1
|
Wu KC, Wu PH, Kazakia G, Patel S, Black DM, Lang TF, Kim TY, King NJ, Hoffman TJ, Chang H, Linfield G, Palilla S, Rogers SJ, Carter JT, Posselt AM, Schafer AL. Skeletal effects of sleeve gastrectomy, by sex and menopausal status and in comparison to Roux-en-Y gastric bypass surgery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.25.24309368. [PMID: 38978665 PMCID: PMC11230331 DOI: 10.1101/2024.06.25.24309368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Context Roux-en-Y gastric bypass (RYGB) has deleterious effects on bone mass, microarchitecture, and strength. Data are lacking on the skeletal effects of sleeve gastrectomy (SG), now the most commonly performed bariatric surgical procedure. Objective We examined changes in bone turnover, areal and volumetric bone mineral density (aBMD, vBMD), and appendicular bone microarchitecture and estimated strength after SG. We compared the results to those previously reported after RYGB, hypothesizing lesser effects after SG than RYGB. Design Setting Participants Prospective observational cohort study of 54 adults with obesity undergoing SG at an academic center. Main Outcome Measures Skeletal characterization with biochemical markers of bone turnover, dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) was performed preoperatively and 6- and 12-months postoperatively. Results Over 12 months, mean percentage weight loss was 28.8%. Bone turnover marker levels increased, and total hip aBMD decreased -8.0% (95% CI -9.1%, -6.7%, p<0.01). Spinal aBMD and vBMD declines were larger in postmenopausal women than men. Tibial and radial trabecular and cortical microstructure worsened, as did tibial estimated strength, particularly in postmenopausal women. When compared to data from a RYGB cohort with identical design and measurements, some SG biochemical, vBMD, and radial microstructural parameters were smaller, while other changes were not. Conclusions Bone mass, microstructure, and strength decrease after SG. Some skeletal parameters change less after SG than after RYGB, while for others, we find no evidence for smaller effects after SG. Postmenopausal women may be at highest risk of skeletal consequences after SG.
Collapse
Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Po-Hung Wu
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Galateia Kazakia
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Thomas F Lang
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Thomas J Hoffman
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Hanling Chang
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Gaia Linfield
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Palilla
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Wu KC, McCauley KE, Lynch SV, Nayak RR, King NJ, Patel S, Kim TY, Condra K, Fadrosh D, Nguyen D, Lin DL, Lynch K, Rogers SJ, Carter JT, Posselt AM, Stewart L, Schafer AL. Alteration in the gut microbiome is associated with changes in bone metabolism after laparoscopic sleeve gastrectomy. J Bone Miner Res 2024; 39:95-105. [PMID: 38477719 PMCID: PMC11240164 DOI: 10.1093/jbmr/zjad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 03/14/2024]
Abstract
Laparoscopic sleeve gastrectomy (LSG), the most common bariatric surgical procedure, leads to durable weight loss and improves obesity-related comorbidities. However, it induces abnormalities in bone metabolism. One unexplored potential contributor is the gut microbiome, which influences bone metabolism and is altered after surgery. We characterized the relationship between the gut microbiome and skeletal health in severe obesity and after LSG. In a prospective cohort study, 23 adults with severe obesity underwent skeletal health assessment and stool collection preoperatively and 6 mo after LSG. Gut microbial diversity and composition were characterized using 16S rRNA gene sequencing, and fecal concentrations of short-chain fatty acids (SCFA) were measured with LC-MS/MS. Spearman's correlations and PERMANOVA analyses were applied to assess relationships between the gut microbiome and bone health measures including serum bone turnover markers (C-terminal telopeptide of type 1 collagen [CTx] and procollagen type 1 N-terminal propeptide [P1NP]), areal BMD, intestinal calcium absorption, and calciotropic hormones. Six months after LSG, CTx and P1NP increased (by median 188% and 61%, P < .01) and femoral neck BMD decreased (mean -3.3%, P < .01). Concurrently, there was a decrease in relative abundance of the phylum Firmicutes. Although there were no change in overall microbial diversity or fecal SCFA concentrations after LSG, those with greater within-subject change in gut community microbial composition (β-diversity) postoperatively had greater increases in P1NP level (ρ = 0.48, P = .02) and greater bone loss at the femoral neck (ρ = -0.43, P = .04). In addition, within-participant shifts in microbial richness/evenness (α-diversity) were associated with changes in IGF-1 levels (ρ = 0.56, P < .01). The lower the postoperative fecal butyrate concentration, the lower the IGF-1 level (ρ = 0.43, P = .04). Meanwhile, the larger the decrease in butyrate concentration, the higher the postoperative CTx (ρ = -0.43, P = .04). These findings suggest that LSG-induced gut microbiome alteration may influence skeletal outcomes postoperatively, and microbial influences on butyrate formation and IGF-1 are possible mechanisms.
Collapse
Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Kathryn E McCauley
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Susan V Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Renuka R Nayak
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Nicole J King
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, United States
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Katherine Condra
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Doug Fadrosh
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Dat Nguyen
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Din L Lin
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Kole Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, United States
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, United States
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, United States
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, United States
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
- Medical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
| |
Collapse
|
3
|
Ditzenberger GL, Oliveira VHF, Jankowski CM, Erlandson KM. The use of non-invasive imaging modalities for the assessment of skeletal muscle quantity and quality in people with HIV: A narrative review. HIV Med 2023; 24:1176-1189. [PMID: 37651982 DOI: 10.1111/hiv.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND People with HIV (PWH) are prone to mobility impairments and physical dysfunction, with the loss of skeletal muscle quantity and quality being a major contributor to the dysfunction. Assessment of skeletal muscle is an important component of care for this patient population for early intervention and treatment. The use of non-invasive imaging techniques to evaluate skeletal muscle, such as dual X-ray absorptiometry, computer tomography and magnetic resonance imaging, has increased in popularity in recent years. PURPOSE This narrative review synthesizes the use of these techniques and summarizes the associations between outcomes from these imaging modalities and physical function in PWH.
Collapse
|
4
|
Wu KC, Cao S, Weaver CM, King NJ, Patel S, Kim TY, Black DM, Kingman H, Shafer MM, Rogers SJ, Stewart L, Carter JT, Posselt AM, Schafer AL. Intestinal Calcium Absorption Decreases After Laparoscopic Sleeve Gastrectomy Despite Optimization of Vitamin D Status. J Clin Endocrinol Metab 2023; 108:351-360. [PMID: 36196648 PMCID: PMC10091486 DOI: 10.1210/clinem/dgac579] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/30/2022] [Indexed: 01/20/2023]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (LSG), now the most commonly performed bariatric operation, is a highly effective treatment for obesity. While Roux-en-Y gastric bypass is known to impair intestinal fractional calcium absorption (FCA) and negatively affect bone metabolism, LSG's effects on calcium homeostasis and bone health have not been well characterized. OBJECTIVE We determined the effect of LSG on FCA, while maintaining robust 25-hydroxyvitamin D (25OHD) levels and recommended calcium intake. DESIGN, SETTING, PARTICIPANTS Prospective pre-post observational cohort study of 35 women and men with severe obesity undergoing LSG. MAIN OUTCOMES FCA was measured preoperatively and 6 months postoperatively with a gold-standard dual stable isotope method. Other measures included calciotropic hormones, bone turnover markers, and bone mineral density (BMD) by dual-energy X-ray absorptiometry and quantitative computed tomography. RESULTS Mean ± SD FCA decreased from 31.4 ± 15.4% preoperatively to 16.1 ± 12.3% postoperatively (P < 0.01), while median (interquartile range) 25OHD levels were 39 (32-46) ng/mL and 36 (30-46) ng/mL, respectively. Concurrently, median 1,25-dihydroxyvitamin D level increased from 60 (50-82) pg/mL to 86 (72-107) pg/mL (P < 0.01), without significant changes in parathyroid hormone or 24-hour urinary calcium levels. Bone turnover marker levels increased substantially, and areal BMD decreased at the proximal femur. Those with lower postoperative FCA had greater areal BMD loss at the total hip (ρ = 0.45, P < 0.01). CONCLUSIONS FCA decreases after LSG, with a concurrent rise in bone turnover marker levels and decline in BMD, despite robust 25OHD levels and with recommended calcium intake. Decline in FCA could contribute to negative skeletal effects following LSG.
Collapse
Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sisi Cao
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Connie M Weaver
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hillary Kingman
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Martin M Shafer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
5
|
Wu KC, Cao S, Weaver CM, King NJ, Patel S, Kingman H, Sellmeyer DE, McCauley K, Li D, Lynch SV, Kim TY, Black DM, Shafer MM, Özçam M, Lin DL, Rogers SJ, Stewart L, Carter JT, Posselt AM, Schafer AL. Prebiotic to Improve Calcium Absorption in Postmenopausal Women After Gastric Bypass: A Randomized Controlled Trial. J Clin Endocrinol Metab 2022; 107:1053-1064. [PMID: 34888663 PMCID: PMC8947782 DOI: 10.1210/clinem/dgab883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The adverse skeletal effects of Roux-en-Y gastric bypass (RYGB) are partly caused by intestinal calcium absorption decline. Prebiotics, such as soluble corn fiber (SCF), augment colonic calcium absorption in healthy individuals. OBJECTIVE We tested the effects of SCF on fractional calcium absorption (FCA), biochemical parameters, and the fecal microbiome in a post-RYGB population. METHODS Randomized, double-blind, placebo-controlled trial of 20 postmenopausal women with history of RYGB a mean 5 years prior; a 2-month course of 20 g/day SCF or maltodextrin placebo was taken orally. The main outcome measure was between-group difference in absolute change in FCA (primary outcome) and was measured with a gold standard dual stable isotope method. Other measures included tolerability, adherence, serum calciotropic hormones and bone turnover markers, and fecal microbial composition via 16S rRNA gene sequencing. RESULTS Mean FCA ± SD at baseline was low at 5.5 ± 5.1%. Comparing SCF to placebo, there was no between-group difference in mean (95% CI) change in FCA (+3.4 [-6.7, +13.6]%), nor in calciotropic hormones or bone turnover markers. The SCF group had a wider variation in FCA change than placebo (SD 13.4% vs 7.0%). Those with greater change in microbial composition following SCF treatment had greater increase in FCA (r2 = 0.72, P = 0.05). SCF adherence was high, and gastrointestinal symptoms were similar between groups. CONCLUSION No between-group differences were observed in changes in FCA or calciotropic hormones, but wide CIs suggest a variable impact of SCF that may be due to the degree of gut microbiome alteration. Daily SCF consumption was well tolerated. Larger and longer-term studies are warranted.
Collapse
Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Correspondence: Karin C. Wu, MD, 1700 Owens St. RM 349, San Francisco, CA 94158, USA.
| | - Sisi Cao
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Hillary Kingman
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Deborah E Sellmeyer
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Kathryn McCauley
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Danny Li
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Susan V Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Martin M Shafer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Mustafa Özçam
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Din L Lin
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
6
|
Goldberg EK, Fung EB. Precision of the Hologic DXA in the Assessment of Visceral Adipose Tissue. J Clin Densitom 2020; 23:664-672. [PMID: 30992223 PMCID: PMC6754313 DOI: 10.1016/j.jocd.2019.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Visceral fat, also known as visceral adipose tissue (VAT), has been the focus of intensive research over the past several yr, as ground breaking studies have investigated its possible role in predicting long-term cardiac dysfunction, hypertension, and diabetes. Historically, magnetic resonance imaging and computed tomography were the instruments of choice for visceral fat quantification. However, with the introduction of visceral fat assessment software for Dual-energy X-ray Absorptiometry (DXA) scanners, DXA's use for VAT assessment has become increasingly common. To effectively utilize DXA in future VAT research studies, information about their precision and accuracy must be known. This study provides novel information regarding the precision of the Hologic Horizon DXA scanner in the assessment of VAT. METHODS Sixty individuals (32.7 ± 17.1 yr, 51% male, 40% with body mass index (BMI) > 25 kg/m2) above the age of 16 years were recruited to participate in this study. Subjects found to be pregnant, have a lumbar vertebral compression fracture, nonremovable metal implants in the abdomen, or scoliosis/lordosis/kyphosis were excluded from the study. All subjects underwent 3 consecutive whole body scans on a Hologic Horizon A DXA scanner. RESULTS VAT mass ranged from 102 g to 1454 g. VAT precision improved with increasing BMI (p = 0.025): coefficient of variation (%CV) was 15.2% for underweight subjects (n = 2), 7.1% for healthy subjects (n = 34), 6.4% for overweight subjects (n = 18), and 4.7% for obese subjects (n = 6). CONCLUSIONS VAT measurement by Hologic DXA displays a satisfactory level of precision in individuals with a BMI of >18.5 kg/m2. Precision was found to be higher in those with the greatest risk of cardio-metabolic dysfunction (individuals with high VAT). Due to its low cost, brief examination time, noninvasiveness, and limited radiation exposure, DXA may be considered the tool of choice for VAT determination in future studies.
Collapse
Affiliation(s)
| | - Ellen B Fung
- Children's Hospital Oakland Research Institute, Oakland, CA, USA; Department of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
| |
Collapse
|
7
|
Zopfs D, Theurich S, Große Hokamp N, Knuever J, Gerecht L, Borggrefe J, Schlaak M, Pinto Dos Santos D. Single-slice CT measurements allow for accurate assessment of sarcopenia and body composition. Eur Radiol 2019; 30:1701-1708. [PMID: 31776743 DOI: 10.1007/s00330-019-06526-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/27/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the correlation between simple planimetric measurements in axial computed tomography (CT) slices and measurements of patient body composition and anthropometric data performed with bioelectrical impedance analysis (BIA) and metric clinical assessments. METHODS In this prospective cross-sectional study, we analyzed data of a cohort of 62 consecutive, untreated adult patients with advanced malignant melanoma who underwent concurrent BIA assessments at their radiologic baseline staging by CT between July 2016 and October 2017. To assess muscle and adipose tissue mass, we analyzed the areas of the paraspinal muscles as well as the cross-sectional total patient area in a single CT slice at the height of the third lumbar vertebra. These measurements were subsequently correlated with anthropometric (body weight) and body composition parameters derived from BIA (muscle mass, fat mass, fat-free mass, and visceral fat mass). Linear regression models were built to allow for estimation of each parameter based on CT measurements. RESULTS Linear regression models allowed for accurate prediction of patient body weight (adjusted R2 = 0.886), absolute muscle mass (adjusted R2 = 0.866), fat-free mass (adjusted R2 = 0.855), and total as well as visceral fat mass (adjusted R2 = 0.887 and 0.839, respectively). CONCLUSIONS Our data suggest that patient body composition can accurately and quantitatively be determined by using simple measurements in a single axial CT slice. This could be useful in various medical and scientific settings, where the knowledge of the patient's anthropometric parameters is not immediately or easily available. KEY POINTS • Easy to perform measurements on a single CT slice highly correlate with clinically valuable parameters of body composition. • Body composition data were acquired using bioelectrical impedance analysis to correlate CT measurements with a non-imaging-based method, which is frequently lacking in previous studies. • The obtained equations facilitate a quick, opportunistic assessment of relevant parameters of body composition.
Collapse
Affiliation(s)
- David Zopfs
- Faculty of Medicine and University Hospital Cologne, Department for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Sebastian Theurich
- Cancer- and Immunometabolism Research Group, Gene Center LMU, Ludwig-Maximilians-University, Munich, Germany.,Department of Medicine III, University Hospital LMU, Ludwig-Maximilian University, Munich, Germany
| | - Nils Große Hokamp
- Faculty of Medicine and University Hospital Cologne, Department for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jana Knuever
- Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Lukas Gerecht
- Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Jan Borggrefe
- Faculty of Medicine and University Hospital Cologne, Department for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Max Schlaak
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Pinto Dos Santos
- Faculty of Medicine and University Hospital Cologne, Department for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| |
Collapse
|
8
|
Sheean P, Gonzalez MC, Prado CM, McKeever L, Hall AM, Braunschweig CA. American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations. JPEN J Parenter Enteral Nutr 2019; 44:12-43. [DOI: 10.1002/jpen.1669] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia Sheean
- Marcella Niehoff School of Nursing Department of Health Promotion Loyola University Chicago Maywood Illinois USA
| | - M. Cristina Gonzalez
- Postgraduate Program in Health and Behavior Catholic University of Pelotas Pelotas Rio Grande do Sul Brazil
| | - Carla M. Prado
- Human Nutrition Research Unit Department of Agricultural Food and Nutritional Science Division of Human Nutrition, University of Alberta Edmonton Alberta Canada
| | - Liam McKeever
- Department of Kinesiology and Nutrition University of Illinois Chicago Illinois USA
| | - Amber M. Hall
- University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Carol A. Braunschweig
- Department of Kinesiology and Nutrition and Division of Epidemiology and Biostatistics University of Illinois at Chicago Chicago Illinois USA
| |
Collapse
|
9
|
Glicksman A, Hadjiyannakis S, Barrowman N, Walker S, Hoey L, Katz SL. Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity. J Clin Sleep Med 2017; 13:545-550. [PMID: 28095969 DOI: 10.5664/jcsm.6538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obesity and regional fat distribution, measured by neck fat mass percentage using dual-energy X-ray absorptiometry (DXA), correlate with obstructive sleep apnea (OSA) severity in adults. In obese children, neck-to-waist-circumference ratio predicts OSA. This study examined associations between body fat percentage and distribution and sleep-disordered breathing (SDB) severity in obese youth, measured with DXA. METHODS Cross-sectional retrospective study conducted at a tertiary children's hospital. Participants were aged 6 to 18 years with obesity (body mass index [BMI] > 99th percentile [BMI z-score 2.35] or > 95th percentile with comorbidity). They underwent polysomnography and DXA to quantify body fat percentage and distribution ratios (neck-to-abdominal fat percentage [NAF % ratio]). SDB was defined as apnea-hypopnea index (AHI) > 5 and OSA as obstructive AHI (OAHI) > 1 event/h. Relationships of BMI z-score and NAF % ratio to log AHI and log OAHI were evaluated. RESULTS Thirty individuals participated; 18 male; median age 14.1 years. Twenty-four individuals had BMI z-scores > 2.35. Ten had AHI > 5 events/h. NAF % ratio was significantly associated with log AHI in males and with log OAHI in all, whereas total fat mass percent was not. The association between log OAHI and NAF % ratio was significant in males, but not females. NAF % ratio was significantly associated with log OAHI in those with BMI z-score above 2.35. CONCLUSIONS NAF % ratio was associated with OSA severity in males and youth with BMI > 99th percentile; however, total fat mass percentage was not, suggesting that body fat distribution is associated with OSA risk in youth.
Collapse
Affiliation(s)
- Amy Glicksman
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stasia Hadjiyannakis
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Scott Walker
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
10
|
DXA-measured visceral adipose tissue predicts impaired glucose tolerance and metabolic syndrome in obese Caucasian and African-American women. Eur J Clin Nutr 2014; 69:329-36. [PMID: 25335442 DOI: 10.1038/ejcn.2014.227] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/05/2014] [Accepted: 09/11/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES New methods to measure visceral adipose tissue (VAT) by dual-energy X-ray absorptiometry (DXA) may help discern sex, race and phenotype differences in the role of VAT in cardiometabolic risk. This study was designed (1) to compare relationships of DXA-VAT, anthropometric and body composition variables with cardiometabolic risk factors in obese women; (2) to determine which variables most robustly predict impaired glucose tolerance (IGT) and metabolic syndrome (MetSx); and (3) to determine thresholds for DXA-VAT by race. SUBJECTS/METHODS VAT mass (g) and volume (cm(3)) were measured in 229 obese (body mass index (BMI), 30-49.9) women aged 21-69 years of European-American (EA=123) and African-American (AA=106) descent using the CoreScan algorithm on a Lunar iDXA scanner. Linear regression modeling and areas under the curve (AUC of ROC (receiver operating characteristic) curves) compared relationships with cardiometabolic risk. Bootstrapping with LASSO (least absolute shrinkage and selection operator) regression modeling determined thresholds and predictors of IGT and MetSx. RESULTS DXA-VAT explained more of the variance in triglycerides, blood pressure, glucose and homeostatic model assessment-insulin resistance (HOMA-IR) compared with anthropometric and other body composition variables. DXA-VAT also had the highest AUC for IGT (0.767) and MetSx (0.749). Including race as a variable and the interaction between VAT and race in modeling did not significantly change the results. Thresholds at which the probability of developing IGT or MetSx was⩾50% were determined separately for AA women (IGT: 2120 cm(3); MetSx: 1320 cm(3)) and EA women (IGT: 2550 cm(3); MetSx: 1713 cm(3)). The odds for IGT or MetSx were fourfold greater with each standard deviation increase in DXA-VAT. CONCLUSIONS DXA-VAT provides robust clinical information regarding cardiometabolic risk in AA and EA obese women and offers potential utility in the risk reduction interventions.
Collapse
|
11
|
Mankal PK, Kotler DP. From wasting to obesity, changes in nutritional concerns in HIV/AIDS. Endocrinol Metab Clin North Am 2014; 43:647-63. [PMID: 25169559 DOI: 10.1016/j.ecl.2014.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Optimal nutrition is an important part of human immunodeficiency virus (HIV) care; to support the immune system, limit HIV-associated complications as well as maintain better quality of life and survival. The presentation and nature of malnutrition in patients with HIV has changed dramatically over the past 30 years from predominantly a wasting syndrome to lipodystrophy and, now, frailty. Nevertheless, we continue to see all 3 presentations in patient care today. The pathogenesis of poor nutrition in HIV-infected patients depends on caloric intake, intestinal nutrient absorption/translocation, and resting energy expenditure, which are features seen in all chronic diseases.
Collapse
Affiliation(s)
- Pavan K Mankal
- Department of Medicine, Mount Sinai St. Luke's, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1111 Amsterdam Avenue, New York, NY 10025, USA; Division of Gastroenterology, Mount Sinai St. Luke's, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Donald P Kotler
- Department of Medicine, Mount Sinai St. Luke's, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1111 Amsterdam Avenue, New York, NY 10025, USA; Division of Gastroenterology and Hepatology, Mount Sinai St. Luke's, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1111 Amsterdam Avenue, New York, NY 10025, USA.
| |
Collapse
|
12
|
Petak S, Barbu CG, Yu EW, Fielding R, Mulligan K, Sabowitz B, Wu CH, Shepherd JA. The Official Positions of the International Society for Clinical Densitometry: body composition analysis reporting. J Clin Densitom 2013; 16:508-19. [PMID: 24183640 DOI: 10.1016/j.jocd.2013.08.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 01/14/2023]
Abstract
Dual-energy x-ray absorptiometry (DXA) measurements of body composition increasingly are used in the evaluation of clinical disorders, but there has been little guidance on how to effectively report these measures. Uniformity in reporting of body composition measures will aid in the diagnosis of clinical disorders such as obesity, sarcopenia, and lipodystrophy. At the 2013 International Society for Clinical Densitometry Position Development Conference on body composition, the reporting section recommended that all DXA body composition reports should contain parameters of body mass index, bone mineral density, BMC, total mass, total lean mass, total fat mass, and percent fat mass. The inclusion of additional measures of adiposity and lean mass are optional, including visceral adipose tissue, appendicular lean mass index, android/gynoid percent fat ratio, trunk to leg fat mass ratio, lean mass index, and fat mass index. Within the United States, we recommend the use of the National Health and Nutrition Examination Survey 1999-2004 body composition dataset as an age-, gender-, and race-specific reference and to calibrate BMC in 4-compartment models. Z-scores and percentiles of body composition measures may be useful for clinical interpretation if methods are used to adjust for non-normality. In particular, DXA body composition measures may be useful for risk-stratification of obese and sarcopenic patients, but there needs to be validation of thresholds to define obesity and sarcopenia. To summarize, these guidelines provide evidence-based standards for the reporting and clinical application of DXA-based measures of body composition.
Collapse
Affiliation(s)
- Steven Petak
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Kendler DL, Borges JLC, Fielding RA, Itabashi A, Krueger D, Mulligan K, Camargos BM, Sabowitz B, Wu CH, Yu EW, Shepherd J. The Official Positions of the International Society for Clinical Densitometry: Indications of Use and Reporting of DXA for Body Composition. J Clin Densitom 2013; 16:496-507. [PMID: 24090645 DOI: 10.1016/j.jocd.2013.08.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/21/2022]
Abstract
The technique of body composition by dual-energy X-ray absorptiometry (DXA) has been used for several years in the research environment. Its ability to accurately and precisely measure lean, fat, and mineral composition in various body compartments has been well validated. Furthermore, the technique is widely available to clinical patients on existing DXA instruments throughout the world through the use of specific software packages and scanning algorithms. There have been few clear statements regarding the clinical indications for body composition measurement in patients outside the research setting. This is in part because of the lack of specific documented interventions that would be affected by body composition test results, beyond usual clinical advice. We have examined a few of the most common, specific scenarios (HIV therapy, sarcopenia, bariatric surgery, obesity) and proposed indications for body composition assessment. We have also discussed contraindications to body composition testing.
Collapse
|
14
|
Falutz J, Rosenthall L, Kotler D, Zona S, Guaraldi G. Surrogate markers of visceral adipose tissue in treated HIV-infected patients: accuracy of waist circumference determination. HIV Med 2013; 15:98-107. [PMID: 24112443 DOI: 10.1111/hiv.12085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The accuracy of the use of anthropometrics to quantify visceral adipose tissue (VAT) in treated HIV-infected patients is unknown. We evaluated the predictive accuracy of waist circumference (WC) with and without dual-energy X-ray absorptiometry (DXA)-derived trunk : limb fat ratio [fat mass ratio (FMR)] as surrogates for VAT determined using computerized axial tomography (CT-determined VAT). METHODS We performed a retrospective cohort analysis of treated HIV-infected male patients followed at the Modena HIV Clinic. We developed prediction equations for VAT using linear regression analysis and Spearman correlations. Receiver operating characteristic (ROC) analysis evaluated the accuracy of WC alone or with FMR at discrete VAT thresholds. RESULTS The 1500 Caucasian male patients had a median age of 45 years, body mass index (BMI) of 24, WC of 87 cm, VAT area of 127 cm(2) and body fat percentage of 14%. The correlation between WC-predicted VAT and CT-VAT was 0.613, and this increased significantly if FMR was added. The WC-associated R(2) of 0.35 increased to 0.51 if the prediction equation included WC plus FMR. The area under the ROC curve (AUC) using WC was 0.795-0.820 at all VAT thresholds. The positive predictive value (PPV) and negative predictive value (NPV) changed reciprocally at CT-VAT thresholds from 75 to 200 cm(2) and ranged from 0.72 to 0.74, respectively, at a representative VAT of 125 cm(2). Adding the FMR to the predictive equations increased the AUC in the range of 0.854-0.889 with the PPV and NPV increasing minimally, ranging from 0.780 to 0.821. Limits of precision were wide, especially at the highest CT-VAT levels, and varied from 24 to 68 cm(2). CONCLUSIONS WC is a limited surrogate for CT-VAT in this population and DXA-derived parameters do not improve performance indices to a clinically relevant level. These findings should inform the applicability of WC to predict VAT in treated HIV-infected male patients.
Collapse
Affiliation(s)
- J Falutz
- Department of Medicine, McGill University Hospital Center, Montreal, Canada
| | | | | | | | | |
Collapse
|
15
|
Assessment of regional adipose tissue depots: a DXA and CT comparison in cadavers of elderly persons. Exp Gerontol 2013; 48:985-91. [PMID: 23871847 DOI: 10.1016/j.exger.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/16/2013] [Accepted: 07/08/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Since dual energy X-ray absorptiometry (DXA) cannot distinguish between different adipose tissue (AT) deposits, it remains unclear how DXA-derived body composition variables relate to anatomical tissue (sub)compartments. The aim of the present study was to compare and relate regional DXA variables with absolute tissue masses obtained by computer tomography (CT) scanning of the lower limbs in elderly persons. METHODS Eleven well-preserved white Caucasian adults (seven male and four female cadavers) with a median age of 79.0 years (ranging from 68 to 96 years) were fully scanned with DXA and CT. Separate densities of skin tissue, AT, muscle tissue and bone were obtained by hydrostatic weighing. RESULTS The leg DXA-variables were significantly related (rho-values between 0.60 and 0.98, P < 0.01) to CT-derived tissue counterparts, but showed significant systematic differences except for subcutaneous AT mass (P = 0.773). After controlling for other AT depots, fat as measured by DXA (fat(DXA)) related only to intermuscular AT (rho = 0.82, P < 0.01) in males and to subcutaneous AT (rho = 0.84, P < 0.05) in females. CONCLUSION Although significantly interrelated, DXA and CT variables should not be used interchangeably since they have different quantitative and physiological significance. Our results suggest that fat(DXA) represents different parts of AT depots in elderly men and women. Since DXA is not appropriate for assessing tissue variability cautious clinical interpretation is warranted.
Collapse
|
16
|
Silver HJ, Niswender KD, Kullberg J, Berglund J, Johansson L, Bruvold M, Avison MJ, Welch EB. Comparison of gross body fat-water magnetic resonance imaging at 3 Tesla to dual-energy X-ray absorptiometry in obese women. Obesity (Silver Spring) 2013; 21:765-74. [PMID: 23712980 PMCID: PMC3500572 DOI: 10.1002/oby.20287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 05/13/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Improved understanding of how depot-specific adipose tissue mass predisposes to obesity-related comorbidities could yield new insights into the pathogenesis and treatment of obesity as well as metabolic benefits of weight loss. We hypothesized that three-dimensional (3D) contiguous "fat-water" MR imaging (FWMRI) covering the majority of a whole-body field of view (FOV) acquired at 3 Tesla (3T) and coupled with automated segmentation and quantification of amount, type, and distribution of adipose and lean soft tissue would show great promise in body composition methodology. DESIGN AND METHODS Precision of adipose and lean soft tissue measurements in body and trunk regions were assessed for 3T FWMRI and compared to dual-energy X-ray absorptiometry (DXA). Anthropometric, FWMRI, and DXA measurements were obtained in 12 women with BMI 30-39.9 kg/m(2) . RESULTS Test-retest results found coefficients of variation (CV) for FWMRI that were all under 3%: gross body adipose tissue (GBAT) 0.80%, total trunk adipose tissue (TTAT) 2.08%, visceral adipose tissue (VAT) 2.62%, subcutaneous adipose tissue (SAT) 2.11%, gross body lean soft tissue (GBLST) 0.60%, and total trunk lean soft tissue (TTLST) 2.43%. Concordance correlation coefficients between FWMRI and DXA were 0.978, 0.802, 0.629, and 0.400 for GBAT, TTAT, GBLST, and TTLST, respectively. CONCLUSIONS While Bland-Altman plots demonstrated agreement between FWMRI and DXA for GBAT and TTAT, a negative bias existed for GBLST and TTLST measurements. Differences may be explained by the FWMRI FOV length and potential for DXA to overestimate lean soft tissue. While more development is necessary, the described 3T FWMRI method combined with fully-automated segmentation is fast (<30-min total scan and post-processing time), noninvasive, repeatable, and cost-effective.
Collapse
Affiliation(s)
- Heidi J Silver
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Taylor AE, Kuper H, Varma RD, Wells JC, Bell JD, V Radhakrishna K, Kulkarni B, Kinra S, Timpson NJ, Ebrahim S, Smith GD, Ben-Shlomo Y. Validation of dual energy X-ray absorptiometry measures of abdominal fat by comparison with magnetic resonance imaging in an Indian population. PLoS One 2012; 7:e51042. [PMID: 23272086 PMCID: PMC3522679 DOI: 10.1371/journal.pone.0051042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/31/2012] [Indexed: 11/20/2022] Open
Abstract
Objective Abdominal adiposity is an important risk factor for diabetes and cardiovascular disease in Indians. Dual energy X-ray absorptiometry (DXA) can be used to determine abdominal fat depots, being more accessible and less costly than gold standard measures such as magnetic resonance imaging (MRI). DXA has not been fully validated for use in South Asians. Here, we determined the accuracy of DXA for measurement of abdominal fat in an Indian population by comparison with MRI. Design 146 males and females (age range 18–74, BMI range 15–46 kg/m2) from Hyderabad, India underwent whole body DXA scans on a Hologic Discovery A scanner, from which fat mass in two abdominal regions was calculated, from the L1 to L4 vertebrae (L1L4) and from the L2 to L4 vertebrae (L2L4). Abdominal MRI scans (axial T1-weighted spin echo images) were taken, from which adipose tissue volumes were calculated for the same regions. Results Intra-class correlation coefficients between DXA and MRI measures of abdominal fat were high (0.98 for both regions). Although at the level of the individual, differences between DXA and MRI could be large (95% of DXA measures were between 0.8 and 1.4 times MRI measures), at the sample level, DXA only slightly overestimated MRI measures of abdominal fat mass (mean difference in L1L4 region: 2% (95% CI:0%, 5%), mean difference in L2L4 region:4% (95% CI: 1%, 7%)). There was evidence of a proportional bias in the association between DXA and MRI (correlation between difference and mean −0.3), with overestimation by DXA greater in individuals with less abdominal fat (mean bias in leaner half of sample was 6% for L1L4 (95%CI: 2, 11%) and 7% for L2L4 (95% CI:3,12%). Conclusions DXA measures of abdominal fat are suitable for use in Indian populations and provide a good indication of abdominal adiposity at the population level.
Collapse
Affiliation(s)
- Amy E Taylor
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Bauer J, Thornton J, Heymsfield S, Kelly K, Ramirez A, Gidwani S, Gallagher D. Dual-energy X-ray absorptiometry prediction of adipose tissue depots in children and adolescents. Pediatr Res 2012; 72:420-5. [PMID: 22821057 PMCID: PMC3668789 DOI: 10.1038/pr.2012.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The measurement of adipose tissue (AT) depots in vivo requires expensive imaging methods not accessible to most clinicians and researchers. The study aim was to derive mathematical models to predict total AT (TAT) and subdepots from total body fat derived from a dual-energy X-ray absorptiometry (DXA) scan. METHODS Models were developed to predict magnetic resonance imaging-derived TAT and subdepots subcutaneous AT, visceral AT, and intermuscular AT from DXA total body fat (Fat(DXA)) using cross-sectional data (time 0 (T0)) and validated results using 1 (T1) and 2 (T2) y follow-up data. Subjects were 176 multiethnic healthy children ages 5-17 y at T0. Twenty-two were measured at T1 and T2. TAT was compared with Fat(DXA). RESULTS At T0, TAT was greater than Fat(DXA) (12.5 ± 8.4 vs.12.0 ± 9.4 kg; P < 0.0001), with a quadratic relationship between TAT and Fat(DXA) that varied by sex. Predicted mean TATs were not different from measured TATs: T1: (9.84 ± 4.45 kg vs. 9.50 ± 4.37 kg; P = 0.11); T2: (12.94 ± 6.75 kg vs. 12.89 ± 7.09 kg; P = 0.76). The quadratic relationship was not influenced by race or age. CONCLUSION In general, the prediction equations for TAT and subdepots were consistent with the measured values using T1 and T2 data.
Collapse
Affiliation(s)
- Jacqueline Bauer
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| | - John Thornton
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| | | | - Kim Kelly
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| | - Alexander Ramirez
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| | - Sonia Gidwani
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| | - Dympna Gallagher
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital, Columbia University, NY, NY
| |
Collapse
|
19
|
Comparison of Gross Body Fat-Water Magnetic Resonance Imaging at 3 Tesla to Dual-Energy X-Ray Absorptiometry in Obese Women. Obesity (Silver Spring) 2012. [DOI: 10.1038/oby.2012.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
20
|
Bodell LP, Mayer LE. Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study. Int J Eat Disord 2011; 44:118-23. [PMID: 20127939 PMCID: PMC4469282 DOI: 10.1002/eat.20801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to replicate and extend our previous findings of an association between percent body fat in recently weight-restored patients with Anorexia Nervosa (AN) and clinical outcome in the year following treatment. METHOD Twenty-two hospitalized, weight-restored women with AN underwent whole body MRI to determine percent adipose tissue. Following hospital discharge, patients were contacted regularly, and at the end of the year, clinical outcome was determined using modified Morgan-Russell (MR) criteria: full, good, fair or poor. Identical to our previous study, outcome was dichotomized into "full, good or fair" and "poor" groups. RESULTS Data from 21 subjects were available for analysis. Percent body fat was significantly lower in the poor outcome group (22% ± 5%) compared to the "full, good or fair" outcome group (27 % ± 4%)(p < 0.035). To further examine the relationship, we combined data from the current study with data from the 26 subjects on whom we had previously reported. Univariate analysis of variance (ANOVA) demonstrated a significant difference in percent adipose tissue across the four MR outcome groups (F = 3.416, df = 3, p<0.03). DISCUSSION Lower percent adipose tissue after short-term weight normalization is associated with poor clinical outcome in the year following inpatient treatment. These findings may be important in the assessment of risk for relapse in patients with AN.
Collapse
Affiliation(s)
| | - Laurel E.S. Mayer
- Correspondence to: Laurel E.S. Mayer, Eating Disorders Research Unit, 1051 Riverside Drive Unit 98, New York, New York 10032.
| |
Collapse
|
21
|
Yao J, Yu W, Li T, Luo L, Lin Q, Tian J, Chang Y. The pilot study of DXA assessment in chinese HIV-infected men with clinical lipodystrophy. J Clin Densitom 2011; 14:58-62. [PMID: 21130671 DOI: 10.1016/j.jocd.2010.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 08/15/2010] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate human immunodeficiency virus (HIV)-infected patient's body composition changes by dual-energy X-ray absorptiometry (DXA) and to analyze factors associated with lipodystrophy (LD). Total-body composition was measured by DXA in HIV-infected men and healthy men. HIV-infected men were divided into LD patients and non-LD patients according to whether they were complicated with LD. Healthy men were selected as controls. Fat mass (FM) of HIV-infected patients correlated negatively with the duration of HIV infection and with the duration of highly active antiretroviral therapy regimen (r(s)=-0.448 and -0.563; p=0.032 and 0.000, respectively). Multiple linear regression results showed that FM had positive correlation with weight and bone mineral content (BMC) and had negative correlation with lean mass (LM). Total body and regional FMs were found to be significantly different among LD patients, non-LD patients, and controls-the lowest in LD patients and the highest in controls (p<0.05). Total body, trunk, and leg BMCs of LD patients were lower than those of controls (p<0.05). Lumbar bone mineral density of LD patients was lower than that of non-LD patients and controls (p=0.04 and 0.007). LM of LD patients was higher than that of non-LD patients, and trunk LM had statistical difference between the 2 groups (p=0.003). Applying DXA to assess HIV-infected patient's body composition changes could provide objective information for physicians to prevent LD and osteoporosis.
Collapse
Affiliation(s)
- Jinpeng Yao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medicine Science, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
22
|
Viganò A, Cerini C, Pattarino G, Fasan S, Zuccotti GV. Metabolic complications associated with antiretroviral therapy in HIV-infected and HIV-exposed uninfected paediatric patients. Expert Opin Drug Saf 2010; 9:431-45. [PMID: 20078250 DOI: 10.1517/14740330903579991] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD HIV-infection has become a chronic disease in paediatric patients with the potential for long-term survival and exposure to antiretroviral (ARV) therapies for 2 decades longer than HIV-infected adults. On the other hand, the administration of ARV to HIV-infected pregnant women has greatly increased both treatment of HIV infection and prevention of perinatal HIV transmission. Therefore, researches aiming to evaluate the safety of ARV therapies in HIV-infected children as well as in HIV-uninfected infants born to HIV-infected mothers are emerging as a new challenge and urgent priority. AREAS COVERED IN THIS REVIEW The purpose of this review is to describe some of the more concerning metabolic complications associated with ARV in paediatric population: hyperlactataemia (HLA) syndromes, body shape abnormalities, disorders of glucose homeostasis and dyslipidaemia in HIV-infected children and adolescents. Frequency, risk factors, clinical findings, prevention and intervention strategies of the previously described abnormalities are discussed in depth. WHAT THE READER WILL GAIN This review covers our current understanding of HLA syndromes in ARV-exposed uninfected infants born to HIV-infected mothers. TAKE HOME MESSAGE Prevention of these metabolic complications should assume prominence and future researches should address several of the existing treatment gaps.
Collapse
Affiliation(s)
- Alessandra Viganò
- Università di Milano, Luigi Sacco Hospital, Department of Pediatrics, Milan, Italy.
| | | | | | | | | |
Collapse
|
23
|
Silver HJ, Welch EB, Avison MJ, Niswender KD. Imaging body composition in obesity and weight loss: challenges and opportunities. Diabetes Metab Syndr Obes 2010; 3:337-47. [PMID: 21437103 PMCID: PMC3047979 DOI: 10.2147/dmsott.s9454] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Obesity is a threat to public health worldwide primarily due to the comorbidities related to visceral adiposity, inflammation, and insulin resistance that increase risk for type 2 diabetes and cardiovascular disease. The translational research portfolio that originally described these risk factors was significantly enhanced by imaging techniques, such as dual-energy X-ray absorptiometry (DEXA), computed tomography (CT), and magnetic resonance imaging (MRI). In this article, we briefly review the important contributions of these techniques to understand the role of body composition in the pathogenesis of obesity-related complications. Notably, these imaging techniques have contributed greatly to recent findings identifying gender and racial differences in body composition and patterns of body composition change during weight loss. Although these techniques have the ability to generate good-quality body composition data, each possesses limitations. For example, DEXA is unable to differentiate type of fat, CT has better resolution but provides greater ionizing radiation exposure, and MRI tends to require longer imaging times and specialized equipment for acquisition and analysis. With the serious need for efficacious and cost-effective therapies to appropriately identify and treat at-risk obese individuals, there is greater need for translational tools that can further elucidate the interplay between body composition and the metabolic aberrations associated with obesity. In conclusion, we will offer our perspective on the evolution toward an ideal imaging method for body composition assessment in obesity and weight loss, and the challenges remaining to achieve this goal.
Collapse
Affiliation(s)
- Heidi J Silver
- Department of Medicine, Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Correspondence: Heidi J Silver, Department of Medicine, Vanderbilt University, Nashville, TN, 37232-2713, USA, Tel +1 615 936 1299, Email and Kevin D Niswender, Department of Medicine, Vanderbilt University, Nashville, TN, 37232-2713, USA, Email
| | - E Brian Welch
- Department of Radiology and Radiological Sciences, Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Malcolm J Avison
- Department of Radiology and Radiological Sciences, Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Kevin D Niswender
- Department of Medicine, Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
24
|
Grunfeld C, Saag M, Cofrancesco J, Lewis CE, Kronmal R, Heymsfield S, Tien PC, Bacchetti P, Shlipak M, Scherzer R. Regional adipose tissue measured by MRI over 5 years in HIV-infected and control participants indicates persistence of HIV-associated lipoatrophy. AIDS 2010; 24:1717-26. [PMID: 20502316 PMCID: PMC3309711 DOI: 10.1097/qad.0b013e32833ac7a2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Peripheral fat loss and visceral fat gain have been reported in HIV infection. There are limited data on long-term change in adipose tissue in HIV-infected patients vs. controls. Therefore, we determined change in regional adipose tissue from baseline examination to 5 years later among participants in the study of Fat Redistribution and Metabolic Change in HIV Infection. METHODS Regional adipose tissue volume was measured using MRI at both examinations in 477 HIV-infected and 214 control men and women. Lipoatrophy was defined as leg subcutaneous adipose tissue (SAT) below the cutoff point marking the lowest decile (10%) of controls at each examination. RESULTS HIV-infected and control participants showed similar adipose tissue gains. In men, all SAT depots and visceral adipose tissue started lower and remained lower on average in HIV-infected vs. controls. In women, leg and arm SAT also started lower and remained lower in HIV-infected vs. controls. Mean leg SAT of HIV-infected men was 67% of control men at baseline and 65% at follow-up; for women 83% and 77%. At baseline, 48% of HIV-infected participants had lipoatrophy; on average those with baseline lipoatrophy gained 0.96L of leg SAT compared with 1.23L gain for controls in the lowest decile (P = 0.16). At follow-up, 53% of HIV-infected participants had lipoatrophy. In multivariable models, discontinuation of stavudine appeared to produce little gain in leg SAT ( approximately 1.1%/year). CONCLUSION HIV-infected participants did not substantially recover SAT compared with controls, although both showed average gains. HIV-associated lipoatrophy persisted after 5 years of follow-up.
Collapse
Affiliation(s)
- Carl Grunfeld
- Office of the Principal Investigator, The FRAM Study, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hepatic steatosis associated with increased central body fat by dual-energy X-ray absorptiometry and uncontrolled HIV in HIV/hepatitis C co-infected persons. AIDS 2010; 24:811-7. [PMID: 20186036 DOI: 10.1097/qad.0b013e3283333651] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the relationship between regional body composition and liver disease (fibrosis or steatosis) in HIV/HCV co-infected individuals. METHODS Whole body dual-energy X-ray absorptiometry (DXA) was performed in 173 HIV/HCV co-infected persons within 12 months of a liver biopsy. Significant fibrosis was defined as a METAVIR stage greater than 1. Steatosis was graded as: 0, none; 1, steatosis involving less than 5% of hepatocytes; 2, 5-29%; 3, 30-60%; 4 greater than 60%, and was defined as more than 0. Poisson regression with robust variance was used to estimate prevalence ratios of the outcome measures. RESULTS The population was 62% male and 84% black with a median body mass index of 25.2 kg/m (interquartile range 22.5, 29.3 kg/m). No differences in regional body fat or fat distribution were observed in 42 patients with significant fibrosis compared to others with less fibrosis. However, the 77 individuals (45%) with steatosis had greater central fat than those without steatosis [prevalence ratio 1.04 per kg trunk fat; 95% confidence interval (CI) 1.04, 1.11], after adjusting for hepatic fibrosis (prevalence ratio 1.77; 95% CI 1.29, 2.42), uncontrolled HIV replication (viral load >400 copies/ml) (prevalence ratio 1.57; 95% CI 1.12, 2.22), age, sex, race and diabetes mellitus. CONCLUSIONS In HIV/HCV co-infected individuals, measures of regional body fat or fat distribution were not associated with hepatic fibrosis. In contrast, increased central adiposity by DXA, as well as concomitant fibrosis and uncontrolled HIV, were associated with hepatic steatosis. The extent to which weight loss and effective antiretroviral therapy can reduce the risk of steatosis deserves further investigation.
Collapse
|
26
|
Mulligan K, Khatami H, Schwarz JM, Sakkas GK, DePaoli AM, Tai VW, Wen MJ, Lee GA, Grunfeld C, Schambelan M. The effects of recombinant human leptin on visceral fat, dyslipidemia, and insulin resistance in patients with human immunodeficiency virus-associated lipoatrophy and hypoleptinemia. J Clin Endocrinol Metab 2009; 94:1137-44. [PMID: 19174500 PMCID: PMC2682465 DOI: 10.1210/jc.2008-1588] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Leptin deficiency is associated with dyslipidemia and insulin resistance in animals and humans with lipoatrophy; leptin replacement ameliorates these abnormalities. OBJECTIVE The objective of the study was to evaluate the effects of leptin therapy in lipoatrophic HIV-infected patients with dyslipidemia and hypoleptinemia. DESIGN This was a 6-month, open-label, proof-of-principle pilot study. SETTING Metabolic ward studies were performed before and 3 and 6 months after leptin treatment. PARTICIPANTS Participants included eight HIV-infected men with lipoatrophy, fasting triglycerides greater than 300 mg/dl, and serum leptin less than 3 ng/ml. INTERVENTION Recombinant human leptin was given by sc injection (0.01 mg/kg and 0.03 mg/kg twice daily for successive 3 month periods). OUTCOME MEASURES Measures included fat distribution by magnetic resonance imaging and dual-energy X-ray absorptiometry; fasting lipids; insulin sensitivity by euglycemic hyperinsulinemic clamp; endogenous glucose production, gluconeogenesis, glycogenolysis, and whole-body lipolysis by stable isotope tracer studies; oral glucose tolerance testing; liver fat by proton magnetic resonance spectroscopy; and safety. RESULTS Visceral fat decreased by 32% (P = 0.001) with no changes in peripheral fat. There were significant decreases in fasting total (15%, P = 0.012), direct low-density lipoprotein (20%, P = 0.002), and non-high-density lipoprotein (19%, P = 0.005) cholesterol. High-density lipoprotein cholesterol increased. Triglycerides, whole-body lipolysis, and free fatty acids decreased during fasting and hyperinsulinemia. Fasting insulin decreased. Endogenous glucose production decreased during fasting and hyperinsulinemia, providing evidence of improved hepatic insulin sensitivity. Leptin was well tolerated but decreased lean mass. CONCLUSIONS Leptin treatment was associated with marked improvement in dyslipidemia. Hepatic insulin sensitivity improved and lipolysis decreased. Visceral fat decreased with no exacerbation of peripheral lipoatrophy. Results from this pilot study suggest that leptin warrants further study in patients with HIV-associated lipoatrophy.
Collapse
Affiliation(s)
- Kathleen Mulligan
- Department of Medicine, University of California, San Francisco, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|