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Benitez-Velasco A, Alzas-Teomiro C, Zurera Gómez C, Muñoz Jiménez C, López Aguilera J, Crespin M, Vallejo-Casas JA, Gálvez-Moreno MÁ, Molina Puerta MJ, Herrera-Martínez AD. Differences in the Evaluation of Malnutrition and Body Composition Using Bioelectrical Impedance Analysis, Nutritional Ultrasound, and Dual-Energy X-ray Absorptiometry in Patients with Heart Failure. Nutrients 2024; 16:1535. [PMID: 38794773 PMCID: PMC11124170 DOI: 10.3390/nu16101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Although malnutrition is frequently observed in patients with heart failure (HF), this diagnosis should be performed carefully since HF itself is associated with increased inflammatory activity, which affects body weight, functionality, and some nutritional parameters; thus, its isolated interpretation can erroneously identify surrogate markers of severity as markers of malnutrition. In this context, we aimed to evaluate the prevalence of malnutrition using different classification systems and perform a comprehensive nutritional evaluation to determine the reliability of different diagnostic techniques. PATIENTS AND METHODS Eighty-three patients with a recent hospital admission due to HF were evaluated. GLIM diagnosis criteria and subjective global assessment (SGA) were performed; a comprehensive anthropometric, functional, and biochemical nutritional evaluation was performed, in which bioelectrical impedance analysis (BIA), nutritional ultrasound, and dual-energy X-ray absorptiometry (DXA) were performed. Additionally, mortality and additional admissions due to HF were determined after a mean follow up of 18 months. RESULTS Malnutrition according to the GLIM criteria (54%) accurately distinguished patients with impaired functionality, lower lean mass, skeletal mass index, and appendicular muscle mass (BIA), as well as lower trunk fat mass, trunk lean mass, fat-free mass (DXA), and decreased albumin and increased C-reactive protein serum levels. According to SGA, there were significant changes in body composition parameters determined by BIA, muscle ultrasound, and functional tests between well-nourished patients and patients with risk of malnutrition (53.7%) or who had malnutrition (7.1%), but not when the last two groups were compared. BIA and DXA showed strong correlations when evaluating muscle and fat mass in HF patients, but correlations with nutritional ultrasound were limited, as well as functional tests. A multivariate analysis showed that no significant association was observed between body composition and mortality, but preperitoneal fat was associated with an increased risk of new hospital admissions (OR: 0.73). CONCLUSIONS GLIM criteria identified a lower percentage of patients with HF and malnutrition compared with SGA; thus, SGA could have a role in preventing malnutrition in HF patients. Nutritional evaluation with BIA and DXA in patients with HF showed reliable results of body composition parameters in HF, and both help with the diagnosis of malnutrition according to the GLIM or SGA criteria and could provide complementary information in some specific cases.
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Affiliation(s)
- Ana Benitez-Velasco
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Nuclear Medicine Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Carlos Alzas-Teomiro
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Carmen Zurera Gómez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Concepción Muñoz Jiménez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - José López Aguilera
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Cardiology Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Manuel Crespin
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Cardiology Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Juan Antonio Vallejo-Casas
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Nuclear Medicine Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María Ángeles Gálvez-Moreno
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María José Molina Puerta
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Aura D. Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Cordoba, Spain
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2
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Fernández-Jiménez R, García-Rey S, Roque-Cuéllar MC, Fernández-Soto ML, García-Olivares M, Novo-Rodríguez M, González-Pacheco M, Prior-Sánchez I, Carmona-Llanos A, Muñoz-Jiménez C, Zarco-Rodríguez FP, Miguel-Luengo L, Boughanem H, García-Luna PP, García-Almeida JM. Ultrasound Muscle Evaluation for Predicting the Prognosis of Patients with Head and Neck Cancer: A Large-Scale and Multicenter Prospective Study. Nutrients 2024; 16:387. [PMID: 38337671 PMCID: PMC10857428 DOI: 10.3390/nu16030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Head and neck cancer (HNC) is a prevalent and aggressive form of cancer with high mortality rates and significant implications for nutritional status. Accurate assessment of malnutrition in patients with HNC is crucial for optimizing treatment outcomes and improving survival rates. This study aimed to evaluate the use of ultrasound techniques for predicting nutritional status, malnutrition, and cancer outcomes in patients with HNC. A total of 494 patients with HNC were included in this cross-sectional observational study. Various tools and body composition measurements, including muscle mass and adipose tissue ultrasound evaluations, were implemented. Using regression models, we mainly found that high levels of RF-CSA (rectus femoris cross-sectional area) were associated with a decreased risk of malnutrition (as defined with GLIM criteria (OR = 0.81, 95% CI: 0.68-0.98); as defined with PG-SGA (OR = 0.78, 95% CI: 0.62-0.98)) and sarcopenia (OR = 0.64, 95% CI: 0.49-0.82) after being adjusted for age, sex, and BMI. To predict the importance of muscle mass ultrasound variables on the risk of mortality, a nomogram, a random forest, and decision tree models were conducted. RF-CSA was the most important variable under the random forest model. The obtained C-index for the nomogram was 0.704, and the Brier score was 16.8. With an RF-CSA < 2.7 (AUC of 0.653 (0.59-0.77)) as a split, the decision tree model classified up to 68% of patients as possessing a high probability of survival. According to the cut-off value of 2.7 cm2, patients with a low RF-CSA value lower than 2.7 cm2 had worse survival rates (p < 0.001). The findings of this study highlight the importance of implementing ultrasound tools, for accurate diagnoses and monitoring of malnutrition in patients with HNC. Adipose tissue ultrasound measurements were only weakly associated with malnutrition and not with sarcopenia, indicating that muscle mass is a more important indicator of overall health and nutritional status. These results have the potential to improve survival rates and quality of life by enabling early intervention and personalized nutritional management.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Department of Endocrinology and Nutrition, QuironSalud Malaga Hospital, 29004 Malaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
| | - Silvia García-Rey
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - María Carmen Roque-Cuéllar
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - María Luisa Fernández-Soto
- Endocrinology and Nutrition Clinical Management Unit, University Hospital San Cecilio, 18012 Granada, Spain;
- Biosanitary Institute of Granada, Medicine Department, Faculty of Medicine of Granada, University of Granada, 18010 Granada, Spain
| | - María García-Olivares
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Department of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital, 29007 Malaga, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, FIBAO (Fundación para la Investigación Biosanitaria de Andalucia Oriental), Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - María González-Pacheco
- Department of Endocrinology and Nutrition, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Puerta del Mar University Hospital, 11009 Cadiz, Spain;
| | | | - Alba Carmona-Llanos
- Department of Endocrinology and Nutrition, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Jerez de la Frontera University Hospital, 11407 Cadiz, Spain;
| | - Concepción Muñoz-Jiménez
- Department of Endocrinology and Nutrition, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, 14011 Cordoba, Spain;
| | | | - Luis Miguel-Luengo
- Department of Endocrinology and Nutrition, Badajoz University Hospital, 06080 Badajoz, Spain;
- Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Hatim Boughanem
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Cordoba, Spain
| | - Pedro Pablo García-Luna
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain; (S.G.-R.); (M.C.R.-C.); (P.P.G.-L.)
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain; (R.F.-J.); (J.M.G.-A.)
- Department of Endocrinology and Nutrition, QuironSalud Malaga Hospital, 29004 Malaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
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3
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Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
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Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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4
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Singh D, Mittal P, Bachani S, Mukherjee B, Mittal MK, Suri J. Ultrasonographic Assessment of Body Fat Index for Prediction of Gestational Diabetes Mellitus and Neonatal Complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102177. [PMID: 37437777 DOI: 10.1016/j.jogc.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To assess maternal pre-peritoneal fat and subcutaneous fat at 16-20 weeks gestation by ultrasound. Thus, calculate body fat index (BFI) and determine its cut-off value for prediction of gestational diabetes mellitus (GDM) and neonatal subcutaneous adiposity. METHODS A cohort study was conducted in 200 pregnant women with singleton fetus during anomaly scan using BFI where they were screened for GDM at 24-28 weeks gestation by oral glucose tolerance test. Labour and neonatal outcomes were recorded. The receiver operating characteristic curve was used to determine the cut-offs for BFI, pre-peritoneal fat thickness, and subcutaneous fat thickness in order to predict GDM. RESULTS The area under receiver operating characteristic curve for BFI was 0.967 (95% CI 0.932-0.987) with a sensitivity of 97.3%, specificity of 89.57%, negative predictive value of 99.3%, and diagnostic accuracy of 91% at a BFI cut-off of 0.88. The study analysis demonstrated BFI to be statistically superior to BMI > 22.9 kg/m2 for prediction of GDM. BFI > 0.88 was a risk factor for developing neonatal subcutaneous adiposity. CONCLUSIONS BFI is a practical and convenient non-invasive screening tool to predict GDM and neonatal subcutaneous adiposity.
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Affiliation(s)
- Deepanjali Singh
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India; Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Faridabad, India
| | - Sumitra Bachani
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Bijoya Mukherjee
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
| | | | - Jyotsna Suri
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
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López-Plaza B, Gil Á, Menéndez-Rey A, Bensadon-Naeder L, Hummel T, Feliú-Batlle J, Palma-Milla S. Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol. Nutrients 2023; 15:4639. [PMID: 37960292 PMCID: PMC10648678 DOI: 10.3390/nu15214639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).
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Affiliation(s)
- Bricia López-Plaza
- Nutrition Research Group, La Paz University Hospital Institute for Health Research (IdiPAZ), 28046 Madrid, Spain;
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Samara Palma-Milla
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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6
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Fernández-Jiménez R, Cabrera Cesar E, Sánchez García A, Espíldora Hernández F, Vegas-Aguilar IM, Amaya-Campos MDM, Cornejo-Pareja I, Guirado-Peláez P, Simón-Frapolli V, Murri M, Garrido-Sánchez L, Martínez Mesa A, Piñel-Jimenez L, Benítez-Cano Gamonoso M, Dalla-Rovere L, García Olivares M, Velasco-Garrido JL, Tinahones-Madueño F, García-Almeida JM. Rectus Femoris Cross-Sectional Area and Phase Angle asPredictors of 12-Month Mortality in Idiopathic Pulmonary Fibrosis Patients. Nutrients 2023; 15:4473. [PMID: 37892547 PMCID: PMC10609753 DOI: 10.3390/nu15204473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The value of the phase angle (PhA), measured via bioelectrical impedance analysis (BIA), could be considered a good marker of the cell mass and the cell damage of a patient; however, there are new techniques, such as muscle ultrasonography, that allow the quantity and quality of muscle to be assessed in a minimally invasive way. The aim of this study is to determine the prognostic value of morphofunctional techniques in the prognosis of mortality in patients with idiopathic pulmonary fibrosis (IPF). METHODS This multicenter, cross-sectional study included 86 patients with idiopathic pulmonary fibrosis with a mean age of 71 years, 82.7% of whom were male. The nutritional risk of the patients was assessed by means of questionnaires, such as the Subjective Global Assessment (SGA), and non-invasive functional techniques, including BIA, nutritional ultrasound, and hand grip strength (HGS). Statistical analysis of the sample was performed using JAMOVI version 2.3.22. RESULTS Correlations were made between the RF-CSA techniques with PhA (r = 0.48, p < 0.001), BCM (r = 0.70, p < 0.001), SMI (r = 0.64, p < 0.001), and HGS (r = 0.54, p < 0.001). The cut-off points for 12-month mortality were PhA = 4.5° (AUC = 0.722, sensitivity of 72.7% and specificity of 66.6%), BCM = 28.8 kg (AUC = 0.609, sensitivity of 32.4% and specificity of 100.0%), RF-CSA = 3.00 cm2 (AUC = 0.857, sensitivity of 64.4% and specificity of 100.0%), 6MMW = 420 m (AUC = 0.830, sensitivity of 63.27% and specificity of 100.0%), and TUG = 7.2 s (AUC = 0.771, sensitivity of 100.0% and specificity of 56.67%). In addition, a multivariate analysis was performed with RF-CSA, HR = 8.11 (1.39-47.16, p = 0.020), and PhA of 6.35 (1.29-31.15, p = 0.023), taking into account age, sex, and BMI to determine mortality. Finally, a Kaplan-Meier survival analysis was conducted with low or normal values for classical parameters (GAP and T6MM) and new parameters (PhA, BCM, RF-CSA, and TUG). CONCLUSION RF-CSA and PhA were shown to be good prognostic markers of 12-month mortality and could, therefore, be useful screening tools to complement the nutritional assessment of IPF patients.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
| | - Eva Cabrera Cesar
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Ana Sánchez García
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | | | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Maria del Mar Amaya-Campos
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Victor Simón-Frapolli
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
| | - Mora Murri
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
- Heart Area Clinical Management Unit, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
| | - Lourdes Garrido-Sánchez
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Alvaro Martínez Mesa
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Lorena Piñel-Jimenez
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Miguel Benítez-Cano Gamonoso
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Lara Dalla-Rovere
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
| | - Maria García Olivares
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
- Department of Endocrinology and Nutrition, Carlos de Haya Regional University Hospital, 29010 Malaga, Spain
| | - Jose Luis Velasco-Garrido
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Francisco Tinahones-Madueño
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
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Şengül M, Selim HŞ. Early Prediction of Gestational Diabetes Mellitus Using Placental Strain Elastography and Subcutaneous Adipose Tissue Thickness. Z Geburtshilfe Neonatol 2023; 227:269-276. [PMID: 37586377 DOI: 10.1055/a-2109-4210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
AIM The aim of this study is to investigate the efficacy of placental strain ratio values measured by real-time sonoelastography and maternal subcutaneous adipose tissue thickness measured by two-dimensional ultrasonography in predicting gestational diabetes mellitus in the first trimester. MATERIALS AND METHODS The population of the study consisted of the first 210 consecutive singleton pregnant women who applied for routine first-trimester screening between the 11th and 14th week of gestation.B-mode subcutaneous adipose tissue thickness sonography and real-time placental strain elastography scanning were performed.All patients underwent 75 g oral glucose tolerance test between the 24th and 28th week of gestation. American Diabetes Association criteria were used in the diagnosis of gestational diabetes mellitus. RESULTS It was observed that body mass index (p<0.001), first-trimester fasting blood sugar (p<0.001), subcutaneous adipose tissue thickness (p<0.001), and placental strain ratio value (p<0.001) affected the development of gestational diabetes mellitus statistically. The multivariate analysis shown that subcutaneous adipose tissue thickness (odds ratio=1.271, 95% CI=1.142-1.416, p<0.001) and placental strain ratio value (odds ratio=3.664, 95% CI=1.927-6.969, p<0.001) were the independent risk factors affecting the development of gestational diabetes mellitus. CONCLUSIONS The findings of this study indicated a positive correlation between 75 g oral glucose tolerance test application and first trimester subcutaneous adipose tissue thickness and placental strain ratio. Using the cut-off values of>11.5 mm for subcutaneous adipose tissue and>0.986 for placental strain ratio, the development of gestational diabetes mellitus may be predicted in the early weeks of pregnancy.
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Affiliation(s)
- Mustafa Şengül
- Obstetrics and Gynecology Department, Izmir Katip Celebi University, Izmir, Turkey
| | - Halime Şen Selim
- Obstetric and Gynecology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
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García-Almeida JM, García-García C, Vegas-Aguilar IM, Ballesteros Pomar MD, Cornejo-Pareja IM, Fernández Medina B, de Luis Román DA, Bellido Guerrero D, Bretón Lesmes I, Tinahones Madueño FJ. Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:74-84. [PMID: 36935167 DOI: 10.1016/j.endien.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 03/19/2023]
Abstract
Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.
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Affiliation(s)
- José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, IBIMA, CIBEROBN, Hospital Quirónsalud, University of Málaga, Spain.
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Isabel María Vegas-Aguilar
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, FIMABIS, Málaga, Spain
| | | | - Isabel María Cornejo-Pareja
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, IBIMA, CIBEROBN, Carlos III Health Institute, Málaga, Spain
| | - Beatriz Fernández Medina
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Daniel A de Luis Román
- Department of Endocrinology and Nutrition, Institute of Endocrinology and Nutrition, Medicine School and Department of Endocrinology and Investigation, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain
| | - Diego Bellido Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, A Coruña, Spain
| | - Irene Bretón Lesmes
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco J Tinahones Madueño
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, Spain
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9
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Rectus Femoris Muscle and Phase Angle as Prognostic Factor for 12-Month Mortality in a Longitudinal Cohort of Patients with Cancer (AnyVida Trial). Nutrients 2023; 15:nu15030522. [PMID: 36771229 PMCID: PMC9919732 DOI: 10.3390/nu15030522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. METHODS We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and "Timed Up and Go Test" (TUG) were evaluated as predictors of mortality. RESULTS Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21-0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39-0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. CONCLUSIONS Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.
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García-Almeida JM, García-García C, Vegas-Aguilar IM, Ballesteros Pomar MD, Cornejo-Pareja IM, Fernández Medina B, de Luis Román DA, Bellido Guerrero D, Bretón Lesmes I, Tinahones Madueño FJ. Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Morphofunctional and Molecular Assessment of Nutritional Status in Head and Neck Cancer Patients Undergoing Systemic Treatment: Role of Inflammasome in Clinical Nutrition. Cancers (Basel) 2022; 14:cancers14030494. [PMID: 35158762 PMCID: PMC8833422 DOI: 10.3390/cancers14030494] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Malnutrition in patients with head and neck cancer is associated with worse clinical evolution and prognosis. Accurate nutritional assessments allow for early-identification of patients at risk of malnutrition. We aimed to perform a novel morphofunctional nutritional evaluation, including molecular analysis in patients with head and neck cancer who are undergoing systemic treatment. A morphofunctional nutritional assessment includes bioimpedance, anthropometric, ultrasound and biochemical measurements. We observed that malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components, which are related with clinical nutritional parameters. This molecular analysis should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients. Abstract Malnutrition in patients with head and neck cancer is frequent, multifactorial and widely associated with clinical evolution and prognosis. Accurate nutritional assessments allow for early identification of patients at risk of malnutrition in order to start nutritional support and prevent sarcopenia. We aimed to perform a novel morphofunctional nutritional evaluation and explore changes in inflammasome-machinery components in 45 patients with head and neck cancer who are undergoing systemic treatment. To this aim, an epidemiological/clinical/anthropometric/biochemical evaluation was performed. Serum RCP, IL6 and molecular expression of inflammasome-components and inflammatory-associated factors (NOD-like-receptors, inflammasome-activation-components, cytokines and inflammation/apoptosis-related components, cell-cycle and DNA-damage regulators) were evaluated in peripheral-blood mononuclear-cells (PBMCs). Clinical-molecular correlations/associations were analyzed. Coherent and complementary information was obtained in the morphofunctional nutritional assessment of the patients when bioimpedance, anthropometric and ultrasound data were analyzed. These factors were also correlated with different biochemical and molecular parameters, revealing the complementary aspect of the whole evaluation. Serum reactive C protein (RCP) and IL6 were the most reliable parameters for determining patients with decreased standardized phase angle, which is associated with increased mortality in patients with solid malignancies. Several inflammasome-components were dysregulated in patients with malnutrition, decreased phase angle and dependency grade or increased circulating inflammation markers. A molecular fingerprint based on gene-expression of certain inflammasome factors (p27/CCL2/ASC) in PBMCs accurately differentiated patients with and without malnutrition. In conclusion, malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components in PBMCs. A comprehensive nutritional assessment including novel morphofunctional techniques and molecular markers allows a broad characterization of the nutritional status in cancer patients. Profile of certain inflammasome-components should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients.
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Hazem M, Ezzat M, Elsamman M, AlYahya A, Alam-Eldeen MH. Non-Invasive Prediction of Coronary Artery Disease by Multiple Abdominal Fat and Anthropometric Indices: Revisit. Int J Gen Med 2021; 14:387-398. [PMID: 33603444 PMCID: PMC7882716 DOI: 10.2147/ijgm.s294331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the efficiency of multiple abdominal fat indices measured by ultrasound and anthropometric indices to predict the presence and severity of coronary artery disease (CAD) assessed by coronary angiography. Patients and Methods All participants subjected to clinical and laboratory assessments. Anthropometric measurements were taken followed by an ultrasound examination to measure fat thickness at multiple abdominal areas. Lastly, selective coronary angiography performed by the Judkins technique. Statistical analysis was performed to detect the association between all variables and CAD, followed by regression analysis, and Odds ratio (OR) was used to quantifies the strength of the association between two events. Results From the abdominal indices, the posterior right perinephric fat thickness (PRPFT) above the best cutoff value had the highest hazard ratio (HR: 12.3, p = 0.001), followed by visceral adipose tissue volume (VAT) (HR: 10.7, p < 0.001), waist circumference (WC) (HR: 6.7, p = 0.001), visceral fat thickness (VFT) (HR: 5.7, p = 0.002), and body mass index (BMI) (HR: 5.48, p = 0.017). It also showed an independent association between the severity of CAD and WC (HR: 4.28, p = 0.012), VFT (HR: 3.7, p = 0.032), VAT (HR: 3.7, p = 0.034), and waist to height ratio (WHtR) (HR: 3.3, p = 0.033). Conclusion Posterior perinephric fat thickness and visceral adipose tissue volume measured by ultrasound are strong noninvasive predictors for coronary artery disease, followed by body mass index, waist circumference and visceral fat thickness.
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Affiliation(s)
- Mohammed Hazem
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, 31982, Saudi Arabia.,Department of Radiology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Ezzat
- Cardiology Division, Internal Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mahmoud Elsamman
- Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Abdulwahab AlYahya
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, 31982, Saudi Arabia.,Radiology Department, Polyclinic Center, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
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13
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Molina-Molina E, Shanmugam H, Di Ciaula A, Grattagliano I, Di Palo DM, Palmieri VO, Portincasa P. ( 13C)-Methacetin breath test provides evidence of subclinical liver dysfunction linked to fat storage but not lifestyle. JHEP Rep 2021; 3:100203. [PMID: 33490935 PMCID: PMC7806794 DOI: 10.1016/j.jhepr.2020.100203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is characterised by the presence of hepatic steatosis in the absence of other causes of secondary hepatic fat accumulation, and is usually associated with visceral, metabolically active obesity. However, the subclinical effects of body and liver fat accumulation on liver function are still unclear. METHODS We used orally administered (13C)-methacetin and breath test to quantify the efficiency of hepatic extraction from portal blood flow and liver microsomal function in 81 participants, in relation to presence/absence of ultrasonographic NAFLD, extent of body fat accumulation, insulin resistance, dietary models, and lifestyle. RESULTS NAFLD was present in 23% of participants with normal weight, and prevalence increased with body fat and insulin resistance. Fat accumulation, NAFLD, and insulin resistance were associated with decreased hepatic extraction efficiency, and liver microsomal function was impaired in moderate-to-severe NAFLD. Caloric intake, dietary models, and lifestyles had a minor role in promoting functional changes. CONCLUSIONS The interplay between body fat accumulation, insulin resistance, and NAFLD is linked with altered hepatic extraction efficiency from blood flow and deranged microsomal function. Non-invasive diagnosis of subclinical alterations of liver function is relevant for primary and secondary prevention measures. Furthermore, the occurrence of NAFLD in lean individuals and the evidence that caloric intake, dietary models, and lifestyle played a minor role require further studies exploring the role of environmental factors in the natural history of these diseases. LAY SUMMARY Obesity is progressively increasing worldwide and is paralleled by fat accumulation in the liver (non-alcoholic fatty liver disease [NAFLD]), the most common chronic liver disease worldwide. NAFLD can alter liver structure and function, with a variety of consequences ranging from asymptomatic and subclinical alterations to cirrhosis and cancer. (13C)-Methacetin breath test, a non-invasive diagnostic tool, can reveal early subclinical alterations of liver dynamic function in individuals with obesity and in patients with NAFLD.
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Key Words
- (13C), carbon-13
- ALT, alanine aminotransferase
- ARFI, acoustic radiation force impulse
- AST, aspartate aminotransferase
- BT, breath test
- Body mass index
- DOB, delta over baseline
- FLI, fatty liver index
- GGT, gamma-glutamyl transferase
- HOMA, Homeostatic Model Assessment for Insulin Resistance
- HRQoL, health-related quality of life
- IDF, International Diabetes Federation
- KICA, ketoisocaproic acid
- Liver function
- MBT, methacetin breath test
- MD, Mediterranean diet
- MET, metabolic equivalent task
- Microsomal function
- NAFL, non-alcoholic fatty liver
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic fatty liver disease
- OR, odds ratio
- Portal blood flow
- R-ATPIII, Revised National Cholesterol Education Programme-Adult Treatment Panel III
- SF-36, 36-Item Short Form Health Survey Questionnaire
- US, ultrasonography
- cPDR, cumulative per cent dose recovery
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Affiliation(s)
- Emilio Molina-Molina
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Harshitha Shanmugam
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Agostino Di Ciaula
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | | | - Domenica Maria Di Palo
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo O. Palmieri
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Piero Portincasa
- Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
- Corresponding author. Address: Clinica Medica ‘Augusto Murri’, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy. Tel.: +39 80 5478 227; fax: +39 80 5478 232.
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Abstract
Introduction Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin. Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional parameters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease.
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Ponti F, De Cinque A, Fazio N, Napoli A, Guglielmi G, Bazzocchi A. Ultrasound imaging, a stethoscope for body composition assessment. Quant Imaging Med Surg 2020; 10:1699-1722. [PMID: 32742962 DOI: 10.21037/qims-19-1048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dysregulation of the human's energy balance, mediated by non-performing endocrine organs (liver, skeletal muscle and adipose tissue, above all), can be related to human metabolic disorders characterized by an impaired body composition (BC), such as obesity and sarcopenia. While it is possible to monitor the BC and its variations at different levels, the tissue-organ composition studies have been proven to provide the most clinically applicable information. Ultrasonography (US), a fast, non-invasive, low-cost and widely available technique, holds great potential in the study of BC, as it can directly measure muscles, organs, visceral and subcutaneous fat tissue in different sections of the abdomen and body, overcoming some limits of anthropometric evaluation and other imaging techniques. Purpose of this review article is to explore the technical aspects and the applied methods of US examination to assess the potential clinical role of this technique in the context of BC characterization, investigating four pivotal topics [abdominal fat compartments, subcutaneous adipose tissue (SAT), skeletal muscle, liver].
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Affiliation(s)
- Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio De Cinque
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Fazio
- Technology Transfer Office, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Napoli
- Department of Radiologic, Oncologic and Pathologic Science, La Sapienza University of Rome, Rome, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy.,Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Cremona A, Hayes K, O’Gorman CS, Laighin CN, Ismail KI, Donnelly AE, Hamilton J, Cotter A. Inter and intra-reliability of ultrasonography for the measurement of abdominal subcutaneous & visceral adipose tissue thickness at 12 weeks gestation. BMC Med Imaging 2019; 19:95. [PMID: 31847832 PMCID: PMC6916062 DOI: 10.1186/s12880-019-0393-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/08/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Excess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population. METHODS Thirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1-5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks. RESULTS Intra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be - 0.45 to 0.46 cm for SAT and - 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%). CONCLUSION Intra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.
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Affiliation(s)
- Alexandra Cremona
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- School of Allied Health (SAH), University of Limerick, Limerick, Ireland
- Institute of Nutrition & Dietetics (INDI), Dublin, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Physical Education and Sport Sciences (PESS), University of Limerick, Limerick, Ireland
| | - Kevin Hayes
- Department of Statistics, University College Cork (UCC), Cork, Ireland
| | - Clodagh S. O’Gorman
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Ciara Ní Laighin
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Khadijah I. Ismail
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Alan E. Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Physical Education and Sport Sciences (PESS), University of Limerick, Limerick, Ireland
| | | | - Amanda Cotter
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
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Ahmadi F, Moukhah S, Hosseini R, Maghari A. Ultrasound Evaluation of Visceral Fat Thickness for Prediction of Metabolic Syndrome in the First Trimester of Pregnancy in a Sample of Non-obese Iranian Women. Oman Med J 2019; 34:308-312. [PMID: 31360319 PMCID: PMC6642717 DOI: 10.5001/omj.2019.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Ultrasonography is a noninvasive and safe modality for assessing body fat and is routinely performed in developed countries. Although pregnant women with obesity are at risk for many unfavorable outcomes, the relationship between abdominal fat distribution and metabolic syndrome (MS) is evident in some studies. Therefore, it is important to evaluate fat thickness in non-obese women and predict MS using fat thickness measurement. Methods A total of 132 pregnant women completed anthropometric and demographic questionnaires. All women were scanned for visceral fat thickness (VFT) via ultrasound at 11-14 weeks gestation. Body mass index (BMI) and waist circumference (WC) were calculated at the first prenatal visit. MS components were also measured in the same weeks. Results MS was detected in seven (5.3%) women. There was a statistically significant difference between women with and without MS for weight, WC, anterior and posterior VFT, insulin, lipid profile (total cholesterol, high-density lipoprotein cholesterol, and triglyceride), and systolic and diastolic blood pressure (p < 0.050). The optimal cut-off points determined for predicting MS disorder were an anterior VFT of 43.83 mm and a posterior VFT of 32.50 mm. Conclusions Fat thickness measurement in the first trimester is a good predictor for MS even in women with a normal BMI. Ultrasonography as a safe, simple, and cost-effective modality can be used to assess fat thickness besides the other screening evaluations in the first trimester of pregnancy.
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Affiliation(s)
- Firoozeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Somayeh Moukhah
- Department of Reproductive Health, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Hosseini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Amirhossein Maghari
- Marine Medicine Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
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Stigall AN, Hunter RL, Evans KD, Spees CK. A Longitudinal Study to Assess Abdominal Adiposity by Sonography, DXA, and BMI. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319848746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A. Nicole Stigall
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Randee L. Hunter
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Colleen K. Spees
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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Kansu-Celik H, Karakaya BK, Tasci Y, Hancerliogullari N, Yaman S, Ozel S, Erkaya S. Relationship maternal subcutaneous adipose tissue thickness and development of gestational diabetes mellitus. Interv Med Appl Sci 2018; 10:13-18. [PMID: 30363336 PMCID: PMC6167636 DOI: 10.1556/1646.10.2018.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective We investigated whether the ultrasonographic measurement of maternal subcutaneous adipose tissue (SAT) thickness in the second trimester played a role in predicting gestational diabetes. Materials and methods This was a prospective cross-sectional study in which 223 women were classified as healthy (n = 177) or as gestational diabetes (n = 46) on the basis of a negative or positive two-step oral Glucose Challenge Test (GCT), respectively. The depth of the abdominal SAT was evaluated by two-dimensional ultrasonography. Body mass index (BMI), waist circumference (WC), and waist/hip ratio were determined. Results There was a positive strong significant correlation between a 50-g GCT level and BMI, WC, and SAT thickness (p < 0.001). Receiver-operating characteristic curve analysis showed SAT thickness above 16.75 mm predicted gestational diabetes mellitus (GDM) with a sensitivity of 71.7%, a specificity of 57.1%, a positive predictive value of 32.3%, and a negative predictive value of 87.6%. There was a good correlation between SAT, BMI, and WC. Conclusion Increased SAT, BMI, and WC measurements may be helpful in predicting the risk of the development of GDM in pregnant women.
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Affiliation(s)
- Hatice Kansu-Celik
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Burcu Kisa Karakaya
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Yasemin Tasci
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Necati Hancerliogullari
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Selen Yaman
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Sule Ozel
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
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Nassr AA, Shazly SA, Trinidad MC, El-Nashar SA, Marroquin AM, Brost BC. Body fat index: A novel alternative to body mass index for prediction of gestational diabetes and hypertensive disorders in pregnancy. Eur J Obstet Gynecol Reprod Biol 2018; 228:243-248. [PMID: 30014931 DOI: 10.1016/j.ejogrb.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the association of ultrasound measurement of maternal abdominal subcutaneous and pre-peritoneal fat thickness in relation to the subsequent diagnosis of gestational diabetes (GDM), and to assess the association of body fat index (BFI), compared to conventional body mass index (BMI), with respect to the development of some obstetric related complications. STUDY DESIGN A prospective study included non-diabetic pregnant women who were scheduled for fetal anatomic survey. Women underwent fat measurements and BFI (pre-peritoneal fat x subcutaneous fat/height) was calculated. They underwent routine glucose screening and diagnostic tests for GDM. Obstetric complications, mode of delivery, and delivery related events were reported. Multivariable logistic regression was used to test potential predictors for development of obesity-related complications. Primary outcome was development of GDM. Secondary outcomes included development of hypertensive disorders during pregnancy and need for cesarean delivery due to labor dystocia. The optimal cut-off points for continuous variables were obtained using a receiver operating characteristic (ROC) curve analyses. RESULTS 389 women met study criteria. Median gestational age at time of ultrasound evaluation was 19.1 weeks. Positive family history of diabetes (adjusted odds ratio "OR" 2.30, 95% CI 1.35-3.92), history of GDM (adjusted OR 6.87, 95% CI 3.03-15.61), subcutaneous fat≥13 mm (adjusted OR 4.63, 95% CI 1.60-13.38) and pre-peritoneal fat≥12 mm (adjusted OR 3.32, 95% CI 1.06-10.42) were significant predictors for development of GDM. ROC analysis demonstrated that a BFI > 0.5 was statistically superior to a BMI > 25 or 30 as a predictor of gestational diabetes (adjusted OR 6.24, 95% CI 1.86-20.96). A Similar ROC analysis demonstrated that a BFI > 0.8 was associated with a higher risk for the development of hypertensive disorders of pregnancy (adjusted OR 2.70 [95% CI 1.60-4.55]), and need for cesarean delivery (adjusted OR 2.01[95% CI 1.23-3.28]) than a BMI > 25 or 30. CONCLUSION Values obtained by ultrasound measurement of subcutaneous and pre-peritoneal fat are associated with development of GDM and hypertensive disorders in pregnancy. Our data suggest that BFI was a better predictor than BMI for development of GDM and hypertensive disorders in pregnancy and should be studied further.
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Affiliation(s)
- Ahmed A Nassr
- Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt; Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Sherif A Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Mari C Trinidad
- Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sherif A El-Nashar
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amber M Marroquin
- Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Brian C Brost
- Division of Maternal Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Stigall AN, Evans KD, Tatarski R, Pargeon RL, Spees C. Abdominal Adiposity Measured by Sonography as a Tool for Determining Disease Risk. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318771552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A preexperimental cohort study was conducted with 67 overweight cancer survivors. This cohort of participants was screened for baseline body composition and anthropometrics based on a variety of techniques, including body mass index (BMI), dual X-ray absorptiometry–percentage body fat (DXA-android %BF), diagnostic medical sonography (DMS), and waist circumference (WC). The combination of subcutaneous fat layer at the xyphoid and umbilicus compared with BMI, WC, and DXA-android %BF. These variables demonstrated moderately positive association and were statistically significant. A total maximum mean score of DMS measures of subcutaneous and visceral fat was also compared with BMI, WC, and DXA-android %BF. The aforementioned comparison had a moderately positive association and was statistically significant. The sonographic measure of mesentery fat was compared with WC and demonstrated a strongly positive strength of association and was statistically significant. Sonography may be an inexpensive, noninvasive, portable, and valid body composition measure for overweight patients.
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Affiliation(s)
- A. Nicole Stigall
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Rachel Tatarski
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Rachel L. Pargeon
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Colleen Spees
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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22
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Woldemariam MM, Evans KD, Butwin AN, Pargeon RL, Volz KR, Spees C. Measuring Abdominal Visceral Fat Thickness With Sonography: A Methodologic Approach. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317747210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This methodological approach to assessing obesity is based on the prepilot work conducted on a small sample of men and women (25-58 years of age) in a laboratory setting. The use of skinfold calipers, body mass index, and sonographic imaging of adipose and visceral fat were obtained. In this pre-experimental work, the rigorous use of sonographic measures of visceral fat demonstrated better trend results than the other measurement tools. The sonographic methods employed were modeled after the work published by Hamagawa et al. All measurements were taken five times, and only the middle three were retained for mean data points. The data are compared and contrasted with a paucity of international studies using sonography to measure visceral adiposity. It is important to determine whether sonography could serve as a non-ionizing imaging technique for the assessment of body composition and a screening technique for cardiovascular disease prediction.
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Affiliation(s)
- Mulubrhan M. Woldemariam
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
| | - Angela N. Butwin
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
| | - Rachel L. Pargeon
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
| | - Kevin R. Volz
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
| | - Colleen Spees
- The College of Medicine, School of Health & Rehabilitation Sciences, Laboratory for Investigatory Imaging, The Ohio State University, Columbus, OH, USA
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Jung JH, Jung MK, Kim KE, Kwon AR, Chae HW, Yoon CS, Kim HS, Kim DH. Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles. Ann Pediatr Endocrinol Metab 2016; 21:75-80. [PMID: 27462583 PMCID: PMC4960018 DOI: 10.6065/apem.2016.21.2.75] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 10/28/2015] [Accepted: 11/30/2015] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.
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Affiliation(s)
- Jae Hwa Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Mo Kyung Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Eun Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Reum Kwon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Choon Sik Yoon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Bazzocchi A, Filonzi G, Ponti F, Albisinni U, Guglielmi G, Battista G. Ultrasound: Which role in body composition? Eur J Radiol 2016; 85:1469-80. [PMID: 27235340 DOI: 10.1016/j.ejrad.2016.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/01/2016] [Accepted: 04/13/2016] [Indexed: 01/21/2023]
Abstract
Ultrasound is a non-invasive, fast, relatively inexpensive and available tool for estimating adiposity in clinical practice, and in several research settings. It does not expose patients to ionizing radiation risks, making the method ideal for the evaluation, and for follow-up studies. Several parameters and indexes based on adipose tissue thickness have been introduced and tested, and these have been correlated with clinical and laboratoristic parameters. Moreover, ultrasound can also be directed to the estimation of adipose tissue and intracellular fat indirectly, at cellular-molecular level: an opportunity for many radiologists who already and sometimes unconsciously perform "body composition" assessment when looking at the liver, at muscle as well as at other organs. However, standardized procedure and parameters are needing to improve accuracy and reproducibility. The purposes of this review are: 1) to provide a complete overview of the most used and shared measurements of adiposity; 2) to analyze technical conditions, accuracy, and clinical meaning of ultrasound in the study of body composition; 3) to provide some elements for the use of ultrasound in the evaluation of intra-cellular lipids accumulation, in two hot spots: liver and skeletal muscle.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy.
| | - Giacomo Filonzi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna. Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Ugo Albisinni
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Battista
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna. Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138 Bologna, Italy
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Effect of combined training versus aerobic training alone on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0329-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gur EB, Ince O, Turan GA, Karadeniz M, Tatar S, Celik E, Yalcin M, Guclu S. Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus. Endocrine 2014; 47:478-84. [PMID: 24452873 DOI: 10.1007/s12020-013-0154-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/20/2013] [Indexed: 12/28/2022]
Abstract
The aim of this study is to evaluate whether ultrasonographic visceral fat thickness measurement in the early gestational period is useful for predicting the development of gestational diabetes mellitus (GDM) and metabolic syndrome (MS). The visceral fat thickness and subcutaneous fat thickness were measured via ultrasound at the first prenatal visit. The correlation between visceral and subcutaneous fat thickness and MS parameters, such as dyslipidemia, hypertension, and insulin resistance, was assessed. We also compared the use of visceral fat thickness measurement with body mass index (BMI) and waist circumference (WC) measurements for predicting the development of GDM. The subcutaneous fat thickness was found to be similar in the normal glucose metabolism and GDM groups at the first visit, whereas the visceral fat thickness was found to be considerably higher in the GDM groups (p = 0.04). The visceral fat thickness in the early stage of the gestation was correlated with hyperglycemia, dyslipidemia, high diastolic blood pressure, and insulin resistance. In contrast to subcutaneous fat thickness, BMI, and WC, only the visceral fat thickness was correlated with insulin resistance. The subcutaneous and visceral fat thicknesses at the first visit were significantly higher in the MS group (p = 0.02). There was a good correlation between visceral and subcutaneous fat thicknesses (r = 0.492, p < 0.001); however, there were poor correlations between visceral fat thickness and BMI and WC (r = 0.338, p = 0.01; r = 0.312, p = 0.02). The visceral fat thickness seemed to be a more sensitive predictor of GDM than WC and BMI. The optimal cutoff points for predicting GDM were visceral fat thickness 19.5 mm [area under curve (AUC) = 0.66, p = 0.043], WC 103.5 cm (AUC = 0.64, p = 0.079), and BMI 34.5 (AUC = 0.64, p = 0.069). Ultrasonographic visceral fat thickness measurement in the early period of gestation may be an easy, safe, and cost-effective scan test for predicting the development of metabolic diseases and GDM.
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Affiliation(s)
- Esra Bahar Gur
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sifa University, Sanayi St. No:7, 35100, Bornova, Izmir, Turkey,
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Gur EB, Genc M, Eskicioglu F, Kurtulmus S, Guclu S. Ultrasonographic visceral fat thickness measurement may be a good scan test for prediction of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2014; 28:893-4. [PMID: 24949931 DOI: 10.3109/14767058.2014.936003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Esra Bahar Gur
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sifa University , Izmir , Turkey
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Hacıhamdioğlu B, Öçal G, Berberoğlu M, Sıklar Z, Fitöz S, Tutar E, Nergisoğlu G, Savaş Erdeve S, Çamtosun E. Preperitoneal fat tissue may be associated with arterial stiffness in obese adolescents. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:871-876. [PMID: 24462148 DOI: 10.1016/j.ultrasmedbio.2013.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 11/03/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Abstract
Vascular aging is a chronic process, and many negative effects of obesity in this process have been well defined. We assessed arterial stiffness in obese adolescents and evaluated the relationship between intra-abdominal fat distribution and arterial stiffness. Arterial stiffness parameters and pulse wave velocity (PWV) were evaluated in 61 obese adolescents and 58 healthy controls. Carotid-femoral PWV was calculated by arterial tonometry. Additionally, all obese children were evaluated for metabolic syndrome and insulin resistance. Intra-abdominal fat distribution, including subcutaneous, preperitoneal and visceral fat thicknesses, was assessed by ultrasonography. PWVs of obese children were significantly higher than those of healthy controls (5.0 ± 0.7 m/s vs. 4.7 ± 0.5 m/s). Parameters affecting PWV were evaluated by regression analysis. The independent variable in the regression analysis model was PWV, and the dependent variables were age, metabolic syndrome, body mass index and Homeostasis Model Assessment--Insulin Resistance, as well as subcutaneous, preperitoneal and visceral fat tissue thicknesses measured by ultrasonography. The only parameter associated with PWV was preperitoneal fat tissue thickness. Vascular changes related to obesity may begin in adolescence, as illustrated by the increased PWV. Preperitoneal fat tissue may be related to arterial stiffness. Intra-abdominal fat distributions obtained by ultrasonography may provide clinicians with valuable information needed to determine cardiovascular disease risk factors in obese adolescents.
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Affiliation(s)
- Bülent Hacıhamdioğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Gönül Öçal
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merih Berberoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Sıklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Suat Fitöz
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gökhan Nergisoğlu
- Department of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Senay Savaş Erdeve
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emine Çamtosun
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Shabestari AA, Bahrami-Motlagh H, Hosseinpanah F, Heidari K. Abdominal fat sonographic measurement compared to anthropometric indices for predicting the presence of coronary artery disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1957-1965. [PMID: 24154900 DOI: 10.7863/ultra.32.11.1957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Sonography for measuring intra-abdominal fat is more accurate than anthropometric measurements. Computed tomographic (CT) angiography has become an accurate noninvasive method for detection of coronary artery disease (CAD). We examined the associations between both sonographic and anthropometric measurements of abdominal adiposity and the presence of CAD on CT angiography. METHODS We evaluated 83 consecutive patients (70% men; mean age ± SD, 56 ± 10.8 years) who were referred for CT angiography. Clinical and laboratory variables were determined, and CT angiography was performed using a 64-slice scanner. The severity of CAD was defined by visual assessment of any plaque, either calcified or noncalcified. Preperitoneal fat, subcutaneous fat, and visceral fat thicknesses were determined on sonography, and the abdominal fat index was calculated as the preperitoneal fat thickness-to-subcutaneous fat thickness ratio. RESULTS Coronary artery disease was detected in 56 patients (67%). Patients with CAD had higher visceral fat thickness (9.3 ± 2.0 versus 8.2 ± 2.2 cm; P = .035) and a higher waist-to-hip ratio (0.97 ± 0.07 versus 0.92 ± 0.07; P = .018) than those without CAD. The preperitoneal fat thickness, subcutaneous fat thickness, and abdominal fat index were not correlated with the CAD status. After adjusting for traditional cardiovascular risk factors, however, only a waist-to-hip ratio higher than 0.95 remained significantly associated with the presence of CAD (odds ratio, 4.03; 95% confidence interval, 1.2-13.4). CONCLUSIONS This study shows that sonographically based obesity measurements are not superior to anthropometric indices in predicting the presence of CAD.
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Affiliation(s)
- Abbas Arjmand Shabestari
- Department of Radiology, Loghman Hospital, Shahid Beheshti University of Medical Science, Makhsus Avenue, Tehran 13336 31152, Iran.
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