Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area

Effectiveness of a mHealth platform-based lifestyle integrated multicomponent exercise (PF-Life) program to reverse pre-frailty in community-dwelling older adults: a randomized controlled trial study protocol

Background

Pre-frailty represents an ideal window of opportunity to potentially prevent frailty and disability. Early and effective interventions to delay or reverse pre-frailty are public health imperative. The present trial aims to evaluate the effectiveness and underlying mechanisms of mobile health (mHealth) platform-supported lifestyle-integrated multicomponent exercise (PF-Life) to reverse pre-frailty in community-dwelling older adults.

Methods

This is an open-label, prospective, two-arm parallel randomized controlled trial with allocation concealment and outcome assessment blinding. We aim to recruit 140 pre-frail community-dwelling older adults who will be randomized into two groups. The control group will receive a health education program, while the intervention group will receive PF-Life training as planned for 1 year. The proportion of pre-frailty, functional performance (muscular strength, aerobic capacity, flexibility, and balance), body composition, and physical activity will be measured at pre-intervention, post-intervention, and 12-month follow-up. Inflammatory biomarkers will also be collected to explore the underlying mechanisms.

Discussion

This is the first study to evaluate the effects of a novel digital lifestyle-integrated multicomponent exercise for pre-frail older people. The results of this trial will provide much-needed information on the short-and long-term effects of PF-Life based on functional performance and body composition. Meanwhile, inflammatory biomarkers and physical activity levels will be used to elucidate the underlying mechanisms of PF-Life. The findings from this trial will provide evidence for the effectiveness of lifestyle multicomponent exercise intervention supported by the mHealth platform that may reverse or even halt the onset of frailty.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=176477, identifier ChiCTR2200063431.

The relationships between emerging adults self-efficacy and motivation levels and physical activity: a cross-sectional study based on the self-determination theory

Objectives

The study aims to examine the associations between exercise self-efficacy, motivation, physical activity, and body composition among emerging adults.

Design

Cross-sectional.

Methods

A convenience sample of 147 emerging adults participated in the Releasing Weight (RELEW) project. The InBody720 analyzer was used to measure body composition, and the International Physical Activity Questionnaire-Short, the Shortened Physical Activity Self-Efficacy Scale, and the Treatment Self-Regulation Questionnaire were used to measure self-reported physical activity, self-efficacy, and motivation. Structural Equation Modeling was used to exam the complex relationships among multiple variables. in this study. The Partial least squares structural equation modeling analysis with bootstrapping in Smart PLS 3 was employed to explore the path coefficients and t-values for the relationships that were thought to exist. Significance was determined using a threshold of p < 0.05.

Results

The mean age of 147 participants was 18.5 ± 1.87, of whom 51.7% were female, recruited for this study. Exercise self-efficacy has a significant positive correlation with exercise motivation (r = 0.220, p = 0.008) and physical activity (r = 0.279, p < 0.001). Exercise motivation does not demonstrate significant associations with physical activity (r = 0.094, p = 0.298). Utilizing SEM, the model explained 9.2% of exercise self-efficacy, 11.8% of physical activity, and 68.3% of body composition variance. Mediation analysis revealed that exercise self-efficacy partially mediated the relationship between exercise motivation and physical activity (β = 0.106, t = 2.538, p < 0.05), and physical activity partially mediated the relationship between exercise self-efficacy and body composition (β = -0.296, t = 4.280, p < 0.001).

Conclusion

This study sheds light on the complex relationships among motivation, self-efficacy, physical activity and body composition during emerging adulthood. Our results highlight the mediating role of self-efficacy and its impact on physical activity behaviors, offering valuable insights for targeted interventions and policy development to improve health outcomes in this demographic.

Association between bone health and dynapenic obesity in postmenopausal women

AIM

The combination of dynapenia (age-related muscle weakness) and obesity is referred to as dynapenic obesity. We examined the associations between dynapenic obesity and cortical bone thickness and trabecular bone density.

METHODS

The participants were 797 community-dwelling postmenopausal women (with an average age of 62.5 years) who were stratified into normopenia without obesity, dynapenia without obesity (dynapenia), normopenia with obesity (obesity) and dynapenia with obesity (dynapenia obesity) groups based on their grip strength and body fat percentage. Cortical bone thickness and trabecular bone density were measured using ultrasonic bone densitometry. The participants were further divided into those with low cortical bone thickness and low trabecular bone density. Logistic regression analysis was used to identify associated factors.

RESULTS

Individuals with dynapenia (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.16-2.68), obesity (OR 2.46, 95% CI 1.62-3.75) and dynapenic obesity (OR 4.07, 95% CI 2.44-6.79) all significantly increased the odds of low cortical bone thickness. Conversely, the odds of low trabecular bone density were significantly lower in the obesity group (OR 0.65, 95% CI 0.43-0.99) and dynapenic obesity group (OR 0.60, 95% CI 0.37-0.97).

CONCLUSIONS

Dynapenic obesity was found to be associated with cortical bone thinning that might compromise bone health. Postmenopausal women with dynapenic obesity might need to be closely monitored for preserving bone health. Geriatr Gerontol Int 2024; 24: 378-384.

Association between visceral fat area and diabetic retinopathy among people with type 2 diabetes mellitus: a cross-sectional study in Ningbo, Zhejiang Province, China

Aim

The objective of this study is to investigate the relationship between visceral fat area (VFA) and diabetic retinopathy (DR) in the context of type 2 diabetes mellitus (T2DM) within Ningbo, China.

Methods

The data of a total of 3,707 subjects with T2DM treated at The First Affiliated Hospital of Ningbo University were enrolled. The existence and severity of diabetic retinopathy were assessed by employing the 45° two-field stereoscopic digital photography. Subjects were categorized into four distinct groups: those without DR (NDR), individuals with mild non-proliferative DR (mild NPDR), people with moderate non-proliferative DR (moderate NPDR), and those suffering from vision-threatening DR (VTDR). Bio-electrical impedance was employed to estimate the Visceral fat area (VFA). Multinomial logistic regression models were utilized to evaluate the association between VFA and DR.

Results

The mean VFA in patients without diabetic retinopathy (NDR) was notably lower compared to that of patients with diabetic retinopathy (DR) (85.21 ± 37.78 vs. 97.37 ± 44.58 cm2, p < 0.001). As the severity of DR increased, VFA increased gradually but insignificantly (94.41 ± 43.13 cm2, 96.75 ± 40.82 cm2, 100.84 ± 49.34 cm2, p = 0.294). After adjusting the confounding factors, there was an association identified between VFA and the occurrence of DR (OR = 1.020, 95% CI = 1.016-1.024). It showed that regardless of BMI, whether it's less than 25 kg/m2 or greater than or equal to 25 kg/m2, a higher VFA (≥100 cm2) level came with a higher prevalence of DR (p < 0.001).

Conclusion

The outcomes of this research indicate a modest association between VFA and the incidence of DR among Chinese patients who have been diagnosed with T2DM in Ningbo.

Association between visceral adiposity and generalized anxiety disorder (GAD)

BACKGROUND AND OBJECTIVES

Due to an increased rate of inflammation in generalized anxiety disorder (GAD), insight into the mediating factors in the onset and recurrence of the inflammatory response can help to achieve novel treatments for alleviating the risk of GAD. In the current study, we aimed to evaluate the possible relationship between visceral adipose tissue (VAT) as an important intermediary in inflammation pathways and GAD in participants of the Employees' Health Cohort Study of Iran (EHCSIR).

METHOD

We analyzed the data from 3889 included participants aged > 18 years in the EHCSIR study, which were collected from 2017 to 2020. Lifetime and 12-month GAD were assessed using the Composite International Diagnostic Interview (CIDI-2.1) questionnaire. The adjusted prevalence ratio was computed to evaluate the association between GAD and visceral adiposity index (VAI), GAD and visceral fat area (VFA), GAD and body mass index (BMI) and ultimately GAD and waist circumference (WC) in males and females using STATA software.

RESULTS

Log-binomial analysis showed a higher prevalence ratio of 12-month GAD associated with VFA in women [PR: 1.42, CI: 1.07-1.87, P: 0.015]. The prevalence of lifetime GAD was higher in obese women (BM1 > 30) [PR: 2.35, CI: 1.07-5.13, P:0.03] than in women with normal BMI. Women with higher VAI were also significantly more likely to suffer lifetime GAD [PR: 1.25, CI: 1.05]. 1.48, P:0.01]. In males, the prevalence of lifetime diagnosed GAD per 1 standard deviation increase in VFA was 0.65 [CI: 0.46-0.91, P: 0.01].

CONCLUSION

Visceral adiposity as a positive agent was associated with GAD prevalence in women. The presence of GAD symptoms showed no relationship to VFA in men.

Cutoffs of different body measurement indexes of central obesity in patients with type 2 diabetes

Few research discuss whether the body measurement indexs of obesity in general populations is applicable to patients with type 2 diabetes. We explore the optimal cutoffs of visceral fat area (VFA) and subcutaneous fat area (SFA) in the diagnosis of central obesity and the cutoffs of corresponding waist circumference (WC) and body mass index (BMI) in patients with Type 2 Diabetes (T2D). Cross-sectional cohort study. 1057 patients with T2D (550 males and 507 females) aged 18 or above that satisfied the criteria were included. The definition and diagnostic criteria of Metabolic syndrome (Mets) were analyzed according to the 2020 Chinese Diabetes Society (CDS) Guideline. The VFA and SFA were measured by bioelectrical impedance analysis (BIA). The optimal VFA and SFA cutoffs and corresponding WC and BMI when two or more nonadipose components of MetS (without central obesity) were met were analyzed by ROC curve. Among all of the T2D patients, the optimal VFA cutoff for identifying two or more nonadipose components of MetS was 73.30 cm2 for females and 69.20 cm2 for males, while the optimal SFA cutoff was 186.70 cm2 for females and 123.30 cm2 for males. The ROC area under curve (AUC) of VFA for identifying two or more nonadipose components of MetS was higher than that of SFA (Female: 0.65 vs. 0.58, P = 0.01). The VFA cutoff of newly diagnosed T2D patients (females = 86.10 cm2, males = 69.00 cm2) was higher than that of non-newly diagnosed T2D patients (females = 73.30 cm2, males = 65.40 cm2). A stratification analysis of gender and whether newly diagnosed with T2D or not showed that the WCs corresponding to VFA were 85.00 cm and BMI was about 24.00 kg/m2. VFA measured by BIA can be a non-invasive method to detect central obesity in patients with T2D, the corresponding WC were 85.00 cm and BMI was 24.00 kg/m2.

Comparison of therapeutic efficacy and safety of sitagliptin, dapagliflozin, or lobeglitazone adjunct therapy in patients with type 2 diabetes mellitus inadequately controlled on sulfonylurea and metformin: Third agent study

AIMS

Compare the efficacy and safety of sitagliptin, dapagliflozin, and lobeglitazone in patients with uncontrolled type 2 diabetes, despite metformin and sulfonylurea therapy.

METHODS

The study randomized patients into three groups, receiving sitagliptin 100 mg, dapagliflozin 10 mg, or lobeglitazone 0.5 mg daily (n = 26 each) and monitored changes in biochemical parameters and body composition for 24 months. The primary efficacy endpoint was changes in HbA1c at 24 months.

RESULTS

The mean change in HbA1c in the sitagliptin, dapagliflozin, and lobeglitazone groups was -0.81 ± 0.21%, -1.05 ± 0.70%, and -1.08 ± 0.98%, after 24 months. Dapagliflozin treatment significantly lowered systolic blood pressure by 5.5 mmHg and alanine aminotransferase levels. Dapagliflozin and lobeglitazone treatment significantly reduced proteinuria and insulin resistance. Dapagliflozin decreased whole body fat percentage by 1.2%, whereas sitagliptin and lobeglitazone increased it by 1.1% and 1.8%, respectively. Whole body muscle percentage increased in the dapagliflozin group and decreased in the lobeglitazone group. The safety profiles of the three treatments were comparable.

CONCLUSIONS

All three drugs displayed good glucose-lowering efficacy and comparable safety profiles. However, dapagliflozin therapy produced favorable changes in body composition. Dapagliflozin may be a suitable adjunct therapy for patients with type 2 diabetes seeking to improve their body composition.

Comparison of the effects of gemigliptin versus glimepiride on cardiac function in patients with type 2 diabetes uncontrolled with metformin: The gemi-heart study

AIM

To investigate the effects of gemigliptin on cardiac function and compare the effects of gemigliptin and glimepiride in patients with type 2 diabetes (T2D).

MATERIALS AND METHODS

Sixty T2D patients being treated with metformin were assigned to a gemigliptin group (50 mg daily) or a glimepiride group (2 mg daily) for 24 weeks. The preadjudicated extension period was up to 52 weeks. Glucose metabolism variables and cardiac biomarkers were measured. Echocardiography was used to evaluate cardiac functions.

RESULTS

The HbA1c levels decreased significantly from 8.1% ± 0.6% to 6.8% ± 0.6% in the gemigliptin group and from 8.1% ± 0.6% to 7.0% ± 0.7% in the glimepiride group, without a between-group difference. Gemigliptin reduced insulin resistance, high sensitivity C-reactive protein and low-density lipoprotein cholesterol levels, and blood pressure, and increased adiponectin level compared with glimepiride therapy. Gemigliptin induced favourable changes in body composition. Left ventricular end-diastolic volume decreased in the gemigliptin group but increased in the glimepiride group, with a borderline between-group difference. Cardiac biomarkers did not change significantly in either group. At 52 weeks, the HbA1c levels in both groups increased slightly; 7.3% ± 0.8% in the gemigliptin group versus 7.7% ± 1.3% in the glimepiride group, without a between-group difference.

CONCLUSIONS

Gemigliptin had a comparable glucose-lowering efficacy without deleterious effects on cardiac functions or on biomarkers reflective of myocardial injury or heart failure during the 24-week observation period. However, larger, longer-term studies are needed to confirm these findings.

Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China

BACKGROUND

Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.

METHODS

Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m² ≤ BMI < 24 kg/m²; overweight when 24 kg/m² ≤ BMI < 28 kg/m²; and obesity when BMI ≥ 28 kg/m². Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm². Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.

RESULTS

In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm². Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).

CONCLUSIONS

T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.

Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study

The efficacy and safety of medications can be affected by alterations in gut microbiota in human beings. Among antidiabetic medications, incretin-based therapy such as dipeptidyl peptidase 4 inhibitors might affect gut microbiomes, which are related to glucose metabolism. This was a randomized, controlled, active-competitor study that aimed to compare the effects of combinations of gemigliptin−metformin vs. glimepiride−metformin as initial therapies on gut microbiota and glucose homeostasis in drug-naïve patients with type 2 diabetes. Seventy drug-naïve patients with type 2 diabetes (mean age, 52.2 years) with a glycated hemoglobin (HbA1c) level ≥7.5% were assigned to either gemigliptin−metformin or glimepiride−metformin combination therapies for 24 weeks. Changes in gut microbiota, biomarkers linked to glucose regulation, body composition, and amino acid blood levels were investigated. Although both treatments decreased the HbA1c levels significantly, the gemigliptin−metformin group achieved HbA1c ≤ 7.0% without hypoglycemia or weight gain more effectively than did the glimepiride−metformin group (59% vs. 24%; p < 0.05). At the phylum level, the Firmicutes/Bacteroidetes ratio tended to decrease after gemigliptin−metformin therapy (p = 0.065), with a notable depletion of taxa belonging to Firmicutes, including Lactobacillus, Ruminococcus torques, and Streptococcus (all p < 0.05). However, regardless of the treatment modality, a distinct difference in the overall gut microbiome composition was noted between patients who reached the HbA1c target goal and those who did not (p < 0.001). Treatment with gemigliptin−metformin resulted in a higher achievement of the glycemic target without hypoglycemia or weight gain, better than with glimepiride−metformin; these improvements might be related to beneficial changes in gut microbiota.

Revised Protein Sparing Diet in Obesity and Type 2 Diabetes Mellitus

Effective nutrition therapy is a pressing issue in obesity and type 2 diabetes mellitus (T2DM) management. As such, this research aimed to determine the performance of a revised dietary strategy built on the protein-sparing diet in obesity and type 2 diabetes mellitus with regard to obtaining a rapid and stable improvement in glucometabolic control, body weight, body composition, and energy metabolism when applying the strategy in just twenty-one days. The revised protein-sparing diet differs from the traditional protein-sparing modified fast (PSMF) because it does not include foods. The daily calorie intake of this diet is exclusively derived from Isolate whey protein in addition to a formulation of Isolate whey protein enriched with essential amino acids in free form, with the addition of lipids such as extra virgin olive oil and coconut oil as a source of medium chain fatty acids, where the latter is taken for only the first four days of the diet, together with the use, for the same duration, of extended-release metformin, as the only antihyperglycemic allowed. Anthropometric measurements, bioimpedance analysis, indirect calorimetry, and blood chemistry assessments were conducted at the beginning of the study, time 0 (T0), and at the end, time 1 (T1), i.e., on the 21st day. The main outcomes of the revised protein-sparing diet after only twenty-one days were a reduction in body weight with the predominant loss of visceral atherogenic abdominal fat and, therefore, a possible contextual reduction in ectopic fat deposits together with a simultaneous reduction in insulin resistance and normalization of insulin levels, maintenance of free fat mass and basal metabolism, restoration of metabolic flexibility, and improvement of the glucometabolic and lipidic parameters. These results demonstrate the promising potential of the revised protein-sparing diet as an "etiologic tool" in the integrated nutritional treatment of metabolic diseases such as obesity and type 2 diabetes mellitus.

Measurement of visceral fat for early prediction of prediabetes-Cross-sectional study from Southern India

Objective

Prediabetes is a precursor to type 2 diabetes mellitus and routine screening of prediabetes is crucial. Visceral fat (VF) is associated with prediabetes and insulin resistance. Ethnic and racial differences resulting in different levels of VF in the Indian population necessitates an India-specific study. There is a dearth of literature on the cut-off values of VF measured using a bioelectrical impedance analyzer (BIA) to predict prediabetes in the Indian population. Hence, the main objective of this study was to determine the sex-specific cut-off value of VF on BIA to predict prediabetes in the Indian population.

Methods

Three hundred individuals aged 18-55 years of both sexes were selected for this cross-sectional study. VF was evaluated as a part of body composition analysis using BIA. The body composition variables for the prediction of prediabetes were examined using backward logistic regression. Optimal cut-off levels of VF to predict prediabetes were identified using receiver operator characteristic curve (ROC) analysis.

Results

VF, total fat, and age were found to be associated with prediabetes (p ≤ 0.05). In females, the cut-off value of VF for predicting prediabetes was identified as 8 with 77.8% sensitivity and 69.3% specificity; in males, it was 11 with 84% sensitivity and 62.9% specificity.

Conclusion

This study contributes to the sex-specific cut-off values of VF level on BIA that can be used for predicting prediabetes in the Indian population.

Associations between visceral adipose tissue estimates produced by near-infrared spectroscopy, mobile anthropometrics, and traditional body composition assessments and estimates derived from dual-energy X-ray absorptiometry

Assessments of visceral adipose tissue (VAT) are critical in preventing metabolic disorders; however, there are limited measurement methods that are accurate and accessible for VAT. The purpose of this cross-sectional study was to evaluate the association between VAT estimates from consumer-grade devices and traditional anthropometrics and VAT and subcutaneous adipose tissue (SAT) from dual-energy X-ray absorptiometry (DXA). Data were collected from 182 participants (female = 114; White = 127; Black/African-American (BAA) = 48) which included anthropometrics and indices of VAT produced by near-infrared reactance spectroscopy (NIRS), visual body composition (VBC) and multifrequency BIA (MFBIA). VAT and SAT were collected using DXA. Bivariate and partial correlations were calculated between DXAVAT and DXASAT and other VAT estimates. All VAT indices had positive moderate–strong correlations with VAT (all P < 0·001) and SAT (all P < 0·001). Only waist:hip (r = 0·69), VATVBC (r = 0·84), and VATMFBIA (r = 0·86) had stronger associations with VAT than SAT (P < 0·001). Partial associations between VATVBC and VATMFBIA were only stronger for VAT than SAT in White participants (r = 0·67, P < 0·001) but not female, male, or BAA participants individually. Partial correlations for waist:hip were stronger for VAT than SAT, but only for male (r = 0·40, P < 0·010) or White participants (r = 0·48, P < 0·001). NIRS was amongst the weakest predictors of VAT which was highest in male participants (r = 0·39, P < 0·010) but non-existent in BAA participants (r = –0·02, P > 0·050) after adjusting for SAT. Both anthropometric and consumer-grade VAT indices are consistently better predictors of SAT than VAT. These data highlight the need for a standardised, but convenient, VAT estimation protocol that can account for the relationship between SAT and VAT that differs by sex/race.

Accuracy of Y-scope, a newly developed portable abdominal impedance analyzer, for the assessment of abdominal visceral fat area

Aim

This study was conducted to evaluate the accuracy of a newly developed multifrequency segmental (MFS) bioelectrical impedance analysis (BIA) method using an additional portable abdominal (PA) impedance analyzer, in the assessment of abdominal visceral fat area (VFA).

Materials and methods

One hundred healthy Korean subjects aged 19 years or over (43 men and 57 women) were recruited, and VFA was estimated by a conventional MFS-BIA machine and a new MFS-BIA machine with a PA-BIA device, indicating MFS-VFA and MFS&PA-VFA, respectively. The accuracy of the VFA values was compared with those evaluated with CT at the level of the umbilicus (CT-VFA).

Results

The mean age was 41 years and mean body mass index (BMI) was 24.4 kg/m². The mean ± SD VFAs measured by CT, conventional MFS-BIA, and new MFS&PA-BIA together were 93.4 ± 60.9, 92.7 ± 53.4, and 93.6 ± 55.4 cm², respectively. Correlation coefficients comparing CT-VFA with MFS-VFA and MFS&PA-VFA were 0.612 and 0.932, respectively (P < 0.001 for both). The mean difference between CT-VFA and MFS&PA-VFA was less affected by age, sex, and BMI compared with that between CT-VFA and MFS-VFA. Intraclass correlation coefficient (95% CI) between CT-VFA and MFS&PA-VFA was also greater than that between CT-VFA and MFS-VFA, 0.96 (0.95–0.98) vs. 0.76 (0.64–0.84), respectively.

Conclusion

In this study, application of a newly developed MFS-BIA machine combined with a PA-BIA device significantly improved the correlation with CT-measured VFA without proportional error. This novel approach using advanced technology may be able to provide more reliable estimates of abdominal VFA.

analysis combined with sagittal abdominal diameter for abdominal subcutaneous fat measurement

Abdominal subcutaneous fat tissue (ASFT) is an independent predictor of mortality. This prospective observational study aimed to establish a rapid, safe, and convenient estimation equation for abdominal subcutaneous fat area (SFA) using bioimpedance analysis (BIA) combined with sagittal abdominal diameter (SAD). A total of 520 adult subjects were recruited and were randomly divided into 2/3 (n = 346) and 1/3 (n = 174) to form a modeling group (MG) and a validation group (VG), respectively. Each subject's abdomen was scanned using computed tomography to obtain target variables (SFA_CT). Predictor variables for all subjects included bioimpedance index (h²/Z), anthropometric parameters height (h), weight (W), waist circumference (WC), hip circumference (HC), and SAD, along with age and sex (male =1, female = 0). SFA estimation equation SFA_BIA+SAD was established for the MG using stepwise multiple regression analysis. Cross-validation was performed using VG to evaluate the performance of the SFA_BIA+SAD estimation equation. Stepwise multiple regression analysis was applied from the MG, including SFA_BIA+SAD = 49.89 + 1.09 SAD-29.90 Sex + 4.71 W-3.63 h²/Z-1.50 h (r = 0.92, SEE = 28.10 cm², n = 346, p < 0.001). Mean differences in SFA_BIA+SAD relative to SFA_CT were -1.21 ± 21.53, 2.85 ± 27.16, and -0.98 ± 36.6 cm² at different levels of obesity (eutrophic, overweight, obese), respectively. This study did not have a large number of samples in different fields, so it did not have completely external validity. Application of BIA combined with SAD in anthropometric parameters achieves fast, accurate and convenient SAF measurement. Results of this study provide a simple, reliable, and practical measurement that can be widely used in epidemiological studies and in measuring individual SFA.

Visceral Fat Area Measured by Abdominal Bioelectrical Impedance Analysis in School-Aged Japanese Children

Abdominal bioelectrical impedance analysis (aBIA) has been in use to measure visceral fat area (VFA) in adults. Accurately measuring visceral fat using aBIA in children is challenging. Forty-six school-aged Japanese children aged 6–17 years (25 boys and 21 girls) were included in this study. All were measured, and their VFA obtained using aBIA (VFA-aBIA) and abdominal computed tomography (CT) (VFA-CT) were compared. VFA-aBIA was corrected using the Passing–Bablok method (corrected VFA-aBIA). The relationships between corrected VFA-aBIA and obesity-related clinical factors were analyzed, including non-alcoholic fatty liver disease (NAFLD) and serum leptin and adiponectin levels. Boys had higher VFA-CT than girls (p = 0.042), although no significant differences were found in their waist circumference, waist-to-height ratio, and body mass index. The corrected VFA-aBIA using y = 9.600 + 0.3825x (boys) and y = 7.607 + 0.3661x (girls) correlated with VFA-CT in both boys and girls. The corrected VFA-aBIA in patients with NAFLD was higher than that in those without NAFLD. Serum leptin and adiponectin levels were positively and negatively correlated with corrected VFA-aBIA, respectively. In conclusion, corrected VFA-aBIA was clearly correlated with VFA-CT and was related to NAFLD and serum leptin and adiponectin levels in school-aged Japanese children.

Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial

INTRODUCTION

Depression is common, increasing among adolescents and carries risk of disability, lower educational achievements, cardiovascular disease, substance abuse, self-harm and suicide. The effects of evidence-based treatments with medication or psychotherapy are modest. Aerobic exercise is a promising intervention for adolescents with depression, but available studies are hampered by methodological shortcomings. This study aims to evaluate aerobic group exercise versus an active comparator of leisure group activities in adolescents from clinical services with mild-to-moderate depression.

METHODS AND ANALYSIS

This study is a multicentre randomised controlled trial at four psychiatric clinics in Sweden. Participants (n=122) will be randomised 1:1 to group exercise delivered by exercise professionals and supported by mental health (MH) workers or leisure activities lead by the same MH workers for 1 hour three times a week for 12 weeks. Participants will be assessed at baseline, single blind after 13 weeks and 26 weeks and openly after 1 year. Participants randomised to the leisure group will be offered exercise in the open phase. The primary outcome is clinician-rated Children's Depression Rating Scale-Revised. Secondary outcomes are self-rated Quick Inventory of Depressive Symptomatology, self-rated functioning; clinician-rated improvement and functioning; objectively measured aerobic capacity, muscular strength, muscular endurance, body composition and presence or activity of selected biological markers of neuroprotection and neuroinflammation in blood samples. Further outcomes are cost-effectiveness and adolescents', parents' and coaches' experiences of the interventions and an exploration of how the adolescents' health and lifestyle are influenced by the interventions through qualitative interviews.

ETHICS AND DISSEMINATION

The study is approved by the Swedish Ethical Review Authority (Ref. 2021-05307-01). Informed consent in writing will be provided from patients and parents of participants below 15 years of age. The results of this study will be communicated to the included participants and healthcare providers and also submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05076214.

A Comparative Study of High-Frequency Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry for Estimating Body Composition

Though bioelectrical impedance analysis (BIA) is a favorable tool for assessing body composition to estimate nutritional status and physical fitness, such as sarcopenia, there are accuracy issues. Hence, high-frequency (HF) BIA equipment uses an additional frequency of 2 and 3 MHz and has been developed as a commercial model. However, there are no studies validating the accuracy and safety of HF-BIA. Therefore, this study aims to assess the validity of HF-BIA in analyzing body composition relative to dual-energy X-ray absorptiometry (DEXA). Appendicular lean mass (ALM), fat-free mass (FFM), and percentage of body fat (PBF) were assessed by HF-BIA and DEXA in 109 individuals; 50.5% (n = 55) were males. The average age and body mass index (BMI) were 43.4 ± 14.7 years and 25.5 ± 6.7 in males and 44.9 ± 14.1 years and 24.0 ± 6.4 in females, respectively. The HF-BIA results showed a high correlation with the DEXA results for assessing ALM (standard coefficient beta (β) ≥ 0.95), FFM (β ≥ 0.98, coefficient of determinations (R²) ≥ 0.95), and PBF (β ≥ 0.94, R² ≥ 0.89). Body composition measured by HF-BIA demonstrated good agreement with DEXA in Korean adults.

Nutritional Influences on Locomotive Syndrome

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investigated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B₁ intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsaturated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

Association of metabolic syndrome traits with urinary biomarkers in Japanese adults

BACKGROUND

Although metabolic syndrome traits are risk factors for chronic kidney disease, few studies have examined their association with urinary biomarkers.

METHODS

Urinary biomarkers, including A-megalin, C-megalin, podocalyxin, albumin, α₁-microglobulin, β₂-microglobulin, and N-acetyl-β-D-glucosaminidase, were cross-sectionally assessed in 347 individuals (52.7% men) with a urine albumin-to-creatinine ratio (ACR)  < 300 mg/g in a health checkup. Metabolic syndrome traits were adopted from the National Cholesterol Education Program (third revision) of the Adult Treatment Panel criteria modified for Asians.

RESULTS

Participants had a mean body mass index, estimated glomerular filtration rate (eGFR), and median ACR of 23.0 kg/m², 74.8 mL/min/1.73 m², and 7.5 mg/g, respectively. In age- and sex-adjusted logistic regression analysis, A-megalin and albumin were significantly associated with the clustering number of metabolic syndrome traits (3 or more). After further adjustment with eGFR, higher quartiles of A-megalin and albumin were each independently associated with the clustering number of metabolic syndrome traits (adjusted odds ratio for A-megalin: 1.30 per quartile, 95% CI 1.03-1.64; albumin: 1.42 per quartile, 95% CI 1.12-1.79).

CONCLUSIONS

Both urinary A-megalin and albumin are associated with the clustering number of metabolic syndrome traits. Further research on urinary A-megalin is warranted to examine its role as a potential marker of kidney damage from metabolic risk factors.

Association Between Elevated Thyroid Peroxidase Antibody and Abdominal Fat Distribution in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

Obesity and autoimmune thyroid disease (AITD) are both common disorders in the general population, which are major drivers for adverse medical conditions. While an interaction between thyroid function and visceral obesity is thought to exist, but very few studies have examined the relationship between AITD and visceral obesity, especially in the patients with type 2 diabetes mellitus (T2DM). In the present study, we investigated the association between elevated thyroid peroxidase antibody (TPOAb) titer and visceral fat area in T2DM patients.

METHODS

A total of 390 T2DM patients who met the criteria for admission and joined the National Metabolic Management Center (MMC) in the Zhejiang Provincial People's Hospital from April 2020 to December 2020 were enrolled in this study. The participants were divided into two groups based on visceral obesity. Thyroid function, thyroid associated antibody and other metabolic indicators were measured by blood tests. The visceral fat area (VFA) and the subcutaneous fat area (SFA) were measured by bioelectrical impedance analysis.

RESULTS

There were 185 participants (47.4%) had visceral obesity. The positive rate of TPOAb was significantly higher in T2DM patients with visceral obesity (12.97% vs 5.37%, p < 0.01). Free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) were both significantly higher in T2DM patients with visceral obesity (p < 0.05). The increased TPOAb titer was significantly positively correlated with visceral fat area (r = 0.175, p < 0.01). Binary logistic analysis showed that the positive rate of TPOAb was associated with an increased risk of visceral obesity [(OR) 4.258, 95% confidence interval (CI) 1.594, 11.375, p = 0.004].

CONCLUSION

TPOAb-positive is more common in T2DM patients with visceral obesity, which has some effects on visceral obesity independent of thyroid function. This suggests that elevated TPOAb titer is a predictor of visceral obesity in T2DM patients.

Accuracy of Waist Circumference Measurement using the WHO versus NIH Protocol in Predicting Visceral Adiposity Using Bioelectrical Impedance Analysis among Overweight and Obese Adult Filipinos in a Tertiary Hospital

Objectives

The study aimed to compare the performance of weight circumference (WC) measurement using the World Health Organization (WHO) versus National Institutes of Health (NIH) protocol in identifying visceral adiposity, and to determine the association of WC with cardiometabolic risk factors among overweight and obese adult Filipinos.

Methodology

A retrospective study involving 221 subjects (99 males, 122 females) evaluated at an outpatient weight intervention center of a tertiary hospital. The WC was measured at the superior border of the iliac crest (WC-NIH) and midway between the lowest rib and the iliac crest (WC-WHO) for each patient. Using visceral fat rating (VF) derived via bioelectrical impedance analysis (BIA) as reference standard, diagnostic accuracy tests for both protocols (using cut-offs of ≥90 cm in males and ≥80 cm in females) were done. Cardiometabolic parameters were also obtained, and binary logistic regression was performed to determine associations with WC.

Results

Among males, WC-WHO had 96% sensitivity (95% CI 88.8%-99.2%) and 25% specificity (95% CI 9.77%-46.7%) while WC-NIH had 94.7% sensitivity (95% CI 86.9%-98.5%) and 29.2% specificity (95% CI 12.6%-51.1%) to predict high VF >12. Among females, WC-WHO had 100% sensitivity (95% CI 90%-100%) and 24.1% specificity (95% CI 15.6%-34.5%) while WC-NIH had 100% sensitivity (95% CI 90%-100%) and 4.6% specificity (95% CI 1.3%-11.4%). Prevalence of high VF was significantly greater among males – 75.8% (95% CI 66.1%-83.8%) vs. 28.7% (95% CI 20.9%-37.6%) in females (p<0.001). Among females, WC-NIH tended to have higher measurements than WC-WHO by an average of 4.67 cm. Females with WC-WHO measurements of at least 80 cm were approximately four times more likely to have low (<50 mg/dL) HDL levels (cOR 3.82, p=<0.05), even after adjusting for age (aOR 3.83, p=<0.05).

Conclusion

WC measurement using the WHO and NIH protocols were both highly sensitive but had low specificity in predicting high VF estimated via BIA among overweight and obese adult Filipinos in this study. WC-NIH measurements tended to be higher among the females, which may affect classification of central obesity when using this protocol. WC ≥80 cm measured using the WHO protocol was associated with low HDL levels among female subjects. Prospective studies conducted among the general Filipino population are recommended to verify these findings.

Precision and accuracy of bioelectrical impedance analysis devices in supine versus standing position with or without retractable handle in Caucasian subjects

BACKGROUND & AIMS

Bioelectrical impedance analysis (BIA) could be facilitated in subjects who are able to stand by using scales without (BIA_std4) or with a retractable handle (BIA_std8), provided that they are as precise as BIA devices commonly used in the supine position in the hospital setting (BIA_sup). This observational prospective cross-sectional study aimed to compare the precision and accuracy of BIA_std4, BIA_std8 and BIA_sup in a Caucasian population.

METHODS

Fat mass percentage (FM%) was measured in 160 healthy Caucasian subjects (80 men/80 women) aged 20-60 years, with a body mass index (BMI) ≥18.5 and < 30 kg/m², using the HAGRID Body Fat Scales (Huawei Technologies Co., Ltd., China) in BIA_std4 or BIA_std8 mode, and the Nutriguard-M (Data Input GmbH, Germany) as BIA_sup. Intra-unit and inter-unit precisions of each device were evaluated by calculating the coefficients of variation (CV%) of 3 measurements with 3 different units of each device. Inter-device precisions were evaluated with Pearson correlations, Bland-Altman plots, and repeated measures ANOVA followed by post-hoc Bonferroni tests. Accuracy of these BIA devices was estimated in a subgroup of 16 subjects, using comparison with dual-energy X-ray absorptiometry (DXA).

RESULTS

The study population was 40 ± 12 years old, with a body height and weight of 171 ± 10 cm and 72.2 ± 11.5 Kg, respectively. All three devices were very precise with intra-unit CV% of 0.5%, 0.9%, and 0.3% and inter-unit CV% of 0.5%, 1.1%, and 0.4% for BIA_std4, BIA_std8 and BIA_sup, respectively. Inter-device precision was ±2.1% for BIA_std4/BIA_sup, ±1.9% for BIA_std8/BIA_sup, and ±1.3% for BIA_std8/BIA_std4. Bland-Altman plots showed bias ±1.96 SD of 0.3 ± 5.2% for BIA_std4/BIA_sup, -0.4 ± 4.5% for BIA_std8/BIA_sup and -0.6 ± 3.1% for BIA_std8/BIA_std4. Compared to DXA, all three devices tended to underestimate FM% in men with low BMI, while only BIA_std4 and BIA_std8 tended to overestimate FM% in women with high BMI. FM% measurement accuracy was ±2.6% for BIA_sup/DXA, ±3.3% for BIA_std4/DXA, and ±3.4% for BIA_std8/DXA.

CONCLUSIONS

Both BIA_std4 and BIA_std8 show a good intra- and inter-unit precision close to BIA_sup, making them suitable for rapid body composition assessment in non-bedridden subjects. However, all these three devices should not be used interchangeably, because BIA_std4 and BIA_std8 tend to accentuate FM% changes during body composition monitoring compared to BIA_sup and DXA.

TRIAL REGISTRATION

ClinicalTrial.gov no. NCT04504799.

Effect of ICT-Based Self-Management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial. (Preprint)

Background

Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated.

Objective

This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA).

Methods

This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes.

Results

Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was −23.5 (SD 20.6) cm² in the intervention group and +1.9 (SD 16.2) cm² in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group.

Conclusions

Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG.

Trial Registration

UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53

Visceral Fat Area by Abdominal Bioelectrical Impedance Analysis as a Risk of Obstructive Sleep Apnea

This is the first study to evaluate directly visceral fat area (VFA) using a visceral fat (VF) meter by the abdominal bioelectrical impedance analysis (A-BIA) method in obstructive sleep apnea (OSA) patients diagnosed with polysomnography (PSG). The purpose of this study is to clarify (1) whether VFA measurement using a VF meter by the A-BIA method is possible even in a private clinic without burdening patients and staff and (2) how much VFA affects OSA compared to body mass index (BMI). Even without a computed tomography scan, which is the gold standard for VFA measurement, a VF meter could analyze patients by the A-BIA method and easily measure VFA. Therefore, it could be used safely even in a private sleep clinic, with very little burden on the patients and the medical staff. We investigated the association between OSA and VFA in 133 OSA patients. Multiple regression analysis revealed that VFA (β = 0.28; P = 0.020) was a stronger coexisting factor for OSA than age, male gender, or BMI (β = 0.26; P = 0.032) in all OSA patients. In the OSA patients with VF accumulation, only VFA was a significant component of OSA severity (β = 0.36; P = 0.006). The A-BIA method instrument could become a useful device for the evaluation of VF accumulation in OSA patients in private sleep clinics. VF accumulation should be recognized as an important risk factor as well as a known risk factor for OSA.

Differences between Active and Semi-Active Students Regarding the Parameters of Body Composition Using Bioimpedance and Magnetic Bioresonance Technologies

The aim of the study was to identify differences in obesity-related parameters between active sports students and semi-active or sedentary students, differentiated by sex, in order to optimize health. The study sample included 286 students, of which the male experimental sample consisted of 86 active sports students, age X ± SD 21.25 ± 0.32 years; height X ± SD 181.08 ± 3.52 cm; control group consisting of 89 semi-active students aged X ± SD 21.07 ± 0.1.13 years; height X ± SD 182.11 ± 1.32. The female experimental sample includes 57 active sports students, age X ± SD 21.02 ± 0.92 years; height X ± SD 167.48 ± 1.34 cm; the control group includes 54 semi-active students aged X ± SD 21.57 ± 0.1.98 years; height X ± SD 168.42 ± 1.76. The study used a thalliometer, Tanita Health Ware software and Quantum Resonance Magnetic Analyzer equipment to investigate height (cm), Body Mass Index (BMI), muscle mass (kg, %), as well as the obesity analysis report, and componential analysis of body and nourishment. The differences registered between the samples of active and semi-active sports subjects were predominantly statistically significant for p < 0.05. The differences registered between the samples of active and semi-active sports subjects were predominantly statistically significant for p < 0.05. The most important parameters regarding obesity and body composition that registered significant differences between the two male groups were in favor of the group of active athletes: triglyceride content of abnormal coefficient 0.844 (CI95% 0.590–1.099), abnormal lipid metabolism coefficient 0.798 (CI95% 1.091–0.504), obesity degree of body (ODB %) 10.290 (CI95% 6.610–13.970), BMI 2.326 (CI95% 1.527–3.126), body fat (kg) 2.042 (CI95% 0.918–3.166), muscle volume (kg) 2.565 (CI95% 1.100–4.031), Lean body weight (kg) 2.841 (CI95% 5.265–0.418). In the case of female samples, the group of active sportswomen registered the biggest differences compared to the group of students who were significantly active in the parameters: abnormal lipid metabolism coefficient 1.063 (CI95% 1.380–0.746), triglyceride content of abnormal coefficient 0.807 (CI95% 0.437–1.178), obesity degree of body (ODB%) 8.082 (CI95% 2.983–13.181), BMI 2.285 (CI95% 1.247–3.324), body fat (kg) 2.586 (CI95% 0.905–4.267), muscle volume (kg) 2.570 (CI95% 0.154–4.985), lean body weight (kg) 4.118 (CI95% 1.160–7.077). The results of the study directly facilitate the understanding of the complexity of the impact of obesity on multiple parameters of body composition and health.

Comparison of Bioelectrical Impedance Analysis and Computed Tomography on Body Composition Changes Including Visceral Fat After Bariatric Surgery in Asian Patients with Obesity

PURPOSE

The accuracy of bioelectrical impedance analysis (BIA) in patients with obesity has been controversial. This study aimed to validate the use of BIA in detecting body composition changes, especially for visceral fat, before and after bariatric surgery using computed tomography (CT) as a reference method.

MATERIALS AND METHODS

This retrospective study included Korean patients with a BMI of ≥ 35, or ≥ 30 with metabolic comorbidities. All patients underwent bariatric surgery, and underwent BIA and CT evaluation before and 6 months after the operation. The skeletal muscle index (SMI) and visceral fat index (VFI), variables corrected for height, were compared between BIA and CT.

RESULTS

Forty-eight patients (18 men, 30 women) demonstrated a mean weight loss of 27.5 kg. Significant decreases in both VFI and SMI were observed in both BIA and CT (all p<0.001), with greater VFI change compared to SMI (48.2% vs. 10.4% in CT, respectively). Both pre- and post-operative measurements of VFI and SMI were significantly correlated between BIA and CT (all p<0.05). However, the percent decrease was significantly correlated only with VFI (ρ=0.71, p<0.001). The Bland-Altman analysis showed that BIA underestimated VFI, with a greater degree of underestimation in subjects with higher VFI.

CONCLUSION

Despite the underestimation of BIA in measuring visceral fat, BIA VFI was associated with CT VFI. The SMI values showed significant correlations before and after surgery, but not with the percent decrease. Our results suggest that BIA can be a reliable tool for measuring body composition, especially for visceral fat, after bariatric surgery.

Association between Low Muscle Mass and Inflammatory Cytokines

Sarcopenia is a multifaceted geriatric syndrome associated with the loss of muscle mass. We examined the relationship between low muscle mass and inflammatory cytokines in the context of aging. This study involved 299 participants (127 men and 172 women; mean age 63.3 ± 9.8 years) who underwent health checkups for body composition and inflammatory cytokine (TNF-alpha, IL-6, and MCP-1) levels. Muscle mass was determined using the skeletal muscle mass index. We divided the participants into the normal (N) and low muscle mass (L) groups and compared the levels of inflammatory cytokines in nonelderly (<65 years) and elderly (≥65 years) participants. Among the nonelderly subjects, C-reactive protein was significantly lower in the L group than in the N group (p < 0.05). However, there was no significant difference in the inflammatory cytokine levels between the groups. Among the elderly subjects, the TNF-alpha level was significantly lower in the L group than in the N group (p < 0.05), whereas there were no significant differences in the IL-6 and MCP-1 levels. Moreover, TNF-alpha was identified as a risk factor for the L group in the logistic regression analysis (Exp (B) 0.935, 95% CI: 0.876–0.997, p = 0.04). Although a low TNF-alpha level is a risk factor for low muscle mass, inflammatory cytokine levels are not necessarily elevated in elderly individuals with the loss of muscle mass.

Beneficial effects of whole-body cryotherapy on glucose homeostasis and amino acid profile are associated with a reduced myostatin serum concentration

The study investigated the effect of single and chronic (10 sessions) whole-body cryotherapy (WBC; 3-min, − 110 °C) on amino acid (AA) profile, myostatin, fibroblast growth factor 21 (FGF21), and concentrations of brain-derived neurotrophic factor (BDNF), irisin and adiponectin in relation to glucose homeostasis. Thirty-five, healthy men were randomly split into experimental (young: 28 ± 7 years and middle-aged: 51 ± 3 years) and control groups. Blood samples were taken before and 1 h after the first and last (10th) WBC session. Baseline myostatin correlated significantly with visceral fat area, glucose, insulin, HOMA-IR and irisin (all p < 0.05). The single session of WBC induced temporary changes in AA profile, whereas chronic exposure lowered valine and asparagine concentrations (p < 0.01 and p = 0.01, respectively) compared to the baseline. The chronic WBC reduced fasting glucose (p = 0.04), FGF21 (− 35.8%, p = 0.06) and myostatin (-18.2%, p = 0.06). Still, the effects were age-dependent. The decrease of myostatin was more pronounced in middle-aged participants (p < 0.01). Concentrations of irisin and adiponectin increased in response to chronic WBC, while BDNF level remained unchanged. By improving the adipo-myokine profile, chronic WBC may reduce effectively the risk of the metabolic syndrome associated with hyperinsulinemia, increased levels of valine and asparagine, and muscle atrophy.

A study on prospective associations between adiposity and 7-year changes in movement behaviors among older women based on compositional data analysis

INTRODUCTION

It is unclear whether adiposity leads to changes in movement behaviors, and there is a lack of compositional analyses of longitudinal data which focus on these associations. Using a compositional approach, this study aimed to examine the associations between baseline adiposity and 7-year changes in physical activity (PA) and sedentary behavior (SB) among elderly women. We also explored the longitudinal associations between change in adiposity and change in movement-behavior composition.

METHODS

This longitudinal study included 176 older women (mean baseline age 62.8 (4.1) years) from Central Europe. Movement behavior was assessed by accelerometers and adiposity was measured by bioelectrical impedance analysis at baseline and follow-up. A set of multivariate least-squares regression analyses was used to examine the associations of baseline adiposity and longitudinal changes in adiposity as explanatory variables with longitudinal changes in a 3-part movement-behavior composition consisting of SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) as outcome variables.

RESULTS

No significant associations were found between baseline adiposity and longitudinal changes in the movement-behavior composition (p > 0.05). We found significant associations of changes in body mass index (BMI) and fat mass percentage (FM%) with changes in the movement-behavior composition. An increase in BMI was associated with an increase of SB at the expense of LPA and MVPA (β = 0.042, p = 0.009) and with a decrease of MVPA in favor of SB and LPA (β = - 0.059, p = 0.037). An increase in FM% was significantly associated only with an increase of SB at the expense of LPA and MVPA (β = 0.019, p = 0.031).

CONCLUSIONS

This study did not support the assumption that baseline adiposity is associated with longitudinal changes in movement behaviors among elderly women, but we found evidence for change-to-change associations, suggesting that a 7-year increase in adiposity is associated with a concurrent increase of SB at the expense of LPA and MVPA and with a concurrent decrease of MVPA in favor of LPA and SB. Public health interventions are needed to simultaneously prevent weight gain and promote physically active lifestyle among elderly women.

Visceral fat area and cardiometabolic risk: The Kardiovize study

BACKGROUND

Visceral fat is associated with adiposity-based complications. Bioimpedance measurement allows estimation of visceral fat area (VFA) in an easy manner. However, a validated cut-off value for VFA by bioimpedance associated with cardiometabolic risk is lacking in European population.

AIM

To determine cut-off values of VFA measured via bioimpedance associated with cardiometabolic risk.

METHODS

Random cross-sectional Czech population-based sample of 25-64 years old subjects. Receiver Operating Characteristic (ROC) curves were used and the area under the curve (AUC), sensitivity, and specificity were calculated. The Cardiometabolic Disease Staging System (CMDS) was used to classify cardiometabolic risk: Stage 1 - 1 or 2 metabolic syndrome (MetS) components, without impaired fasting glucose (IFG); Stage 2 - MetS or IFG; Stage 3 - MetS with IFG; Stage 4 - type 2 diabetes and/or cardiovascular disease.

RESULTS

2052 participants (54.5% females, median age 49 years) were included. Median VFA (inter-quartile range) were 82.2 cm² (54.8) in men and 89.8 cm² (55.6) in women. The best VFA cut-offs associated with Stage 1 in men and women were 71 cm² (sensitivity = 0.654; specificity = 0.427) and 83 cm² (sensitivity = 0.705; specificity = 0.556) ; Stage 2: 84 cm² (sensitivity = 0.673; specificity = 0.551) and 98 cm² (sensitivity = 0.702; specificity = 0.628) ; Stage 3: 90 cm² (sensitivity = 0.886; specificity = 0.605) and 109 cm² (sensitivity = 0.755; specificity = 0.704); Stage 4: 91 cm² (sensitivity = 0.625; specificity = 0.611) and 81 cm² (sensitivity = 0.695; specificity = 0.448), respectively.

CONCLUSION

A cut-off value of VFA of 71 cm² in men and 83 cm² in women exhibited the earliest stage of cardiometabolic risk, and 90 cm² in men and 109 cm² in women showed the best performance to detect risk.

Age-specific markers of adiposity in patients with obstructive sleep apnea

OBJECTIVES

Adiposity can have varying effects on the individual depending upon its distribution pattern. We assessed age-related distribution of adipose tissue by anthropometric measures and bioelectrical impedance analysis, as well as their association with obstructive sleep apnea (OSA) severity.

METHODS

Participants were 169 elderly (aged ≥ 65 years) and 142 non-elderly (aged < 65 years) referred for overnight polysomnography. The associations between obesity parameters and apnea-hypopnea index (AHI) were determine by univariate and multivariate linear regression analyses. Area under receiver operating characteristic curve (AUC) was used to access the predicting performance of some parameters.

RESULTS

Compared with non-elderly, elderly showed higher conicity index and visceral adiposity (VA)/subcutaneous adiposity (SA), lower body mass index (BMI), neck circumference, waist circumference, hip circumference and SA. Multiple regression analyses revealed that VA and VA/SA were independently associated with AHI in elderly (explained 17.2% of the AHI ^0.5 variability), while BMI and VA/SA were independently associated with AHI in non-elderly (explained 25.9% of the AHI ^0.5 variability), after adjusting for age, sex, cigarette smoking, alcohol drinking and main comorbidities. In elderly, VA over 128 cm² and VA/SA less than 0.41 resulted in sensitivity, specificity and AUC of 0.382, 0.790, 0.580 and 0.176, 0.947, 0.553 in predicting moderate-to-severe OSA, respectively. In non-elderly, BMI over 24.7 kg/m² and VA/SA over 0.54 resulted in sensitivity, specificity and AUC of 0.883, 0.484, 0.704 and 0.550, 0.710, 0.667 in predicting moderate-to-severe OSA, respectively.

CONCLUSIONS

VA is strongly associated with OSA severity in elderly, independently of general obesity as per BMI standards, while general adiposity appears to be more strongly associated with OSA severity in non-elderly. Our study supports age-specific approaches should be developed with respect to prediction and treatment of OSA.

Standing 8-Electrode Bioelectrical Impedance Analysis as an Alternative Method to Estimate Visceral Fat Area and Body Fat Mass in Athletes

Purpose

To investigate the potential of standing 8-electrode bioelectrical impedance analysis (BIA) for assessing visceral fat area (VFA) and body fat mass (BFM) in athletes.

Materials and Methods

A total of 95 subjects (50 males and 45 females) were recruited. VFA and BFM measurements were obtained using three standing 8-electrode BIA devices, InBody230, InBody770, and IOI353. These acquired VFA and BFM were expressed as VFA_IOI353, VFA_InBody230, VFA_InBody770 V, BFM_IOI353, BFM_InBody230, and BFM_InBody770, respectively. As reference measurement, the VFA acquired from computer tomography (CT) was expressed as VFA_CT, and the BFM measured by dual-energy X-ray absorptiometry (DXA) was denoted as BFM_DXA.

Results

The coefficient of determination (r²) in regression analysis between the measurements by VFA_IOI353, VFA_InBody230, VFA_InBody770 and VFA_CT were 0.425, 0.492, and 0.473, respectively. Also, the limits of agreement (LOA) obtained from Bland–Altman analysis were −25.18 to 56.62, −29.74 to 62.44, and −32.96 to 71.93 cm². For BFM, r² in regression analysis between the measurements by BFM_IOI353, BFM_InBody230, BFM_InBody770 and BMF_DXA were 0.894, 0.950, and 0.955, respectively; LOA were −7.21 to 5.75, −4.70 to 4.05, and −5.48 to 3.05 kg, respectively.

Conclusion

The results showed when assessing BFM, these instruments delivered comparable measurements, and the degree of agreement ranged from excellent to moderate compared with the reference method. However, when assessing VFA, the agreements were weak. Therefore, the application of standing 8-electrode BIA devices for assessing athletes’ VFA still needs improvement.

A pro-diabetogenic mtDNA polymorphism in the mitochondrial-derived peptide, MOTS-c

Type 2 Diabetes (T2D) is an emerging public health problem in Asia. Although ethnic specific mtDNA polymorphisms have been shown to contribute to T2D risk, the functional effects of the mtDNA polymorphisms and the therapeutic potential of mitochondrial-derived peptides at the mtDNA polymorphisms are underexplored. Here, we showed an Asian-specific mitochondrial DNA variation m.1382A>C (rs111033358) leads to a K14Q amino acid replacement in MOTS-c, an insulin sensitizing mitochondrial-derived peptide. Meta-analysis of three cohorts (n = 27,527, J-MICC, MEC, and TMM) show that males but not females with the C-allele exhibit a higher prevalence of T2D. In J-MICC, only males with the C-allele in the lowest tertile of physical activity increased their prevalence of T2D, demonstrating a kinesio-genomic interaction. High-fat fed, male mice injected with MOTS-c showed reduced weight and improved glucose tolerance, but not K14Q-MOTS-c treated mice. Like the human data, female mice were unaffected. Mechanistically, K14Q-MOTS-c leads to diminished insulin-sensitization in vitro. Thus, the m.1382A>C polymorphism is associated with susceptibility to T2D in men, possibly interacting with exercise, and contributing to the risk of T2D in sedentary males by reducing the activity of MOTS-c.

Does physical activity lower the risk for metabolic syndrome: a longitudinal study of physically active older women

Background

The associations between physical activity and metabolic syndrome (MetS) have been mainly found in cross-sectional studies. The aim of this longitudinal study was to examine the relationship between meeting step-based guidelines and changes in the risk of metabolic syndrome.

Methods

This study included data from older women (baseline age 62.9 ± 4.3 years) from a 7-year longitudinal study in Central Europe. At baseline and follow-up, physical activity was measured by an accelerometer, and the risk for MetS was assessed according to the NCEP-ATP III criteria. In 59 women, multivariate repeated measures ANOVA was used to compare differences in changes in the risk of MetS in groups based on meeting step-based guidelines (10,000 steps/day and 9000 steps/day for women aged <65 and ≥ 65 years, respectively).

Results

Over 7 years, steps/day increased from 10,944 ± 3560 to 11,652 ± 4865, and the risk of MetS decreased from 41 to 12% in our sample. Women who longitudinally met step-based guidelines had a significantly higher mean concentration of high-density cholesterol (HDL-C) (64.5 and 80.3 mg/dL at baseline and follow-up, respectively) and a lower concentration of triglycerides (TGs) (158.3 and 123.8 mg/dL at baseline and follow-up, respectively) at follow-up compared to baseline. Moreover, women who increased their daily steps over 7 years to the recommended steps/day value significantly decreased the concentration of TGs (158.3 mg/dL and 123.8 mg/dL at baseline and follow-up, respectively).

Conclusions

Our study might suggest that the long-term meeting of step-based guidelines or an increase in daily steps/day to achieve the recommended value could be related to a lower risk of MetS, specifically in concentrations of HDL-C and TG. These findings may help in designing interventions aiming to decrease the risk of MetS in older women.

Optimal Cut-Off Values of Visceral Fat Area for Predicting Metabolic Syndrome Among Type 2 Diabetes Patients in Ningbo, China

OBJECTIVE

To examine the optimal cut-off values of visceral fat area (VFA) for predicting metabolic syndrome (MetS) among type 2 diabetes (T2D) patients in Ningbo China.

METHODS

A total of 1017 subjects were selected from T2D patients who accepted standardized management by the National Standardized Metabolic Disease Management Center at Ningbo First Hospital from March 2018 to January 2020. Demography and medical information were collected through questionnaires. Regional adiposity was examined by a visceral fat analyzer using the dual bioelectrical impedance method.

RESULTS

Overall, 769 (75.6%) T2D patients were defined to have MetS. Patients with MetS had higher anthropometric values and biomarkers, compared to those without MetS. VFA was significantly correlated with risk factors of MetS. Further logistic regression models showed that VFA was significantly associated with MetS in men (OR=1.02) and in women (OR=1.03) (P<0.001 for both genders) after controlling for related factors. Receiver-operating characteristic curve analysis demonstrated that the optimal cut-off values of VFA were 84.7 cm² for men and 81.1 cm² for women to predict MetS in T2D patients.

CONCLUSION

VFA was associated with MetS and could be an independent predictor of MetS in T2D patients.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, number: NCT03811470.

Larger muscle mass of the upper limb correlates with lower amplitudes of deltoid MEPs following transcranial stimulation

To perform spinal surgery safely, it is important to understand the risk factors, including factors that negatively influence intraoperative neuromonitoring (IONM). Transcranial motor evoked potentials (TcMEPs) are important in IONM. Therefore, we aimed to investigate whether muscle mass affects the waveforms of TcMEPs to understand the risk factors influencing TcMEPs. We enrolled 48 patients with thoracolumbar spinal diseases who underwent surgery at our facility between April 2015 and March 2018. Before surgery, the body composition, including muscle mass and fat mass, of all patients was measured using bioelectrical impedance analysis (BIA). During surgery, cranial stimulation under general anesthesia was used to derive TcMEPs, enabling us to measure the amplitude, using the control wave of the TcMEPs of the deltoid muscles and the abductor digiti minimi (ADM) muscles. We found a negative correlation between the amplitude of deltoid-muscle TcMEPs and muscle mass of the upper limb. The amplitude of deltoid-muscle TcMEPs did not correlate with the skeletal muscle index (SMI), muscle mass of the lower limb, or body fat mass. The amplitude of ADM-muscle TcMEPs did not correlate with SMI, muscle mass of any limb, or body fat mass. In conclusion, a larger muscle mass of the upper limb correlated with a lower amplitude of deltoid-muscle TcMEPs. By contrast, there was no correlation between the muscle mass of the upper limb and the amplitude of ADM-muscle TcMEPs. These findings suggest that TcMEPs of the ADM are less influenced by muscle mass and are more stable than those of the deltoid.

Prospective study on sedentary behaviour patterns and changes in body composition parameters in older women: A compositional and isotemporal substitution analysis

BACKGROUND & AIMS

The aims of this study were to examine the prospective compositional associations between sedentary behaviour (SB) patterns and longitudinal changes in body composition parameters, and to use compositional isotemporal substitution modelling to analyse the longitudinal changes in body composition parameters associated with time reallocation from SB to physical activity (PA) in older women.

METHODS

The study included women aged 60 years and older (n = 182) with valid data at baseline and at the subsequent 7-year follow-up. For both time points, the ActiGraph GT1M accelerometer was used for SB and PA assessments and multi-frequency bioimpedance analysis was used to assess the body composition parameters related to adiposity and muscle mass. Compositional regression models were used to analyse the associations between proportion of time spent in sedentary bouts of different duration and longitudinal changes in body composition parameters. A compositional isotemporal substitution model was created to estimate the differences in body composition parameters associated with one-to-one time reallocations between baseline SB and PA.

RESULTS

A significant increase in fat mass index (β_ilr1 = 0.61, 95% confidence interval [CI]: 0.18, 1.04) and visceral adipose tissue (β_ilr1 = 6.01, 95% CI: 1.52, 10.5) was associated with a higher baseline proportion of time spent in long sedentary bouts (i.e. sedentary bout of ≥30 min). Reallocating 1 h/week and 3.5 h/week from the time spent in long sedentary bouts in favour of light PA was associated with a significant decrease in fat mass index by 0.78% (95% CI: 0.24, 1.32) and 3.13% (95% CI: 0.97, 5.29), respectively. No association was found for indicators of muscle mass.

CONCLUSIONS

This study suggests that long-term adiposity status could be improved by increasing the proportion of time spent in light PA at the expense of time spent in prolonged SB. This finding may help in designing more effective and feasible interventions for the maintenance of healthy body composition in advanced age.

The utility of visceral fat level measured by bioelectrical impedance analysis in predicting metabolic syndrome

BACKGROUND

Visceral adipose tissue dysfunction contributes to metabolic syndrome (MetS) and cardiovascular diseases. This study aims to investigate the association between visceral fat level measured by bioelectric impedance analysis (BIA) and MetS.

MATERIAL AND METHODS

This cross-sectional study recruited Taiwanese volunteers aged ≥20 years between 2012 and 2014. Anthropometric measurements and plasma concentrations of glucose, insulin, and lipid profiles were collected after at least 8 h of fasting. Insulin resistance was calculated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Visceral fat level (VFL, ranges: 1-59) and trunk fat percentage were measured through by the Body Composition Analyzer TANITA AB 140 Viscan.

RESULTS

A total of 1086 volunteers (mean age = 44.2 ± 13.2 years) were enrolled. Multiple regression analyses showed that triglycerides levels and blood pressure increased while high-density lipoprotein-cholesterol decreased with VFL in both genders (p < 0.05). Increased HOMA-IR and VFL had a synergistic effect on MetS. Higher VFL was independently associated with MetS in both men (OR = 1.33, 95% CI: 1.19-1.48) and women (OR = 1.28, 95% CI: 1.17-1.39).

CONCLUSIONS

Higher VFL is associated with MetS and its components. The portable BIA machine is easily applicable and useful tool to measure visceral fat in the community setting.

Is adherence to the 24-hour movement guidelines associated with a reduced risk of adiposity among children and adolescents?

BACKGROUND

Little is known about the combined effect of physical activity (PA), recreational screen time (ST), and sleep in preventing childhood obesity. Hence, this study aimed to analyze the associations between meeting the PA, ST, and sleep recommendations within the 24-hour movement guidelines and adiposity indicators among children and adolescents.

METHODS

A total of 679 children and adolescents aged 8-18 years were included. The time spent in moderate-to-vigorous PA and the sleep duration were estimated from raw data from a wrist-worn accelerometer. Recreational ST was reported by the child or parent. Body mass index (BMI) z-score, fat mass percentage (FM%), and visceral adipose tissue (VAT) were used as adiposity indicators. Participants with ≥ 60 min/day of moderate-to-vigorous PA, < 2 h/day of recreational ST, and uninterrupted sleep for 9-11 h/day (for children) or 8-10 h/day (for adolescents) were considered to meet the overall 24-hour movement guidelines.

RESULTS

Meeting the ST only recommendation was associated with reduced odds of a high BMI z-score (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.17-0.89), excess FM% (OR = 0.34, 95% CI: 0.13-0.93), and excess VAT (OR = 0.27, 95% CI: 0.10-0.74) in adolescents. Significantly reduced odds of a high BMI z-score was associated with meeting the combination of the ST and sleep recommendations (OR = 0.11, 95% CI: 0.01-0.89). Adolescents who met one recommendation (OR = 0.51, 95% CI: 0.27-0.96) or any two recommendations (OR = 0.33, 95% CI: 0.11-0.94) had reduced ORs of having a high BMI z-score. Adolescents had lower odds of having excess VAT if they met one recommendation (OR = 0.39, 95% CI: 0.19-0.81) or any two recommendations (OR = 0.25, 95% CI: 0.07-0.90). No significant associations were found in children.

CONCLUSIONS

The present study showed no associations between meeting all three recommendations within the 24-hour movement guidelines and adiposity indicators. However, meeting ST only recommendation and the combination of the ST and sleep recommendations was associated with a reduced risk of excess adiposity. This finding should be considered when designing effective strategies and interventions to prevent childhood obesity.

Relationship of Body Composition and Urinary Incontinence in Women: A Cross-Sectional Case-Control Study

OBJECTIVE

To describe the profile of segmental body composition through the bioelectrical impedance analysis (BIA) method in continent and incontinent women and analyze the association between overweight/obesity and urinary incontinence (UI).

METHODS

This was a cross-sectional case-control study that included women aged between 20 and 65 years, who were not pregnant, were outside of their menstrual period, without neurological, psychiatric, orthopedic, or cardiac comorbidities. The presence of UI was verified using the International Consultation on Incontinence Questionnaire-Short Form. Segmental body composition was assessed with BIA. The independent Student t test was used to compare body composition means between groups, and multivariate logistic regression was used to test the association between body composition and UI.

RESULTS

The study included 62 women with a mean age of 34.4 ± 11.6 years, of whom 27 (43.5%) had UI. Of these, 15 (55.6%) were nulliparous and had a body mass index of 25.1 ± 4.2 kg/m, similar to that of continent women, who had a body mass index of 23.6 ± 3.9 kg/m (P=0.16). The sociodemographic and obstetric data were similar among continent and incontinent women. With respect to the parameters of segmental body fat, visceral fat, and waist circumference, incontinent women presented higher values than the continent group. In the final multivariate analysis model, women with high levels of visceral fat had a 1.13-times higher likelihood of presenting UI.

CONCLUSIONS

In adult women, there is an association between the level of visceral fat assessed by BIA and complaints of urinary loss, being more evident in overweight and obese women.

Associations between visceral obesity and renal impairment in health checkup participants: a retrospective cohort study

BACKGROUND

Obesity is a risk factor for chronic kidney disease. Although body mass index (BMI) or waist circumference is indicators of obesity, actual measurements of visceral fat area (VFA) more accurately reflect the amount of visceral fat. We aimed to determine the most sensitive obesity indicator for predicting renal impairment among VFA, BMI, waist circumference, waist-to-height ratio, and visceral-to-subcutaneous fat ratio (VSR).

METHODS

Subjects who underwent VFA measurements during health checkups in 2012 were included. Obesity was defined using a separate baseline value for each indicator [VFA (100 cm²), BMI (25 kg/m²), waist circumference (85 cm for men and 90 cm for women), waist-to-height ratio (0.5), VSR (0.4)]. Changes in estimated glomerular filtration rate (eGFR_cr) and time to new-onset proteinuria were measured. The relationships between obesity indicators and eGFR_cr were evaluated using a linear mixed-effects model. The relationships between obesity indicators and new-onset proteinuria were evaluated using Poisson regression analysis.

RESULTS

Analysis was performed on 2753 subjects (mean age 50.3 years). The VFA ≥ 100 cm² group exhibited a larger annual difference in eGFR_cr compared to the < 100 cm² group (- 0.24 mL/min/1.73 m², P = 0.03). There was a statistically significant difference in the proteinuria incidence rate ratio, which was 1.54 times (95% confidence interval 1.01-2.35) in the VFA ≥ 100 cm² group. Statistically significant correlations were not observed with any of the other obesity indicators.

CONCLUSION

VFA is suggested to be the most sensitive obesity indicator for decline in kidney function and new-onset proteinuria.

Change in body composition in patients with achalasia before and after peroral endoscopic myotomy

BACKGROUND AND AIM

Patients with achalasia experience weight loss because of dysphagia caused by impaired relaxation of the lower esophageal sphincter. This study aimed to use dual bioelectrical impedance analysis (BIA) to determine the change in bodyweight and body composition in patients with achalasia before and after peroral endoscopic myotomy (POEM).

METHODS

Patients with achalasia who underwent POEM from 2013 to 2018 (n = 72) were retrospectively analyzed for change in bodyweight before and after 3 months. Additionally, change in body composition was prospectively investigated in the final 10 of 72 patients using non-radiation dual BIA.

RESULTS

Twenty patients (27.8%) were underweight (body mass index < 18.5) before undergoing POEM. No clinical parameters were identified to be associated with the underweight condition before POEM and be predictive of an increase in bodyweight after POEM. Low visceral fat volume observed on dual BIA correlated closely with the result obtained using computed tomography (Pearson correlation coefficient: r = 0.850, P < 0.01). Patients with achalasia had a statistically significant increase in visceral (P < 0.01) and subcutaneous fat volumes (P < 0.01) after POEM. Skeletal muscle mass index slightly increased (P = 0.02), although the value after POEM was still low. No blood biomarkers were indicators for low bodyweight or low visceral fat volume.

CONCLUSIONS

Dual BIA is an effective non-invasive tool to evaluate the change in body composition of underweight patients with achalasia. Skeletal muscle volume was not enough after POEM, although a rapid increase in the intra-abdominal fat volume was observed. Additional studies are warranted to understand the pathological implications.

Magnetic Resonance Imaging and Bioelectrical Impedance Analysis to Assess Visceral and Abdominal Adipose Tissue

OBJECTIVE

This study aimed to compare a state-of-the-art bioelectrical impedance analysis (BIA) device with two-point Dixon magnetic resonance imaging (MRI) for the quantification of visceral adipose tissue (VAT) as a health-related risk factor.

METHODS

A total of 63 male participants were measured using a 3-T MRI scanner and a segmental, multifrequency BIA device. MRI generated fat fraction (FF) maps, in which VAT volume, total abdominal adipose tissue volume, and FF of visceral and total abdominal compartments were quantified. BIA estimated body fat mass and VAT area.

RESULTS

Coefficients of determination between abdominal (r²  = 0.75) and visceral compartments (r²  = 0.78) were similar for both groups, but slopes differed by a factor of two. The ratio of visceral to total abdominal FF was increased in older men compared with younger men. This difference was not detected with BIA. MRI and BIA measurements of the total abdominal volume correlated moderately (r²  = 0.31-0.56), and visceral measurements correlated poorly (r²  = 0.13-0.44).

CONCLUSIONS

Visceral BIA measurements agreed better with MRI measurements of the total abdomen than of the visceral compartment, indicating that BIA visceral fat area assessment cannot differentiate adipose tissue between visceral and abdominal compartments in young and older participants.

Agreement Between Body Composition Assessed by Bioelectrical Impedance Analysis and Doubly Labeled Water in Obese Women Submitted to Bariatric Surgery : Body Composition, BIA, and DLW

INTRODUCTION

Bariatric surgery has a significant influence on body composition (BC), which should be monitored. However, there is a need to recommend low-cost practical methods, with good estimation of BC for class III obese and/or bariatric patients.

OBJECTIVE

The aim of this study was to determine accuracy and agreement between BC assessed by direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA) and doubly labeled water (DLW) as reference method.

MATERIAL AND METHODS

Twenty class III obese women (age 29.3 ± 5.1 years; body mass index 44.8 ± 2.4 kg/m²) underwent Roux-en-Y gastric bypass surgery. BC (fat mass [FM], fat-free mass [FFM], and total body water [TBW]) was assessed by InBody 230 and DLW in the following periods: before and 6 and 12 months after surgery. Accuracy between the methods was evaluated by the bias and root mean square error. Pearson's correlation, concordance correlation coefficient (CCC), and Bland-Altman method were used to evaluate agreement between the methods.

RESULTS

Correlations were significant (p < 0.001) and CCC was good/excellent between both methods for the evaluation of FM (r = 0.84-0.92, CCC = 0.84-0.95), FFM (r = 0.73-0.90, CCC = 0.68-0.80), and TBW (r = 0.76-0.91, CCC = 0.72-0.81) before and after bariatric surgery. In addition, no significant bias was observed between DSM-BIA and DLW for FM (mean error [ME] = - 1.40 to 0.06 kg), FFM (ME = 0.91-1.86 kg), and TBW (ME = 0.71-1.24 kg) measurements.

CONCLUSION

The DSM-BIA was able to estimate the BC of class III obese women submitted to bariatric surgery with values consistent with those of the DLW method.

Efficacy of visceral fat estimation by dual bioelectrical impedance analysis in detecting cardiovascular risk factors in patients with type 2 diabetes

Background

Visceral fat area (VFA) is a good surrogate marker of obesity-related disorders, such as hypertension, dyslipidemia and glucose intolerance. Although estimating the VFA by X-ray computed tomography (CT) is the primary index for visceral obesity, it is expensive and requires invasive radiation exposure. Dual bioelectrical impedance analysis (BIA) is a simple and reliable method to estimate VFA; however, the clinical usefulness of dual BIA remains unclear in patients with type 2 diabetes (T2D).

Methods

We estimated the VFAs by dual BIA and CT in 98 patients with T2D and assessed anthropometric parameters, blood test results, and the presence of comorbid hypertension and dyslipidemia. We compared the correlation between the VFAs examined by dual BIA and CT. Furthermore, we performed the receiver operating characteristic (ROC) analyses for the VFAs to detect the presence of comorbid hypertension and/or dyslipidemia with T2D, which are major comorbidities of visceral obesity, and estimated the area under the curve (AUC).

Results

The measurement error between the VFAs by dual BIA and CT was significantly higher among patients with brain natriuretic peptide (BNP) ≥ 100 pg/mL than those with BNP < 100 pg/mL (39.2% ± 31.1% vs. 24.1% ± 18.6%, P < 0.05). After excluding patients with BNP ≥ 100 pg/mL, the VFA by dual BIA significantly correlated with the VFA by CT (r = 0.917; P < 0.0001). The AUC in the ROC analysis for the VFA by dual BIA to detect the presence of comorbid hypertension and/or dyslipidemia with T2D was almost equivalent to that for the VFA by CT.

Conclusions

In patients with T2D without elevated BNP > 100 pg/mL as indicator for fluid accumulation interfering with BIA, estimation of the VFA by dual BIA significantly correlated with that by CT and also detected comorbid hypertension and/or dyslipidemia with T2D equivalent to those detected by CT. Hence, dual BIA could be an alternative to CT as a standard method for estimating the VFA in patients with diabetes.

Improving Physical Activity and Body Composition in a Medical Workplace Using Brief Goal Setting

Objective

To evaluate the use of a wearable activity tracker and brief feedback in the workplace to motivate employees to improve activity.

Patients and Methods

A total of 135 adult participants were randomized to 1 of 3 groups: control group (blinded to their step activity), intervention group (received counseling based on their step count), or no step-tracking device group. Participants were recruited from June 27, 2016, through February 21, 2018.

Results

Most of the 135 participants were women (84%), with a mean ± SD age of 42.6±10.1 years. Most participants (96%) completed 11 of the 12 weeks of step counts. Comparing treatment groups at week 12 (end of treatment), the intervention group (vs the control group) had significantly more steps (644.8; P<.01), had an 11.1% increase in step count from baseline (P<.01), was more likely to achieve goal (odds ratio=1.73; P=.02), increased distance traveled per week (0.46 miles; P<.01) and calories burned (90.6; P<.01), and had a decrease in some bioelectrical impedance measurements over time, including a greater loss in body fat mass (–0.90 kg; P=.01), percentage fat (–0.96; P<.01), and visceral fat level (–0.60; P<.01). Finally, the intervention group indicated significantly greater satisfaction with their assigned randomization (89% vs 77%; P=.01) and greater confidence in the effectiveness of their activity tracker (P<.01).

Conclusion

Brief counseling accompanied by use of a step-counting device can improve workplace activity, which, in turn, can increase steps and decrease body fat, including visceral fat.

Trial Registration

clinicaltrials.gov Identifier: NCT02794727

Waist Circumference Measured by Bioelectrical Impedance Analysis Is Interchangeable with Manual Measurement: Increased Waist Circumference Is Associated with Locomotive Syndrome Risk

Objectives

The importance of preventive medicine in an aging society is increasing. Locomotive syndrome (LS) is attracting increasing attention. Recently, advances in bioelectrical impedance analysis (BIA) devices have made it possible to automatically measure waist circumference (WC). Nevertheless, there have been no reports evaluating the agreement or interchangeability between WC measured manually and using BIA. Therefore, we aimed to perform these analyses in the context of health checkups and investigated the associations with LS risk.

Methods

We enrolled 597 participants who underwent the following: two-step tests and stand-up tests; evaluations using a 25-question geriatric locomotive function scale for the LS risk test; anthropometric marker measurements including WC measured by manual and BIA; and measurements of total cholesterol and triglycerides. We used Bland–Altman analysis to calculate agreement and interchangeability of the WC measurement using BIA and the manual method. A statistical comparative study was then conducted between normal and LS risk groups. Subsequently, significant risk factors for LS were investigated using multivariate analysis.

Results

The Bland–Altman analysis showed that bias (BIA-manual) was negative overall (−2.024), for males (−1.418) and for females (−2.460), suggesting underestimation using BIA compared with manual measurements. Interchangeability was found between WC measurement by BIA and by manual methods, because the percentage error was less than 15% overall (12.3%), for males (10.2%) and for females (13.8%). Univariate analysis showed that WC was significantly higher in the LS risk group than in the normal group. Multivariate analysis adjusted for confounding factors showed that increase in WC significantly correlated with LS risk.

Conclusions

BIA and manual methods for measuring WC are interchangeable. The increase in WC measured by BIA was significantly associated with LS risk. It is important to continue focusing on increased WC and early detection of LS risk.

Intra-Abdominal Adipose Tissue Quantification by Alternative Versus Reference Methods: A Systematic Review and Meta-Analysis

OBJECTIVE

This meta-analysis aimed to assess the agreement between intra-abdominal adipose tissue (IAAT) quantified by alternative methods and the reference standards, computed tomography (CT) and magnetic resonance imaging (MRI).

METHODS

MEDLINE and EMBASE electronic databases were systematically searched to identify studies that quantified IAAT thickness, area, or volume by a comparator method and CT or MRI. Using an inverse variance weighted approach (random-effects model), the mean differences and 95% limits of agreement (LoA) were pooled between methods.

RESULTS

The meta-analysis included 24 studies using four comparator methods. The pooled mean differences were -0.3 cm (95% LoA: -3.4 to 3.2 cm; P = 0.400) for ultrasound and -11.6 cm² (95% LoA: -43.1 to 19.9 cm² ; P = 0.004) for bioelectrical impedance analysis. Dual-energy x-ray absorptiometry (DXA) quantified both IAAT area and volume with mean differences of 8.1 cm² (95% LoA: -98.9 to 115.1 cm² ; P = 0.061) and 10 cm³ (95% LoA: -280 to 300 cm³ ; P = 0.808), respectively.

CONCLUSIONS

Ultrasound and DXA measure IAAT with minimal bias from CT or MRI, while bioelectrical impedance analysis systematically underestimates IAAT. However, with the exception of DXA for IAAT volume, the wide LoA caution against clinical or research use of the comparator methods and emphasize the need to optimize alternatives to the reference standards.