The association of waist circumference with walking difficulty among adults with or at risk of knee osteoarthritis: the Osteoarthritis Initiative

Causal analysis of body composition measurements in osteoarthritis knee: a two-sample mendelian randomization study

BACKGROUND

To analyse the causal associations of different physical measures with osteoarthritis knee (KOA).

METHODS

Exposure factors (weight, body mass index (BMI), body fat percentage, waist circumference, hip circumference, waist-hip ratio (WHR), and basal metabolic rate (BMR)), and outcome factor KOA were analyzed by inverse-variance weighted (IVW) method, along with heterogeneity test, sensitivity and pleiotropy analyses. Meta-analysis was used to combine the effect values of IVW methods in different data sources.

RESULTS

Weight, BMI, body fat percentage, waist circumference, hip circumference and BMR analyses showed causal association with increased KOA risk, while WHR analysis indicated a reduction of the incidence of KOA. P-value for all the results was less than 0.05 and F-value large than 20. All results were negative for heterogeneity tests and sensitivity analyses, and there was pleiotropy in weight and BMR. Meta-analysis results showed that the results of Odds Ratios (95% Confidence Intervals) for Weight (1.43(1.35-1.51)), BMI (1.40(1.10-1.78)), body fat percentage (1.56(1.44-1.68)), waist circumference (1.40(1.10-1.78)), hip circumference (1.37(1.30-1.44)), WHR (0.86(0.71-1.04)) and BMR (1.36(1.27-1.46) were consistent with the ones by Mendelian randomization analyses.

CONCLUSIONS

Body fat percentage may be a better indicator of KOA than BMI. In addition, weight and BMR may have a causal effect in KOA, but WHR does not have a causal relationship. BMI, body fat percentage, waist circumference, and hip circumference has a causal effect on KOA.

The prevalence and factors associated with sarcopenia in Thai older adults: A systematic review and meta-analysis

Objective

This systematic review and meta-analysis aimed to assess the prevalence and identify factors associated with sarcopenia in older Thais.

Methods

Research studies were searched in online databases, including PubMed, Embase, Scopus, and Thai-Journal Citation Index. The articles included in this review were limited to being published between January 1, 2013 and January 31, 2023 and observational study designs. The research quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. A meta-analysis was performed using the JBI SUMARI software. The review protocol has been registered on PROSPERO with the assigned ID CRD42023420514.

Results

A total of 265 research articles were initially identified, out of which 17 articles were included in this study, including a total of 4,668 participants aged 60 years and over, consisting of 1,380 (29.6%) men and 3,288 (70.4%) women. The overall prevalence of sarcopenia in Thai older adults was 20.7% (95% CI 14.4%-27.8%). Subgroup analysis of the sarcopenia prevalence based on the study areas revealed that the prevalence was 33.4% (95% CI 28.7%-38.3%) in hospitalized individuals, 23.2% (95% CI 12.5%-35.9%) in outpatient clinic settings, and 17.3% (95% CI 9.4%-26.8%) in community-living older adults. Advanced age (OR = 4.60, 95% CI 3.07-6.91), being male (OR = 2.30, 95% CI 1.37-3.85), low body mass index (BMI) (OR = 8.95, 95% CI 6.05-13.25), and malnutrition (OR = 2.78, 95% CI 2.09-3.70) are strong predictors of sarcopenia in older adults in Thailand.

Conclusions

This systematic review represents the first assessment of the overall prevalence and factors associated with sarcopenia in Thai older adults, indicating its significant concern within this population. These findings are of importance for public health management aimed at preventing and managing sarcopenia in the country.

Causal associations of anthropometric measurements with osteoarthritis: A Mendelian randomization study

OBJECTIVE

We believe that there is a causal relationship between waist circumference and knee osteoarthritis. To confirm the hypothesis, we have conducted this study.

METHODS

Genetic variants associated with the five anthropometric variables were obtained from previous large-scale genomewide association studies. Summary-level data on osteoarthritis were obtained from the UK Biobank. The univariable and multivariable MR framework were used to evaluate the associations. The two-sided p value was considered to be statistically significant at 0.01 (where p = 0.05/5) after Bonferroni correction for the five exposure variables.

RESULTS

In the univariable MR, there was evidence of a detrimental effect of height, weight, BMI, waist circumference, and hip circumference on osteoarthritis risk in the main IVW analyses (height: OR 1.115, 95% CI 1.054-1.180; weight: OR 1.765, 95% CI 1.650-1.889; BMI: OR 1.952, 95%CI 1.841-2.068; waist circumference: OR 2.140, 95% CI 1.994-2.296; hip circumference: OR 1.719, 95% CI 1.600-1.846). And the analyses on knee osteoarthritis and hip osteoarthritis yielded similar results. However, the multivariable MR showed that only waist circumference was causally associated with osteoarthritis, after adjusting for the confounding exposure effects (waist circumference: OR 1.877, 95% CI 1.286-2.739). Such association was also repeated in the analyses on knee osteoarthritis but not hip osteoarthritis.

CONCLUSION

Our study highlighted the causal associations between waist circumference and knee osteoarthritis risk.

Reliability of pain scores during a body weight support protocol in individuals with knee osteoarthritis

PURPOSE

To explore the reliability of percentage of Body Weight Support (BWS) needed for maximal pain relief and of pain scores across 12 walking conditions including pre and post-over-ground walking and an unweighting protocol from 0% to 40% BWS on a lower body positive pressure (LBPP) treadmill for individuals with knee osteoarthritis (OA).

MATERIALS AND METHODS

Twenty individuals (64 ± 9.44 years) with knee OA completed over-ground walking and an unweighting protocol on an LBPP treadmill. The amount of BWS started at 0% and increased by 5% increments until it reached 40%. Pain scores were recorded at the end of each increment.

RESULTS

The reliability of pain scores was assessed using a Spearman's rho. This study found moderate reliability of the percentage of BWS for maximal pain relief. Additionally, there was good reliability of pain scores with pre and post-over-ground walking and from 0% BWS to 30% BWS, but moderate reliability of pain scores was found at 35% and 40% BWS.

CONCLUSION

This study supports the use of pain scores as a reliable measure during an unweighted walking session on an LBPP treadmill.IMPLICATIONS FOR REHABILITATIONBoth the OARSI and ACR recommend exercise in the treatment of individuals with knee OA but acknowledge that pain during exercise and exercise preference/accessibility are important when considering the type of exercise for an individual.LBPP treadmills decrease pain in individuals with knee OA during walking.Pain scores during unweighted walking show moderate to good reliability for individuals with knee OA.This study provides an unweighting protocol to use clinically to determine the Body Weight Support needed to decrease pain.

Compensatory Responses During Slip-Induced Perturbation in Patients With Knee Osteoarthritis Compared With Healthy Older Adults: An Increased Risk of Falls?

Background: Functional impairment of the knee joint affected by osteoarthritis and loss of muscle strength leads to a significant increase in the number of falls. Nevertheless, little is known about strategies for coping with gait perturbations in patients with knee osteoarthritis (KOA). Thus, this study aimed to examine the compensatory strategies of patients with KOA in response to a backward slip perturbation compared with healthy older adults.

Methods: An automated perturbation program was developed by using D-Flow software based on the Gait Real-time Analysis Interactive Lab, and an induced backward slip perturbation was implemented on nine patients with severe KOA (68.89 ± 3.59 years) and 15 age-matched healthy older adults (68.33 ± 3.29 years). Step length, gait speed, range of motion, vertical ground reaction forces, lower extremity joint angles, and joint moments were computed and analyzed.

Results: Compared with older adults, patients with KOA had significantly lower step length, gait speed, and vertical ground reaction forces in both normal walking and the first recovery step following backward slip perturbations. Inadequate flexion and extension of joint angles and insufficient generation of joint moments predispose patients with KOA to fall. Hip extension angle and flexion moment, knee range of motion, and vertical ground reaction forces are key monitoring variables.

Conclusion: The risk of falls for patients with KOA in response to backward slip perturbations is higher. Patients with KOA should focus not only on quadriceps muscle strength related to knee range of motion but also on improving hip extensor strength and activation through specific exercises. Targeted resistance training and perturbation-based gait training could be better options.

Effects of obesity and foot arch height on gait mechanics: A cross-sectional study

Foot arch structure contributes to lower-limb joint mechanics and gait in adults with obesity. However, it is not well-known if excessive weight and arch height together affect gait mechanics compared to the effects of excessive weight and arch height alone. The purpose of this study was to determine the influences of arch height and obesity on gait mechanics in adults. In this study, 1) dynamic plantar pressure, 2) spatiotemporal gait parameters, 3) foot progression angle, and 4) ankle and knee joint angles and moments were collected in adults with normal weight with normal arch heights (n = 11), normal weight with lower arch heights (n = 10), obesity with normal arch heights (n = 8), and obesity with lower arch heights (n = 18) as they walked at their preferred speed and at a pedestrian standard walking speed, 1.25 m/s. Digital foot pressure data were used to compute a measure of arch height, the Chippaux-Smirak Index (CSI). Our results revealed that BMI and arch height were each associated with particular measures of ankle and knee joint mechanics during walking in healthy young adults: (i) a higher BMI with greater peak internal ankle plantar-flexion moment and (ii) a lower arch height with greater peak internal ankle eversion and abduction moments and peak internal knee abduction moment (i.e., external knee adduction moment). Our results have implications for understanding the role of arch height in reducing musculoskeletal injury risks, improving gait, and increasing physical activity for people living with obesity.

Short Physical Performance Battery (SPPB) score as a discriminator of dynapenic abdominal obesity among community-dwelling older adults

The aim of this study is to verify the utility of using physical performance to discriminate the presence of dynapenic abdominal obesity (DAO) in older adults. This cross-sectional study was conducted with 382 community-dwelling older adults. DAO was identified when dynapenia (cut-off points of <26 kilogram-force [kgf] for men and <16 kgf for women) was detected together with abdominal obesity (waist circumference >102 cm for men and >88 cm for women). Physical performance was assessed with the Short Physical Performance Battery (SPPB). SPPB scores and DAO were inversely associated even after adjustment (OR: 0.69; 95%CI: 0.58-0.83). Cut-off points of ≤9 for SPPB scores were the most efficient for discriminating the presence of DAO in both men (AUC= 0.836; 95%CI: 0.76-0.89; sensitivity: 90.91% and specificity: 60.33%) and women (AUC= 0.677; 95%CI: 0.62-0.73; sensitivity: 73.33% and specificity: 40.91%). Physical performance assessed with SPPB can discriminate DAO and be useful for the timely identification and management of this condition in older adults.

Potentially modifiable risk factors for slow gait in community-dwelling older adults: A systematic review

PURPOSE

Slow gait speed in older adults is associated with increased risk for falls and fractures, functional dependence, multimorbidity, and even mortality. The risk of these adverse outcomes can be reduced by intervening on potentially modifiable risk factors. The purpose of this systematic review was to identify potentially modifiable risk factors associated with slow gait speed and clinically meaningful gait speed decline in older community-dwelling adults.

METHODS

Literature searches were conducted in MEDLINE, EMBASE, and CINAHL, Google Scholar, and in the bibliographies of retrieved articles.

RESULTS

Forty studies met the inclusion criteria for qualitative review. Study designs were cross-sectional and longitudinal. Operational definitions of 'slow gait' and 'meaningful gait speed decline' were variable and based on sample distributions (e.g. quartiles), external criteria (e.g. < 0.8 m/s), and dynamic changes over time (e.g. ≥ 0.05 m/s decline per year). Twenty-six potentially modifiable risk factors were assessed in at least two studies. The risk factors most commonly investigated and that showed significant associations with slow gait and/or meaningful gait speed decline include physical activity, education, body mass index-obesity, pain, and depression/depressive symptoms.

CONCLUSION

Our results suggest that there are modifiable targets to maintain gait speed that are amenable to potential treatment.

Effects of Obesity on Adaptation Transfer from Treadmill to Over-Ground Walking

Discerning whether individuals with obesity transfer walking adaptation from treadmill to over-ground walking is critical to advancing our understanding of walking adaptation and its usefulness in rehabilitating obese populations. We examined whether the aftereffects following split-belt treadmill adaptation transferred to over-ground walking in adults with normal-weight body mass index (BMI) and obese BMI. Nineteen young adults with obesity and 19 age-matched adults with normal weight walked on flat ground at their preferred speed before and after walking on a treadmill with tied belts (preferred speed) and with the split-belt at their preferred speed and at a speed 50% slower than their preferred speed. The adaptation and aftereffects in step length and double-limb support time symmetry were calculated. We found that the amount of temporal adaptation was similar for adults with obesity and with normal weight (p > 0.05). However, adults with obesity showed greater asymmetry for double-limb support time following split-belt treadmill walking compared to adults with normal weight (p < 0.05). Furthermore, the transfer of asymmetry for double-limb support time from the treadmill to over-ground walking was less in adults with obesity than in adults with normal weight (p < 0.05). The transfer of adapted gait following split-belt treadmill walking provides insight into how atypical walking patterns in individuals with obesity could be remediated using long-term gait training.

Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study

Objectives

We aimed to develop a model for predicting the 4-year risk of knee osteoarthritis (KOA) based on survey data obtained via a random, nationwide sample of Chinese individuals.

Methods

Data was analyzed from 8193 middle-aged and older adults included in the China Health and Retirement Longitudinal Study (CHARLS). The incident of symptomatic KOA was defined as participants who were free of symptomatic KOA at baseline (CHARLS2011) and diagnosed with symptomatic KOA at the 4-year follow-up (CHARLS2015). The effects of potential predictors on the incident of KOA were estimated using logistic regression models and the final model was internally validated using the bootstrapping technique. Model performance was assessed based on discrimination—area under the receiver operating characteristic curve (AUC)—and calibration.

Results

A total of 815 incidents of KOA were identified at the 4-year follow-up, resulting in a cumulative incidence of approximately 9.95%. The final multivariable model included age, sex, waist circumference, residential area, difficulty with activities of daily living (ADLs)/instrumental activities of daily living (IADLs), history of hip fracture, depressive symptoms, number of chronic comorbidities, self-rated health status, and level of moderate physical activity (MPA). The risk model showed good discrimination with AUC = 0.719 (95% confidence interval [CI] 0.700–0.737) and optimism-corrected AUC = 0.712 after bootstrap validation. A satisfactory agreement was observed between the observed and predicted probability of incident symptomatic KOA. And a simple clinical score model was developed for quantifying the risk of KOA.

Conclusion

Our prediction model may aid the early identification of individuals at the greatest risk of developing KOA within 4 years.

Long-term effects of physical activity prescription after bariatric surgery: A randomized controlled trial

PURPOSE

This study examined the effects of physical activity prescription (PAP) in patients after gastric bypass surgery. Patients' physical activity (PA) levels and outcomes were followed over their first postoperative year.

METHODS

Patients slated for bariatric surgery were randomized to a control group (n = 64) (basic information about postoperative PA) or an intervention group (n = 57) (also received physical therapist-prescribed PAP). Outcome measures were self-reported PA/exercise and sedentary time; and weight, waist circumference, blood pressure, and blood lipids; recorded pre-operatively and at 2, 6, and 12 months postoperatively. Follow-ups were conducted by nurses/dieticians. Trial registration: "Research and Development in Sweden" number 107371.

RESULTS

There were no differences between the groups except for higher level of PA (579 vs. 182 minutes/week) six months after surgery (p = .046) and a larger decrease in cholesterol (-24 vs. -8%) after a year (p = .017) in the intervention group. Patients in both groups lost considerable weight, had reduced waist circumference, and increased PA (p < .001).

CONCLUSION

Although marked differences between groups were not observed over one year, the intervention group increased its PA 6-months postoperatively, but not at other time points. Whether long-term outcomes of PAP use are more robust with physical therapist participation across follow-ups warrants study.

A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data

Objectives

We examine here the association of multidimensional functional fitness with type 2 diabetes mellitus (T2DM) as compared to anthropometric indices of obesity such as body mass index (BMI) and waist to hip ratio (WHR) in a sample of Indian population.

Research design and method

We analysed retrospective data of 663 volunteer participants (285 males and 378 females between age 28 and 84), from an exercise clinic in which every participant was required to undergo a health related physical fitness (HRPF) assessment consisting of 15 different tasks examining 8 different aspects of functional fitness.

Results

The odds of being diabetic in the highest quartile of BMI were not significantly higher than that in the lowest quartile in either of the sexes. The odds of being a diabetic in the highest WHR quartile were significantly greater than the lowest quartile in females (OR = 4.54 (1.95, 10.61) as well as in males (OR = 3.81 (1.75, 8.3). In both sexes the odds of being a diabetic were significantly greater in the lowest quartile of HRPF score than the highest (males OR = 10.52 (4.21, 26.13); females OR = 10.50 (3.53, 31.35)). After removing confounding, the predictive power of HRPF was significantly greater than that of WHR. HRPF was negatively correlated with WHR, however for individuals that had contradicting HRPF and WHR based predictions, HRPF was the stronger predictor of T2DM.

Conclusion

The association of multidimensional functional fitness score with type 2 diabetes was significantly stronger than obesity parameters in a cross sectional self-selected sample from an Indian city.

Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending tool for deafferentation, weight offloading and stereotyped movement: Interim analysis

Deafferentation and weight offloading can increase brain and spinal motor neuron excitability, respectively. End-effector gait robots (EEGRs) can blend these effects with stereotyped movement-induced neuroplasticity. The authors aimed to evaluate the usefulness of EEGRs as a postoperative neuro-muscular rehabilitation tool. This prospective randomized controlled trial included patients who had undergone unilateral total knee arthroplasty (TKA). Patients were randomly allocated into two groups: one using a 200-step rehabilitation program in an EEGR or the other using a walker on a floor (WF) three times a day for five weekdays. The two groups were compared by electrophysiological and biomechanical methods. Since there were no more enrollments due to funding issues, interim analysis was performed. Twelve patients were assigned to the EEGR group and eight patients were assigned to the WF group. Although the muscle volume of the quadriceps and hamstring did not differ between the two groups, the normalized peak torque of the operated knee flexors (11.28 ± 16.04 Nm/kg) was improved in the EEGR group compared to that of the operated knee flexors in the WF group (4.25 ± 14.26 Nm/kg) (p = 0.04). The normalized compound motor action potentials of the vastus medialis (VM) and biceps femoris (BF) were improved in the EEGR group (p < 0.05). However, the normalized real-time peak amplitude and total, mean area under the curve of VM were decreased during rehabilitation in the EEGR group (p < 0.05). No significant differences were found between operated and non-operated knees in the EEGR group. Five-day EEGR-assisted rehabilitation induced strengthening in the knee flexors and the muscular reactivation of the BF and VM after TKA, while reducing the real-time use of the VM. This observation may suggest the feasibility of this technique: EEGR modulated the neuronal system of the patients rather than training their muscles. However, because the study was underpowered, all of the findings should be interpreted with the utmost caution.

Diet and Nutrition Risk Affect Mobility and General Health in Osteoarthritis: Data from the Canadian Longitudinal Study on Aging

BACKGROUND

This study examined whether aspects of diet and nutrition risk explain variance in physical capacity and general health, after controlling for covariates, in Canadian adults with osteoarthritis (OA).

METHODS

This was a cross-sectional study of baseline data from the Canadian Longitudinal Study on Aging (CLSA). Data from 1,404 participants with hand, hip, and/or knee OA were included. A series of regression analyses were conducted with independent variables of food intake (fiber and high calorie snack intake) and nutrition risk; and dependent variables of physical capacity and general health. Physical capacity was characterized through grip strength and a pooled index of four mobility tests. General health was characterized through an index of self-reported general health, mental health, and healthy aging.

RESULTS

Higher fiber intake was related to greater mobility (p = .01). Food intake was not related to any other outcome. Nutrition risk was significantly associated with mobility (p < .001) and general health (p < .001); those with a high nutrition risk classification had poorer general health (p < .001, d = 0.65) than those at low nutrition risk. As well, those with moderate nutrition risk had poorer general health than those with low nutrition risk (p = .001, d = 0.31).

CONCLUSIONS

Nutrition risk screening for older adults with OA provides insight into behavioral characteristics associated with reduced mobility and poorer general health. Also, those consuming greater amounts of fiber demonstrated better mobility. Thus, this research suggests that quality of diet and nutritional behaviors can impact both physical and mental aspects of health in those with OA.

The Association of an Increasing Waist Circumference and Risk of Incident Low Physical Function in Adults with Knee Osteoarthritis

OBJECTIVE

To investigate an 8-year change in waist circumference (WC) with the risk of incident low physical function over 1 year in adults with, or at risk of, knee osteoarthritis (OA).

METHODS

Data from the Osteoarthritis Initiative were used. Change in WC was measured from study enrollment (0 month) to the 96-month visit and classified as Increase (≥ 5cm gain) or Maintain (< 5cm gain). We identified World Health Organization (WHO) risk category based on WC at study enrollment as Large WC (males ≥ 102 cm, females ≥ 88 cm) or Small WC (males < 102 cm, females < 88 cm). The outcome was incident low physical function (≥ 28 Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at the 108-month visit. To investigate the association of the 8-year change in WC with the risk of low physical function, we calculated risk ratios (95% CI) and adjusted for potential confounders. We repeated the analyses stratified by the WHO disease risk category.

RESULTS

The Increase WC group had 1.43 (95% CI 1.04-1.96) times the risk of incident low physical function compared to adults in the Maintain WC group. Adults with a Large WC at baseline who increased WC had 1.55 (95% CI 1.00-2.37) times the risk of incident low physical function compared to those who maintained WC. Adults with a Small WC at baseline who increased WC had 1.97 (95% CI 0.84-4.63) times the risk compared to those who maintained WC.

CONCLUSION

Increasing WC increases the risk of incident low physical function in the following year. Maintaining WC may mitigate developing low physical function.

Effort-Based Decision-Making and Gross Motor Performance: Are They Linked?

The purpose of this study was to investigate the relationship between effort-based decision making and gross motor performance. Effort-based decision making was measured using a modified version of the Effort Expenditure for Rewards Task (EEfRT), in which participants pressed a button on a keyboard to fill a bar on a screen for monetary reward. Participants received monetary rewards that were commensurate with the level of effort that they were willing to expend. Gross motor performance was measured with a walking task, in which participants matched their steps to the beat of an audio metronome; they walked to metronome beats that were slower and also faster than their normal walking pace. We hypothesized that increased effort during the effort-based decision making task would be paired with an increase in steps taken per minute during the gross motor task. However, the results of this study indicated a lack of a statistically significant relationship between the effort-based decision making task and the gross motor task. Planning rather than decision-making may have been the cognitive construct that governed our gross motor task. These findings can be beneficial when thinking about potential interventions for populations who experience deficits in motor performance and cognition as well as for understanding the relationship between both cognitive and motor performance in healthy adults.

The Effect of Physical Activity and High Body Mass Index on Health-Related Quality of Life in Individuals with Metabolic Syndrome

The main objective of this study was to examine the relationship between the level of physical activity (PA) and the degree of obesity with health-related quality of life (HRQoL) in individuals with metabolic syndrome (MetS) who participated in the Predimed-Plus study. A total of 6875 subjects between 55 and 75 years of age with MetS were selected and randomized in 23 Spanish centers. Subjects were classified according to categories of body mass index (BMI). PA was measured with the validated Registre Gironí del Cor (REGICOR) questionnaire and subjects were classified according to their PA level (light, moderate, vigorous) and the HRQoL was measured with the validated short-form 36 (SF-36) questionnaire. By using the ANOVA model, we found a positive and statistically significant association between the level of PA and the HRQoL (aggregated physical and mental dimensions p < 0.001), but a negative association with higher BMI in aggregated physical dimensions p < 0.001. Furthermore, women obtained lower scores compared with men, more five points in all fields of SF-36. Therefore, it is essential to promote PA and body weight control from primary care consultations to improve HRQoL, paying special attention to the differences that sex incurs.

Gait speed and body mass index: Results from the AMI study

BACKGROUND

While physical frailty and malnutrition/obesity (parameters easily measured by a nurse) are not the same, older persons who are malnourished/obese are more likely to be frail and there is a potential overlap between these conditions. The objective was to examine the relationship between gait speed (GS) and body mass index (BMI) in men and women aged 75 years and older.

DESIGN

Cross-sectional analysis.

SETTING, PARTICIPANTS

Data from the Aging Multidisciplinary Investigation (AMI), a French prospective cohort study with participants randomly selected from the farmer Health Insurance rolls.

MEASUREMENTS

Usual GS was measured over a 4 meters-track. BMI was categorized using clinical cut-points for European populations: (e.g, <20.0 kg/m2; 20.0-24.9 kg/m2; 25.0-29.9 kg/m2; 30.0-34.9 kg/m2; ≥35.0 kg/m2).

RESULTS

The current analyses were performed in 449 participants. Mean age was 81 years. Being malnourished/obese was significantly associated with slow GS. Unadjusted and age-adjusted models showed that underweight, overweight and obesity statuses were significantly associated with slow GS for both women (0.83m/s [0.61; 1.04], 0.87m/s [0.72; 1.02], 0.70 m/s [0.41; 0.98], respectively) and men (0.83m/s [0.61; 1.04], 1.11m/s [1.03; 1.20], 0.97m/s [0.75; 1.19], respectively).

CONCLUSION

Malnourished/obese are associated with slow GS in older persons. These variables could be contributed at comprehensively and complementarily assessing the older person.

Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis

Obesity is one of the most important risk factors of knee osteoarthritis (KOA), but its impact on clinical and functional consequences is less clear. The main objective of this cross-sectional study was to describe the relation between body mass index (BMI) and clinical expression of KOA. Participants with BMI ≥ 25 kg/m² and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m²), stage I obesity (BMI 30-35 kg/m²) and stage II/III obesity (BMI ≥ 35 kg/m²). The groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMI and contributes to preventing the clinical consequences of KOA.

Measurement of Visceral Fat, Abdominal Circumference and Waist-hip Ratio to Predict Health Risk in Males and Females

BACKGROUND AND OBJECTIVE

Obesity is a risk factor for a broad range of diseases. This study aimed to estimate association between selected variables (visceral fat, abdominal circumference and waist-hip ratio) and health risk in between male and female.

MATERIALS AND METHODS

The university student based cross-sectional study was conducted among male and female students. The anthropometric measurements were taken through the auto-calibrated digital scale. Bioelectrical impedance analyzer device was used to determine visceral fat area, abdominal circumference and waist-hip ratio. Independent t-test and Pearson Chi-Square was used for statistical analysis. To see the association among the all three variables, scatter plots were also drawn.

RESULTS

The results showed that 28.3% male and 9.4% female at risk for visceral fat, for the abdominal circumference 16.9% male and 6% female at risk and for waist-hip ratio 27.5% male and 6% female fell under risk category. There was a significant relationship among all variable for male and female.

CONCLUSION

Findings suggested that visceral fat area, abdominal circumference and waist-hip ratio were strong predictors of health risk. Male were more prone to health risk than female participants.

Effects of obesity class on flat ground walking and obstacle negotiation

OBJECTIVES

Although much is known about the impact of obesity on gait, not much is understood about how classes of obesity affect movement. The purpose of this study was to examine the effects of weight classification on walking.

METHODS

Sixty-seven women with normal BMI (n=13), overweight/Class I obesity (n=18), Class II obesity (n=16), and Class III obesity (n=20) participated. Gait parameters (velocity and percent of the gait cycle spent in swing and stance phases) were collected as participants walked on flat ground and crossed three obstacle heights.

RESULTS

Adults with normal BMI had faster velocities (F(3,63)=12.60, p=.000017), shorter portions of the gait cycle spent in stance (F(3,62)=7.29, p=.00029), and a larger percent of the gait cycle spent in swing than those with higher BMI scores (F(3,62)=5.43, p=.002). Adults with overweight/Class I obesity had faster velocities than those with Class III obesity (p=.000082, d=1.20) as well as less variable velocities than those with Class II (p=.002, d=-.40) and Class III (p=.01, d=-1.0) obesity. No differences in velocity were found between those with Class II and Class III obesity (p=.12, d=.57).

CONCLUSIONS

These results suggest the need to encourage adults to decrease overweight/Class I obesity but that an equally important goal is to prevent an increase in BMI leading to Class II obesity.

Association of Vitamin K Status Combined With Vitamin D Status and Lower-Extremity Function: A Prospective Analysis of Two Knee Osteoarthritis Cohorts

OBJECTIVE

Vitamins K and D are important for the function of vitamin K-dependent proteins in joint tissues. It is unclear whether these nutrients are mutually important to functional outcomes related to knee osteoarthritis (OA). We evaluated the association of vitamin K and D sufficiency with lower-extremity function in the Health, Aging and Body Composition knee OA substudy (Health ABC) and conducted a replication analysis in an independent cohort, the Osteoarthritis Initiative (OAI).

METHODS

In Health ABC (60% female, mean ± SD age 75 ± 3 years) baseline nutrient status was measured using circulating vitamin K and 25-hydroxyvitamin D (25[OH]D). Lower-extremity function was assessed using the Short Physical Performance Battery (SPPB) and usual 20-meter gait speed. In the OAI (58% female, mean ± SD age 61 ± 9 years), baseline nutrient intake was estimated by food frequency questionnaire. Lower-extremity function was assessed using usual 20-meter gait speed and chair stand completion time. Multivariate mixed models were used to evaluate the association of vitamin K and D status and intake with lower-extremity function over 4-5 years.

RESULTS

Health ABC participants with sufficient plasma vitamin K (≥1.0 nmoles/liter) and serum 25(OH)D (≥50 nmoles/liter) generally had better SPPB scores and faster usual gait speed over followup (P ≤ 0.002). In the OAI, sufficient vitamin K and vitamin D intake combined was associated with overall faster usual gait speed and chair stand completion time over followup (P ≤ 0.029).

CONCLUSION

Sufficient vitamin K status combined with sufficient vitamin D status was associated with better lower-extremity function in 2 knee OA cohorts. These findings merit confirmation in vitamin K and D co-supplementation trials.

Differential involvement of synovial adipokines in pain and physical function in female patients with knee osteoarthritis. A cross-sectional study

OBJECTIVE

Adipokines have been reported to play a role in the development, progression and severity of knee osteoarthritis but the influence of the different adipokines are not well known. The aim of this study was to evaluate the association between different synovial fluid adipokines with pain and disability knee osteoarthritis patients.

METHODS

Cross-sectional study with systematic inclusion of 115 symptomatic primary knee osteoarthritis female patients with ultrasound-confirmed joint effusion. Age, physical exercise, symptoms duration and different anthropometric measurements were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function scales. Seven adipokines and three inflammatory markers were measured by ELISA in synovial fluid. Partial Correlation Coefficient (PCC) and corresponding 95% confidence interval were used as a measure of association.

RESULTS

Leptin, osteopontin and inflammatory factors, especially TNF-alpha, were associated to pain and function. After adjustment for potential confounders including inflammatory factors and all adipokines, an association was found for adiponectin with pain (PCC 0.240 [0.012, 0.444]) and for resistin and visfatin with function (PCC 0.336 [0.117, 0.524] and -0.262 [-0.463, -0.036]). No other adipokines or inflammatory markers were statistically and independently associated. An association between physical exercise and pain and disability remained after adjustment, whereas an attenuation of the influence of anthropometric measurements was observed.

CONCLUSIONS

Different patterns of association between synovial fluid adipokines were observed regarding pain and disability in knee osteoarthritis patients. Specifically, adiponectin was associated to pain while resistin and visfatin were mainly related to function.

Body-scaled action in obesity during locomotion: Insights on the nature and extent of body representation disturbances

OBJECTIVE

Conscious perception of our own body, also known as body image, can influence body-scaled actions. Certain conditions such as obesity are frequently accompanied by a negative body image, leaving open the question if body-scaled actions are distorted in these individuals.

METHODS

To shed light on this issue, we asked individuals affected by obesity to process dimensions of their own body in a real action: they walked in a straight-ahead direction, while avoiding collision with obstacles represented by door-like openings that varied in width.

RESULTS

Participants affected by obesity showed a body rotation behavior similar to that of the healthy weighted, but differences emerged in parameters such as step length and velocity.

CONCLUSION

When participants with obesity walk through door-like openings, their body parts rotation is scaled according to their physical body dimensions; however, they might try to minimize risk of collision. Our study is in line with the hypothesis that unconscious body-scaled actions are related to emotional, cognitive and perceptual components of a negative body image.