) of the group with normal weight. Compared to the patients with normal weight, the sural sensory nerve in the right lower limbs of the patients with obesity was more susceptible to damage. Hypertriglyceridemia in the patients with obesity was a significant independent risk factor for DPN (odds ratio [OR], 3.90 [95% confidence interval (CI), 1.01 to 15.02]; P = .04), while the duration of diabetes (OR, 1.33 [95% CI, 1.07 to 1.65]; P<.01) and leg subcutaneous fat mass (OR, 0.72 [95% CI, 0.57 to 0.90]; P<.01) in the patients with normal weight were independent risk factors for DPN. The presence of obesity alone in patients with T2DM could predict high DPN risk (OR, 3.09 [95% CI, 1.11 to 8.65]; P = .04). CONCLUSION Reducing total body adiposity and triglyceride levels, as well as avoiding leg subcutaneous fat atrophy, could be new prevention strategies for DPN in Chinese patients with T2DM. ABBREVIATIONS ALB = albumin; ALT = alanine transaminase; AST = aspartate transaminase; AUC = area under the curve; AUCc-p/AUCglu = AUC of C-peptide/AUC of glucose; BMI = body mass index; BP = blood pressure; CI = confidence interval; Cr = creatinine; DBP = diastolic blood pressure; DPN = diabetic peripheral neuropathy; FC-P = fasting C-peptide; FPG = fasting plasma glucose; FFA = free fatty acid; γ-GGT = γ-glutamyl transferase; HbA1c = glycated hemoglobin A1c; HDL-C = high-density-lipoprotein cholesterol; ISI = insulin sensitivity index; ISSI-2 = insulin secretion-sensitivity index-2; LDL-C = low-density-lipoprotein cholesterol; MNCS = motor nerve conduction velocity; OGTT = oral glucose tolerance test; PG = plasma glucose; SAT = subcutaneous adipose tissue; SBP = systolic blood pressure; SNCS = sensory nerve conduction velocity; T2DM = type 2 diabetes mellitus; TC = total cholesterol; TG = triglyceride; UA = uric acid; VAT = visceral adipose tissue; WC = waist circumference.
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Nomura T, Ishiguro T, Ohira M, Oka H, Ikeda Y. Isometric knee extension force in Japanese type 2 diabetic patients without apparent diabetic polyneuropathy: Data from the Multicenter Survey of the Isometric Lower Extremity Strength in Type 2 Diabetes study. SAGE Open Med 2019; 7:2050312118823412. [PMID: 30671244 PMCID: PMC6329036 DOI: 10.1177/2050312118823412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/16/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To determine standard reference values for isometric knee extension force using a cohort of Japanese type 2 diabetic patients without diabetic polyneuropathy. METHODS Patient data were collected from the Multicenter Survey of the Isometric Lower Extremity Strength in Type 2 Diabetes study and compared with previously published data of healthy control subjects. In total, we enrolled 898 patients with type 2 diabetes aged 30-87 years, who did not have diabetic polyneuropathy. The control group included 510 healthy subjects aged 30-88 years. Maximum isometric knee extension force (KEF) values were obtained by using a hand-held dynamometer with belt stabilization. In addition, KEF (kgf) was adjusted for bodyweight (kg) to calculate %KEF. RESULTS KEF and %KEF decreased with age in both patients with diabetes and healthy control subjects. The mean values of KEF and %KEF in patients with diabetes were reduced by 9.7% and 20.8%, respectively, in males, and by 11.6% and 23.0%, respectively, in females compared to the values in healthy control subjects. CONCLUSION KEF and %KEF in patients with type 2 diabetes without diabetic polyneuropathy may reduce by approximately 10% and 20%, respectively, compared to these values in healthy control subjects. This study provides reference values for isometric KEF with respect to sex in a population covering a wide age range.
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Affiliation(s)
- Takuo Nomura
- Division of Physical Therapy, Department
of Rehabilitation Sciences, Kansai University of Welfare Sciences, Osaka,
Japan
| | - Tomoyasu Ishiguro
- Department of Physical Therapy, Health
Science University, Yamanashi, Japan
- Faculty of Human Care, Tohto College of
Health Sciences, Saitama, Japan
| | - Masayoshi Ohira
- School of Health Sciences, Shinshu
University, Nagano, Japan
| | - Hiroyuki Oka
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The
University of Tokyo, Tokyo, Japan
| | - Yukio Ikeda
- Diabetes Center, Kochi Memorial
Hospital, Kochi, Japan
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Buras ED, Converso-Baran K, Davis CS, Akama T, Hikage F, Michele DE, Brooks SV, Chun TH. Fibro-Adipogenic Remodeling of the Diaphragm in Obesity-Associated Respiratory Dysfunction. Diabetes 2019; 68:45-56. [PMID: 30361289 PMCID: PMC6302533 DOI: 10.2337/db18-0209] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/03/2018] [Indexed: 12/19/2022]
Abstract
Respiratory dysfunction is a common complication of obesity, conferring cardiovascular morbidity and increased mortality and often necessitating mechanical ventilatory support. While impaired lung expansion in the setting of increased adipose mass and reduced central response to hypercapnia have been implicated as pathophysiological drivers, the impact of obesity on respiratory muscles-in particular, the diaphragm-has not been investigated in detail. Here, we demonstrate that chronic high-fat diet (HFD) feeding impairs diaphragm muscle function, as assessed in vivo by ultrasonography and ex vivo by measurement of contractile force. During an HFD time course, progressive adipose tissue expansion and collagen deposition within the diaphragm parallel contractile deficits. Moreover, intradiaphragmatic fibro-adipogenic progenitors (FAPs) proliferate with long-term HFD feeding while giving rise to adipocytes and type I collagen-depositing fibroblasts. Thrombospondin 1 (THBS1), a circulating adipokine, increases with obesity and induces FAP proliferation. These findings suggest a novel role for FAP-mediated fibro-adipogenic diaphragm remodeling in obesity-associated respiratory dysfunction.
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Affiliation(s)
- Eric D Buras
- Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI
| | - Kimber Converso-Baran
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - Carol S Davis
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - Takeshi Akama
- Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI
| | - Fumihito Hikage
- Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI
| | - Daniel E Michele
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - Susan V Brooks
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | - Tae-Hwa Chun
- Division of Metabolism Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI
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Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes 2019. [PMID: 31372016 DOI: 10.2147/dmso.s186600[publishedonlinefirst:2019/08/03]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The incidence and prevalence of metabolic and musculoskeletal diseases are increasing. Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, inflammation, advanced glycation end-product accumulation and increased oxidative stress. These characteristics can negatively affect various aspects of muscle health, including muscle mass, strength, quality and function through impairments in protein metabolism, vascular and mitochondrial dysfunction, and cell death. Sarcopenia is a term used to describe the age-related loss in skeletal muscle mass and function and has been implicated as both a cause and consequence of T2DM. Sarcopenia may contribute to the development and progression of T2DM through altered glucose disposal due to low muscle mass, and also increased localized inflammation, which can arise through inter- and intramuscular adipose tissue accumulation. Lifestyle modifications are important for improving and maintaining mobility and metabolic health in individuals with T2DM and sarcopenia. However, evidence for the most effective and feasible exercise and dietary interventions in this population is lacking. In this review, we discuss the current literature highlighting the bidirectional relationship between T2DM and sarcopenia, highlight current research gaps and treatments, and provide recommendations for future research.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
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Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes 2019; 12:1057-1072. [PMID: 31372016 PMCID: PMC6630094 DOI: 10.2147/dmso.s186600] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 12/05/2022] Open
Abstract
The incidence and prevalence of metabolic and musculoskeletal diseases are increasing. Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, inflammation, advanced glycation end-product accumulation and increased oxidative stress. These characteristics can negatively affect various aspects of muscle health, including muscle mass, strength, quality and function through impairments in protein metabolism, vascular and mitochondrial dysfunction, and cell death. Sarcopenia is a term used to describe the age-related loss in skeletal muscle mass and function and has been implicated as both a cause and consequence of T2DM. Sarcopenia may contribute to the development and progression of T2DM through altered glucose disposal due to low muscle mass, and also increased localized inflammation, which can arise through inter- and intramuscular adipose tissue accumulation. Lifestyle modifications are important for improving and maintaining mobility and metabolic health in individuals with T2DM and sarcopenia. However, evidence for the most effective and feasible exercise and dietary interventions in this population is lacking. In this review, we discuss the current literature highlighting the bidirectional relationship between T2DM and sarcopenia, highlight current research gaps and treatments, and provide recommendations for future research.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Correspondence: Jakub MesinovicDepartment of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Clayton, Victoria3068, AustraliaTel + 6 138 572 2919Fax + 6 139 594 6495Email
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
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Bittel AJ, Bittel DC, Tuttle LJ, Strube MJ, Mueller MJ, Cade WT, Sinacore DR. Explanators of Sarcopenia in Individuals With Diabesity: A Cross-Sectional Analysis. J Geriatr Phys Ther 2018; 40:86-94. [PMID: 26859462 DOI: 10.1519/jpt.0000000000000076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Excess lower extremity intermuscular adipose tissue (IMAT), reduced strength, and functional limitations are common in obese individuals with and without diabetes (the former termed diabesity). Individuals with diabesity are particularly susceptible to accelerated sarcopenia, which may be underdiagnosed. The purpose of this study was to determine critical values for leg IMAT volume, plantar flexor (PF) muscle strength, and physical performance that help identify individuals with diabesity who have sarcopenia. METHODS Forty-three age- and sex-matched obese adults were studied: 12 with type 2 diabetes, 21 with diabetes and peripheral neuropathy, and 10 nondiabetic controls. Dual-energy x-ray absorptiometry-derived skeletal muscle index determined classification of sarcopenia. Leg fat (% IMAT), ankle (PF) peak torque, and power while ascending 10 steps, were used as explanators of sarcopenia. Receiver operating curves identified critical values for each explanator individually. Logistic regression models using all 3 explanators, and only PF torque and stair power, were also created. Receiver operating curve analyses identified the predicted probability that maximized each model's sensitivity and specificity. A leave-one-out cross validation was used to simulate the models' performance in an independent sample. RESULTS AND DISCUSSION Thirty-two participants were sarcopenic, and 11 were not. Critical values for individual explanators were 21% IMAT, 68 Nm PF torque, and 441 watts of stair power. Predicted probabilities of .76 and .67 were chosen as the optimal cutoff probabilities for the model combining all 3 explanators, and the model combining PF torque and stair power, respectively. The cross-validation analysis produced an accuracy of 82.4%, using the cutoff probability of .5, and an accuracy of 76.5% using the cutoff of 0.76. The area under the curve for the cross validation receiver operating curve analysis was 0.82. Critical values of leg % IMAT, PF torque, and stair power can classify individuals with diabesity as sarcopenic. The results of the cross validation give us confidence that the sample used in this study was representative of the target population, and suggests models created from this sample may perform well in externally derived data sets. CONCLUSION Clinicians may be able to use these critical values to select interventions that specifically target sarcopenia. Measures of % IMAT, PF torque, and stair power may offer a customized alternative to traditional sarcopenic classification systems, which may not be optimally suited to the common impairments among individuals with diabesity.
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Affiliation(s)
- Adam J Bittel
- 1Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri. 2Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
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38
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Lee KA, Lee NY, Park TS, Jin HY. Morphologic Comparison of Peripheral Nerves in Adipocyte Tissue from db/db Diabetic versus Normal Mice. Diabetes Metab J 2018; 42:169-172. [PMID: 29676547 PMCID: PMC5911521 DOI: 10.4093/dmj.2018.42.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
Present study investigated the morphologic changes of autonomic nerves in the adipose tissue in diabetic animal model. Male obese type 2 diabetic db/db mice and age matched non-diabetic db/m control mice were used. Epididymal adipose tissue from diabetic db/db mice with that from control heterozygous db/m mice was compared using confocal microscopy-based method to visualize intact whole adipose tissue. Immunohistochemistry with tyrosine hydroxylase for sympathetic (SP), choline acetyltransferase for parasympathetic (PSP), and protein gene product 9.5 (PGP 9.5) for whole autonomic nerves was performed. The quantity of immunostained portion of SP, PSP, and PGP 9.5 stained nerve fibers showed decreased trend in diabetic group; however, the ratio of SP/PSP of adipose tissue was higher in diabetic group compared with control group as follows (0.70±0.30 vs. 0.95±0.25, P<0.05; normal vs. diabetic, respectively). Both SP and PSP nerve fibers were observed in white adipose tissue and PSP nerve fibers were suggested as more decreased in diabetes based on our observation.
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Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Na Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
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Addison O, Kundi R, Ryan AS, Goldberg AP, Patel R, Lal BK, Prior SJ. Clinical relevance of the modified physical performance test versus the short physical performance battery for detecting mobility impairments in older men with peripheral arterial disease. Disabil Rehabil 2017; 40:3081-3085. [PMID: 28835180 DOI: 10.1080/09638288.2017.1367966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The study is to compare the Modified Physical Performance Test (MPPT) and Short Physical Performance Battery (SPPB) as metrics of mobility and function in older men with peripheral arterial disease (PAD). MATERIALS AND METHODS A total of 51 men (55-87 years) with PAD underwent functional testing including the SPPB, MPPT, Walking Impairment Questionnaire (WIQ), stair ascent, and 6-min walk distance. Individuals were grouped according to SPPB and MPPT scores as not limited on either, limited only on the MPPT, or limited on both. RESULTS The MPPT identified a higher proportion of patients as being functionally limited than the SPPB (p < 0.001). Men identified as limited only by the MPPT, and not the SPPB, were subsequently confirmed to have lower function on all measures compared to those not identified as limited by either the SPPB or the MPPT (p < 0.02). CONCLUSIONS These findings suggest the MPPT is an appropriate measure to identify early declines in men with PAD and may identify global disability better than SPPB. Implications for rehabilitation Individuals with peripheral arterial disease have low activity levels and are at risk for a loss of independence and global disability. Early detection of decline in mobility and global function would allow for interventions before large changes in ambulatory ability or a loss of functional independence occur. This study shows the Modified Physical Performance Test may be an appropriate test to identify early decline in function in men with peripheral arterial disease.
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Affiliation(s)
- Odessa Addison
- a Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research , Education and Clinical Center (GRECC) , Baltimore , MD , USA.,b Department of Physical Therapy and Rehabilitation Science , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Rishi Kundi
- c Department of Surgery, Division of Vascular Surgery , University of Maryland and Baltimore VA Medical Center , Baltimore , MD , USA
| | - Alice S Ryan
- a Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research , Education and Clinical Center (GRECC) , Baltimore , MD , USA.,d Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Andrew P Goldberg
- d Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Richa Patel
- c Department of Surgery, Division of Vascular Surgery , University of Maryland and Baltimore VA Medical Center , Baltimore , MD , USA
| | - Brajesh K Lal
- c Department of Surgery, Division of Vascular Surgery , University of Maryland and Baltimore VA Medical Center , Baltimore , MD , USA
| | - Steven J Prior
- a Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research , Education and Clinical Center (GRECC) , Baltimore , MD , USA.,d Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Parasoglou P, Rao S, Slade JM. Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy. Clin Ther 2017; 39:1085-1103. [PMID: 28571613 PMCID: PMC5503477 DOI: 10.1016/j.clinthera.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The present review highlights current concepts regarding the effects of diabetic peripheral neuropathy (DPN) in skeletal muscle. It discusses the lack of effective pharmacologic treatments and the role of physical exercise intervention in limb protection and symptom reversal. It also highlights the importance of magnetic resonance imaging (MRI) techniques in providing a mechanistic understanding of the disease and helping develop targeted treatments. METHODS This review provides a comprehensive reporting on the effects of DPN in the skeletal muscle of patients with diabetes. It also provides an update on the most recent trials of exercise intervention targeting DPN pathology. Lastly, we report on emerging MRI techniques that have shown promise in providing a mechanistic understanding of DPN and can help improve the design and implementation of clinical trials in the future. FINDINGS Impairments in lower limb muscles reduce functional capacity and contribute to altered gait, increased fall risk, and impaired balance in patients with DPN. This finding is an important concern for patients with DPN because their falls are likely to be injurious and lead to bone fractures, poorly healing wounds, and chronic infections that may require amputation. Preliminary studies have shown that moderate-intensity exercise programs are well tolerated by patients with DPN. They can improve their cardiorespiratory function and partially reverse some of the symptoms of DPN. MRI has the potential to bring new mechanistic insights into the effects of DPN as well as to objectively measure small changes in DPN pathology as a result of intervention. IMPLICATIONS Noninvasive exercise intervention is particularly valuable in DPN because of its safety, low cost, and potential to augment pharmacologic interventions. As we gain a better mechanistic understanding of the disease, more targeted and effective interventions can be designed.
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Affiliation(s)
- Prodromos Parasoglou
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York; Center for Advanced Imaging Innovation and Research (CAI(2)R), Department of Radiology, New York University School of Medicine, New York, New York.
| | - Smita Rao
- Department of Physical Therapy, New York University, New York, New York
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan; Biomedical Imaging Research Center, Michigan State University, East Lansing, Michigan
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Orlando G, Balducci S, Bazzucchi I, Pugliese G, Sacchetti M. The impact of type 1 diabetes and diabetic polyneuropathy on muscle strength and fatigability. Acta Diabetol 2017; 54:543-550. [PMID: 28285381 DOI: 10.1007/s00592-017-0979-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/01/2017] [Indexed: 01/01/2023]
Abstract
AIMS Although it is widely accepted that diabetic polyneuropathy (DPN) is linked to a marked decline in neuromuscular performance, information on the possible impact of type 1 diabetes (T1D) on muscle strength and fatigue remains unclear. The purpose of this study was to investigate the effects of T1D and DPN on strength and fatigability in knee extensor muscles. METHODS Thirty-one T1D patients (T1D), 22 T1D patients with DPN (DPN) and 23 matched healthy control participants (C) were enrolled. Maximal voluntary contraction (MVC) and endurance time at an intensity level of 50% of the MVC were assessed at the knee extensor muscles with an isometric dynamometer. Clinical characteristics of diabetic patients were assessed by considering a wide range of vascular and neurological parameters. RESULTS DPN group had lower knee extensor muscles strength than T1D (-19%) and the C group (-37.5%). T1D group was 22% weaker when compared to the C group. Lower body muscle fatigability of DPN group was 22 and 45.5% higher than T1D and C group, respectively. T1D group possessed a higher fatigability (29.4%) compared to C group. A correlation was found between motor and sensory nerve conduction velocity and muscle strength and fatigability. CONCLUSIONS Patients with T1D are characterised by both a higher fatigability and a lower muscle strength, which are aggravated by DPN. Our data suggest that factors other than nervous damage play a role in the pathogenesis of such defect.
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Affiliation(s)
- Giorgio Orlando
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Ilenia Bazzucchi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135, Rome, Italy.
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Zanuso S, Sacchetti M, Sundberg CJ, Orlando G, Benvenuti P, Balducci S. Exercise in type 2 diabetes: genetic, metabolic and neuromuscular adaptations. A review of the evidence. Br J Sports Med 2017; 51:1533-1538. [DOI: 10.1136/bjsports-2016-096724] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/18/2022]
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Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther 2017; 97:31-43. [PMID: 27445060 PMCID: PMC6256941 DOI: 10.2522/ptj.20160124] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022]
Abstract
Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person's insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group.
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Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes. Phys Ther 2016; 96:1861-1864. [PMID: 27909254 PMCID: PMC5131183 DOI: 10.2522/ptj.20160326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
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Hussain SJ, Frey-Law L. 3D strength surfaces for ankle plantar- and dorsi-flexion in healthy adults: an isometric and isokinetic dynamometry study. J Foot Ankle Res 2016; 9:43. [PMID: 27843491 PMCID: PMC5105238 DOI: 10.1186/s13047-016-0174-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/02/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The ankle is an important component of the human kinetic chain, and deficits in ankle strength can negatively impact functional tasks such as balance and gait. While peak torque is influenced by joint angle and movement velocity, ankle strength is typically reported for a single angle or movement speed. To better identify deficits and track recovery of ankle strength after injury or surgical intervention, ankle strength across a range of movement velocities and joint angles in healthy adults is needed. Thus, the primary goals of this study were to generate a database of strength values and 3-dimensional strength surface models for plantarflexion (PF) and dorsiflexion (DF) ankle strength in healthy men and women. Secondary goals were to develop a means to estimate ankle strength percentiles as well as examine predictors of maximal ankle strength in healthy adults. METHODS Using an isokinetic dynamometer, we tested PF and DF peak torques at five joint angles (-10° [DF], 0° [neutral], 10° [PF], 20° [PF] and 30° [PF]) and six velocities (0°/s, 30°/s, 60°/s, 90°/s, 120°/s and 180°/s) in 53 healthy adults. These data were used to generate 3D plots, or "strength surfaces", for males and females for each direction; surfaces were fit using a logistic equation. We also tested predictors of ankle strength, including height, weight, sex, and self-reported physical activity levels. RESULTS Torque-velocity and torque-angle relationships at the ankle interact, indicating that these relationships are interdependent and best modeled using 3D surfaces. Sex was the strongest predictor of ankle strength over height, weight, and self-reported physical activity levels. 79 to 97 % of the variance in mean peak torque was explained by joint angle and movement velocity using logistic equations, for men and women and PF and DF directions separately. CONCLUSIONS The 3D strength data and surface models provide a more comprehensive dataset of ankle strength in healthy adults than previously reported. These models may allow researchers and clinicians to quantify ankle strength deficits and track recovery in patient populations, using angle- and velocity-specific ankle strength values and/or strength percentiles from healthy adults.
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Affiliation(s)
- Sara J Hussain
- Department of Health and Human Physiology, The University of Iowa, E102 Field House, Iowa City, IA 52242 USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242 USA
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Addison O, Inacio M, Bair WN, Beamer BA, Ryan AS, Rogers MW. Role of Hip Abductor Muscle Composition and Torque in Protective Stepping for Lateral Balance Recovery in Older Adults. Arch Phys Med Rehabil 2016; 98:1223-1228. [PMID: 27840133 DOI: 10.1016/j.apmr.2016.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/09/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine differences in hip abductor strength and composition between older adults who primarily use medial step versus cross-step recovery strategies to lateral balance perturbations. DESIGN Cross-sectional. SETTING University research laboratory. PARTICIPANTS Community-dwelling older adults (N=40) divided into medial steppers (n=14) and cross-steppers (n=26) based on the first step of balance recovery after a lateral balance perturbation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Computed tomography scans to quantify lean tissue and intramuscular adipose tissue (IMAT) areas in the hip abductor, hip abductor isokinetic torque, and first step length. RESULTS Medial steppers took medial steps in 71.1% of trials versus 4.6% of trials with cross-steps. The cross-steppers when compared with medial steppers, had lower hip abductor IMAT (24.7±0.7% vs 29.9±2.8%; P<.05), greater abductor torque (63.3±3.6Nm vs 48.4±4.1Nm; P<.01), and greater normalized first step length (.75±.03 vs .43±.08; P<.001). There was no difference in hip abductor lean tissue between the groups (P>.05). CONCLUSIONS Our findings suggest that older adults who initially use a medial step to recover lateral balance have lower hip abductor torque and may be less able to execute a biomechanically more stable cross-step. This may be related to increased IMAT levels. Assessments and interventions for enhancing balance and decreasing fall risk should take the role of the hip abductor into account.
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Affiliation(s)
- Odessa Addison
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore, MD; Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Mario Inacio
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Woei-Nan Bair
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Brock A Beamer
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
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Cheuy VA, Hastings MK, Commean PK, Mueller MJ. Muscle and Joint Factors Associated With Forefoot Deformity in the Diabetic Neuropathic Foot. Foot Ankle Int 2016; 37:514-21. [PMID: 26666675 PMCID: PMC5111819 DOI: 10.1177/1071100715621544] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic forefoot joint deformities are a known risk factor for skin breakdown and amputation, but the causes of deformity are not well understood. The purposes of this study were to determine the effects of intrinsic foot muscle deterioration and limited ankle joint mobility on the severity of metatarsophalangeal joint (MTPJ) deformity, and determine the relationships between these potential contributing factors and indicators of diabetic complications (peripheral neuropathy and advanced glycation end products). METHODS A total of 34 participants with diabetic neuropathy (average age, 59 years; range 41-73) were studied. MTPJ angle and intrinsic foot muscle deterioration were measured with computed tomography and magnetic resonance imaging, respectively. Maximum ankle dorsiflexion was measured using kinematics. Skin intrinsic fluorescence served as a proxy measure for advanced glycation end product accumulation. RESULTS Total forefoot lean muscle volume (r = -0.52, P < .01) and maximum ankle dorsiflexion (r = -0.42, P < .05) were correlated with severity of MTPJ deformity. Together they explained 35% of the variance of MTPJ angle. Neuropathy was correlated with forefoot muscle deterioration (ρ = 0.53, P < .01). Skin intrinsic fluorescence was correlated to severity of neuropathy (r = 0.50, P < .01) but not maximum ankle dorsiflexion, or forefoot deterioration when controlling for neuropathy. CONCLUSION These results suggest that the interplay of intrinsic foot muscle deterioration and limited ankle mobility may be the primary contributor to the development of MTPJ deformity. Identifying these muscle and ankle motion impairments as risk factors for MTPJ deformity supports the need for targeted interventions early in the disease process to slow, or possibly stop the progression of deformity over time and reduce the risk of amputation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Victor A. Cheuy
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J. Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Hastings MK, Mueller MJ, Woodburn J, Strube MJ, Commean P, Johnson JE, Cheuy V, Sinacore DR. Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy. Clin Biomech (Bristol, Avon) 2016; 32:261-7. [PMID: 26588885 PMCID: PMC4779409 DOI: 10.1016/j.clinbiomech.2015.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes mellitus related medial column foot deformity is a major contributor to ulceration and amputation. However, little is known about the relationship between medial column alignment and function and the integrity of the soft tissues that support and move the medial column. The purposes of this study were to determine the predictors of medial column alignment and function in people with diabetes and peripheral neuropathy. METHODS 23 participants with diabetes and neuropathy had radiographs, heel rise kinematics, magnetic resonance imaging and isokinetic muscle testing to measure: 1) medial column alignment (Meary's angle--the angle between the 1st metatarsal longitudinal axis and the talar head and neck), 2) medial column function (forefoot relative to hindfoot plantarflexion during heel rise), 3) intrinsic foot muscle and fat volume, ratio of posterior tibialis to flexor digitorum tendon volume, 4) plantar fascia function (Meary's angle change from toes flat to extended) and 5) plantarflexor peak torque. Predictors of medial column alignment and function were determined using simultaneous entry multiple regression. FINDINGS Posterior tibialis to flexor digitorum tendon volume ratio and intrinsic foot muscle volume were significant predictors of medial column alignment (P<.05), accounting for 44% of the variance. Intrinsic foot fat volume and plantarflexor peak torque were significant predictors of medial column function (P<.05), accounting for 37% of the variance. INTERPRETATION Deterioration of medial column supporting structures predicted alignment and function. Prospective research is required to monitor alignment, structure, and function over time to inform early intervention strategies to prevent deformity, ulceration, and amputation.
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Affiliation(s)
- Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - James Woodburn
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow City, UK
| | - Michael J Strube
- Department of Psychology, Washington University in St. Louis, MO 63105, USA
| | - Paul Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey E Johnson
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Victor Cheuy
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David R Sinacore
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
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Vella J, Vella M, Cassar K, Camilleri L, Serracino-Inglott A, Azzopardi LM, LaFerla G. Factors Affecting Penetration of Ciprofloxacin in Lower Extremity Ischemic Tissues. INT J LOW EXTR WOUND 2015; 15:126-31. [PMID: 26711367 DOI: 10.1177/1534734615623707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to evaluate factors influencing the distribution of ciprofloxacin in tissue of patients suffering from varying degrees of peripheral arterial disease (PAD). Blood and tissue samples were collected from patients undergoing debridement or amputation procedures and the amount of ciprofloxacin in them was determined using high-performance liquid chromatography. All patients were administered a 200-mg dose of intravenous ciprofloxacin prior to the debridement or amputation procedure. Data, including patient gender, age, type of diabetes, presence of neuropathy, medications taken, and severity of PAD were collected. These data were then analyzed to determine factors influencing the concentrations of ciprofloxacin in tissue of the lower limbs. The Kruskal-Wallis test, Spearman correlation, and chi-square test were used to relate covariates and fixed factors with the concentration of ciprofloxacin in tissue. Following bivariate analysis, a 3-predictor regression model was fitted to predict tissue concentrations of ciprofloxacin given information about these predictors. Blood and tissue samples were collected from 50 patients having an average age of 68 years. Thirty-three patients were males and 35 patients suffered from type 2 diabetes. The average number of medications that these patients were taking was 10. The majority of patients (n = 35) were suffering from severe PAD. Tissue concentrations of ciprofloxacin were mainly related to plasma concentrations of ciprofloxacin, number of medications that the patients were taking and severity of PAD.
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