Assessing body composition with DXA and bioimpedance: effects of obesity, physical activity, and age

Body composition assessment for sarcopenic obesity and 3-year mortality in older adults: A comparison study

BACKGROUND

There is no universally accepted definition of sarcopenic obesity (SO), and its prevalence is ambiguous. This study aimed to investigate the prevalence of SO in older adults based on different definitions and determine which predicts all-cause mortality.

METHODS

This prospective longitudinal follow-up study included outpatients aged ≥60 years. SO was defined by sarcopenia definition based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria plus obesity. Three different methods were used to define obesity. Body mass index (BMI) ≥ 30 kg/m2, waist circumference (WC) ≥ 102 cm for men and ≥88.0 cm for women, and body fat percentage (BF%) ≥ 37.3% for men and ≥51.1% for women. Different definitions of SO and their mortality predictions were compared.

RESULTS

The median age of the 584 patients in the study was 70.0 (interquartile range, 66.0-76.0) years. The prevalence of sarcopenia was 38.5% (47.5% in men and 35.7% in women). The prevalence of SO based on BMI, WC, and BF% was 15.3%, 16.4%, and 10.5%, respectively. The mortality rate was 6.7%. SO based on BMI (odds ratio [OR], 2.73; 95% CI, 1.12-17.9; P = 0.024) and BF% (OR, 1.43; 95% CI, 1.19-3.02; P = 0.007) were significantly associated with 3-year mortality after adjusting for the confounding variables of age, sex, and number of comorbidities. SO based on WC was not associated with mortality (OR, 0.78; 95% CI, 0.07-1.27; P = 0.104).

CONCLUSION

The use of BF% and BMI for defining SO is appropriate in outpatient older adults.

Fat-free mass may play a dominant role in the association between systolic blood pressure and body composition in children and adolescents

Systolic blood pressure (SBP) is significantly associated with body composition in children and adolescents. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We, therefore, aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey with cross-sectional analysis. In total, 13 618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Multiple linear regression showed that SBP was associated with higher total fat-free mass in boys (β = 0·49, P < 0·001) and girls (β = 0·47, P < 0·001) and with higher total fat mass only in boys (β = 0·12, P < 0·001) after adjustment for covariates. When taking fat distribution into consideration, SBP was associated with higher trunk fat mass (boys: β = 0·28, P < 0·001; girls: β = 0·15, P < 0·001) but negatively associated with leg fat mass (Boys: β = -0·14, P < 0·001; Girls: β = -0·11, P < 0·001), in both boys and girls. Dominance analysis showed that total fat-free mass was the dominant contributor to SBP (boys: 49 %; girls: 55·3 %), followed by trunk fat mass (boys: 32·1 %; girls: 26·9 %); leg fat mass contributed the least to SBP in boys (18·9 %) and girls (17·8 %). Our findings indicated that total fat-free mass was not only associated with SBP but also the most dominant contributor to SBP variation in American children and adolescents.

Meal Frequency Does Not Affect Weight Loss in Overweight/Obese Women but Affects the Body Composition: A Randomized Controlled Trial

OBJECTIVES

Studies showing the relationship between meal frequency, weight loss and anthropometric measurements are contradictory. This study aims to determine the effect of meal frequency on weight loss, anthropometric measurements, and body composition.

METHODS

This is a parallel designed randomized control trial that was conducted with 40 female volunteers between the ages of 19-64 years, with a Body Mass Index (BMI) ≥27 who applied to a private clinic. Participants were randomized in two treatment arms (3 meals + 3 snacks/day (n = 20) vs 3 meals/day (n = 20)) and same dietary energy restriction (-500kcal) was applied for 3 months. Food consumption was questioned with 3 day food records, and anthropometric measurements and body composition were measured before the study and repeated each week till the end of the study by the researcher.

RESULTS

All of the participants completed the study period. Body weight (kg), BMI (kg/m2), total body fat (kg), body fat percentage (%), fat free mass (kg) and waist circumference (cm) decreased, while fat free mass percentage (%) increased significantly in both of the groups at the end of the study (p < 0.05). The rate of difference for body weight, BMI (kg/m2) and waist circumference (cm) were similar among the groups. When difference in body composition analyses was examined, the rate of reduction in total body fat (-18.82 ± 4.97% vs -14.87 ± 7.44%) and body fat percentage (%)(-10.79 ± 4.63% vs -7.68 ± 7.04%) and the rate of increase in fat free mass percentage (%)(7.65 ± 3.16% vs 5.04 ± 3.44%) were significantly higher in 3 meals + 3 snacks group (p < 0.05).

CONCLUSION

When energy restricted and balanced weight loss programs are applied, alteration in body weight, BMI and waist circumference is not affected from meal frequency, but body composition does.

CLINICAL TRIAL NUMBER

NCT05581862 (Date of Trial Registration: 13/10/2022).

Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 8-10 years of age: LIMIT randomised trial follow-up

BACKGROUND

The LIMIT randomised controlled trial looked at the effect of a dietary and lifestyle intervention compared with routine antenatal care for pregnant women with overweight and obesity on pregnancy outcomes. While women in the intervention group improved diet and physical activity with a reduction of high birth weight, other outcomes were similar. We have followed the children born to women in this study at birth, 6 and 18 months and 3-5 years of age and now report follow-up of children at 8-10 years of age.

METHODS

Children at 8-10 years of age who were born to women who participated in the LIMIT randomised trial, and whose mother provided consent to ongoing follow-up were eligible for inclusion. The primary study endpoint was the incidence of child BMI z-score > 85th centile for child sex and age. Secondary study outcomes included a range of anthropometric measures, neurodevelopment, child dietary intake, and physical activity. Analyses used intention to treat principles according to the treatment group allocated in pregnancy. Outcome assessors were blinded to the allocated treatment group.

RESULTS

We assessed 1,015 (Lifestyle Advice n = 510; Standard Care n = 505) (48%) of the 2,121 eligible children. BMI z-score > 85th percentile was similar for children of women in the dietary Lifestyle Advice Group compared with children of women in the Standard Care Group (Lifestyle Advice 479 (45%) versus Standard Care 507 (48%); adjusted RR (aRR) 0.93; 95% CI 0.82 to 1.06; p = 0.302) as were secondary outcomes. We observed that more than 45% of all the children had a BMI z-score > 85th percentile, consistent with findings from follow-up at earlier time-points, indicating an ongoing risk of overweight and obesity.

CONCLUSIONS

Dietary and lifestyle advice for women with overweight and obesity in pregnancy has not reduced the risk of childhood obesity, with children remaining at risk of adolescent and adult obesity. Other strategies are needed to address the risk of overweight and obesity in children including investigation of preconception interventions to assess whether this can modify the effects of maternal pre-pregnancy BMI. The LIMIT randomised controlled trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

The Mediation and Moderation Effect Association among Physical Activity, Body-Fat Percentage, Blood Pressure, and Serum Lipids among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2015

Physical activity (PA) is of benefit and particularly important for cardiovascular disease risk factors as being sedentary becomes a lifestyle habit. Research into Chinese complex association among physical activity, body-fat percentage (BF%), blood pressure, and serum lipids is limited. The present study is based on an observational study among adults (>18 years old) residing in fifteen provinces in China. Data of 10,148 adult participants in the 2015 China Health and Nutrition Survey (CHNS) were analyzed. The simple mediation effect models with covariates were utilized to assess the association among PA and blood pressure or serum lipids, and BF% was played as a mediator. The serial multiple-mediator models with covariates were constructed to the further analysis of the relationship between PA and blood pressure, and BF% was the mediator 1 and blood lipids were the mediator 2. Based on the above hypothesis, the moderated mediation models with covariates were used to analyze the association among PA, BF%, and blood pressure; in addition, BF% was used as the mediator and blood lipids played as the moderator. In the simple mediation models, the model with a dependent variable was high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C); BF% was played as the partly mediation effect and the proportion of contribution was 0.23 and 0.25, respectively. In the serial multiple-mediator models, blood lipids, as the second mediator, played the mediation effect; however, the effect was smaller than the BF%. In the moderated mediation model, blood lipids had the moderation effect as the moderator variable. HDL-C played a moderating role in the latter pathway of the "PA→BF%→SBP/DBP" mediation model, and LDL-C/TC played a moderating role in the direct effect of the "PA→BF%→DBP". In conclusion, BF% played a mediating role in the relationship between PA and blood pressure. HDL-C, LDL-C, and TC were more likely to act as moderating variables in the mediation model "PA→BF%→SBP/DBP". PA could directly and indirectly benefit to control the CVD risk factors simultaneously.

Cardiac output and arteriovenous oxygen difference contribute to lower peak oxygen uptake in patients with fibromyalgia

BACKGROUND

Patients with fibromyalgia (FM) exhibit low peak oxygen uptake ([Formula: see text]O_2peak). We aimed to detect the contribution of cardiac output to ([Formula: see text]) and arteriovenous oxygen difference [Formula: see text] to [Formula: see text] from rest to peak exercise in patients with FM.

METHODS

Thirty-five women with FM, aged 23 to 65 years, and 23 healthy controls performed a step incremental cycle ergometer test until volitional fatigue. Alveolar gas exchange and pulmonary ventilation were measured breath-by-breath and adjusted for fat-free body mass (FFM) where appropriate. [Formula: see text] (impedance cardiography) was monitored. [Formula: see text] was calculated using Fick's equation. Linear regression slopes for oxygen cost (∆[Formula: see text]O₂/∆work rate) and [Formula: see text] to [Formula: see text]O₂ (∆[Formula: see text]/∆[Formula: see text]O₂) were calculated. Normally distributed data were reported as mean ± SD and non-normal data as median [interquartile range].

RESULTS

[Formula: see text]O_2peak was lower in FM patients than in controls (22.2 ± 5.1 vs. 31.1 ± 7.9 mL∙min^-1∙kg^-1, P < 0.001; 35.7 ± 7.1 vs. 44.0 ± 8.6 mL∙min^-1∙kg FFM^-1, P < 0.001). [Formula: see text] and C(a-v)O₂ were similar between groups at submaximal work rates, but peak [Formula: see text] (14.17 [13.34-16.03] vs. 16.06 [15.24-16.99] L∙min^-1, P = 0.005) and C(a-v)O₂ (11.6 ± 2.7 vs. 13.3 ± 3.1 mL O₂∙100 mL blood^-1, P = 0.031) were lower in the FM group. No significant group differences emerged in ∆[Formula: see text]O₂/∆work rate (11.1 vs. 10.8 mL∙min^-1∙W^-1, P = 0.248) or ∆[Formula: see text]/∆[Formula: see text]O₂ (6.58 vs. 5.75, P = 0.122) slopes.

CONCLUSIONS

Both [Formula: see text] and C(a-v)O₂ contribute to lower [Formula: see text]O_2peak in FM. The exercise responses were normal and not suggestive of a muscle metabolism pathology.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03300635. Registered 3 October 2017-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03300635 .

Differences in calculated body fat percentage estimated from published equations based on bioelectric impedance analysis in healthy young South African adults

Background

Adult overweight and obesity, in addition to the intake of saturated fat and total serum cholesterol must be monitored as biological risk factors for non-communicable diseases (NCDs). Bioelectric impedance analysis (BIA) provides data on body fat for use in epidemiological settings. However, optimized equations should be used to calculate percentage body fat (%BF). The purpose of this study was to assess the differences between %BF calculated using different published BIA equations and %BF measured by BIA in young South African adults.

Design and methods

In this observational study, differences in calculated %BF were assessed, with different BIA equations retrieved from the literature used in 1128 healthy young adults aged 20-30 years. The %BF (measured by BIA) was compared between equations, between Black and White men and women, respectively.

Results

The results showed statistically significant differences in the %BF calculated from published BIA equations when used in young South African adults (χ² = 946, χ² = 2528, χ² = 2088, respectively, p < 0.0001). In Black and White men and women, respectively, %BF levels were significantly higher when calculated by equations, than when measured by BIA (p < 0.0001).

Conclusion

There seem to be large discrepancies in estimating %BF by BIA equations and these values cannot be used interchangeably for young South African adults. A South African age, ethnicity and sex-specific BIA equation needs to be developed to accurately estimate %BF in young South African adults.

Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011-2018

We compared the relationship between sedentary activity (SA) and physical activity (PA) with bone mineral density (BMD) and body fat percentage in the United States and found a negative association between SA and BMD and a positive association with body fat percentage. A positive association between PA and BMD and a negative association with body fat percentage. SA and PA are associated with changes in skeletal parameters and body fat percentage, and we aimed to investigate and compare the relationship between SA, PA and bone mineral density (BMD) and body fat percentage in men and women. We assessed the relationship between SA, PA and BMD and body fat percentage in 9787 Americans aged 20-59 years (mean age 38.28 ± 11.39 years) from NHANES 2011-2018. BMD and body fat percentage were measured by dual-energy X-ray bone densitometry (DXA). We used multiple linear regression models to examine the relationships between SA, PA and lumbar spine BMD and total body fat percentage, adjusted for a large number of confounding factors. After adjusting for race/ethnicity, age, alcohol and smoking behavior, body mass index (BMI), total protein, blood calcium, blood uric acid, cholesterol, blood phosphorus, vitamin D, and blood urea nitrogen, SA was negatively associated with lumbar spine BMD (β = - 0.0011 95% CI - 0.0020 to - 0.0002, P = 0.022), and SA was positively associated with total fat percentage (β = PA was positively associated with lumbar BMD (β = 0.0046 95% CI 0.0010 to 0.0082, P = 0.012) and there was a negative association between PA and body fat percentage (β = - 1.177 95% CI - 1.326 to -1.027, P < 0.001). Our results show that physical activity is a key component of maintaining bone health in both men and women and is strongly associated with lower body fat percentages. Sedentary activity is negatively correlated with bone density and is strongly associated with an increase in body fat percentage. Healthcare policy makers should consider reducing sedentary activity and increasing physical activity when preventing osteoporosis and obesity.

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.

Association of physical function and body composition with falls in pre-frail older adults with poor physical performance: A cross-sectional study

BACKGROUND

Falls in pre-frail older adults is often attributed to poor physical performance, lower muscle quality and quantity. The aims of our study were to determine (i) demographics, physical function, and body composition in pre-frail older adults with poor physical performance (ii) characteristics of fallers amongst those with poor physical performance and (iii) association of physical function and body composition measures with falls in pre-frail older adults with poor physical performance.

METHODS

Cross-sectional study of 328 pre-frail community-dwelling older adults ≥ 60 years. Data was collected on demographics, cognition, short physical performance battery (SPPB) and gait speed. Poor physical performance was defined by SPPB ≤ 9, 5x chair-stand time ≥12 s or gait speed <1 m/s. InBody S10 used to measure body composition.

RESULTS

Mean age 72.51 years, 185(56.4%) females, 276(84.1%) of Chinese ethnicity and 257 (78.4%) had poor physical performance. Within the poor performers, SPPB balance (OR 0.50; 95% CI 0.27-0.92; p = 0.025) and 5x-chair-stand (OR 1.09; 95% CI 1.01-1.18; p = 0.038) in addition to higher body fat percentage, fat mass index, fat mass to fat free mass ratio, all segmental lean masses except for left leg and body cell mass were significantly associated with falls.

CONCLUSIONS

Longer chair-stand time, lower balance, low muscle and high fat mass are associated with falls in poor performers and could serve as screening tools for those at increased risk of falls. The findings from our study need to be validated prospectively in a larger population study.

Adipocytes in obesity: A perfect reservoir for SARS-CoV-2?

Research evidence suggests that adipocytes in obesity might facilitate SARS-CoV-2 replication, for it was only found in adipose tissue of individuals with overweight or obesity but not lean individuals who died from COVID-19. As lipid metabolism is key to adipocyte function, and viruses are capable of exploiting and manipulating lipid metabolism of host cells for their own benefit of infection, we hypothesize that adipocytes could not only impair host immune defense against viral infection, but also facilitate SARS-CoV-2 entry, replication and assembly as a reservoir to boost the viral infection in obesity. The latter of which could mainly be mediated by SARS-CoV-2 hijacking the abnormal lipid metabolism in the adipocytes. If these were to be confirmed, an approach to combat COVID-19 in people with obesity by taking advantage of the abnormal lipid metabolism in adipocytes might be considered, as well as modifying lipid metabolism of other host cells as a potential adjunctive treatment for COVID-19.

Optimal body composition indices cutoff values based on all-cause mortality in the elderly

The cutoffs of body composition indices are inconclusive in older populations. This study is designed toward determining the optimal cutoffs of the body composition indices based on the association with all-cause mortality. During 2009 and 2010, a cohort population of 1200 was enrolled in central western Taiwan. Of the 1200 subjects, 428 older subjects (mean age: 72.5 ± 5.4 yrs.; 47.7 % were women) were censored in this study. The waist circumference (WC) and body mass index (BMI) were measured using standard anthropometric methods. A multi-frequency bioelectrical impedance analysis device was utilized to estimate each participant's body composition indices, including percent body fat (PBF) and skeletal muscle mass index (SMMI). All claims records of death from 2009 to 2018 in the National Health Insurance Research Databank were identified. A receiver operating characteristic curve method and the highest Youden index were used to identify the optimal cutoffs. A Cox proportional hazards regression analysis was used to model associations between each of the recommended cutoff values with all-cause mortality. The all-cause mortality rate was 20.09 % after a follow-up period of 5.86 ± 2.39 person-years. The significant indices cutoff value was identified to be WC (86.7 cm) for older women and BMI (23.8 kg/m²) and as WC (77.6 cm), and SMMI (8.7 kg/m²) for older men. The recommended optimal cutoffs of the body composition indices were gender-specific and can be utilized to predict the risk of all-cause mortality.

Validation of bioelectrical impedance analysis in the evaluation of body composition in patients with breast cancer

BACKGROUND

The evaluation of body composition is an essential parameter for preventing obesity and sarcopenic obesity, which are prognostic factors in breast cancer. This study aims to validate the bioelectrical impedance analysis (BIA) of women who are breast cancer survivors by using the dual-energy x-ray absorptiometry (DXA) measurement method.

METHODS

This validation study included 104 women without metastasis between 32 and 72 years old (mean 47.03 ± 8.59) whose treatment was completed 6 months prior. Body composition analysis was performed sequentially using both measurements and when participants were hungry.

RESULTS

Meaningful differences were found in fat-free mass (FFM) (BIA: 46.57 ± 5.54 kg; DXA: 41.06 ± 5.11 kg), body fat percentage (%BF) (BIA: 34.28% ± 6.24%; DXA: 43.91% ± 5.58%), body fat mass (FM) (BIA: 25.37 ± 8.84 kg; DXA: 31.24 ± 9.09 kg), and lean soft tissue mass (LSTM) (BIA: 4.42 ± 5.66 kg; DXA: 38.75 ± 4.98 kg) (P < 0.001). Powerful associations for body FM and strong associations for other parameters were seen. A constant and/or proportional error was found between the two devices within the direction of strong and solid components. Compared with DXA, the BIA measurement gives a lower estimate of %BF and FM and a higher estimate of LSTM and FFM.

CONCLUSIONS

By the mathematical relationship between the two measurement methods, it seems possible to adapt the body composition parameters obtained from BIA of patients with breast cancer to DXA results. In the future, there will be a need to evaluate these two devices with more extensive studies.

High precision but systematic offset in a standing bioelectrical impedance analysis (BIA) compared with dual-energy X-ray absorptiometry (DXA)

Bioelectrical impedance analysis (BIA) provides a practical method of body composition estimation for field research and weight management programmes, with devices and algorithms that have improved in recent years. We compared suitability of a commercial BIA system that uses multi-frequency-based proprietary algorithms (InBody 770, Cerritos, California, USA) and a laboratory-based validated single-frequency system (Quantum IV, RJL Systems, Clinton Township, Michigan, USA) with dual-energy X-ray absorptiometry (DXA) (iDXA, GE Lunar, Madison, Wisconsin, USA). Volunteers included fit non-obese active duty US Marines (480 men; 315 women), assessed by DXA and the two BIA systems. Both RJL and InBody BIA devices predicted DXA-based fat-free mass (FFM) (mean absolute error (MAE) 2.8 and 3.1 kg, respectively) and per cent body fat (%BF) (MAE 3.4% and 3.9%, respectively), with higher correlations from the InBody device (r²=0.96 (%BF) and 0.84 (FFM)) versus the RJL (r²=0.92 (%BF) and 0.72 (FFM)). InBody overpredicted FFM (bias +2.7, MAE 3.1 kg) and underpredicted %BF (bias -3.4 and MAE 3.9%) versus the RJL. A 3% correction factor applied to the InBody device results provided values very close to the DXA measurements. These findings support the application of modern BIA systems to body composition goals of maximum %BF and minimum lean body mass for both men and women.

Cardio-sarcopenia: A syndrome of concern in aging

Cardiac alterations in structure and function, namely, the left ventricle, have been intensely studied for decades, in association with aging. In recent times, there has been keen interest in describing myocardial changes that accompany skeletal muscle changes in older adults. Initially described as a cardio-sarcopenia syndrome where alterations in myocardial structure were observed particularly among older adults with skeletal muscle sarcopenia, investigations into this syndrome have spurred a fresh level of interest in the cardiac-skeletal muscle axis. The purpose of this perspective is to summarize the background for this "syndrome of concern," review the body of work generated by various human aging cohorts, and to explore future directions and opportunities for understanding this syndrome.

Association of the dietary inflammatory index and body composition among Paralympic athletes with hemodialysis and hemophilia

BACKGROUND & AIMS

One of the essential parameters of athletes that enhancing fitness and success rate in sports career is body composition. Additionally, perfect performance of athletes is significantly influenced by training and dietary intake. This study aimed to determine the association between the dietary inflammatory index (DII) and body composition among Iran's Paralympic athletes with hemodialysis and hemophilia.

METHODS

A cross-sectional study was conducted, which recruited 100 athletes with hemodialysis and hemophilia who participated in the 2020 competitive pre-season tests. Sociodemographic, anthropometric, physical activity, sleep pattern, and dietary intake were used in the analysis. DII was scored based on information obtained using food frequency questionnaire. Body composition was assessed using Bio impedance analyzer BIA (TANITA BC-418) and with 7-points skinfold measures. Linear regression model was used for finding the associations between DII with body composition.

RESULTS

The overall DII score was -2.83 and there was a significant difference for the mean body fat percent (P = 0.001) and mean fat free mass percent (P = ≤0.001) between 7-points skin fold measurements and BIA. No significant association had been found between the DII of the participants with the components of their body composition including, body mass index BMI (P = 0.99), waist circumference (P = 0.33), waist hip ratio (P = 0.25), fat mass percent (P = 0.47) and fat free mass percent (P = 0.47).

CONCLUSION

Although athletes in the current study had DII scores indicating their anti-inflammatory diets, we did not find any significant associations between DII with the parameters of body composition.

Effects of age and gender on body composition indices as predictors of mortality in middle-aged and old people

To determine whether body composition indices interact with age and gender as a predictor of all-cause mortality, 1200 participants at least 40 years of age were recruited in 2009 and 2010. A multi-frequency bioelectrical impedance analysis device was used to measure each participant's body composition indices, including the fat mass index (FMI), fat free mass index (FFMI), skeletal muscle mass index (SMMI), and visceral fat area index (VFAI). A baseline questionnaire was used to collect demographic information about lifestyle habits, socioeconomic status, and medical conditions. All claimed records of death from 2009 to 2018 in the National Health Insurance Research Databank were identified. The all-cause mortality rate was 8.67% after a mean follow-up period of 5.86 ± 2.39 person-years. The Cox proportional hazard model analysis showed significantly negative associations between FFMI or SMMI with all-cause mortality in the total group and those aged ≥ 65 y/o. The FFMI and SMMI were negative predictors of mortality in both genders. The FMI and VFAI were positive predictors of mortality exclusively in females. In conclusion, the SMMI is a better predictor of mortality than the BMI, FMI, and FFMI, especially in older adults. A higher fat mass or visceral fat distribution may predict higher mortality in females.

Comparison of Bioelectrical Impedance Analysis with DXA in Adolescents with Cystic Fibrosis before and after a Resistance Training Intervention

Background: The purpose of this pilot study was to compare body composition metrics obtained by two portable bioelectrical impedance analysis (BIA) devices with dual-energy X-ray absorptiometry (DXA) among adolescents with cystic fibrosis (CF) before and after a resistance exercise training program. Methods: Participants with CF were assessed using DXA, single-frequency BIA (SFBIA), and multiple-frequency BIA (MFBIA) to quantify percent body fat (%Fat), fat mass (FM), and fat-free mass (FFM) at baseline and after a home-based resistance training intervention comprised of 36, 1 h sessions completed in 12–14 weeks. Repeated measures analysis of variance, paired samples t-tests, Cohen’s d effect sizes, and Pearson’s correlations were used to compare differences between and within methods at baseline and post-intervention. Results: Ten participants (15.8 ± 2.2 yr, 60.1 ± 15.1 kg) completed the assessments. At baseline, both SFBIA and MFBIA scales significantly underestimated %Fat and FM and overestimated FFM, with small to moderate effect sizes. Post-intervention, small, non-significant differences were found between DXA and both BIA scales for all body composition metrics. Significant changes in %Fat and FFM were observed with DXA. MFBIA displayed less constant error than SFBIA when compared to DXA for pre- and post-intervention assessments for %Fat (MFBIA: pre and post −2.8 and −0.8 vs. SFBIA: −4.6 and −2.0), FM (−0.4 and −0.4 vs. −3.0 and −1.1), and FFM (+0.8 and +0.6 vs. +3.1 and +1.3). Near-perfect correlations were observed at both time points between DXA and each BIA scale. Conclusions: Portable BIA results should be interpreted with caution, and further validation studies in CF patients are needed prior to clinical use.

The Thermal Environment of Housing and Its Implications for the Health of Older People in South Australia: A Mixed-Methods Study

Older people are often over-represented in morbidity and mortality statistics associated with hot and cold weather, despite remaining mostly indoors. The study “Improving thermal environment of housing for older Australians” focused on assessing the relationships between the indoor environment, building characteristics, thermal comfort and perceived health/wellbeing of older South Australians over a study period that included the warmest summer on record. Our findings showed that indoor temperatures in some of the houses reached above 35 °C. With concerns about energy costs, occupants often use adaptive behaviours to achieve thermal comfort instead of using cooling (or heating), although feeling less satisfied with the thermal environment and perceiving health/wellbeing to worsen at above 28 °C (and below 15 °C). Symptoms experienced during hot weather included tiredness, shortness of breath, sleeplessness and dizziness, with coughs and colds, painful joints, shortness of breath and influenza experienced during cold weather. To express the influence of temperature and humidity on perceived health/wellbeing, a Temperature Humidity Health Index (THHI) was developed for this cohort. A health/wellbeing perception of “very good” is achieved between an 18.4 °C and 24.3 °C indoor operative temperature and a 55% relative humidity. The evidence from this research is used to inform guidelines about maintaining home environments to be conducive to the health/wellbeing of older people.

Nordic Walking Rather Than High Intensity Interval Training Reduced Myostatin Concentration More Effectively in Elderly Subjects and the Range of This Drop Was Modified by Metabolites of Vitamin D

The COVID-19 pandemic and subsequent self-isolation exacerbated the problem of insufficient amounts of physical activity and its consequences. At the same time, this revealed the advantage of vitamin D. Thus, there was a need to verify the effects of those forms of training that can be performed independently. In this study, we examined the effects of Nordic walking (NW) and high intensity interval training (HIIT) with regard to the impact of the metabolite vitamin D. We assigned 32 overweight adults (age = 61 ± 12 years) to one of two training groups: NW = 18 and HIIT = 14. Body composition assessment and blood sample collection were conducted before starting the training programs and a day after their completion. NW training induced a significant decrease in myostatin (p = 0.05) concentration; however, the range was dependent on the baseline concentrations of vitamin D metabolites. This drop was accompanied by a significant negative correlation with the decorin concentration. Unexpectedly, NW caused a decrement in both forms of osteocalcin: undercarboxylated (Glu-OC) and carboxylated-type (Gla-OC). The scope of Glu-OC changes was dependent on a baseline concentration of 25(OH)D₂ (r = −0.60, p = 0.01). In contrast, the HIIT protocol did not induce any changes. Overall results revealed that NW diminished the myostatin concentration and that this effect is more pronounced among adults with a sufficient concentration of vitamin D metabolites.

Total and regional fat-to-muscle mass ratio measured by bioelectrical impedance and risk of incident type 2 diabetes

BACKGROUND

The fat-to-muscle mass ratio (FMR) might be an indicator to assess type 2 diabetes risk independent of general obesity. However, no longitudinal studies have explored the extent to which total and regional FMRs may confer risks. We aimed to measure the sex-specific associations between FMRs of the arm, leg, trunk and whole body and incident type 2 diabetes.

METHODS

A total of 464 817 participants (207 286 men and 257 531 women, mean age 56.5 ± 8.2 and 56.2 ± 8.0 years old, respectively) free of diabetes at baseline were included in this prospective cohort study with UK Biobank data. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device (Tanita BC 418MA). FMR was calculated as fat mass divided by muscle mass in corresponding body parts (total body, arm, leg and trunk). Cox proportional hazard models were used to estimate the aforementioned associations among men and women. Interaction analyses were performed between FMRs and body mass index (BMI) categories (BMI < 25 kg/m² and BMI ≥ 25 kg/m² ).

RESULTS

Over the median 11.0 years (5 057 534 person-years) of follow-up, we documented 11 618 cases of type 2 diabetes. There was a significantly positive association between total and regional FMR and incident type 2 diabetes, even after adjusting for BMI and other covariates. Compared with other body parts, FMRs of the whole body and leg showed the strongest relationship among men and women, respectively (hazard ratio per 1 SD, 95% confidence interval: 1.67, 1.55-1.80; 1.45, 1.39-1.53). A significant interaction (P for interaction < 0.001) between BMI category and FMRs of different body parts was observed. In the stratified analysis by BMI category and tertiles of FMRs, overweight/obese individuals with a high FMR tertile tended to have the highest hazard ratio, ranging from 5.91 to 7.94 in whole body and regional areas.

CONCLUSIONS

In this large prospective study, higher total and regional FMRs were associated with a higher risk of developing type 2 diabetes, independent of BMI. This association was markedly strengthened in participants with BMI ≥ 25 kg/m² .

Effects of COVID-19 Lockdown on Weight, Body Composition, and Behavior of Children, Adolescents, and Young Adults with Prader-Willi Syndrome

To reduce transmission of the coronavirus disease 2019 (COVID-19), many countries implemented lockdowns, causing the closure of childcare services. This study was designed to evaluate the impact of the COVID-19 lockdown in March-April 2020 on children, adolescents, and young adults with Prader-Willi syndrome (PWS) living in Germany. We recruited 180 participants with a genetically confirmed PWS. All families completed a questionnaire, and participants underwent a post-lockdown assessment; the last examination before the lockdown was determined as the pre-lockdown assessment. We used bivariate analyses to compare pre- and post-lockdown outcomes. Weight standard deviation scores (SDS_PWS) and body mass index (BMI)-SDS_PWS remained stable or even decreased in some age groups. A statistically significant gain in lean body mass (LBM) was found in all groups <18 years of age. We observed an increase in IGF-I and IGFBP-3 concentrations without a significant change in growth hormone (GH) dosage. Most families (95.4%) reported set mealtimes and implementation of structured activities (72.2%) during the lockdown period. We therefore suggest that the favorable development of weight/BMI and LBM was caused by an interplay of a suspected enhanced GH administration and continuous parental commitment. However, more intense behavioral problems were observed in 45.7%, which persisted post-lockdown in 33.7%.

Frailty phenotype and associated nutritional factors in a sample of Portuguese outpatients with heart failure

BACKGROUND AND AIM

Frailty phenotype (FP) is very common in heart failure (HF) and both syndromes worsen one another. The aim of this study is to first describe FP in a sample of Portuguese patients with HF, and to analyse its association with nutritional and clinical statuses, namely, muscle mass, obesity and functional class.

METHODS AND RESULTS

In this cross-sectional study, a sample of 136 outpatients with HF (24-81 years, 33.8% women) were randomly selected from the appointments' listings of a HF and Transplant clinic in a Portuguese University Hospital. FP was assessed according to Fried et al. muscle mass was estimated from the mid-upper arm muscle circumference; weight status was assessed using the body mass index; HF functional classes were registered. The association between participants' characteristics and FP categories was analysed using logistic ordinal regression. The frequency of pre-frailty and frailty is 57.4% and 15.4%, respectively. Within frail individuals, 52.4% were under the age of 65. In multivariable analysis, frailty was positively associated with age 70 or older (OR = 3.44) and obesity (OR = 2.66), and negatively associated with muscle mass (OR = 0.77) and HF functional classes I (OR = 0.14) or II (OR = 0.29).

CONCLUSION

Muscle mass seems to be an important predictor of frailty in patients with HF and should be taken into account when designing intervention plans that allow for reverting or modifying frailty and pre-frailty. Younger patients should be monitored for the presence and evolution of FP.

The diagnostic value of phase angle, an integrative bioelectrical marker, for identifying individuals with dysmobility syndrome: the Korean Urban-Rural Elderly study

Low phase angle, a non-invasive bioimpedance marker, is associated with elevated odds of dysmobility syndrome and its components. Phase angle (estimated cutoffs: < 4.8° in men; < 4.5° in women) can be used to detect dysmobility syndrome in community-dwelling older adults as a simple, integrative screening tool.

INTRODUCTION

Dysmobility syndrome uses a score-based approach to predict fracture risk that incorporates the concepts of osteoporosis, sarcopenia, and obesity. Low phase angle (PhA), a simple, non-invasive bioelectrical impedance marker, was associated with low lean mass, high fat mass, and poor muscle function. We aimed to investigate the association between PhA and dysmobility syndrome, with the exploration of the diagnostic cutoffs.

METHODS

In a community-dwelling Korean older adult cohort, dysmobility syndrome was defined as the presence of ≥ 3 of the following components: osteoporosis, low lean mass, falls in the preceding year, low grip strength, high fat mass, and poor timed up and go performance.

RESULTS

Among the 1825 participants (mean age 71.6, women 66.7%), subjects were classified into sex-stratified PhA tertiles. The prevalence of dysmobility syndrome increased from the highest PhA tertile group to the lowest (15.50 to 2.45% in men; 33.41 to 12.25% in women, P for trend < 0.001). The mean PhA values decreased as the dysmobility score increased (5.33° to 4.65° in men; 4.76° to 4.39° in women, P for trend < 0.001). Low PhA (cutoff: < 4.8° in men; < 4.5° in women) was associated with twofold elevated odds of dysmobility syndrome after adjusting for age, sex, and conventional risk factors. Low PhA improved the identification of individuals with dysmobility syndrome when added to the conventional risk model (area under the curve, 0.73 to 0.75, P = 0.002).

CONCLUSION

Low PhA was associated with dysmobility syndrome and its components, independent of age, sex, body mass index, nutritional status, and inflammation.

Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity

BACKGROUND & AIMS

Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population.

METHODS

The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes.

RESULTS

A total of 8303 patients with obesity, aged 18 to 90 y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m²) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p < 0.0001) in women while FFM index (FFMI) was higher in men (p < 0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p < 0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both.

CONCLUSIONS

The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity.

Accuracy and reliability of the InBody 270 multi-frequency body composition analyser in 10-12-year-old children

The aim of this study was at examining the validity and reliability of a marketed bioimpedance (BIA) scale for body composition assessment, in children engaged in an educational football project (FIFA 11 for Health). One-hundred and twenty-seven children (70 boys and 57 girls; age 10.7±0.5 years, body mass 41.2±9.0 kg, Body mass index 18.5±3.3 kg·m^-2 and stature 149±7 cm) were evaluated for total body mass, lean body mass, muscle mass, using BIA (InBody 270, Biospace, California, USA) and dual-energy X-ray absorptiometry (DEXA, Lunar Prodigy, GE Medical Systems, Madison, Wisconsin, USA), at baseline conditions. Data analyses were carried out separately for girls and boys. Nearly perfect associations (r = 0.97−0.99) and excellent absolute (TEM = 0.04−1.9%) and relative (ICC = 0.98−1.00) inter-device reliability were found between DEXA and BIA variables. Fat and lean body mass bias (p < .0001) were practically relevant both for the boys (2.56 and 11.22 kg, respectively) and the girls (2.33 and 10.49 kg, respectively). Muscle mass and body fat were underestimated and overestimated, respectively, for the boys and girls. InBody 270 is a valid BIA system for estimating body composition with an excellent inter-device relative and absolute reliability. However, the remarkable measurements bias of BIA fat and muscle mass values discourage its use for clinical prescription. The BIA body composition biases were sex dependent.

The Specific Judo Training Program Combined With the Whole Body Cryostimulation Induced an Increase of Serum Concentrations of Growth Factors and Changes in Amino Acid Profile in Professional Judokas

This study aimed to evaluate the effect of a specific training program, supported by 10 sessions of whole body cryostimulation, on growth factors concentrations, amino acids profile and motor abilities in professional judokas. Ultimately, twelve athletes took part in the study. They were randomly assigned to the cryostimulation group (CRY, n = 6) or the control group (CON, n = 6). During 2 weeks of the judo training program, the CRY group performed 10 cryo-sessions (3-min, at a temperature of -110°C) and the CON group rested passively. Anthropometric measurements, a strength test, the Special Judo Efficiency Test (SJET) were assessed 2 days before and after the judo training program. Blood samples were collected at rest, 1 h after the first and the second SJET and 1 h after the first and the last cryo-session to establish growth factors and amino acid concentrations. Lactate level was measured before, immediately after and 1 h after the first and the second SJET. The applied intervention resulted in a significant increase of resting concentrations of brain-derived neurotrophic factor (from 10.23 ± 1.61 to 15.13 ± 2.93 ng⋅ml^-1; p = 0.01) and insulin-like growth factor 1 (IGF-1; from 174.29 ± 49.34 to 300.50 ± 43.80 pg⋅ml^-1; p = 0.00) in the CRY group. A different response was registered 1 h directly post SJET in the CRY group (a significant increase of IGF-1, interleukin 15 and irisin: p = 0.01; p = 0.00; p = 0.03). Additionally, the significant drop of proline and leucine concentrations in the CRY group was obtained. Athletes' performance remained unchanged in both groups. However, subjects perceived positive changes induced by the intervention - not directly after cryostimulation but in response to the specific training workload. The increase of growth factors concentrations and the improvement of amino acid profile (proline and leucine) contributed to maintaining a high level of muscle function.

Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS)

(1) Background. Visceral adiposity index (VAI) has been recently identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidaemia. The aim of the present paper was to evaluate the relationship between VAI, daily energy intake and metabolic syndrome (MetS) in a cohort of obese Caucasian children and adolescents, aged 8 to 15 years. (2) Methods. Consecutive Italian children and adolescents with obesity, according to World Health Organization were enrolled. Anthropometric parameters and blood pressure were measured. Fasting blood samples have been analyzed for lipids, insulin and glucose levels. MetS was diagnosed using identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) or International Diabetes Federation (IDF) criteria according to age. Homeostatic model assessment index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), A body shape index (ABSI) and VAI were calculated. Multivariable logistic regression analyses with sex, age and each anthropometric parameter (body mass index (BMI) z-score, ABSI, waist-to-height ratio (WHR)) or VAI was performed to predict MetS. Receiver operation curve (ROC) analysis was used to define the optimal VAI cut-off to identify MetS. Multiple regression was performed to predict the BMI z-score and VAI from daily energy intake after adjusting for age and sex. (3) Results. Six hundred and thirty-seven (313 boys and 324 girls) children and adolescents with obesity with median age 11 (interquartile range 10–13) years were included in the analysis. MetS was diagnosed in 79 patients. VAI correlated with BMI, WHR, ABSI, HOMA-IR, QUICKI, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides and triglycerides-to-HDL ratio (p < 0.050). Optimal VAI cut-off (AUC) values to identify MetS were 1.775 (0.774), 1.685 (0.776) and 1.875 (0.797) in the whole population, boys and girls, respectively. Energy intake was positively associated with BMI z-score but no association was found with VAI. (4) Conclusion. VAI is a promising tool to identify MetS in children and adolescents with obesity and should be used in the management of abdominal obesity together with dietary assessment.

Beyond BMI for self-estimates of body size and shape: A new method for developing stimuli correctly calibrated for body composition

Accurate self-assessment of body shape and size plays a key role in the prevention, diagnosis, and treatment of both obesity and eating disorders. These chronic conditions cause significant health problems, reduced quality of life, and represent a major problem for health services. Variation in body shape depends on two aspects of composition: adiposity and muscularity. However, most self-assessment tools are unidimensional. They depict variation in adiposity only, typically quantified by the body mass index. This can lead to substantial, and clinically meaningful, errors in estimates of body shape and size. To solve this problem, we detail a method of creating biometrically valid body stimuli. We obtained high-resolution 3D body shape scans and composition measures from 397 volunteers (aged 18-45 years) and produced a statistical mapping between the two. This allowed us to create 3D computer-generated models of bodies, correctly calibrated for body composition (i.e., muscularity and adiposity). We show how these stimuli, whose shape changes are based on change in composition in two dimensions, can be used to match the body size and shape participants believe themselves to have, to the stimulus they see. We also show how multivariate multiple regression can be used to model shape change predicted by these 2D outcomes, so that participants' choices can be explained by their measured body composition together with other psychometric variables. Together, this approach should substantially improve the accuracy and precision with which self-assessments of body size and shape can be made in obese individuals and those suffering from eating disorders.

Comparison of Multifrequency Bioelectrical Impedance vs. Dual-Energy X-ray Absorptiometry for Assessing Body Composition Changes After Participation in a 10-Week Resistance Training Program

Schoenfeld, BJ, Nickerson, BS, Wilborn, CD, Urbina, SL, Hayward, SB, Krieger, J, Aragon, AA, and Tinsley, G. Comparison of multifrequency bioelectrical impedance vs. dual-energy x-ray absorptiometry for assessing body composition changes after participation in a 10-week resistance training program. J Strength Cond Res 34(3): 678-688, 2020-The purpose of this study was to assess the ability of multifrequency bioelectrical impedance analysis (MF-BIA) to determine alterations in total and segmental body composition across a 10-week resistance training (RT) program in comparison with the criterion reference dual-energy X-ray absorptiometry (DXA). Twenty-one young male volunteers (mean ± SD; age = 22.9 ± 3.0 years; height = 175.5 ± 5.9 cm; body mass = 82.9 ± 13.6 kg; body mass index = 26.9 ± 3.6) performed an RT program that included exercises for all major muscle groups. Body composition was assessed using both methods before and after the intervention; change scores were determined by subtracting pre-test values from post-test values for percent body fat ([INCREMENT]%BF), fat mass ([INCREMENT]FM), and fat-free mass ([INCREMENT]FFM). Mean changes were not significantly different when comparing MF-BIA with DXA for [INCREMENT]%BF (-1.05 vs. -1.28%), [INCREMENT]FM (-1.13 vs. -1.19 kg), and FFM (0.10 vs. 0.37 kg, respectively). Both methods showed strong agreement for [INCREMENT]%BF (r = 0.75; standard error of the estimate [SEE] = 1.15%), [INCREMENT]FM (r = 0.84; SEE 1.0 kg), and [INCREMENT]FFM (r = 0.71; SEE of 1.5 kg). The 2 methods were poor predictors of each other in regards to changes in segmental measurements. Our data indicate that MF-BIA is an acceptable alternative for tracking changes in FM and FFM during a combined diet and exercise program in young, athletic men, but segmental lean mass measurements must be interpreted with circumspection.

Validation of a Multielectrode Bioelectrical Impedance Analyzer With a Dual-Energy X-Ray Absorptiometer for the Assessment of Body Composition in Older Adults

Changes in body composition are related to mobility, fall risk, and mortality, especially in older adults. Various devices and methods exist to measure body composition, but bioelectrical impedance analysis (BIA) has several advantages. The purpose of this study was to validate a common BIA device with a dual-energy X-ray absorptiometer (DXA) in older adults and develop prediction equations to improve the accuracy of the BIA measurements. The participants were 277 older adults (162 women and 115 men; age 73.9 ± 5.8 years) without a history of cancer and without a history of severe medical or mental conditions. Individuals fasted 12 hr before BIA and DXA measurement. The correlations between the two methods for appendicular lean mass (ALM), fat-free mass (FFM), and percentage body fat (%BF) were .86, .93, and .92, respectively, adjusting for age and sex. The mean percentage error (DXA-InBody) and mean absolute percentage error were -12% and 13% for ALM, -13% and 13% for FFM, and 16% and 17% for %BF. The prediction equations estimated ALM, FFM, and %BF; sex was coded as 1 for male and 0 for female: DXAALM=0.0673+(0.6732×BIAALM)+(2.33507×sex)+(0.13349×BMI),R2=.94; DXAFFM=0.72323+(0.72384×BIAFFM)+(3.675012×sex)+(0.2816×BMI),R2=.97; and DXA%BF=15.8896+(0.64694×BIA%BF) -(3.99945×sex)+(0.13824×BMI),R2=.91 Although highly correlated, BIA overestimated FFM, and ALM and underestimated %BF compared with DXA. An application of prediction equations eliminated the mean error and reduced the range of individual error across the sample. Prediction equations may improve BIA accuracy sufficiently to substitute for DXA in some cases.

Body fat percentage assessment by skinfold equation, bioimpedance and densitometry in older adults

Background

Body fat estimation allows measuring changes over time attributed to interventions and treatments in different settings such as hospitals, clinical practice, nursing homes and research. However, only few studies have compared different body fat estimation methods in older adults with inconsistent results. We estimated body fat percentage (%BF) and the level of agreement among dual energy X-ray absorptiometry (DXA), bioelectrical impedance (BIA) and Durnin & Womersley’s skinfold eq. (SF) in older Brazilian adults aged 60 years and older from the Elderly Project Goiânia, Brazil.

Methods

The analytical sample comprised of 132 participants who had DXA data. The level of agreement for the %BF estimated by BIA, SF and DXA i.e. reference method, was examined using Bland and Altman’s and Lin’s plot.

Results

Overall, women had higher body mass index and %BF values measured by all three methods used. BIA and SF equation showed strong concordance to estimate body fat percentage in all participants (CCC = 0.857 and 0.861, respectively) and among women (CCC = 0.788 and 0.726, respectively) when compared to DXA. However, both methods underestimated body fat percentage in women and men with high body fat percentage. A strong level of agreement was observed between DXA and the anthropometric equation developed by Durnin & Womersley in men (CCC = 0.846), while BIA had a moderate concordance (CCC = 0.505) in this group.

Conclusion

The examined methods indicated different body fat estimates. However, the best agreement was observed between DXA and the anthropometric SF equation for men. Future research in older adults should develop new SF equations considering different ethnic groups.

Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents?

(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent β-cell function (HOMA-β), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents.

Advanced Glycation End Product Accumulation Is Associated With Low Skeletal Muscle Mass, Weak Muscle Strength, and Reduced Bone Density: The Nagahama Study

BACKGROUND

The accumulation of advanced glycation end product (AGE) might exert deleterious effects on musculoskeletal properties. Our study aims to clarify this possible association in a large general population.

METHODS

This study investigated a general population of 9,203 patients (mean age, 57.8 years). Skeletal muscle mass was measured by bioelectrical impedance analysis, whereas accumulation of AGEs was assessed by skin autofluorescence (SAF-AGE). The muscle strength of upper and lower limbs and usual gait speed were measured in a portion of older (≥60 years of age) participants (n = 1,934). The speed of sound (SOS) in the calcaneal bone was assessed via a quantitative ultrasound technique.

RESULTS

In the total population, the frequency of low skeletal muscle mass linearly increased with the SAF-AGE quartiles (Q1: 14.2%, Q2: 16.1%, Q3: 21.1%, Q4: 24.8%; p < .001), and this association was independent of covariates including glycemic traits (Q4: odds ratio [OR] = 1.48, p < .001). The association between the highest SAF-AGE quartile and low skeletal muscle mass remained significant in the older subpopulation (OR = 1.85, p = .002). A similar but weak association was observed for low SOS (Q1: 8.9%, Q2: 8.3%, Q3: 10.4%, Q4: 12.2%; p < .001). Similar inverse associations were also observed with grip strength (OR = 1.98, p = .003), hip flexion strength (OR = 1.50, p = .012), and hip abduction strength (OR = 1.78, p = .001), but not with usual gait speed.

CONCLUSION

Accumulation of AGEs might be a deleterious factor for musculoskeletal properties.

Measurement of total and visceral fat mass in young adult women: a comparison of MRI with anthropometric measurements with and without bioelectrical impedance analysis

OBJECTIVE

MRI is established for measurement of body fat mass (FM) and abdominal visceral adipose tissue (VAT). Anthropometric measurements and bioelectrical impedance analysis (BIA) have been proposed as surrogates to estimation by MRI. Aim of this work is to assess the predictive value of these methods for FM and VAT measured by MRI.

METHODS

Patients were selected from cohort study PPS-Diab (prediction, prevention and subclassification of Type 2 diabetes). Total FM and VAT were quantified by MRI and BIA together with clinical variables like age, waist and hip circumference and height. Least-angle regressions were utilized to select anthropometric and BIA parameters for their use in multivariable linear regression models to predict total FM and VAT. Bland-Altman plots, Pearson correlation coefficients, Wilcoxon signed-rank tests and univariate linear regression models were applied.

RESULTS

116 females with 35 ± 3 years and a body mass index of 25.1 ± 5.3 kg/m2 were included into the analysis. A multivariable model revealed weight (β = 0.516, p < 0.001), height (β = -0.223, p < 0.001) and hip circumference (β = 0.156, p = 0.003) as significantly associated with total FM measured by MRI. A additional multivariable model also showed a significant predictive value of FMBIA (β = 0.583, p < 0.001) for FM. In addition, waist circumference (β = 0.054, p < 0.001), weight (β = 0.016, p = 0.031) in one model and FMBIA (β = 0.026, p = 0.018) in another model were significantly associated with VAT quantified by MRI. However, deviations reached more than 5 kg for total FM and more than 1 kg for VAT.

CONCLUSION

Anthropometric measurements and BIA show significant association with total FM and VAT.

ADVANCES IN KNOWLEDGE

As these measurements show significant deviations from the absolute measured values determined by MRI, MRI should be considered the gold-standard for quantification.

The association between physical activity and body fat percentage with adjustment for body mass index among middle-aged adults: China health and nutrition survey in 2015

BACKGROUND

The inverse association between physical activity and body fat percentage (%) varies among different populations. We aim to examine whether the significant association between them was uniform across the subpopulations after taking into account body mass index (BMI).

METHODS

Our study relied on data from China Health and Nutrition Surveys in 2015, including 5763 participants aged 40-64 years from 15 regions. Physical activity was calculated as metabolic equivalent task hours per day (MET·h/d). Body fat% was measured by bioelectrical impedance analysis. Body mass index < 24 kg/m2 was defined as normal weight and BMI ≥ 24 kg/m2 was overweight/obese. The effects of physical activity on body fat% were estimated using the Kruskal-Wallis test among sex, age, BMI groups, education, income, region and urbanization. Quantile regression analyses were utilized to describe the relationship between physical activity and body fat% distribution.

RESULTS

Older adults, overweight/obese, higher education, higher income, residents of central China and those living in areas of higher urbanization had the lower physical activity. Participants who engaged in the highest level of physical activity had 2.0 and 1.5% lower body fat% than the lowest level of physical activity group (23.4, 34.8%) for men and women, respectively. There were 10.4 and 8.8% of normal weight males and females called normal weight obese. Overall, 1 h extra 4.5 MET•h/d was significantly associated with 0.079 and 0.110% less total body fat% at the 75th and 90th percentiles in normal weight males, with 0.071% less at the 25th percentiles in overweight/obese males, with 0.046-0.098% less at the 25th to 90th percentiles in normal weight females, and with 0.035-0.037% less from the 50th to 90th percentiles in overweight/obese females. The inverse association between physical activity and total body fat% was stronger in normal weight obese participants than other subgroups.

CONCLUSIONS

In middle-aged Chinese adults, the inverse association between physical activity and body fat% was only in particular subpopulations rather than the entire population. We should pay much attention to normal weight obese and give a suitable physical activity guideline taking into account people with different body fat%.

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity

BACKGROUND AND AIM

An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity.

METHODS

Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement.

RESULTS

Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots.

CONCLUSION

Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.

Sarcopenia in COPD: a systematic review and meta-analysis

COPD is associated with a progressive loss of muscle mass and function. However, there is an unmet need to define and standardise methods to estimate the prevalence of sarcopenia in COPD patients.

We performed a systematic review and meta-analysis of the prevalence of this extrapulmonary manifestation in COPD patients. We searched Embase, Medline (Ovid), CINAHL (EBSCO), Web of Science, Scopus and Google Scholar for studies published up to January 17, 2019, assessing sarcopenia in COPD patients based on low muscle mass and decreased muscle function. Interventional studies, in vitro experiments, protocols or reviews and meta-analyses were excluded. We estimated heterogeneity (I²) and assessed significance (Q) using a Chi-squared test for estimates obtained from random-effects models.

4465 articles were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 62 full-text articles. Finally, 10 articles (n=2565 COPD patients) were included in this systematic review and meta-analyses. Overall, the prevalence of sarcopenia in patients with COPD was 21.6% (95% CI 14.6–30.9%, I²=94%), ranging from 8% in population-based to 21% in clinic-based studies, and 63% in COPD patients residing in nursing homes.

Sarcopenia is frequently observed in COPD patients, with varying prevalence across population settings. Sarcopenia in COPD should be assessed using standardised tests and cut-off points from sarcopenia consensus criteria for clinical practice and international comparisons.

We confirmed a high prevalence of sarcopenia in COPD patients, with varying prevalence across population settings. We recommend adhering to the sarcopenia consensus criteria to systematically evaluate the muscle health of COPD patients.http://bit.ly/2KA6weh

In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

INTRODUCTION

The aim of this study was to evaluate the association between fetal ultrasound and newborn biometry and adiposity measures in the setting of maternal obesity.

MATERIAL AND METHODS

The study population involved 845 overweight or obese pregnant women, who participated in the Standard Care Group of the LIMIT randomised trial (ACTRN12607000161426, 9/03/2007). At 36 weeks gestation, fetal biometry, estimated fetal weight (EFW) and adiposity measures including mid-thigh fat mass (MTFM), subscapular fat mass (SSFM), and abdominal fat mass (AFM) were undertaken using ultrasound. Neonatal anthropometric measurements obtained after birth included birthweight, head circumference (HC), abdominal circumference (AC) and skinfold thickness measurements (SFTM) of the subscapular region and abdomen.

RESULTS

At 36 weeks gestation, every 1 g increase in EFW was associated with a 0.94 g increase in birthweight (95% CI 0.88-0.99; P < 0.001). For every 1 mm increase in the fetal ultrasound measure, there was a 0.69 mm increase in birth HC (95% CI 0.63-0.75, P < 0.001) and 0.69 mm increase in birth AC (95% CI 0.60-0.79, P < 0.001). Subscapular fat mass in the fetus and the newborn (0.29 mm, 95% CI 0.20-0.39, P < 0.001) were moderately associated, but AFM measurements were not (0.06 mm, -0.03 to 0.15, P = 0.203). There is no evidence that these relationships differed by maternal body mass index.

CONCLUSION

In women who are overweight or obese, fetal ultrasound accurately predicts neonatal HC and AC along with birthweight.

Changes in Serum Iron and Leukocyte mRNA Levels of Genes Involved in Iron Metabolism in Amateur Marathon Runners-Effect of the Running Pace

Iron is essential for physical activity due to its role in energy production pathways and oxygen transportation via hemoglobin and myoglobin. Changes in iron-related biochemical parameters after physical exercise in athletes are of substantial research interest, but molecular mechanisms such as gene expression are still rarely tested in sports. In this paper, we evaluated the mRNA levels of genes related to iron metabolism (PCBP1, PCBP2, FTL, FTH, and TFRC) in leukocytes of 24 amateur runners at four time points: before, immediately after, 3 h after, and 24 h after a marathon. We measured blood morphology as well as serum concentrations of iron, ferritin, and C-reactive protein (CRP). Our results showed significant changes in gene expression (except for TFRC), serum iron, CRP, and morphology after the marathon. However, the alterations in mRNA and protein levels occurred at different time points (immediately and 3 h post-run, respectively). The levels of circulating ferritin remained stable, whereas the number of transcripts in leukocytes differed significantly. We also showed that running pace might influence mRNA expression. Our results indicated that changes in the mRNA of genes involved in iron metabolism occurred independently of serum iron and ferritin concentrations.

Body Composition with Dual-Energy X-Ray Absorptiometry and Bioelectrical Impedance Analysis in Breast Cancer Survivors

BACKGROUND

Because obesity is an independent risk factor for breast cancer recurrence, assessment of body composition is crucial to guide weight management in breast cancer survivors (BCS). This study assessed whether dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) yield similar results for body composition in BCS.

METHODS

Body fat percentage, lean body mass, and fat mass were estimated using DXA and BIA under fasting conditions in 89 BCS. BMI categories included normal (18-24.99 kg/m2 ; n = 28), overweight (25.0-29.9 kg/m2 ; n = 21), obese (>30 kg/m2 ; n = 23), and severely obese BCS (>35 kg/m2 ; n = 17). Agreement between the devices was assessed by Bland-Altman analysis.

RESULTS

There was no agreement between the 2 devices for body fat percentage (DXA: 44.2 ± 6.2% vs BIA: 40.4 ± 7.8%), lean body mass (DXA: 39.1 ± 7.6 kg vs BIA: 42.9 ± 5.9 kg), and fat mass (DXA: 32.4 ± 10.8 kg vs BIA: 30.6 ± 11.0 kg; P < .001). These findings were consistent in normal, overweight, and obese BCS. There was agreement between the 2 devices for fat mass (DXA: 48.7 ± 7.2 kg vs BIA: 47.9 ± 5.7 kg) in severely obese BCS (P = .102), possibly due to small sample size.

CONCLUSIONS

BIA may underestimate body fat percentage and fat mass and overestimate lean body mass, compared with DXA. Future studies are warranted to assess the use of these 2 devices in a larger cohort of BCS within BMI categories.

The beneficial effects of 15 units of high-intensity circuit training in women is modified by age, baseline insulin resistance and physical capacity

AIM

To investigate the effect of a single and 15 units of high-intensity circuit training (HICT) programme on glucose metabolism, myokines' response and selected genes' expression in women.

METHODS

Thirty-three, non-active women (mean age: 38 ± 12) were split into a HICT (n = 20) or a control group (CON, n = 13). The training protocol included three circuits of nine exercises with own body weight as a workload performed 3 times a week for five weeks. The CON group performed HICT twice. Blood samples were taken before, 1 h and 24 h after the first and last unit to determine IGF-1, myostatin, irisin, decorin, HSP27, interleukin-15 concentrations using the ELISA immunoenzymatic method. To evaluate HSPB1, TNF-α and DCN mRNA, real-time PCR was used. Pre- and post-intervention, the oral glucose test and body composition assessment were completed.

RESULTS

The following parameters tended to decrease after the 5-week HICT program: insulin and HOMA-IR Training diminished insulin/IGF-1 ratio (51% CI: -63% to -34%) and induced the drop of myostatin concentration but significantly only among middle-aged women and at baseline insulin resistance.

CONCLUSION

Obtained data revealed that HICT improved an insulin sensitivity and diminished myostatin concentration among older, insulin-resistant women with lower baseline physical capacity.

Circulating Salicylic Acid and Metabolic Profile after 1-Year Nutritional⁻Behavioral Intervention in Children with Obesity

Objectives and Study: Salicylic acid (SA), a phenolic compound produced by plants, may play a beneficial role on health. A pilot study showed that children with obesity had lower serum SA than normal-weight children. The aim of this trial was to evaluate the effect of a 1-year nutritional–behavioral intervention on serum SA levels and to study a possible association between SA levels and metabolic profile changes in children with obesity. Methods: This was an interventional longitudinal observational uncontrolled cohort study. Forty-nine children with obesity, aged >6 years were evaluated. BMI (body mass index) z-scores were calculated. Fasting blood samples were analyzed for lipids, insulin, and glucose. The most significant metabolic variables were calculated. Serum SA was measured using a gas chromatography–mass spectrometry method. The 1-year intervention was based on the promotion of a balanced and normocaloric diet, in accordance with the national guidelines for treatment of childhood obesity. Additionally, behavioral education, based on the revised CALO-RE (Coventry, Aberdeen, and London-REfined) taxonomy, was performed. Results: At the end of intervention, children showed an increase in serum SA levels (mean (Standard Deviation, SD) 0.06 (0.02) vs. 0.09 (0.05) µmol/L; p < 0.001), a reduction of BMI z-score (3.14 (0.79) vs. 3.02 (0.82); p < 0.001), TyG index (4.52 (0.20) vs. 4.48 (0.23); p < 0.001), AIP (atherogenic index of plasma) (0.36 (0.21) vs. 0.27 (0.25); p < 0.001), and triglycerides/HDL (high density lipoprotein) cholesterol (2.57 (1.28) vs. 2.18 (1.22); p < 0.001) ratio. No statistically significant change in HOMA-IR (homeostasis model assessment index) was observed (4.20 (3.29) vs. 4.03 (2.28)). An association between the longitudinal variation of serum SA and HOMA-IR was found (correlation coefficient: −0.338, p = 0.02). Conclusion: Nutritional–behavioral intervention may improve the circulating SA and the metabolic profile in children with obesity. Serum SA could influence mainly glucose metabolism. Further larger studies are needed to evaluate whether a nutritional intervention based on specific advice regarding the quantity and type of fruit and vegetables (FV) consumption could provide benefits in terms of metabolic syndrome.

Comparison of Dual-Energy X-ray Absorptiometry (DXA) Versus a Multi-Frequency Bioelectrical Impedance (InBody 770) Device for Body Composition Assessment after a 4-Week Hypoenergetic Diet

The purpose of this investigation was to compare two different methods of assessing body composition (i.e., a multi-frequency bioelectrical impedance analysis (MF-BIA) and dual-energy x-ray absorptiometry (DXA)) over a four-week treatment period in exercise-trained men and women. Subjects were instructed to reduce their energy intake while maintaining the same exercise regimen for a period of four weeks. Pre and post assessments for body composition (i.e., fat-free mass, fat mass, percent body fat) were determined via the MF-BIA and DXA. On average, subjects reduced their energy intake by ~18 percent. The MF-BIA underestimated fat mass and percentage body fat and overestimated fat-free mass in comparison to the DXA. However, when assessing the change in fat mass, fat-free mass or percent body fat, there were no statistically significant differences between the MF-BIA vs. DXA. Overall, the change in percent body fat using the DXA vs. the MF-BIA was -1.3 ± 0.9 and -1.4 ± 1.8, respectively. Our data suggest that when tracking body composition over a period of four weeks, the MF-BIA may be a viable alternative to the DXA in exercise-trained men and women.