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Brath MSG, Kristensen SV, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM. Influence of weight-adjusted contrast enhancement on computed tomography-derived skeletal muscle measures: a retrospective proof-of-concept comparative study between Danish females and males. Am J Clin Nutr 2024:S0002-9165(24)00578-1. [PMID: 38936776 DOI: 10.1016/j.ajcnut.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Computed tomography (CT) has an underutilized potential for evaluating body composition in clinical settings. Often conducted with intravenous contrast (IVC), CT scans yield unused body composition data due to unclear effects on skeletal muscle area (SMA), skeletal muscle index (SMI), and muscle density (SMD). OBJECTIVES This study investigates whether weight-adjusted IVC influences SMA, SMI, and SMD differently in females and males compared with noncontrast abdominal CT. In addition, the study explores associations between contrast and noncontrast-assessed SMA, SMI, SMD, and demographic factors. METHODS A comparative observational retrospective study was conducted on Danish patients who underwent consecutive 4-phased contrast-enhanced abdominal CT scans (noncontrast, arterial, venous, and late venous phases). Muscle measures were evaluated using validated semiautomated threshold-based software by 3 independent raters. RESULTS The study included 72 patients (51 males and 21 females) with a mean age of 59 (55 and 62) y. Weight-adjusted IVC increased SMA by ≤3.28 cm2 (95% confidence interval [CI]: 2.58, 3.98) corresponding to 2.4% (1.8, 2.9) in the late venous phase compared with noncontrast CT. Analysis between sexes showed no difference in the effects of IVC on SMA and SMI between females and males. However, females exhibited a higher increase in SMD during the venous by a mean of 1.7 HU (0.9; 2.5) and late venous phases with a mean HU of 1.80 (1.0; 2.6) compared with males. Multivariate regression analysis indicated an association between the differences in SMD and sex during venous (-1.38, 95% CI: -2.48, -0.48) and late venous phases (-1.23, 95% CI: -2.27, -0.19). CONCLUSIONS Weight-adjusted IVC leads to increased SMA, SMI, and SMD. Although SMA and SMI differences were consistent across the sexes, females exhibited a significantly higher SMD increase than males in the venous and late venous phases. Further investigations are necessary to determine the applicability of SMD as a muscle quality proxy in IVC CT scans.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Sebastian Villesen Kristensen
- Institute of Regional Health Research, Southern Danish University, Odense, Denmark; Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding, Denmark
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Danish Nutrition Science Center, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Center for Nutrition and Intestinal Failure, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research Unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Palmowski A, Nielsen SM, Boyadzhieva Z, Hartman L, Oldenkott J, Svensson B, Hafström I, Wassenberg S, Choy E, Kirwan J, Christensen R, Boers M, Buttgereit F. The Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis: Individual Patient Data From Five Randomized Trials. Ann Intern Med 2023; 176:1181-1189. [PMID: 37579312 DOI: 10.7326/m23-0192] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Weight gain and hypertension are well known adverse effects of treatment with high-dose glucocorticoids. OBJECTIVE To evaluate the effects of 2 years of low-dose glucocorticoid treatment in rheumatoid arthritis (RA). DESIGN Pooled analysis of 5 randomized controlled trials with 2-year interventions allowing concomitant treatment with disease-modifying antirheumatic drugs. SETTING 12 countries in Europe. PATIENTS Early and established RA. INTERVENTION Glucocorticoids at 7.5 mg or less prednisone equivalent per day. MEASUREMENTS Coprimary end points were differences in change from baseline in body weight and mean arterial pressure after 2 years in intention-to-treat analyses. Difference in the change of number of antihypertensive drugs after 2 years was a secondary end point. Subgroup and sensitivity analyses were done to assess the robustness of primary findings. RESULTS A total of 1112 participants were included (mean age, 61.4 years [SD, 14.5]; 68% women). Both groups gained weight in 2 years, but glucocorticoids led, on average, to 1.1 kg (95% CI, 0.4 to 1.8 kg; P < 0.001) more weight gain than the control treatment. Mean arterial pressure increased by about 2 mm Hg in both groups, with a between-group difference of -0.4 mm Hg (CI, -3.0 to 2.2 mm Hg; P = 0.187). These results were consistent in sensitivity and subgroup analyses. Most patients did not change the number of antihypertensive drugs, and there was no evidence of differences between groups. LIMITATION Body composition was not assessed, and generalizability to non-European regions may be limited. CONCLUSION This study provides robust evidence that low-dose glucocorticoids, received over 2 years for the treatment of RA, increase weight by about 1 kg but do not increase blood pressure. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Andriko Palmowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark (A.P.)
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark (S.M.N.)
| | - Zhivana Boyadzhieva
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
| | - Linda Hartman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (L.H.)
| | - Judith Oldenkott
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
| | - Björn Svensson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden (B.S.)
| | - Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden (I.H.)
| | | | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Cardiff University, Cardiff, United Kingdom (E.C.)
| | - John Kirwan
- University of Bristol, Bristol, United Kingdom (J.K.)
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Research Unit of Rheumatology, Frederiksberg, and Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark (R.C.)
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (M.B.)
| | - Frank Buttgereit
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
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Aparisi Gómez MP, Aparisi F, Morganti AG, Fanti S, Bazzocchi A. Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System. Semin Musculoskelet Radiol 2022; 26:338-353. [PMID: 35654099 DOI: 10.1055/s-0041-1740995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The effects of radiation and chemotherapy on the musculoskeletal (MSK) system are diverse, and interpretation may be challenging. The different lines of treatment have effects on diseased and normal marrow, and they may lead to complications that must be differentiated from recurrence or progression. This review analyzes the changes induced by radiotherapy and chemotherapy in the MSK system in the adult and pediatric population, and the expected associated imaging findings. Treatments are often combined, so the effects may blend. Awareness of the spectrum of changes, complications, and their imaging appearances is paramount for the correct diagnosis. The assessment of body composition during and after treatment allows potential interventions to implement long-term outcomes and personalize treatments. Imaging techniques such as computed tomography or magnetic resonance imaging provide information on body composition that can be incorporated into clinical pathways. We also address future perspectives in posttreatment assessment.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiroum Bologna University, Bologna, Italy.,Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Lin JZ, Chen CT, Ma JD, Mo YQ, Li QH, Chen LF, Yang ZH, Cheng WM, He XL, Zheng DH, Dai L. Neglected extra-articular manifestations in rheumatoid arthritis patients with normal body mass index: reduced skeletal muscle overlapping overfat. Ther Adv Chronic Dis 2020; 11:2040622320975241. [PMID: 33294150 PMCID: PMC7705189 DOI: 10.1177/2040622320975241] [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: 07/29/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Chronic inflammation in rheumatoid arthritis (RA) can induce reduced muscle mass (myopenia) and ectopic fat deposition probably showing normal body mass index (BMI). We aimed to investigate their body composition (BC) characteristics and clinical significance. Methods: BMI and BC were collected in consecutive RA patients and control subjects. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) ⩽7.0 kg/m2 in men and ⩽5.7 kg/m2 in women. Overfat was defined by body fat percentage (BF%) as ⩾25% for men and ⩾35% for women. Results: There were 620 RA patients (57.6% with normal BMI) and 2537 control subjects (62.5% with normal BMI) recruited. After 1:1 age and sex matching with control subjects, RA patients with normal BMI (n = 240) showed significantly higher prevalence of myopenia (43.3% versus 22.1%) and overfat (19.2% versus 7.1%) as well as myopenia overlapping overfat (17.1% versus 3.3%). In all RA patients with normal BMI (n = 357), there were 18.2% patients with myopenia overlapping overfat who had the worst radiographic scores and highest rates of previous glucocorticoid treatment and hypertension. Compared with those without, normal BMI RA patients with previous glucocorticoid treatment (24.4% versus 10.3%) or hypertension (27.8% versus 13.6%) had a higher rate of myopenia overlapping overfat. Previous glucocorticoid treatment [odds ratio (OR) = 2.844, 95% confidence interval (CI) 1.441–5.614] and hypertension (OR = 2.452, 95% CI 1.283–4.685) were potential associated factors of myopenia overlapping overfat in RA patients with normal BMI. Conclusion: Myopenia overlapping overfat is an important extra-articular manifestation which should not be ignored in RA patients with normal BMI, especially with glucocorticoid treatment and hypertension.
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Affiliation(s)
- Jian-Zi Lin
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Chu-Tao Chen
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Jian-Da Ma
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Ying-Qian Mo
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Le-Feng Chen
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Ze-Hong Yang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, PR China
| | - Wan-Mei Cheng
- Shanghai Healthare Co. Ltd, Zhangjiang Innopark, Shanghai, PR China
| | - Xiao-Ling He
- Shanghai Healthare Co. Ltd, Zhangjiang Innopark, Shanghai, PR China
| | - Dong-Hui Zheng
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, PR China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong 510120, PR China
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Müller R, Kull M, Põlluste K, Valner A, Lember M, Kallikorm R. Factors Associated With Low Lean Mass in Early Rheumatoid Arthritis: A Cross- Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E730. [PMID: 31717450 PMCID: PMC6915666 DOI: 10.3390/medicina55110730] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022]
Abstract
Background and Objectives: The aim of the study was to evaluate body composition (BC) of rheumatoid arthritis (RA) patients at disease onset compared to population controls focusing on the associations between low lean mass and disease specific parameters, nutritional factors and physical activity. Materials and Methods: 91 patients with early rheumatoid arthritis (ERA) (72% female) and 328 control subjects (54% female) were studied. BC- lean and fat mass parameters were measured with a Lunar Prodigy Dual Energy X-Ray Absorptiometry (DXA) machine. The prevalence, age and gender adjusted odds ratios of having low lean mass and overfat, associations between nutrition, physical activity, and ERA disease specific parameters and the presence of low lean mass were evaluated. Results: We found that the BC of patients with recent onset RA differs from control subjects-ERA patients had a higher mean body fat percentage (BFP) and lower appendicular lean mass (ALM). 41.8% of the ERA patients and 19.8% of the controls were classified as having low lean mass adjusted OR 3.3 (95% C.I. 1.9-5.5, p < 0.001). 68.1% of the ERA subjects and 47.3% of the controls were overfat (adjusted OR 1.9 (95% C.I. 1.1-3.3, p = 0.02)) and the adjusted odds of having both low lean mass and overfat were 4.4 times higher (26.4% vs. 7.0% 95% C.I. 2.3-8.4, p < 0.001) among the ERA group. Higher ESR (OR 1.03, C.I.1.002-1.051, p = 0.03), CRP (OR 1.03, C.I. 1.002-1.061, p = 0.04), lower protein intake (OR 0.98 C.I. 0.96-0.99, p = 0.04), corticosteroid usage (OR 3.71 C.I. 1.4-9.9, p < 0.01) and lower quality of life (higher HAQ score OR 2.41 C.I. 1.24-4.65, p < 0.01) were associated with having low lean mass in the ERA group (adjusted to age and gender). Conclusions: Patients with early RA have lower appendicular lean mass and higher body fat percentage compared to healthy controls. Loss of lean mass in early RA is associated with elevated inflammatory markers inducing catabolism, lower protein intake and also with GCS treatment.
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Affiliation(s)
- Raili Müller
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
- Department of Internal Medicine, Tartu University Hospital, 50406 Tartu, Estonia
| | - Mart Kull
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
- Viljandi County Hospital, 71024 Viljandi maakond, Estonia
| | - Kaja Põlluste
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
| | - Annika Valner
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
- Department of Internal Medicine, Tartu University Hospital, 50406 Tartu, Estonia
| | - Margus Lember
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
- Department of Internal Medicine, Tartu University Hospital, 50406 Tartu, Estonia
| | - Riina Kallikorm
- Institute of Clinical Medicine, Tartu University, 50090 Tartu, Estonia; (M.K.); (K.P.); (A.V.); (M.L.); (R.K.)
- Department of Internal Medicine, Tartu University Hospital, 50406 Tartu, Estonia
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