Body Fat and Fat-Free Mass and All-Cause Mortality

Nutritional Considerations During Major Weight Loss Therapy: Focus on Optimal Protein and a Low-Carbohydrate Dietary Pattern

PURPOSE OF REVIEW

Considering the high prevalence of obesity and related metabolic impairments in the population, the unique role nutrition has in weight loss, reversing metabolic disorders, and maintaining health cannot be overstated. Normal weight and well-being are compatible with varying dietary patterns, but for the last half century there has been a strong emphasis on low-fat, low-saturated fat, high-carbohydrate based approaches. Whereas low-fat dietary patterns can be effective for a subset of individuals, we now have a population where the vast majority of adults have excess adiposity and some degree of metabolic impairment. We are also entering a new era with greater access to bariatric surgery and approval of anti-obesity medications (glucagon-like peptide-1 analogues) that produce substantial weight loss for many people, but there are concerns about disproportionate loss of lean mass and nutritional deficiencies.

RECENT FINDINGS

No matter the approach used to achieve major weight loss, careful attention to nutritional considerations is necessary. Here, we examine the recent findings regarding the importance of adequate protein to maintain lean mass, the rationale and evidence supporting low-carbohydrate and ketogenic dietary patterns, and the potential benefits of including exercise training in the context of major weight loss. While losing and sustaining weight loss has proven challenging, we are optimistic that application of emerging nutrition science, particularly personalized well-formulated low-carbohydrate dietary patterns that contain adequate protein (1.2 to 2.0 g per kilogram reference weight) and achieve the beneficial metabolic state of euketonemia (circulating ketones 0.5 to 5 mM), is a promising path for many individuals with excess adiposity.

Association of fat-to-muscle mass ratio with physical activity and dietary protein, carbohydrate, sodium, and fiber intake in a cross-sectional study

Higher fat-to-muscle mass ratio (FMR) is reported to be a risk factor for various diseases, including type 2 diabetes and cardiovascular diseases, and mortality. Although this association suggests that reducing FMR may help to prevent certain diseases and mortality, the relationship between FMR and lifestyle factors is unclear. Therefore, we performed a cross-sectional study with the aim to elucidate this relationship. This cross-sectional study included 1518 healthy Japanese adults aged 30 to 64 years. We measured FMR in the whole body, arms, legs, and trunk and assessed various lifestyle factors. Then, we performed forced entry multiple regression analyses for FMR with the following variables: sex, age, physical activity, dietary intake, sleep quality, cigarette smoking, stress levels, and body mass index. As a result, whole-body and regional FMRs were correlated with female sex (β = 0.71); age (β = 0.06); physical activity (β = - 0.07); dietary intake of protein (β = - 0.12), carbohydrate (β = 0.04), sodium (β = 0.13), and fiber (β = - 0.16); and body mass index (β = 0.70). The results suggest that in the Japanese middle-aged population, low FMR is associated with certain lifestyle factors, i.e. higher physical activity and a diet with higher protein and fiber and lower carbohydrate and sodium, independent of age, sex, and body mass index.

The longitudinal association of adipose-to-lean ratio with incident cardiometabolic morbidity: The CARDIA study

AIM

To assess the association of adipose-to-lean ratio (ALR) with incident type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia in middle adulthood.

METHOD

Black and White Coronary Artery Risk Development in Young Adults participants without T2DM, hypertension, or dyslipidemia in 2005-06 (baseline) were included. Baseline adipose and lean mass were assessed via dual-energy X-ray absorptiometry. ALR was calculated as adipose divided by lean mass and then standardized within sex strata. Single time-point incident morbidity was assessed every five years from baseline through 2016. Cox proportional hazards regression was used to estimate hazard ratios (HR) for morbidity over 10 years per 1-SD increment in ALR adjusted for cardiovascular risk factors.

RESULT

The cumulative incidence of T2DM was 7.9 % (129 events/N = 1643; 16,301 person-years), 26.7 % (485 events/N = 1819; 17,895 person-years) for hypertension, and 49.1 % (435 events/N = 855, 8089 person-years) for dyslipidemia. In the adjusted models, ALR was positively associated with a risk of T2DM (HR [95 % CI]; 1.69 [1.31, 2.19]) and hypertension (1.23 [1.08, 1.40]). There was no significant interaction between ALR and sex for any morbidity.

CONCLUSION

ALR in middle adulthood is associated with incident T2DM and hypertension. The extent to which localized body composition measures might inform morbidity risk merits further investigation.

The relationship between anthropometric indices and the presence of hypertension in an Iranian population sample using data mining algorithms

Hypertension (HTN) is a common chronic condition associated with increased morbidity and mortality. Anthropometric indices of adiposity are known to be associated with a risk of HTN. The aim of this study was to identify the anthropometric indices that best associate with HTN in an Iranian population. 9704 individuals aged 35-65 years were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Demographic and anthropometric data of all participants were recorded. HTN was defined as a systolic blood pressure (SBP) ≥ 140 mmHg, and/ or a diastolic blood pressure (DBP) ≥ 90 mmHg on two subsequent measurements, or being treated with oral drug therapy for BP. Data mining methods including Logistic Regression (LR), Decision Tree (DT), and Bootstrap Forest (BF) were applied. Of 9704 participants, 3070 had HTN, and 6634 were normotensive. LR showed that body roundness index (BRI), body mass index (BMI) and visceral adiposity index (VAI) were significantly associated with HTN in both genders (P < 0.0001). BRI showed the greatest association with HTN (OR = 1.276, 95%CI = (1.224, 1.330)). For BMI we had OR = 1.063, 95%CI = (1.047, 1.080), for VAI we had OR = 1.029, 95%CI = (1.020, 1.038). An age < 47 years and BRI < 4.04 was associated with a 90% probability of being normotensive. The BF indicated that age, sex and BRI had the most important role in HTN. In summary, among anthropometric indices the most powerful indicator for discriminating hypertensive from normotensive patients was BRI.

Assessment of the performance of the body mass index in diagnosing obesity in community-dwelling older adults in Latin American and Caribbean countries

BACKGROUND

The body mass index (BMI) ≥30 kg/m2 is the universally accepted cut-off point for defining obesity; however, its accuracy in classifying obesity in older adults is poorly understood.

OBJECTIVES

To assess the performance of the BMI cut-off point ≥30 kg/m2 in classifying obesity in older adults, using the fat mass index (FMI) and fat mass percentage (FM%) as reference criteria; and to establish region- and sex-specific BMI-based cut-off points to classify obesity in older adults.

METHODS

The present study is a secondary analysis derived from a cross-sectional project that included a sample of 1463 older adults from ten Latin American and Caribbean countries. Volunteers underwent total body water measurements using the deuterium dilution technique to determine FMI and FM%. Accuracy of the BMI and derived cutoff points was assessed by the area under the receiver operating characteristic curve (AUC).

RESULTS

The BMI cut-off point ≥30 kg/m2 had low sensitivity for classifying obesity in these older adults compared to the FMI and FM%. The AUC values for the optimal BMI-derived cut-off points showed an acceptable-to-outstanding discriminatory capacity in diagnosing obesity defined by the FMI. There was also a better balance between sensitivity and specificity than with the values obtained by a BMI ≥30 kg/m2 in older subjects in both regions.

CONCLUSION

The BMI cut-off point ≥30 kg/m2 had poor sensitivity for accurately diagnosing obesity in older adults from two regions. The region- and sex-specific BMI-derived cut-off points for defining obesity using the FMI are more accurate in classifying obesity in older men and women subjects from both regions.

Association of trajectory of body shape index with all-cause and cause-specific mortality: 18 years follow-up

Objectives

The current study aimed to examine how the trajectory of a body shape index (ABSI) could predict mortality in a prospective cohort of 5587 participants.

Methods

A Growth Mixture Model (GMM) was employed to identify ABSI and body shape trajectories spanning from 2000 to 2018. Multivariate Cox regression models with hazard ratio (HR) and 95% confidence intervals (CIs) were built to assess the association of death from all-cause and cardiovascular disease (CVD) with ABSI and body shape trajectories.

Results

We found that individuals with a low ABSI-marked increase (Class II) and high ABSI-marked increase trajectory (Class III) had a higher risk of all-cause (adjusted HR for Class II, 1.37; 95%CI, 1.04-1.79; adjusted HR for Class III, 1.42; 95%CI, 1.05-1.91) and non- CVD mortality (adjusted HR for Class II, 1.38; 95%CI, 1.00-1.91; adjusted HR for Class III, 1.42; 95%CI, 1.00-2.05) as well as an increased risk of CVD (adjusted HR for Class II, 1.40; 95%CI, 1.14-1.71; adjusted HR for Class III, 1.42; 95%CI, 1.13-1.78) and coronary heart disease (CHD) (adjusted HR for Class II, 1.52; 95%CI, 1.18-1.96; adjusted HR for Class III, 1.47; 95%CI, 1.11-1.95. The trajectories of body shape phenotypes did not show any significant associations with mortality, CVD, or CHD events.

Conclusions

ABSI trajectories might be associated with subsequent risk of mortality and CVD events.

Association of fat mass and fat-free mass with all-cause and cause-specific mortality in Asian individuals: A prospective cohort study

OBJECTIVE

The study's objective was to investigate the association of fat mass index (FMI) and fat-free mass index (FFMI) with all-cause mortality and cause-specific mortality in the Chinese population.

METHODS

A total of 422,430 participants (48.1% men and 51.9% women) from the Taiwan MJ Cohort with an average follow-up of 9 years were included.

RESULTS

The lowest (Q1) and highest (Q5) quintiles of FMI and FFMI were associated with increased all-cause mortality. Compared with those in the third quintile (Q3) group of FMI, participants in Q1 and Q5 groups of FMI had hazard ratios and 95% CI of 1.32 (1.24-1.40) and 1.13 (1.06-1.20), respectively. Similarly, compared with those in Q3 group of FFMI, people in Q1 and Q5 groups of FFMI had hazard ratios of 1.14 (1.06-1.23) and 1.16 (1.10-1.23), respectively. In the restricted cubic spline models, both FMI and FFMI showed a J-shaped association with all-cause mortality. People in Q5 group of FFMI had a hazard ratio of 0.72 (0.58-0.89) for respiratory disease.

CONCLUSIONS

The mortality risk increases in those with excessively high or low FMI and FFMI, yet the associations between FMI, FFMI, and the risk of death varied across subgroups and causes of death.

Association of body fat distribution with all-cause and cardiovascular mortality in US adults: a secondary analysis using NHANES

OBJECTIVE

To investigate the association of fat and lean mass in specific regions with all-cause and cardiovascular-related mortality.

DESIGN

Population based cohort study.

SETTING

US National Health and Nutrition Examination Survey (2003-2006 and 2011-2018).

PARTICIPANTS

22 652 US adults aged 20 years or older.

EXPOSURES

Fat and lean mass in specific regions obtained from the whole-body dual-energy X-ray absorptiometry.

MAIN OUTCOME MEASURES

All-cause and cardiovascular-related mortality.

RESULTS

During a median of 83 months of follow-up, 1432 deaths were identified. Associations between body composition metrics and mortality risks were evident above specific thresholds. For all-cause mortality, Android fat mass showed elevated HRs above 2.46 kg (HR: 1.17, 95% CI 1.02 to 1.34), while Android lean mass (ALM) had similar trends above 2.75 kg (HR: 1.17, 95% CI 1.03 to 1.33), and Android total mass above 5.75 kg (HR: 1.08, 95% CI 1.01 to 1.16). Conversely, lower HRs were observed below certain thresholds: Gynoid fat mass (GFM) below 3.71 kg (HR: 0.72, 95% CI 0.56 to 0.93), Gynoid lean mass below 6.44 kg (HR: 0.77, 95% CI 0.64 to 0.92), and Gynoid total mass below 11.78 kg (HR: 0.76, 95% CI 0.70 to 0.84). Notably, below 0.722 kg, the HR of visceral adipose tissue mass (VATM) was 1.25 (95% CI 1.04 to 1.48) for all-cause mortality, and above 3.18 kg, the HR of total abdominal fat mass was 2.41 (95% CI 1.15 to 5.05). Cardiovascular-related mortality exhibited associations as well, particularly for Android fat mass (AFM) above 1.78 kg (HR: 1.22, 95% CI 1.01 to 1.47) and below 7.16 kg (HR: 0.50, 95% CI 0.36 to 0.69). HRs varied for Gynoid total mass below and above 10.98 kg (HRs: 0.70, 95% CI 0.54 to 0.93, and 1.12, 95% CI 1.02 to 1.23). Android per cent fat, subcutaneous fat mass (SFM), AFM/GFM, and VATM/SFM were not statistically associated with all-cause mortality. Android per cent fat, Gynoid per cent fat, AFM/GFM, and VATM/SFM were not statistically associated with cardiovascular-related mortality. Conicity index showed that the ALM/GLM had the highest performance for all-cause and cardiovascular-related mortality with AUCs of 0.785, and 0.746, respectively.

CONCLUSIONS

The relationship between fat or lean mass and all-cause mortality varies by region. Fat mass was positively correlated with cardiovascular mortality, regardless of the region in which they located. ALM/GLM might be a better predictor of all-cause and cardiovascular-related mortality than other body components or body mass index.

Dose-Response of Myofibrillar Protein Synthesis To Ingested Whey Protein During Energy Restriction in Overweight Postmenopausal Women: A Randomized, Controlled Trial

BACKGROUND

Diet-induced weight loss is associated with a decline in lean body mass, as mediated by an impaired response of muscle protein synthesis (MPS). The dose-response of MPS to ingested protein, with or without resistance exercise, is well characterized during energy balance but limited data exist under conditions of energy restriction in clinical populations.

OBJECTIVE

To determine the dose-response of MPS to ingested whey protein following short-term diet-induced energy restriction in overweight, postmenopausal, women at rest and postexercise.

DESIGN

Forty middle-aged (58.6±0.4 y), overweight (BMI: 28.6±0.4), postmenopausal women were randomly assigned to 1 of 4 groups: Three groups underwent 5 d of energy restriction (∼800 kcal/d). On day 6, participants performed a unilateral leg resistance exercise bout before ingesting either a bolus of 15g (ERW15, n = 10), 35g (ERW35, n = 10) or 60g (ERW60, n = 10) of whey protein. The fourth group (n = 10) ingested a 35g whey protein bolus after 5 d of an energy balanced diet (EBW35, n = 10). Myofibrillar fractional synthetic rate (FSR) was calculated under basal, fed (FED) and postexercise (FED-EX) conditions by combining an L-[ring-13C6] phenylalanine tracer infusion with the collection of bilateral muscle biopsies.

RESULTS

Myofibrillar FSR was greater in ERW35 (0.043±0.003%/h, P = 0.013) and ERW60 (0.042±0.003%/h, P = 0.026) than ERW15 (0.032 ± 0.003%/h), with no differences between ERW35 and ERW60 (P = 1.000). Myofibrillar FSR was greater in FED (0.044 ± 0.003%/h, P < 0.001) and FED-EX (0.048 ± 0.003%/h, P < 0.001) than BASAL (0.027 ± 0.003%/h), but no differences were detected between FED and FED-EX (P = 0.732) conditions. No differences in myofibrillar FSR were observed between EBW35 (0.042 ± 0.003%/h) and ERW35 (0.043 ± 0.003%/h, P = 0.744).

CONCLUSION

A 35 g dose of whey protein, ingested with or without resistance exercise, is sufficient to stimulate a maximal acute response of MPS following short-term energy restriction in overweight, postmenopausal women, and thus may provide a per serving protein recommendation to mitigate muscle loss during a weight loss program.

TRIAL REGISTRY

clinicaltrials.gov (ID: NCT03326284).

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

BACKGROUND AND AIMS

Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults.

METHODS

This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression.

RESULTS

The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance.

CONCLUSIONS

RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

Excessive Gestational Weight Gain Alters DNA Methylation and Influences Foetal and Neonatal Body Composition

BACKGROUND

Changes in body weight are associated with the regulation of DNA methylation (DNAm). In this study, we investigated the associations between maternal gestational weight gain-related DNAm and foetal and neonatal body composition.

METHODS

Brazilian pregnant women from the Araraquara Cohort Study were followed up during pregnancy, delivery, and after hospital discharge. Women with normal pre-pregnancy BMI were allocated into two groups: adequate gestational weight gain (AGWG, n = 45) and excessive gestational weight gain (EGWG, n = 30). Foetal and neonatal body composition was evaluated via ultrasound and plethysmography, respectively. DNAm was assessed in maternal blood using Illumina Infinium MethylationEPIC BeadChip arrays. Linear regression models were used to explore the associations between DNAm and foetal and neonatal body composition.

RESULTS

Maternal weight, GWG, neonatal weight, and fat mass were higher in the EGWG group. Analysis of DNAm identified 46 differentially methylated positions and 11 differentially methylated regions (DMRs) between the EGWG and AGWG groups. Nine human phenotypes were enriched for these 11 DMRs located in 13 genes (EMILIN1, HOXA5, CPT1B, CLDN9, ZFP57, BRCA1, POU5F1, ANKRD33, HLA-B, RANBP17, ZMYND11, DIP2C, TMEM232), highlighting the terms insulin resistance, and hyperglycaemia. Maternal DNAm was associated with foetal total thigh and arm tissues and subcutaneous thigh and arm fat, as well as with neonatal fat mass percentage and fat mass.

CONCLUSION

The methylation pattern in the EGWG group indicated a risk for developing chronic diseases and involvement of maternal DNAm in foetal lean and fat mass and in neonatal fat mass.

Overall and abdominal obesity and risks of all-cause and cause-specific mortality in Korean adults: a pooled analysis of three population-based prospective cohorts

BACKGROUND

Studies found a J-shaped association between body mass index (BMI) and mortality. However, it is unclear whether the association is driven by biases, particularly confounding by fat-free mass.

METHODS

We conducted an individual-level pooled analysis of three cohorts of Korean adults (aged ≥ 40 years; n = 153 248). Mortality was followed up through December 2019. Anthropometric data were directly measured at baseline. Fat and fat-free mass were predicted using validated prediction models. Using Cox proportional hazards models, we estimated the associations of BMI and waist circumference (WC) with all-cause and cause-specific mortality. To account for biases, we excluded participants aged ≥ 70 years, deaths that occurred within 5 years of follow-up and ever smokers, and adjusted for fat-free mass index (FFMI).

RESULTS

During the follow-up of up to 18 years, 6061 deaths were identified. We observed J-shaped association of BMI (nadir at 22-26) and monotonically positive association of WC with all-cause, cardiovascular, and cancer mortality among Korean adults without a history of cancer or cardiovascular disease. In the BMI analysis, excluding ever smokers and adjusting for FFMI attenuated the excess mortality in underweight participants and transformed the J-shaped association into a monotonically positive shape, suggesting an increased mortality at BMI > 22.0. Excluding participants aged ≥ 70 years and deaths that occurred within 5 years of follow-up did not change the results. In the WC analysis, the monotonic positive associations did not change after the control. Similar results were observed among participants with a history of cancer or cardiovascular disease.

CONCLUSIONS

Our data suggest that both overall and abdominal body fat are associated with increased mortality in Korean adults.

Changes in Fat-Free Mass, Protein Intake and Habitual Physical Activity Following Roux-en-Y Gastric Bypass Surgery: A Prospective Study

PURPOSE

Large inter-individual variations in post-bariatric fat-free mass loss (FFML) are observed, which might relate to differences in protein intake and physical activity across patients. We performed repetitive assessments of protein intake and physical activity before and after banded Roux-en-Y gastric bypass surgery, and examined its relations to FFML during 6 months of follow-up.

MATERIALS AND METHODS

FFML (bio-impedance analyses), protein intake (24-h dietary recalls) and moderate-to-vigorous physical activity (MVPA; activPAL) were assessed in 28 patients (4 males, age 42 ± 12 years) before surgery and at 1-, 3- and 6-months post-surgery. Changes in protein intake and MVPA were evaluated with mixed model analysis, whereas associations with FFML were assessed by univariate regression analysis.

RESULTS

Six-month FFML was -7.3 ± 3.6 kg. Protein intake decreased from 80 ± 29 g/day (pre-surgery) to 45 ± 26 g/day (1 month post-surgery (P < 0.001)) and did not improve thereafter (51 ± 21 g/day; P > 0.05). Seven participants (25%) consumed ≥ 60 g protein/day at 6 months post-surgery. Participants performed 7394 ± 2420 steps/day in 54 ± 20 min/day of MVPA, which did not change from pre- to post-surgery (P > 0.05). A higher step count (B = -0.002; 95%CI = [-0.004 - 0.000]; P = 0.048) and higher level of MVPA (B = -0.29; 95%CI = [-0.54 - -0.03]; P = 0.018) were related to a lower FFML.

CONCLUSION

A lower post-surgery FFML was attributable to higher MVPA levels but not protein intake. This may be due to the low total protein intake and the observation that only a minority of patients achieved a protein intake ≥ 60 g/day. Future studies should focus on interventions to increase post-bariatric protein intake and MVPA levels.

Association of muscle wasting with mortality risk among adults: A systematic review and meta-analysis of prospective studies

The relationship between muscle wasting and mortality risk in the general population remains unclear. Our study was conducted to examine and quantify the associations between muscle wasting and all-cause and cause-specific mortality risks. PubMed, Web of Science and Cochrane Library were searched until 22 March 2023 for main data sources and references of retrieved relevant articles. Prospective studies investigating the associations of muscle wasting with risks of all-cause and cause-specific mortality in the general population were eligible. A random-effect model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CIs) for the lowest versus normal categories of muscle mass. Subgroup analyses and meta-regression were performed to investigate the potential sources of heterogeneities among studies. Dose-response analyses were conducted to evaluate the relationship between muscle mass and mortality risk. Forty-nine prospective studies were included in the meta-analysis. A total of 61 055 deaths were ascertained among 878 349 participants during the 2.5- to 32-year follow-up. Muscle wasting was associated with higher mortality risks of all causes (RR = 1.36, 95% CI, 1.28 to 1.44, I²  = 94.9%, 49 studies), cardiovascular disease (CVD) (RR = 1.29, 95% CI, 1.05 to 1.58, I²  = 88.1%, 8 studies), cancer (RR = 1.14, 95% CI, 1.02 to 1.27, I²  = 38.7%, 3 studies) and respiratory disease (RR = 1.36, 95% CI, 1.11 to 1.67, I²  = 62.8%, 3 studies). Subgroup analyses revealed that muscle wasting, regardless of muscle strength, was significantly associated with a higher all-cause mortality risk. Meta-regression showed that risks of muscle wasting-related all-cause mortality (P = 0.06) and CVD mortality (P = 0.09) were lower in studies with longer follow-ups. An approximately inverse linear dose-response relationship was observed between mid-arm muscle circumference and all-cause mortality risk (P < 0.01 for non-linearity). Muscle wasting was associated with higher mortality risks of all causes, CVD, cancer and respiratory disease in the general population. Early detection and treatment for muscle wasting might be crucial for reducing mortality risk and promoting healthy longevity.

Association between android fat mass, gynoid fat mass and cardiovascular and all-cause mortality in adults: NHANES 2003-2007

Objectives

Evidence of the relationship between android fat mass and gynoid fat mass with the mortality prediction is still limited. Current study analyzed the NHANES database to investigate the relationship between android fat mass, gynoid fat mass and CVD, with all-cause mortality.

Method

The study subjects were NHANES participants over 20 years old, two indicators of regional body composition, android fat and gynoid fat were measured by Dual Energy x-ray Absorptiometry (DEXA). The other various covariates data obtained from the NHANES questionnaire and laboratory measurements, including age, gender, education, race/ethnicity, uric acid, total serum cholesterol, albumin, Vitamin C, folate, alcohol drinking, smoking status, history of diabetes, and hypertension. Mortality status was ascertained from a linked mortality file prepared by the National Center for Health Statistics. The study population was divided quartiles based on the distribution of android fat mass and gynoid fat mass. The relationship between these two indicators with cardiovascular and all-cause mortality was investigated by using Cox regression. The covariates age, gender, smoking status, drinking status, history of diabetes, and history of hypertension were stratified.

Results

In the fully adjusted model, Q3 had the lowest HR in android fat mass and gynoid fat mass. When examining the relationship between android fat mass and CVD mortality, current smokers and drinkers had the lowest CVD risk in Q2 [smoking: 0.21 (0.08, 0.52), drinking: 0.14 (0.04, 0.50)]. In diabetic patients, compared with Q1, other groups with increased android fat mass can significantly reduce the risk of CVD [Q4: 0.17 (0.04, 0.75), Q3: 0.18 (0.03, 1.09), Q2: 0.27 (0.09, 0.83)]. In ≥60 years old and female, the greater the gynoid fat mass, the smaller the HR of all-cause mortality [Q4 for ≥60 years old: 0.57 (0.33, 0.96), Q4 for female: 0.37 (0.23, 0.58)]. People <60 years old had a lower risk of all-cause mortality with gynoid fat mass in Q3 than those ≥60 years old [<60 years: 0.50 (0.27, 0.91), ≥60 years: 0.65 (0.45, 0.95)]. Among subjects without hypertension, the group with the largest android fat mass had the lowest risk of CVD mortality, and the group with the largest gynoid fat mass had the lowest risk of all-cause mortality [Android fat mass: 0.36 (0.16, 0.81), gynoid fat mass: 0.57 (0.39, 0.85)].

Conclusion

Moderate android fat mass and gynoid fat mass (Q3) had the most protective effect. Smokers and drinkers need to control their body fat. Being too thin is harmful to people with diabetes. Increased gynoid fat mass is a protective factor for all-cause mortality in older adults and females. Young people's gynoid fat mass is more protective in the moderate range than older people's. If no high blood pressure exists, people with more android and gynoid fat mass have a lower risk of CVD or all-cause mortality.

Adipopenia is associated with osteoporosis in community-dwelling non-underweight adults independent of sarcopenia

The effect of fat deficit on bone metabolism is understudied. This study showed that low body fat percent (adipopenia) in non-underweight community adults was associated with elevated odds of osteoporosis independent of low lean mass, highlighting potential clinical importance of adipopenia as an osteoporosis risk factor particularly in older adults.

PURPOSE

Although underweight is risk factor for osteoporosis, the association of low body fat percent (adipopenia) with osteoporosis in non-underweight adults remains unclear.

METHODS

Among individuals aged ≥ 50 years with body mass index ≥ 18.5 kg/m² in the Korean National Health and Nutrition Examination Survey 2008-2011, appendicular lean mass (ALM) and body fat percent (BFP) were measured using dual-energy x-ray absorptiometry. Low lean mass was defined as ALM/height² < 7.0 kg/m² and < 5.4 kg/m² in men and women, respectively. Osteoporosis was defined as a bone mineral density (BMD) T-score ≤ -2.5 at the lumbar spine, femoral neck, or total hip. Participants were grouped into adipopenia (BFP < 17% in men; < 30%, in women; 1 standard deviation below the mean), normal, and obesity (BFP > 30% in men; > 40% in women) groups.

RESULTS

Of the 5,830 participants (women 50.2%, mean age 63.9 years), 793 had adipopenia. The adipopenia group had a higher prevalence of osteoporosis (31%) than the normal (21%) or obesity groups (27%; p < 0.001). The presence of adipopenia was associated with 61% elevated odds of prevalent osteoporosis (p < 0.001) independent of low lean mass and covariates, which remained robust using different thresholds for adipopenia. Individuals with adipopenia and low lean mass had 3.5-fold elevated odds of osteoporosis compared to those with normal lean mass and fat percent. The association between adipopenia and osteoporosis was stronger in older women compared to middle-aged women (OR 1.93 vs. 0.99, P for interaction = 0.023).

CONCLUSION

Adipopenia was associated with osteoporosis in non-underweight adults, independent of low lean mass and covariates.

Relationships of BMI, muscle-to-fat ratio, and handgrip strength-to-BMI ratio to physical fitness in Spanish children and adolescents

This study aimed to determine the relationship of body mass index (BMI), muscle-to-fat ratio (MFR), and handgrip strength-to-BMI ratio to physical fitness parameters in an active young population according to sex across four different time points. A total of 2256 Spanish children and adolescents (aged 5-18) from rural areas participating in an extracurricular sport in different municipal sports schools participated in this study. Participants were divided into children (5-10 years) and adolescents (11-18 years), boys and girls, and across four different time points (2018, 2019, 2020, 2021). Data on anthropometric measures (BMI, MFR, appendicular skeletal muscle mass) and physical fitness (handgrip strength, cardiorespiratory fitness, and vertical jump) were collected. Boys who were overweight, but especially boys with obesity, had higher absolute handgrip strength in children and adolescents than their normal weight counterparts in 2020 and 2021. Boys and girls with normal weight presented higher cardiorespiratory fitness and vertical jump than their overweight and obese peers over the years. The MFR was directly correlated with the cardiorespiratory fitness and vertical jump variables, but not with handgrip strength, in boys and girls. The handgrip strength-to-BMI ratio in both sexes was positively correlated to the different physical fitness parameters.  Conclusion: BMI, MFR, and handgrip strength-to-BMI can be used as health and physical fitness indicators in this population. What is Known: • BMI is the main indicator commonly used as a proxy for obesity for many years. Nevertheless, it cannot differentiate between fat mass and fat-free mass. • There are other indicators such as MFR and handgrip strength-to-BMI that might be more accurate and can serve to monitor the health and fitness of children and adolescents. What is New: • MFR showed a positive and significant correlation with cardiorespiratory fitness and vertical jump in both sexes. On the other hand, the handgrip strength-to-BMI presented a positive correlation with cardiorespiratory fitness, vertical jump, and handgrip strength. • The use of these indicators obtained through different parameters of body composition and physical fitness can serve as a tool to identify the relationships of the paediatric population with physical fitness.

Muscle distribution in relation to all-cause and cause-specific mortality in young and middle-aged adults

BACKGROUND

The relationship between muscle and prognosis, especially that between muscle distribution across different body parts, and the related prognosis is not well established.

OBJECTIVE

To investigate the relationship between muscle distribution and all-cause and cause-specific mortality and their potential modifiers.

DESIGN

Longitudinal cohort study. C-index, IDI, and NRI were used to determine the best indicator of prognosis. COX regression analysis was performed to explore the relationship between variables and outcomes. Interaction and subgroup analyses were applied to identify the potential modifiers.

PARTICIPANTS

A total of 5052 participants (weighted: 124,841,420) extracted from the NHANES 2003-2006 of median age 45 years and constituting 50.3% men were assessed. For validation, we included 3040 patients from the INSCOC cohort in China.

MAIN MEASURES

Muscle mass and distribution. KEY RESULTS: COX regression analysis revealed that upper limbs (HR = 0.41, 95% CI 0.33-0.51), lower limbs (HR = 0.54, 95% CI 0.47-0.64), trunk (HR = 0.71, 95% CI, 0.59-0.85), gynoid (HR = 0.47, 95% CI 0.38-0.58), and total lean mass (HR = 0.55, 95% CI 0.45-0.66) were all associated with the better survival of participants (P _trend < 0.001). The changes in the lean mass ratio of the upper and lower limbs and the lean mass ratio of the android and gynoid attenuated the protective effect of lean mass. Age and sex acted as potential modifiers, and the relationship between lean mass and the prognosis was more significant in men and middle-aged participants when compared to that in other age groups. Sensitive analyses depicted that despite lean mass having a long-term impact on prognosis (15 years), it has a more substantial effect on near-term survival (5 years).

CONCLUSION

Muscle mass and its distribution affect the prognosis with a more significant impact on the near-term than that on the long-term prognosis. Age and sex acted as vital modifiers.

Associations of Total Body Fat Mass and Skeletal Muscle Index with All-Cause and Cancer-Specific Mortality in Cancer Survivors

Purpose: The importance of body composition on cancer outcomes is of great clinical interest. Measures of body composition that differentiate fat mass from skeletal muscle mass can help redefine our understanding of body composition for cancer survival. We investigated whether the risk of all-cause and cancer-specific mortality differ by levels of total fat mass and sarcopenia status in cancer survivors. Our secondary aim was a subgroup analysis assessing the role of race within these associations. Methods: Participants included 1682 adult cancer survivors who had undergone a dual-energy X-ray absorptiometry (DXA) examination to measure body composition, from the 1999-2006 and 2011-2018 National Health and Nutrition Examination Survey (NHANES). Total fat mass was categorized into tertiles (we assessed high vs. low tertiles), and sarcopenia was considered as having an appendicular skeletal muscle mass index less than 7.26 kg/m2 for males and less than 5.45 kg/m2 for females. Multivariable Cox proportional hazard models estimated the adjusted hazard ratio (aHR) and 95% confidence interval (CI). Results: The mean age of study participants was 61.9 years, and they were followed up for an average of 9.67 years. The prevalence of sarcopenia was 25.0% (N = 304), and 33.4% (N = 561) had a high total fat mass. Participants with a higher fat mass (aHR = 1.30, 95% CI = 1.06-1.61) and with sarcopenia (aHR = 1.51, 95% CI = 1.22-1.88) had a 30% and 51% increased risk of all-cause mortality compared to participants with a low fat mass and with no sarcopenia, respectively. Further, sarcopenia (aHR = 1.74, 95% CI = 1.23-2.29) was associated with a higher risk of cancer-specific mortality in cancer survivors. The association between sarcopenia and all-cause mortality was twice as strong in Black people (aHR = 2.99, 95% CI = 1.39-6.06) compared to White people (aHR = 1.53, 95% CI = 1.19-1.95). Conclusions: Our findings show the opposing relations of fat mass and appendicular skeletal muscle mass index with mortality in a national sample of cancer survivors, and that the relationships may differ by race. These results emphasize the importance of maintaining a healthy body composition among cancer survivors.

Diagnosis, Prevalence and Significance of Obesity in a Cohort of CKD Patients

BACKGROUND

data regarding the association between obesity and morbidity/mortality in patients with chronic kidney disease (CKD) are uncertain and sometimes contradictory. The aims of our study were to determine the associations among different measures of obesity and adiposity, and the risk of all-cause mortality or dialysis entry in stage 3-5 CKD patients.

MATERIALS

this observational cohort study included 178 CKD patients followed for a median of 71 months. Biochemistry, anthropometric measures such as body mass index (BMI), waist-to-hip ratio, mid-arm muscle circumference (MAMC) and body composition by bioimpedance analysis were evaluated.

RESULTS

we found a weak agreement between BMI and other measures of adiposity. In multivariable regression analysis, all measures of obesity such as BMI, waist circumference and waist-to-height ratio were not associated with dialysis entry and/or mortality. Instead, MAMC was associated with dialysis entry HR 0.82 [95% CI: 0.75-0.89] and high FM% with mortality HR 2.08 [95% CI: 1.04-4.18].

CONCLUSIONS

in our CKD population, lower MAMC was predictive of dialysis commencing, while a higher percentage of fatty mass was a predictor of mortality. Instead, obesity, as defined by BMI, is not associated with dialysis commencing or all-cause mortality.

The Use of Different Anthropometric Indices to Assess the Body Composition of Young Women in Relation to the Incidence of Obesity, Sarcopenia and the Premature Mortality Risk

The objective of the study was to evaluate the stratification of young women based on the assessment of body composition according to several currently recommended anthropometric indices and parameters, as well as the presence of obesity, sarcopenic obesity and the risk of premature death. Three hundred and three young Caucasian women aged 18-25 years were included in the cross-sectional observational study. For the purposes of the study, we used the bioelectrical impedance method and applied the obtained data to calculate indices defining obesity, sarcopenic obesity and premature mortality risk (ABSI z-score). We found significant differences between indicators of total and abdominal obesity when determining the rate of risk of premature death and diagnosis of obesity. Our results also suggest that FMI and FM/FFM indices correlate excellently with fat mass and visceral adipose tissue, better than BMI. Even in the case of abdominal obesity, FMI appears to correlate relatively strongly, more so than BMI. The results of the study support the opinion that in the assessment of body composition and health status, the presence of obesity (sarcopenic obesity) and the risk of premature death, anthropometric parameters and indices focusing not only on body weight (BMI, ABSI), but also on the proportionality and distribution of fat (WC, WHR, WHtR, VFA) and muscle tissue (FFMI, SMMI, FM/FFM ratio) should be used.

Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Background

In recent years, the pleiotropic roles of antioxidants have drawn extensive attention in various diseases. Vitamin C is a well-known antioxidant, and it has been used to treat patients with chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis aim to demonstrate the impact of vitamin C supplementation in patients with COPD.

Methods

We searched PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), SinoMed, Wanfang, and China Science and Technology Journal Database (cqvip.com) for eligible randomized controlled trials (RCTs) from their respective inception to May 18^th, 2021, by using the searching terms of COPD, vitamin C, and RCTs. A meta-analysis was performed to evaluate the effects of vitamin C on lung function, antioxidant levels, and nutritional conditions in COPD patients by using Review Manager (Version 5.4).

Results

Ten RCTs including 487 participants were eligible for our study. Meta-analysis results showed that vitamin C supplementation (≥400 mg/day) can significantly improve the forced expiratory volume in one second as a percentage (FEV1%) in COPD (SMD:1.08, 95% CI:0.03, 2.12, P=0.04). Moreover, vitamin C supplementation significantly improved the ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) (WMD:0.66, 95% CI: 0.26, 1.06, P=0.001), vitamin C level in serum (SMD:0.63, 95% CI: 0.02, 1.24, P=0.04) and glutathione (GSH) level in serum (SMD:2.47, 95% CI: 1.06, 3.89, P=0.0006). While no statistically significant difference was observed in body mass index (BMI), fat-free mass index (FFMI), vitamin E level and superoxide dismutase (SOD) level in serum.

Conclusion

Vitamin C supplementation could increase the levels of antioxidation in serum (vitamin C and GSH) and improve lung function (FEV1% and FEV1/FVC), especially in patients treated with vitamin C supplementation greater than 400 mg/day. However, further prospective studies are needed to explore the role of vitamin C in improving nutritional status.

Implications of leg length for metabolic health and fitness

Background and objectives

Several studies have linked longer legs with favorable adult metabolic health outcomes and greater offspring birth weight. A recent Mendelian randomization study suggested a causal link between height and cardiometabolic risk; however, the underlying reasons remain poorly understood.

Methodology

Using a cross-sectional design, we tested in a convenience sample of 70 healthy young women whether birth weight and tibia length as markers of early-life conditions associated more strongly with metabolically beneficial traits like organ size and skeletal muscle mass (SMM) than a statistically derived height-residual variable indexing later, more canalized growth.

Results

Consistent with the 'developmental origins of health and disease' hypothesis, we found relatively strong associations of tibia length-but not birth weight-with adult organ size, brain size, SMM and resting energy expenditure measured by magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry and indirect calorimetry, respectively.

Conclusions and implications

Building on prior work, these results suggest that leg length is a sensitive marker of traits directly impacting metabolic and reproductive health. Alongside findings in the same sample relating tibia length and height-residual to MRI-measured pelvic dimensions, we suggest there may exist a degree of coordination in the development of long bone, lean mass and pelvic traits, possibly centered on early, pre-pubertal growth periods. Such phenotypic coordination has important implications for fitness, serving to benefit both adult health and the health of offspring in subsequent generations.

Predicted fat mass and lean mass in relation to all-cause and cause-specific mortality

BACKGROUND

Studies on the prospective association of body composition with mortality in US general populations are limited. We aimed to examine this association by utilizing data from the National Health and Nutrition Examination Survey (NHANES), a representative sample of US adults, linked with data from the National Death Index.

METHODS

We analysed data of NHANES 1988-1994 and 1999-2014, with 55 818 participants [50.6% female, baseline mean age: 45.0 years (SE, 0.2)]. Predicted fat mass and lean mass were calculated using the validated sex-specific anthropometric prediction equations developed by the NHANES based on individual age, race, height, weight, and waist circumference. Body composition and other covariates were measured at only one time point. Multivariable Cox regression was used to investigate the associations of predicted fat mass and lean mass with overall and cause-specific mortality, adjusting for potential confounders. Interactions between age and body composition on mortality were examined with likelihood ratio testing.

RESULTS

Mean predicted fat mass was 24.1 kg [95% confidence interval (CI): 23.9-24.3) for male participants and 29.9 kg (95% CI: 29.6-30.1) for female participants, while mean predicted lean mass was 59.3 kg (95% CI: 59.1-59.5) for male participants and 41.7 kg (95% CI: 41.5-41.8) for female participants. During a median period of 9.7 years from the survey, 10 408 deaths occurred. When predicted fat and lean mass were both included in the model, predicted fat mass showed a U-shaped association with all-cause mortality, with significantly higher risk at two ends: Quintile 1 (HR, 1.17; 95% CI: 1.05-1.31), Quintile 2 (HR, 1.14; 95% CI: 1.04-1.26) and Quintile 5 (HR, 1.37; 95% CI: 1.12-1.68) compared with Quintile 3. In contrast, predicted lean mass showed a L-shaped association with all-cause mortality, with higher mortality in those with lower lean mass: Quintile 1 (HR, 1.64; 95% CI: 1.46-1.83) and Quintile 2 (HR, 1.29; 95% CI: 1.18-1.42) compared with Quintile 3. Similar results were found for cardiovascular, cancer, and respiratory cause-specific mortality. Age was a significant modifier: There was a monotonic positive association of predicted fat mass with mortality in younger participants (<60 years), but an approximate J-shaped association in older participants (≥60 years) (P interaction <0.001); there was a stronger inverse association between predicted lean mass and mortality in older participants (≥60) compared with those <60 years (P interaction <0.001).

CONCLUSIONS

In this US general population, predicted fat mass and lean mass were independent predictors for overall and cause-specific mortality. Age was a significant modifier on the associations.

Body composition, physical fitness and cardiovascular risk factors in 9-year-old children

The independent associations of body composition and physical fitness components with cardiovascular disease (CVD) risk factors in childhood are not fully understood. Thus, this cross-sectional study examined the independent associations of body composition and physical fitness with CVD risk factors in Swedish 9-year-old children (n = 411). Unadjusted linear regression analyses showed that body mass index (BMI), % fat mass and fat mass index were all positively associated with systolic and diastolic blood pressure, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Metabolic Syndrome (MetS) score (all β ≥ 0.229, P ≤ 0.001). These associations were virtually unaffected by adjustments for basic covariates (child's age and sex, maternal educational level and maternal BMI), fat-free mass and physical fitness. Fat-free mass index had generally weak associations with CVD risk factors and no associations were statistically significant after adjustments (all P > 0.27). Greater cardiorespiratory fitness and motor fitness were associated with lower HOMA-IR and MetS score in unadjusted models (all β ≤ - 0.158, P ≤ 0.039) but not after adjustments for basic covariates and body composition. These findings indicate that cardiovascular health promotion in childhood may focus on the maintenance of a healthy fat mass.

Liraglutide changes body composition and lowers added sugar intake in overweight persons with insulin pump-treated type 1 diabetes

AIMS

To present secondary outcome analyses of liraglutide treatment in overweight adults with insulin pump-treated type 1 diabetes (T1D), focusing on changes in body composition and dimensions, and to evaluate changes in food intake to identify potential dietary drivers of liraglutide-associated weight loss.

MATERIALS AND METHODS

A 26-week randomized placebo-controlled study was conducted to investigate the efficacy and safety of liraglutide 1.8 mg daily in 44 overweight adults with insulin pump-treated T1D and glucose levels above target, and demonstrated significant glycated haemoglobin (HbA1c)- and body weight-reducing effects. For secondary outcome analysis, dual X-ray absorptiometry scans were completed at Weeks 0 and 26, and questionnaire-based food frequency recordings were obtained at Weeks 0, 13 and 26 to characterize liraglutide-induced changes in body composition and food intake.

RESULTS

Total fat and lean body mass decreased in liraglutide-treated participants (fat mass -4.6 kg [95% confidence interval {CI} -5.7; -3.5], P < 0.001; lean mass -2.5 kg [95% CI -3.2;-1.7], P < 0.001), but remained stable in placebo-treated participants (fat mass -0.3 kg [95% CI -1.3;0.8], P = 0.604; lean mass 0.0 kg [95% CI -0.7;0.7]; P = 0.965 [between-group P values <0.001]). Participants reduced their energy intake numerically more in the liraglutide arm (-1.1 MJ [95% CI -2.0;-0.02], P = 0.02) than in the placebo arm (-0.9 MJ [95% CI -2.0;0.1], P = 0.22), but the between-group difference was statistically insignificant (P = 0.42). However, energy derived from added sugars decreased by 27% in the liraglutide arm compared with an increase of 14% in the placebo arm (P = 0.004).

CONCLUSIONS

Liraglutide lowered fat and lean body mass compared with placebo. Further, liraglutide reduced intake of added sugars. However, no significant difference in total daily energy intake was detected between liraglutide- and placebo-treated participants.

Short-term and long-term effects of major depressive disorder subtypes on obesity markers and impact of sex on these associations

BACKGROUND

Only a few studies with conflicting results have examined the effects of sex on the prospective association between depression and subsequent obesity.

OBJECTIVE

(1) To simultaneously assess the associations of the subtypes (atypical, melancholic, unspecified) of major depressive disorder (MDD) measured at baseline and subtypes of major depressive episodes (MDE) that emerged during a 5.5-year follow-up with changes in obesity markers (body mass index, waist circumference, fat mass) during this follow-up, and (2) to test the effect of sex on these associations.

METHODS

Data from CoLaus|PsyCoLaus, a population-based cohort study including 2702 participants (50.1% women, mean age 49.6 years). Criteria for mental disorders were elicited using semi-structured interviews.

RESULTS

History of atypical MDD at baseline was associated with a steeper increase in BMI and waist circumference, whereas atypical MDE during follow-up was associated with a steeper increase in the three studied obesity markers. Melancholic MDD at baseline was associated with a steeper increase in BMI. Several significant interactions with sex were found indicating higher increase in fat mass in men than in women following melancholic MDD reported at baseline, higher decrease in BMI and fat mass in women than in men related to melancholic MDE emerging during follow-up and higher increase in waist circumference in men than in women following unspecified MDD reported at baseline.

LIMITATIONS

Urban sample which may not be representative for the whole population.

CONCLUSIONS

Our results further advocate for the specific need of a thorough monitoring of obesity markers in patients with atypical MDD and suggest less favorable obesity marker changes mainly related to melancholic MDE in men.

Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk

Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex-based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1-45, 2022.

Influence of changes in body fat on clinical outcomes in a general population: a 12-year follow-up report on the Ansan-Ansung cohort in the Korean Genome Environment Study

BACKGROUND

The impact of the changes in the obesity status on mortality has not been established; thus, we investigated the long-term influence of body fat (BF) changes on all-cause deaths and cardiovascular outcomes in a general population.

METHODS

A total of 8374 participants were observed for 12 years. BF was measured at least two times using a bioimpedance method. The causes of death were acquired from the nationwide database. A major adverse cardiovascular event (MACE) was defined as a composite of myocardial infarction, coronary artery disease, stroke, and cardiovascular death. Standard deviations (SDs) were derived using a local regression model corresponding to the time elapsed between the initial and final BF measurements (SD_T) and were used to standardize the changes in BF (ΔBF/SD_T).

RESULTS

The incidence rates of all-cause death, cardiovascular death, and MACE were the highest in the participants with ΔBF/SD_T <-1 and lowest in the participants with ΔBF/SD_T ≥1. Multivariate Cox proportional hazard models adjusted for relevant covariates, including baseline obesity and physical activity, showed that the risks of all-cause deaths (hazard ratio [HR] 0.58; 95% confidence intervals [CI] 0.53-0.64), cardiovascular deaths (HR 0.63; 95% CI 0.51-0.78) and MACEs (HR 0.68; 95% CI 0.62-0.75) decreased as ΔBF/SD_T increased. Subgroup analyses showed that existing cardiovascular diseases weakened the associations between higher ΔBF/SD_T and better outcomes, while high physical activity and exercise did not impact the associations.

CONCLUSION

Increasing BF was associated with a lower risk of all-cause death, cardiovascular death, and MACE in the general population.Key messagesIncreasing body fat is associated with a lower risk of all-cause death, cardiovascular death, and major cardiovascular adverse events in a low-risk ageing general population, independently of physical activity, underlying cardiovascular disease burden, changes in muscle mass, and baseline obesity status.Fatness measured at baseline requires adjustment for the changes in fatness during the follow-up to reveal its impact on the clinical outcomes.

Body Composition and Metabolomics in the Alberta Physical Activity and Breast Cancer Prevention Trial

BACKGROUND

Obesity is correlated with many biomarkers, but the extent to which these correlate with underlying body composition is poorly understood.

OBJECTIVES

Our objectives were to 1) describe/compare distinct contributions of fat/lean mass with BMI-metabolite correlations and 2) identify novel metabolite biomarkers of fat/lean mass.

METHODS

The Alberta Physical Activity and Breast Cancer Prevention Trial was a 2-center randomized trial of healthy, inactive, postmenopausal women (n = 304). BMI (in kg/m2) was calculated using weight and height, whereas DXA estimated fat/lean mass. Ultra-performance liquid chromatography and mass spectrometry measured relative concentrations of serum metabolite concentrations. We estimated partial Pearson correlations between 1052 metabolites and BMI, adjusting for age, smoking, and site. Fat mass index (FMI; kg/m2) and lean mass index (LMI; kg/m2) correlations were estimated similarly, with mutual adjustment to evaluate independent effects.

RESULTS

Using a Bonferroni-corrected α level <4.75 × 10-5,  we observed 53 BMI-correlated metabolites (|r| = 0.24-0.42). Of those, 21 were robustly correlated with FMI (|r| > 0.20), 25 modestly (0.10 ≤ |r| ≤ 0.20), and 7 virtually null (|r| < 0.10). Ten of 53 were more strongly correlated with LMI than with FMI. Examining non-BMI-correlated metabolites, 6 robustly correlated with FMI (|r| = 0.24-0.31) and 2 with LMI (r = 0.25-0.26). For these, correlations for fat and lean mass were in opposing directions compared with BMI-correlated metabolites, in which correlations were mostly in the same direction.

CONCLUSIONS

Our results demonstrate how a thorough evaluation of the components of fat and lean mass, along with BMI, provides a more accurate assessment of the associations between body composition and metabolites than BMI alone. Such an assessment makes evident that some metabolites correlated with BMI predominantly reflect lean mass rather than fat, and some metabolites related to body composition are not correlated with BMI. Correctly characterizing these relations is important for an accurate understanding of how and why obesity is associated with disease.

Effectiveness of Body Roundness Index (BRI) and a Body Shape Index (ABSI) in Predicting Hypertension: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: The body roundness index (BRI) and a body shape index (ABSI) are novel anthropometric indices established to determine both the amount visceral adipose tissue and body fat. Objective: to investigate whether BRI and ABSI are better predictors of hypertension than body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR). Methods: A systematic search was conducted in the Scopus, PubMed and Web of Science databases up until 31 December 2020. Results: The estimated pooled area under curve [AUC (95% CI)] for BRI [0.67 (0.65–0.70)] for the prediction of hypertension were superior to that of ABSI (0.58 (0.56–0.60)), similar to that of BMI [0.67 (0.64–0.69)], and lower than those WC [0.68 (0.66–0.70)] and WHtR [0.68 (0.66–0.71)]. Nevertheless, the difference of BRI compared to WC and WHtR in the context of predicting hypertension was non-significant. ABSI was significantly lower (p < 0.05) than BRI, BMI, WC and WHtR. Similar findings were observed with the summary receiver operating characteristic curve (AUC-SROC). There were no significant differences between subgroups according to type of population or diagnostic criteria of hypertension. The diagnostic odds ratio (dORs) proved that increased BRI and ABSI were related with an elevated hypertension risk. Conclusions: BRI and ABSI have discriminatory power for hypertension in adult women and men from different populations. Although, WHtR and WC provided the best performance when assessing hypertension, no significant differences were found for BRI. Finally, BRI was significantly better predictor of hypertension than ABSI.

Establishing growth charts for proposed body shape and size index of the Pakistani population, using quantile regression approach

Background:

Obesity leads to other fatal diseases like diabetes, cardiovascular diseases, depression, and some forms of cancer. Still, the well-known tool to measure obesity is the body mass index. But it usually failed in the measurement of adipose tissues. So, we present a novel anthropometric measure, called body shape and size index which is developed by the combination of major anthropometric determinants: body surface area, body mass index, weight, and height.

Methods:

This study is based on cross-sectional data consisting of 7224 individuals that were taken from the city Multan, Punjab, Pakistan. All the individuals, both males, and females, of age 2 years and above were included in the study except the pregnant women. The variables included in this study are gender, area (urban and rural), age (years), weight (kg), and height (meters). Growth charts of quantile regression are used for the inferential analysis of data. Comparison of proposed body shape and size index at different obesity levels has also been made to access the relationship of proposed body shape and size index with obesity.

Results:

The results show that the proposed body shape and size index has a great association with body surface area, body mass index, weight, height, and age. The proposed body shape and size index has a high negative association with body surface area, moderate negative association with body mass index and weight, and low negative association with height and age. According to growth charts of body shape and size index, after the age of 25 years, body shape and size index curves go upward while it smoothly goes downward at the age of 50 years but decreases in earlier ages. Body shape and size index showed a significant association with body shape and body size (body development) at the same time.

Conclusion:

Body shape and size index is found, generally linear with age, and increased with decreasing body mass index and body surface area. The proposed index has an indirect relationship with obesity. Body shape and size index with low values indicates a high risk of obesity. While, however, body shape and size index with high values indicates a low risk of obesity. Applications of the proposed body shape and size index are also presented in statistical modeling.

The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology

Body composition is a key component for maintaining good general health and longevity. It can be influenced by a variety of factors, including genetics, environment, and lifestyle choices. The assessment of body composition is an essential tool for nutrition specialists to effectively evaluate nutritional status and monitor progression during dietary interventions. As humans age, there is a natural increase in fat mass coupled with a gradual decline in lean mass, specifically in bone and muscle mass. Individuals with a high body fat percentage are at a greater risk of cardiovascular diseases, type 2 diabetes, several types of cancer, and early mortality. Significant decreases in bone mineral density signify osteopenia and osteoporosis, while reductions in skeletal muscle mass increase the risk of developing sarcopenia. Moreover, undernutrition exacerbates the effects of many medical conditions and is important to address. Though weight tracking and calculation of BMI are used commonly by clinicians and dietitians, these measures do not provide insight on the relative contributions of fat mass and fat-free mass or the changes in these compartments that may reflect disease risk. Therefore, it is important that healthcare professionals have a critical understanding of body composition assessment and the strengths and limitations of the methods available.

The association between serum liver enzymes and cancer mortality

Interpreting levels of liver enzymes is often challenging because they may be influenced by metabolic processes beyond the liver. Given their pathophysiologic roles in inflammation and oxidative stress, higher levels of these enzymes may be associated with increased risk of mortality. However, studies have found inconsistent results. Thus, we examined the association of liver enzymes levels with cancer mortality in the general US adult population. We used the US National Health and Nutrition Examination Survey from 1999 to 2016. Kaplan-Meier survival curve comparisons were examined across quartiles of liver enzymes. Cox proportional hazards models were built to examine the relationship between cancer mortality and liver enzymes quartiles without and with adjustment for potential confounding factors. During the 338,882 person-years follow-up, 1059 participants had cancer-related deaths. There was a nonlinear U-shaped relationship between serum alanine and aspartate aminotransferase (ALT and AST) levels and cancer mortality. There was no relationship between cancer mortality and gamma-glutamyltransferase (GGT); however, each 10 IU/L increase in GGT after median was associated with 1% higher mortality risk (HR = 1.01; 95% CI = 1.00, 1.02; P = 0.001). Only subjects with high levels of alkaline phosphatase (ALP) had higher cancer mortality (HR = 1.63; 95CI = 1.30, 2.05; P < 0.001 and HR = 1.52; 95%CI = 1.20, 1.94; P = 0.001, respectively). Only the lowest and highest serum ALT and AST levels are associated with increased cancer mortality. For ALP, the relationship is present at higher levels. The association with GGT was not robust to different analyses. The mechanisms underlying the observed relationships need further exploration.

Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial

The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72–2.14, P ≤ 0.003), HOMA-IR (ORs: 3.01–3.80, P < 0.001), blood pressure (ORs: 1.81–2.05, P < 0.001) and MetS score (ORs: 3.29–3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26–1.82, P = 0.001–0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88–1.54, P = 0.039–0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57–0.63, P  ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.

Can High-Intensity Interval Training Promote Skeletal Muscle Anabolism?

Exercise training in combination with optimal nutritional support is an effective strategy to maintain or increase skeletal muscle mass. A single bout of resistance exercise undertaken with adequate protein availability increases rates of muscle protein synthesis and, when repeated over weeks and months, leads to increased muscle fiber size. While resistance-based training is considered the 'gold standard' for promoting muscle hypertrophy, other modes of exercise may be able to promote gains in muscle mass. High-intensity interval training (HIIT) comprises short bouts of exercise at or above the power output/speed that elicits individual maximal aerobic capacity, placing high tensile stress on skeletal muscle, and somewhat resembling the demands of resistance exercise. While HIIT induces rapid increases in skeletal muscle oxidative capacity, the anabolic potential of HIIT for promoting concurrent gains in muscle mass and cardiorespiratory fitness has received less scientific inquiry. In this review, we discuss studies that have determined muscle growth responses after HIIT, with a focus on molecular responses, that provide a rationale for HIIT to be implemented among populations who are susceptible to muscle loss (e.g. middle-aged or older adults) and/or in clinical settings (e.g. pre- or post-surgery).

High BMI with Adequate Lean Mass Is Not Associated with Cardiometabolic Risk Factors in Children and Adolescents

BACKGROUND

Despite an increasing number of studies investigating the links between increased BMI and a better prognosis of cardiovascular disease, which has been termed the "obesity paradox," few of them take the lean mass into consideration.

OBJECTIVES

This study aimed to explore the associations of body composition compartments, especially the lean mass, with cardiometabolic abnormalities in children and adolescents.

METHODS

In a nationwide cross-sectional study of 6- to 18-y-old children (n = 8967, 50.1% boys), we measured body composition using DXA scan, and calculated BMI, fat mass index (FMI), and lean mass index (LMI). The exploratory outcomes were cardiometabolic abnormalities, including hypertension, dyslipidemia, hyperglycemia, and insulin resistance. Adjusted linear regression coefficients and ORs were calculated to assess the associations between body composition indicators and cardiometabolic abnormalities.

RESULTS

Unlike BMI and FMI, LMI was inversely associated with homeostasis model assessment of insulin resistance (β: -0.06; 95% CI: -0.09, -0.03; P < 0.001), fasting plasma glucose (β: -0.08; 95% CI: -0.11, -0.05; P < 0.001), non-HDL cholesterol (β: -0.10; 95% CI: -0.13, -0.08; P < 0.001), LDL cholesterol (β: -0.12; 95% CI: -0.14, -0.09; P < 0.001), and total cholesterol (TC) (β: -0.16; 95% CI: -0.19, -0.14; P < 0.001). After multivariable adjustment, all the odds of cardiometabolic abnormalities were increased from the lowest quartile to the highest quartile of BMI and FMI (P-trend < 0.05); however, the odds of high TC, high LDL cholesterol, hyperglycemia, and insulin resistance were decreased with LMI (P-trend < 0.05). Obese children with high LMI did not have significantly increased odds of high TC, high LDL cholesterol, and high non-HDL cholesterol compared with normal-weight children without high LMI.

CONCLUSIONS

Greater lean mass may have a protective impact on high TC, high LDL cholesterol, hyperglycemia, and insulin resistance in children and adolescents. This finding suggests that the "obesity paradox" may be partly explained by high lean mass.

Associations of Skeletal Muscle Mass and Fat Mass With Incident Cardiovascular Disease and All-Cause Mortality: A Prospective Cohort Study of UK Biobank Participants

Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all-cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole-body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all-cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person-years of follow-up, there were 27 784 CVD events and 15 844 all-cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06-1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19-1.22) and 1.25 (95% CI, 1.23-1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J-shaped associations between aSMM and FM with all-cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population-level CVD incidence or all-cause mortality.

Relation of body fat mass and fat-free mass to total mortality: results from 7 prospective cohort studies

BACKGROUND

Fat mass and fat-free mass may play independent roles in mortality risk but available studies on body composition have yielded inconsistent results.

OBJECTIVE

The aim was to determine the relations of body fat mass and fat-free mass to risk of mortality.

METHODS

In pooled data from 7 prospective cohorts encompassing 16,155 individuals aged 20 to 93 y (median, 44 y), we used Cox regression and restricted cubic splines to estimate HRs and 95% CIs for the relation of body composition, measured by bioelectrical impedance analysis, to total mortality. We adjusted for age, study, sex, ethnicity, history of diabetes mellitus, education, smoking, physical activity, and alcohol consumption.

RESULTS

During a median follow-up period of 14 y (range, 3-21 y), 1347 deaths were identified. After mutual adjustment for fat mass and fat-free mass, fat mass showed a J-shaped association with mortality (overall P value < 0.001; P for nonlinearity = 0.003). Using a fat mass index of 7.3 kg/m2 as the reference, a high fat mass index of 13.0 kg/m2 was associated with an HR of 1.56 (95% CI: 1.30, 1.87). In contrast, fat-free mass showed an inverse association with mortality (overall P value < 0.001; P for nonlinearity = 0.001). Compared with a low fat-free mass index of 16.1 kg/m2, a high fat-free mass of 21.9 kg/m2 was associated with an HR of 0.70 (95% CI: 0.56, 0.87).

CONCLUSIONS

Fat mass and fat-free mass show opposing associations with mortality. Excess fat mass is related to increased mortality risk, whereas fat-free mass protects against risk of mortality. These findings suggest that body composition provides important prognostic information on an individual's mortality risk not provided by traditional proxies of adiposity such as BMI.

Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults

Background

Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices.

Methods

Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.

Results

After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.

Conclusions

AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.

Physical Activity and Mortality Across Levels of Adiposity: A Prospective Cohort Study From the UK Biobank

OBJECTIVE

To examine the combined and stratified associations of physical activity and adiposity measures, modelled as body mass index (BMI), abdominal adiposity (waist circumference), and body fat percentage (BF) with all-cause mortality.

PATIENTS AND METHODS

Using the UK Biobank cohort, we extracted quintiles of self-reported weekly physical activity. Categories of measured BMI, waist circumference, and BF were generated. Joint associations between physical activity-adiposity categories and mortality were examined using Cox proportional hazards models adjusted for demographic, behavioral, and clinical covariates. Physical activity-mortality associations were also examined within adiposity strata. Participants were followed from baseline (2006 to 2010) through January 31, 2018.

RESULTS

A total of 295,917 participants (median follow-up, 8.9 years, during which 6684 deaths occurred) were included. High physical activity was associated with lower risk of premature mortality in all strata of adiposity except for those with BMI ≥35 kg/m². Highest risk (HR, 1.54; 95% CI; 1.33 to 1.79) was observed in individuals with low physical activity and high BF as compared with the high physical activity-low BF referent. High physical activity attenuated the risk of high adiposity when using BF (HR, 1.24; 95% CI; 1.04 to 1.49), but the association was weaker with BMI (HR, 1.45; 95% CI; 1.21 to 1.73). Physical activity also attenuated the association between mortality and high waist circumference.

CONCLUSION

Low physical activity and adiposity were both associated with a higher risk of premature mortality, but high physical activity attenuated the increased risk with adiposity irrespective of adiposity metric, except in those with a BMI ≥35 kg/m².

Fat-to-muscle Ratio: A New Indicator for Coronary Artery Disease in Healthy Adults

Background: Coronary artery disease (CAD) is an important issue in public health. Previous studies have shown that the ratio of fat to muscle mass is a significant predictor of metabolic disease, and it is known to be associated with atherosclerosis. In this study, we evaluated the association between the fat-to-muscle ratio (FMR) and CAD in healthy adults. Methods: A total of 617 participants without diabetes mellitus, hypertension, known CAD, or stroke who visited the Health Promotion Center from 2009 to 2018 were included in this study. Computed tomography imaging and bioelectrical impedance analysis were used to ascertain the coronary artery calcium (CAC) score, degree of CAD, and FMR. Results: Univariate logistic regression analysis showed that old age, male sex, smoking history, creatinine, aspartate aminotransferase, gamma-glutamyl transferase, uric acid, total cholesterol, and low-density lipoprotein cholesterol were significantly associated with CAC. After adjusting for potential confounding covariates, the presence of CAC was independently associated with FMR (OR, 1.014; 95% CI, 1.002-1.026; p = 0.019. The association was maintained even after adjusting for body mass index and waist circumference (odds ratio, 1.019; 95% confidence interval, 1.004 -1.034; P = 0.012). Conclusion: In this study, a high FMR was significantly associated with CAC. A large-scale prospective study on the association with FMR and cardiovascular diseases is necessary to confirm this relationship.

Characterizing body composition, cardiorespiratory fitness, and physical activity in women with anterior cruciate ligament reconstruction

OBJECTIVES

The purpose was to compare body composition, cardiorespiratory fitness, and physical activity (PA) engagement between women with ACLR and healthy controls.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Ten women with ACLR (time since surgery = 33.0 ± 18.3 months; age = 21.4 ± 3.8 years) and 10 healthy women (age = 21.9 ± 3.1 years) matched based on age (±2 years) and Tegner Activity Level (±2) participated.

MAIN OUTCOME MEASURES

Body fat percentage (%BF) was estimated using air displacement plethysmography, cardiorespiratory fitness was assessed via a graded cycle test, and PA was assessed using accelerometers worn for 7 days. Groups were compared using Mann-Whitney U tests. Time (minutes/week) spent in moderate-to-vigorous PA and step count (steps/day) were compared between groups using a one-way ANCOVA with 7-day total wear time as the only covariate. Statistical significance was established a priori as α ≤ 0.05.

RESULTS

Women with ACLR had significantly higher %BF than controls (ACLR = 32.7 ± 6.7%, healthy = 22.6 ± 4.9%; p < 0.01) and participated in less steps per day (ACLR = 6650 ± 3227 steps/day, healthy = 9361 ± 2626 steps/day; p = 0.02).

CONCLUSIONS

There may be persistent negative effects on body composition and PA engagement for women following ACLR. Low PA and high %BF have adverse consequences for premature mortality and morbidity; therefore, it is crucial to assess these characteristics and determine interventions to maintain PA and healthy body composition following ACLR.

DNA methylation in infants with low and high body fatness

BACKGROUND

Birth weight is determined by the interplay between infant genetics and the intrauterine environment and is associated with several health outcomes in later life. Many studies have reported an association between birth weight and DNA methylation in infants and suggest that altered epigenetics may underlie birthweight-associated health outcomes. However, birth weight is a relatively nonspecific measure of fetal growth and consists of fat mass and fat-free mass which may have different effects on health outcomes which motivates studies of infant body composition and DNA methylation. Here, we combined genome-wide DNA methylation profiling of buccal cells from 47 full-term one-week old infants with accurate measurements of infant fat mass and fat-free mass using air-displacement plethysmography.

RESULTS

No significant association was found between DNA methylation in infant buccal cells and infant body composition. Moreover, no association between infant DNA methylation and parental body composition or indicators of maternal glucose metabolism were found.

CONCLUSIONS

Despite accurate measures of body composition, we did not identify any associations between infant body fatness and DNA methylation. These results are consistent with recent studies that generally have identified only weak associations between DNA methylation and birthweight. Although our results should be confirmed by additional larger studies, our findings may suggest that differences in DNA methylation between individuals with low and high body fatness may be established later in childhood.

Mismatch between poor fetal growth and rapid postnatal weight gain in the first 2 years of life is associated with higher blood pressure and insulin resistance without increased adiposity in childhood: the GUSTO cohort study

BACKGROUND

Using longitudinal ultrasounds as an improved fetal growth marker, we aimed to investigate if fetal growth deceleration followed by rapid postnatal weight gain is associated with childhood cardiometabolic risk biomarkers in a contemporary well-nourished population.

METHODS

We defined fetal growth deceleration (FGD) as ultrasound-measured 2nd-3rd-trimester abdominal circumference decrease by ≥0.67 standard deviation score (SDS) and rapid postnatal weight gain (RPWG) as 0-2-year-old weight increase by ≥0.67 SDS. In the GUSTO mother-offspring cohort, we grouped 797 children into four groups of FGD-only (14.2%), RPWG-only (23.3%), both (mismatch, 10.7%) or neither (reference, 51.8%). Adjusting for confounders and comparing with the reference group, we tested associations of these growth groups with childhood cardiometabolic biomarkers: magnetic resonance imaging (MRI)-measured abdominal fat (n = 262), liver fat (n = 216), intramyocellular lipids (n = 227), quantitative magnetic resonance-measured overall body fat % (BF%) (n = 310), homeostasis model assessment of insulin resistance (HOMA-IR) (n = 323), arterial wall thickness (n = 422) and stiffness (n = 443), and blood pressure trajectories (ages 3-6 years).

RESULTS

Mean±SD birthweights were: FGD-only (3.11 ± 0.38 kg), RPWG-only (3.03 ± 0.37 kg), mismatch (2.87 ± 0.31 kg), reference (3.30 ± 0.36 kg). FGD-only children had elevated blood pressure trajectories without correspondingly increased BF%. RPWG-only children had altered body fat partitioning, higher BF% [BF = 4.26%, 95% confidence interval (CI) (2.34, 6.19)], HOMA-IR 0.28 units (0.11, 0.45)] and elevated blood pressure trajectories. Mismatch children did not have increased adiposity, but had elevated ectopic fat, elevated HOMA-IR [0.29 units (0.04,0.55)] and the highest blood pressure trajectories. Associations remained even after excluding small-for-gestational-age infants from analyses.

CONCLUSIONS

Fetal growth deceleration coupled with rapid postnatal weight gain was associated with elevated childhood cardiometabolic risk biomarkers without correspondingly increased BF%.

Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies

OBJECTIVE

To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included.

DATA SYNTHESIS

A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves.

RESULTS

Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I²=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I²=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I²=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I²=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I²=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I²=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I²=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I²=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index.

CONCLUSIONS

Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

Advanced Skeletal Muscle Mass Reduction (Sarcopenia) Secondary to Neuromuscular Disease

We describe a young male patient chronically on a ventilator secondary to decreased mobility from amyotrophic lateral sclerosis (ALS). He had both a tracheostomy for breathing and percutaneous endoscopic gastrostomy (PEG) for feeding. Using 24-hour urinary creatinine excretion data, we calculated an estimate of skeletal muscle (SM) mass. SM mass was indexed to height and weight to obtain the SM index. The SM index is used as a determinant to define sarcopenia. From the data, we found that this patient had the smallest SM index ever recorded at 2.2 kg/m², consistent with extremely advanced sarcopenia. As a comparison, "severe" sarcopenia in a male is defined as a SM index ≤ 8.5 kg/m². This method can be used in ICU patients to evaluate for sarcopenia which is a predictive marker for mortality.