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Krishna S, Quindry JC, Valentine RJ, Selsby JT. The Interaction of Duchenne Muscular Dystrophy and Insulin Resistance. Exerc Sport Sci Rev 2024; 52:31-38. [PMID: 38126403 DOI: 10.1249/jes.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Duchenne muscular dystrophy (DMD), caused by deficiency of functional dystrophin protein, is a fatal, progressive muscle disease that frequently includes metabolic dysregulation. Herein, we explore the physiologic consequences of dystrophin deficiency within the context of obesity and insulin resistance. We hypothesized that dystrophin deficiency increases the frequency of insulin resistance, and insulin resistance potentiates muscle pathology caused by dystrophin deficiency.
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Affiliation(s)
- Swathy Krishna
- Departments of Animal Science and Kinesiology, Iowa State University, Ames, IA
| | - John C Quindry
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | - Rudy J Valentine
- Departments of Animal Science and Kinesiology, Iowa State University, Ames, IA
| | - Joshua T Selsby
- Departments of Animal Science and Kinesiology, Iowa State University, Ames, IA
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2
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de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
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Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
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3
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Lapp HS, Freigang M, Hagenacker T, Weiler M, Wurster CD, Günther R. Biomarkers in 5q-associated spinal muscular atrophy-a narrative review. J Neurol 2023; 270:4157-4178. [PMID: 37289324 PMCID: PMC10421827 DOI: 10.1007/s00415-023-11787-y] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
5q-associated spinal muscular atrophy (SMA) is a rare genetic disease caused by mutations in the SMN1 gene, resulting in a loss of functional SMN protein and consecutive degeneration of motor neurons in the ventral horn. The disease is clinically characterized by proximal paralysis and secondary skeletal muscle atrophy. New disease-modifying drugs driving SMN gene expression have been developed in the past decade and have revolutionized SMA treatment. The rise of treatment options led to a concomitant need of biomarkers for therapeutic guidance and an improved disease monitoring. Intensive efforts have been undertaken to develop suitable markers, and numerous candidate biomarkers for diagnostic, prognostic, and predictive values have been identified. The most promising markers include appliance-based measures such as electrophysiological and imaging-based indices as well as molecular markers including SMN-related proteins and markers of neurodegeneration and skeletal muscle integrity. However, none of the proposed biomarkers have been validated for the clinical routine yet. In this narrative review, we discuss the most promising candidate biomarkers for SMA and expand the discussion by addressing the largely unfolded potential of muscle integrity markers, especially in the context of upcoming muscle-targeting therapies. While the discussed candidate biomarkers hold potential as either diagnostic (e.g., SMN-related biomarkers), prognostic (e.g., markers of neurodegeneration, imaging-based markers), predictive (e.g., electrophysiological markers) or response markers (e.g., muscle integrity markers), no single measure seems to be suitable to cover all biomarker categories. Hence, a combination of different biomarkers and clinical assessments appears to be the most expedient solution at the time.
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Affiliation(s)
- H S Lapp
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - M Freigang
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - T Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Science (C-TNBS), University Medicine Essen, Essen, Germany
| | - M Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C D Wurster
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE) Ulm, Ulm, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany.
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4
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Sherlock SP, Palmer J, Wagner KR, Abdel-Hamid HZ, Tian C, Mah JK, Muntoni F, Guglieri M, Butterfield RJ, Charnas L, Marraffino S. Dual-energy X-ray absorptiometry measures of lean body mass as a biomarker for progression in boys with Duchenne muscular dystrophy. Sci Rep 2022; 12:18762. [PMID: 36335191 PMCID: PMC9637094 DOI: 10.1038/s41598-022-23072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
We evaluated whether whole-body dual-energy X-ray absorptiometry (DXA) measures of lean body mass can be used as biomarkers for disease progression and treatment effects in patients with Duchenne muscular dystrophy. This post hoc analysis utilized data from a randomized, 2-period study of domagrozumab versus placebo in 120 ambulatory boys with DMD. DXA measures of lean body mass were obtained from the whole body (excluding head), arms, legs and appendicular skeleton at baseline and every 16 weeks. Treatment effects on DXA measures for domagrozumab versus placebo were assessed at Week 49. At Week 49, domagrozumab statistically significantly increased lean body mass versus placebo in the appendicular skeleton (p = 0.050) and arms (p < 0.001). The relationship between lean body mass at Week 49 and functional endpoints at Week 97 was evaluated. Changes in lean body mass at Week 49 in all regions except arms were significantly correlated with percent change from baseline in 4-stair climb (4SC) at Week 97. DXA-derived percent lean mass at Week 49 also correlated with 4SC and North Star Ambulatory Assessment at Week 97. These data indicate that whole-body DXA measures can be used as biomarkers for treatment effects and disease progression in patients with DMD, and warrant further investigation.Trial registration: ClinicalTrials.gov, NCT02310763; registered 8 December 2014.
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Affiliation(s)
| | | | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hoda Z Abdel-Hamid
- Division of Child Neurology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cuixia Tian
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jean K Mah
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
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5
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Davidson ZE, Bray P, Rose K, Rodrigues MJ, Corben L, North KN, Ryan MM, Burns J. Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy. Disabil Rehabil 2021; 44:5450-5467. [PMID: 34165385 DOI: 10.1080/09638288.2021.1936221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination. RESULTS This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD. CONCLUSIONS The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases.Implications for rehabilitationImplementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life.A model for developing best practice statements for other rare neurological diseases is described.Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice.
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Affiliation(s)
- Z E Davidson
- Murdoch Children's Research Institute, Parkville, Australia.,Neurology Department, Royal Children's Hospital, Parkville, Australia.,Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Australia
| | - P Bray
- The Children's Hospital at Westmead, Westmead, Australia.,School of Health Sciences, University of Sydney, Sydney, Australia
| | - K Rose
- School of Health Sciences, University of Sydney, Sydney, Australia.,Department of Physiotherapy, Sydney Children's Hospital, Randwick, Australia.,ATOM International Pty Ltd, Newcastle upon Tyne, UK
| | - M J Rodrigues
- Muscular Dystrophy Association of New Zealand, Auckland, New Zealand.,Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - L Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,School of Psychological Sciences, Monash University, Clayton, Australia
| | - K N North
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - M M Ryan
- Murdoch Children's Research Institute, Parkville, Australia.,Neurology Department, Royal Children's Hospital, Parkville, Australia.,Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - J Burns
- The Children's Hospital at Westmead, Westmead, Australia.,School of Health Sciences, University of Sydney, Sydney, Australia
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6
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Plasma lipidomic analysis shows a disease progression signature in mdx mice. Sci Rep 2021; 11:12993. [PMID: 34155298 PMCID: PMC8217252 DOI: 10.1038/s41598-021-92406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is a rare genetic disorder affecting paediatric patients. The disease course is characterized by loss of muscle mass, which is rapidly substituted by fibrotic and adipose tissue. Clinical and preclinical models have clarified the processes leading to muscle damage and myofiber degeneration. Analysis of the fat component is however emerging as more evidence shows how muscle fat fraction is associated with patient performance and prognosis. In this article we aimed to study whether alterations exist in the composition of lipids in plasma samples obtained from mouse models. Analysis of plasma samples was performed in 4 mouse models of DMD and wild-type mice by LC–MS. Longitudinal samplings of individual mice covering an observational period of 7 months were obtained to cover the different phases of the disease. We report clear elevation of glycerolipids and glycerophospholipids families in dystrophic mice compared to healthy mice. Triacylglycerols were the strongest contributors to the signatures in mice. Annotation of individual lipids confirmed the elevation of lipids belonging to these families as strongest discriminants between healthy and dystrophic mice. A few sphingolipids (such as ganglioside GM2, sphingomyelin and ceramide), sterol lipids (such as cholesteryl oleate and cholesteryl arachidonate) and a fatty acyl (stearic acid) were also found to be affected in dystrophic mice. Analysis of serum and plasma samples show how several lipids are affected in dystrophic mice affected by muscular dystrophy. This study sets the basis to further investigations to understand how the lipid signature relates to the disease biology and muscle performance.
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LoMauro A, Gandossini S, Russo A, Velardo D, Comi GP, Turconi AC, Bresolin N, Aliverti A, D'Angelo MG. A Multidisciplinary Evaluation of Patients with DMD in An Italian Tertiary Care Center. J Neuromuscul Dis 2020; 8:235-249. [PMID: 33361606 DOI: 10.3233/jnd-190417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With more widespread prolonged survival, Duchenne muscular dystrophy patients progressively experience multisystem complications. We retrospectively reviewed the charts of 132 Duchenne patients (112 alive/20 dead, age 3.5÷32.3 years) with the aims: 1) to provide a comprehensive description of the clinical status considering different aspects of the disease; 2) to propose a new scoring tool able to consider and pool together heterogeneous different functional. Five functions were analyzed: cardiac, respiratory, nutritional, ambulation and scoliosis. For each function, different items were considered and classified according to clinical severity (as indicated by international guidelines) and an incremental scoring was assigned. In addition, a global score incorporating all functions was defined. The scoring system confirmed that despite the significant protective role of steroids, all functions deteriorated with age. The severity of the global score became significantly higher since the age of 13 years. The severity of cardiac, respiratory and nutritional dysfunction was higher since 18 years. Deceased patients were characterized by significantly worse cardiac function, absence of steroid therapy and later use of respiratory assistive devices. The index proposed in this pilot study is a promising tool able to aggregate and correlate heterogeneous functions. It could become either an individual prognostic indicator of decline or a global score to evaluate changes in clinical trials therefore allowing multicenter studies, optimizing the management of both the primary and the secondary complications of the disease and understanding their relative impact.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - S Gandossini
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - A Russo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - D Velardo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - G P Comi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan
| | - A C Turconi
- Scientific Institute, IRCCS E. Medea- via don Luigi Monza, Bosisio P (Lecco) Italy
| | - N Bresolin
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - M G D'Angelo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
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8
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Summer SS, Wong BL, Rutter MM, Horn PS, Tian C, Rybalsky I, Shellenbarger KC, Kalkwarf HJ. Age-related changes in appendicular lean mass in males with Duchenne muscular dystrophy: A retrospective review. Muscle Nerve 2020; 63:231-238. [PMID: 33104257 DOI: 10.1002/mus.27107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Appendicular lean mass (ALM) trajectory in males with Duchenne muscular dystrophy (DMD) has potential applicability for treatment and research and has not been characterized. METHODS This chart review included longitudinal data on 499 males with DMD receiving glucocorticoids and 693 controls, ages 5 to 22.9 y. ALM (kg) was measured by dual energy x-ray absorptiometry (DXA). Appendicular lean mass index (ALMI, kg/m2 ) was calculated for height adjustment. Reference centiles were generated using data from healthy controls, and ALM and ALMI Z-scores were calculated for patients with DMD. Generalized linear models were used to estimate median Z-scores by age and functional mobility status (FMS) score. ALM velocity by age was modeled using superimposition, translation and rotation (SITAR). RESULTS Compared to controls, males with DMD had lower ALM from an early age. ALMI Z-scores dropped below 0 at age 8 y or FMS of 2, and below -2.0 at age 13 y or FMS of 3 (P < .05). Age at peak ALM velocity was similar in both groups, but the magnitude was higher in controls (3.5 vs. 0.7 kg/y, P < .0001). Patients with DMD had a transient loss of ALM around age 12 y, an increase at age 14 y, then a further decline at age 16 y, remaining low thereafter. CONCLUSIONS Males with DMD have progressive decline in lean mass with age and worsening functional mobility. DXA measurement of ALM may be useful for monitoring lean mass status in patients with DMD, providing valuable information for individual treatment plans and research endeavors.
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Affiliation(s)
- Suzanne S Summer
- Center for Clinical and Translational Science and Training, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brenda L Wong
- DMD Program, Department of Pediatrics and Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Meilan M Rutter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Horn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cuixia Tian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Irina Rybalsky
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - K Courtney Shellenbarger
- DMD Program, Department of Pediatrics and Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Grilo EC, Cunha TA, Costa ÁDS, Araújo BGM, Lopes MMGD, Maciel BLL, Alves CX, Vermeulen-Serpa KM, Dourado-Júnior MET, Leite-Lais L, Brandão-Neto J, Vale SHL. Validity of bioelectrical impedance to estimate fat-free mass in boys with Duchenne muscular dystrophy. PLoS One 2020; 15:e0241722. [PMID: 33216757 PMCID: PMC7679022 DOI: 10.1371/journal.pone.0241722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022] Open
Abstract
The evaluation of fat-free mass (FFM) in patients with Duchenne muscular dystrophy (DMD) is useful to investigate disease progression and therapeutic efficacy. This study aimed to validate the Bioelectrical impedance (BIA) method compared with the dual-energy X-ray absorptiometry (DXA) for estimating the %FFM in boys with DMD. This is a cross-sectional study performed with children and adolescents diagnosed with DMD. Resistance and reactance were measured with a BIA analyzer, from which eight predictive equations estimated the %FFM. The %FFM was also determined by DXA and its used as a reference method. Pearson correlation test, coefficient of determination, the root-mean-square error, the interclass correlation coefficient, and linear regression analysis were performed between %FFM values obtained by BIA and DXA. The agreement between these values was verified with the Bland-Altman plot analysis. Forty-six boys aged from 5 to 20 years were enrolled in the study. All the equations showed a correlation between the %FFM estimated by BIA and determined by DXA (p < 0.05). The Bland-Altman method indicated that two equations have a significant bias (p < 0.05) and six equations showed no significant bias of %FFM (p > 0.05). However, one of them has high variation and wide limits of agreement. Five of eight %FFM predictive equations tested in DMD were accurate when compared with the DXA. It can be concluded that BIA is a validity method to evaluate patients with DMD.
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Affiliation(s)
- Evellyn C. Grilo
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Thais A. Cunha
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ádila Danielly S. Costa
- Postgraduate Nutrition Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Bárbara G. M. Araújo
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Bruna L. L. Maciel
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Camila X. Alves
- Neurology outpatient facility, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Karina M. Vermeulen-Serpa
- Postgraduate Health Sciences Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Lucia Leite-Lais
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Brandão-Neto
- Department of Internal Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sancha Helena L. Vale
- Nutrition Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
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10
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McPherson AC, Amin R, McAdam L, Kalnins D, Lui T. Growth assessment and weight management in paediatric neuromuscular clinics: a cross-sectional survey across Canada. Disabil Rehabil 2020; 43:3015-3020. [PMID: 32058820 DOI: 10.1080/09638288.2020.1725155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify current practices related to the assessment, monitoring and discussion of bodyweight, growth and obesity in neuromuscular clinics for children with Duchenne muscular dystrophy (DMD). METHODS A cross-sectional, online survey was distributed using snowball sampling to healthcare providers working with children with DMD across Canadian neuromuscular clinics. Summary and descriptive statistics were calculated. Content analysis was performed on open text responses. RESULTS Thirty-seven responses were received, representing a range of healthcare disciplines. Height and weight were routinely assessed by 32/37 (87%) respondents, although only 21/37 (57%) responses reported having a clinic standard for measuring height and 23/37 (62%) for weight. While 32/36 (89%) reported discussing weight during consultations, only 13/37 (35%) felt confident doing so. Dietitians were considered the most appropriate person to discuss and manage weight with children and families, although only 17/37 (46%) reported having a dietitian involved in their clinic. CONCLUSIONS Neuromuscular clinics could benefit from implementing consistent and recommended growth assessment practices. The development of evidence-based tools, training and protocols tailored to Duchenne muscular dystrophy should be a priority.IMPLICATIONS FOR REHABILITATIONGrowth and weight monitoring approaches vary within and between neuromuscular clinics.Additional training on discussing and managing weight are warranted across disciplines.Advocacy is required to ensure access to dietetic expertise within neuromuscular clinics.
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Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Reshma Amin
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Laura McAdam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | - Toni Lui
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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11
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Evidence of muscle loss delay and improvement of hyperinsulinemia and insulin resistance in Duchenne muscular dystrophy supplemented with omega-3 fatty acids: A randomized study. Clin Nutr 2019; 38:2087-2097. [DOI: 10.1016/j.clnu.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/15/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022]
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12
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Assessment of muscle involvement in patients with Duchenne muscular dystrophy via segmental multifrequency bioelectrical analysis. Neuromuscul Disord 2019; 29:671-677. [PMID: 31501001 DOI: 10.1016/j.nmd.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
Abstract
We investigated the usefulness of segmental multifrequency bioelectrical impedance analyses (MBIA) for assessing muscle involvement in Duchenne muscular dystrophy (DMD) patients. Bioelectrical impedance data of the upper arm, thigh, and lower leg were obtained from 29 boys with DMD (ages 2-17 years old; mean 10.8 ± 3.9 years) at three institutions along with 41 healthy controls (ages 3-16; mean 9.8 ± 3.5 years). Then the muscle density index (MDI: 1- Z250/Z5) was calculated using segmental MBIA and compared between groups. The MDI was lower in boys with DMD, relative to controls, with older DMD patients exhibiting a significant decrease in MDI. The MDI of patient thighs was significantly correlated with the percent muscle volume index (%MVI), as measured using computed tomography (r = 0.79). MDI values for the upper arm, thigh, and lower leg were all significantly correlated with the Brooke and the Vignos scales, respectively, with correlation coefficients of 0.56-0.77. Finally, MDI was significantly greater in the glucocorticoid-treated group, relative to the untreated group in all regions. Taken together, these data show that segmental MBIA is feasible for evaluating muscle involvement and might serve as an outcome measure in DMD.
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Ellegård L, Aldenbratt A, Svensson MK, Lindberg C. Body composition in patients with primary neuromuscular disease assessed by dual energy X-ray absorptiometry (DXA) and three different bioimpedance devices. Clin Nutr ESPEN 2019; 29:142-148. [PMID: 30661678 DOI: 10.1016/j.clnesp.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with primary neuromuscular disease have reduced muscle mass, and use of body mass index to assess nutritional status and body composition can therefore be questioned. Dual emission X-ray absorptiometry (DXA) can estimate muscle mass, but is not always readily available. Bioimpedance is a simple, portable and "easy to use" method for the assessment of body composition. OBJECTIVES To assess muscle mass by DXA in 143 patients with primary neuromuscular disease and validate three bioimpedance devices; Impedimed SFB7, (BISIMPEDIMED), Xitron4200 (BISXITRON) and Tanita MC180MA (MFBIATANITA). METHODS Body composition was assessed by DXA in 143, by BISIMPEDIMED in 116, by MFBIATANITA in 104 and by BISXITRON in 35 patients. RESULTS Muscle mass assessed by DXA, and phase angle (PhA) were below reference values in all female and 96% of male patients. BISIMPEDIMED underestimated muscle mass by 6.5 ± 14.2 kg (p < 0.001), but this could be corrected after exclusion of resistance (Ri) values > 3500 Ohm (p = 0.84). MFBIATANITA overestimated muscle mass by 30.8 ± 9.1 kg (p < 0.001) with systematic bias, whereas BISXITRON was in agreement with DXA, and without systematic bias. Muscle mass was strongly correlated to PhA (rPEARSON = 0.75, p < 0.01). CONCLUSION Patients with primary neuromuscular disease have proportionally more fat and less muscle mass than the population in general, despite normal BMI. Muscle mass can be assessed by bioimpedance in these patients, but performance and bias depends on device. Phase angle by bioimpedance correlates to muscle mass, and could therefore potentially be used a surrogate measure of muscle mass during follow up.
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Affiliation(s)
- L Ellegård
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - A Aldenbratt
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - C Lindberg
- Department of Neurology, Neuromuscular Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bernabe-García M, Rodríguez-Cruz M, Atilano S, Cruz-Guzmán ODR, Almeida-Becerril T, Calder PC, González J. Body composition and body mass index in Duchenne muscular dystrophy: Role of dietary intake. Muscle Nerve 2018; 59:295-302. [PMID: 30194761 DOI: 10.1002/mus.26340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In Duchenne muscular dystrophy (DMD) muscle is replaced by adipose tissue. The role of dietary intake (DI) in DMD has not been evaluated. In this study we examined body composition, body mass index (BMI), and adequacy of DI in patients with DMD and evaluated the influence of DI on body composition. METHODS Patients (n = 101; age 3-18 years; BMI 11.8-29.5 kg/m2 ) completed a dietary recall to determine DI and then underwent dual-energy X-ray absorptiometry to determine body composition. RESULTS Preschool-age and school-age boys with DMD had high total energy intake. Protein intake per kilogram exceeded recommendations. As age increased, the percentage of boys with abnormal BMI and fat mass increased, while lean mass decreased. Dietary intake did not predict body fat or lean mass. DISCUSSION Age-dependent changes in BD in boys with DMD may be due to endogenous metabolic factors related to the underlying disease process and to disease-related mobility impairments. Muscle Nerve 59:295-302, 2019.
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Affiliation(s)
- Mariela Bernabe-García
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc No. 330, Col. Doctores, Delegación Cuauhtémoc, 06725, Ciudad de México, México
| | - Maricela Rodríguez-Cruz
- Laboratorio de Nutrición Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Salvador Atilano
- Laboratorio de Nutrición Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Oriana Del Rocío Cruz-Guzmán
- Laboratorio de Nutrición Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Tomás Almeida-Becerril
- Laboratorio de Nutrición Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Julia González
- Laboratorio de Nutrición Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Morse CI, Bostock EL, Twiss HM, Kapp LH, Orme P, Jacques MF. The cardiorespiratory response and physiological determinants of the assisted 6-minute handbike cycle test in adult males with muscular dystrophy. Muscle Nerve 2018; 58:427-433. [PMID: 29669172 PMCID: PMC6175197 DOI: 10.1002/mus.26146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The assisted 6-minute cycle test (A6MCT) distance was assessed in adults with muscular dystrophy (MD). METHODS Forty-eight males, including those with Duchenne MD (DMD), limb-girdle MD (LGMD), fascioscapulohumeral MD (FSHD), and Becker MD (BMD), as well as a group without MD (CTRL), completed handgrip strength (HGS), lung function [forced expiratory volume in 1 second (FEV1 ) and forced vital capacity (FVC)], body fat, and biceps thickness assessments. During the A6MCT, ventilation (VE), oxygen uptake (VO2 ), carbon dioxide (VCO2 ), and heart rate (HR) were recorded. RESULTS A6MCT and HGS were lower in MD than CTRL subjects. FEV1 , FVC, and biceps thickness were lower in MD than CTRL; lower in DMD than BMD, LGMD, and FSHD; but were not different between BMD, LGMD, and FSHD. A6MCT correlated with HGS, FEV1 , FVC, body fat, VO2 , VCO2 , HR, and VE (r = 0.455-0.708) in pooled BMD, LGMD, and FSHD participants. DISCUSSION A shorter A6MCT distance in adult males with MD was attributable to HGS and lung function. The A6MCT is appropriate for assessment of physical function in adults with MD. Muscle Nerve 58: 427-433, 2018.
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Affiliation(s)
- Christopher I. Morse
- Health, Exercise and Active Living Research Centre, Department of Sport and Exercise SciencesManchester Metropolitan University CheshireCreweCW1 5DUUK
| | - Emma L. Bostock
- Health, Exercise and Active Living Research Centre, Department of Sport and Exercise SciencesManchester Metropolitan University CheshireCreweCW1 5DUUK
| | - Harriet M. Twiss
- Health, Exercise and Active Living Research Centre, Department of Sport and Exercise SciencesManchester Metropolitan University CheshireCreweCW1 5DUUK
| | - Laura H. Kapp
- Health, Exercise and Active Living Research Centre, Department of Sport and Exercise SciencesManchester Metropolitan University CheshireCreweCW1 5DUUK
| | - Paul Orme
- The Neuromuscular CentreWinsfordCheshireUK
| | - Matthew F. Jacques
- Health, Exercise and Active Living Research Centre, Department of Sport and Exercise SciencesManchester Metropolitan University CheshireCreweCW1 5DUUK
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Nutrition in Duchenne muscular dystrophy 16–18 March 2018, Zaandam, the Netherlands. Neuromuscul Disord 2018; 28:680-689. [DOI: 10.1016/j.nmd.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
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Roumelioti ME, Glew RH, Khitan ZJ, Rondon-Berrios H, Argyropoulos CP, Malhotra D, Raj DS, Agaba EI, Rohrscheib M, Murata GH, Shapiro JI, Tzamaloukas AH. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018; 7:1-28. [PMID: 29359117 PMCID: PMC5760509 DOI: 10.5527/wjn.v7.i1.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Robert H Glew
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan Edwards School of Medicine, Marshall University, Huntington, WV 25701, United States
| | - Helbert Rondon-Berrios
- Division of Renal and Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Dominic S Raj
- Division of Renal Disease and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Emmanuel I Agaba
- Division of Nephology, Department of Medicine, Jos University Medical Center, Jos, Plateau State 930001, Nigeria
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Glen H Murata
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
| | | | - Antonios H Tzamaloukas
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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Chula de Castro JA, Lima TRD, Silva DAS. Body composition estimation in children and adolescents by bioelectrical impedance analysis: A systematic review. J Bodyw Mov Ther 2017; 22:134-146. [PMID: 29332738 DOI: 10.1016/j.jbmt.2017.04.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/06/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) has commonly been used to assess the body composition of children and adolescents. BIA validation studies have found distinct correlation values with reference methods. OBJECTIVES To assess the reproducibility, correlation and mean differences in body composition estimated by BIA and reference methods, we systematically reviewed the literature in the pediatric population. METHOD The search for articles was conducted in March 2016 and was limited to articles published from 2005 to 2015 in the PubMed, Embase, EBSCO, Web of Science, Scopus and SciELO databases. Two reviewers independently performed data selection and extraction of studies that investigated the BIA validity, responsiveness, reliability and/or measurement error (reproducibility) to estimate body composition in children and adolescents with an average age ≤ 18 years. RESULTS The search produced 48 articles. Almost perfect reproducibility was found in the body fat percentage estimated by BIA, and there was almost perfect correlation between the BIA ratings and reference methods for fat mass and fat-free mass. Regarding component estimates, BIA underestimated the fat mass in both sexes. CONCLUSIONS The body fat percentage estimated by BIA exhibited almost perfect reproducibility. The fat mass and fat-free mass estimated by BIA correlated almost perfectly with the reference methods in both sexes. BIA underestimated the fat mass in both sexes.
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Affiliation(s)
- João Antônio Chula de Castro
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil.
| | - Tiago Rodrigues de Lima
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil
| | - Diego Augusto Santos Silva
- Universidade Federal de Santa Catarina, Centro de Desportos, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano, Florianópolis, Santa Catarina, Brazil
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Jacques MF, Orme P, Smith J, Morse CI. Resting Energy Expenditure in Adults with Becker's Muscular Dystrophy. PLoS One 2017; 12:e0169848. [PMID: 28060911 PMCID: PMC5218559 DOI: 10.1371/journal.pone.0169848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/23/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was: 1) To compare Resting energy expenditure (REE) in adult males with Becker's Muscular Dystrophy (BeMD, n = 21, 39 ±12 years) and healthy controls (CTRL, n = 12, 37 ±12 years) 2) Determine whether other physiological parameters correlate with REE in BeMD, and 3) Compare current prediction methods of REE with measured REE. METHODS REE was calculated via indirect calorimetry using continuous, expired gas analysis following an overnight fast. Fat free mass (FFM) and fat mass were measured by bioelectrical impedance. B-mode ultrasound measured Tibialis Anterior (TA) and Gastrocnemius Medialis (GM) anatomical cross sectional area (ACSA). The Bone Specific Physical Activity Questionnaire measured physical activity. RESULTS No difference in REE was found between CTRL and BeMD groups (1913 ±203 & 1786 ±324 Kcal respectively). Other physiological comparisons showed increased fat mass (+54%), decreased TA ACSA (-42%), increased GM ACSA (+25%) as well as reduced respiratory function (FVC -28%; FEV1-27%) in BeMD adults compared to controls. REE estimated from prediction equations (Schofield's) in Muscular Dystrophy were different from measured REE (P<0.05, bias = -728kcal), while the Mifflin equation was no different from measured REE (r2 = 0.58, Bias = -8kcal). Within the present BeMD, REE predicted from FFM (REE = FFM x 34.57-270; r2 = 0.85) and body mass (REE = BM x 15.65 + 421.5; r2 = 0.66), were not different from measured REE (bias equals 0 and 0.2kcals, respectively). CONCLUSIONS Despite no differences in REE between CTRL and BeMD adults, increased fat masses highlights the requirement for explicit nutritional guidelines, as well as maintenance of physical activity levels, where possible. Prediction equations are frequently used in clinical settings, however these have been shown to be less accurate in BeMD; therefore, the equations proposed here should be used where possible.
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Affiliation(s)
- Matthew F. Jacques
- Health, Exercise & Active Living (HEAL) Research Centre, Manchester Metropolitan University, Cheshire Campus, Crewe, United Kingdom
| | - Paul Orme
- The Neuromuscular Centre, Winsford, Cheshire, United Kingdom
| | - Jonathon Smith
- The Neuromuscular Centre, Winsford, Cheshire, United Kingdom
| | - Christopher I. Morse
- Health, Exercise & Active Living (HEAL) Research Centre, Manchester Metropolitan University, Cheshire Campus, Crewe, United Kingdom
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Barja S, Pérez R. Clinical assessment underestimates fat mass and overestimates resting energy expenditure in children with neuromuscular diseases. Clin Nutr ESPEN 2016; 15:11-15. [DOI: 10.1016/j.clnesp.2016.03.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 01/22/2023]
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Chew K, Carey K, Ho G, Mallitt KA, Widger J, Farrar M. The relationship of body habitus and respiratory function in Duchenne muscular dystrophy. Respir Med 2016; 119:35-40. [DOI: 10.1016/j.rmed.2016.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/28/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
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Rodríguez-Cruz M, Cruz-Guzmán OR, Escobar RE, López-Alarcón M. Leptin and metabolic syndrome in patients with Duchenne/Becker muscular dystrophy. Acta Neurol Scand 2016; 133:253-60. [PMID: 26133644 DOI: 10.1111/ane.12450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether patients with Duchenne/Becker muscular dystrophy (DMD/BMD) have components of metabolic syndrome (MetSy) and to evaluate whether leptin is associated with components of MetSy. METHODS This study included 78 patients (nine, <6 years of age; 54, 6 to <16 years of age; and 15 patients, ≥16 years of age). Obesity and body fat mass were determined by waist circumference and dual-energy X-ray absorptiometry, respectively. A 12-h fasting blood sample was collected in the morning. Patients were categorized into four groups according to the number of criteria for MetSy: group 0: none; group 1: one; group 2: two and group 3: three or more criteria. RESULTS All age groups showed components of MetSy. The concentration of these components was significantly higher in patients ≥16 years old. The prevalence of hypertriglyceridemia was from ~37% to 46% in all age groups. The prevalence of MetSy was 7.1% for patients from 6 to <16 years of age and 24% for patients ≥16 years of age. Serum leptin levels increased significantly (P < 0.05) with age; the highest (13.43 ± 9.4 ng/ml) value was observed in patients >16 years of age. Total leptin was correlated with the number of patients with MetSy (r = 0.383; P = 0.001). CONCLUSIONS Components of MetSy are significant in patients with DMD/BMD. A high prevalence of hypertriglyceridemia was observed. Younger patients with DMD/BMD have risk factors for MetSy. Although leptin increased according to different degrees of MetSy, this relation disappeared when the body fat was corrected by leptin; therefore, the association could be caused by a common risk factor-fat.
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Affiliation(s)
- M. Rodríguez-Cruz
- Laboratorio de Biología Molecular; Unidad de Investigación Médica en Nutrición; Hospital de Pediatría; Centro Médico Nacional Siglo XXI; IMSS; México D.F. México
| | - O. R. Cruz-Guzmán
- Laboratorio de Biología Molecular; Unidad de Investigación Médica en Nutrición; Hospital de Pediatría; Centro Médico Nacional Siglo XXI; IMSS; México D.F. México
| | - R. E. Escobar
- Servicio de Electrodiagnóstico y Distrofia Muscular; Instituto Nacional de la Rehabilitación; México D.F. México
| | - M. López-Alarcón
- Laboratorio de Biología Molecular; Unidad de Investigación Médica en Nutrición; Hospital de Pediatría; Centro Médico Nacional Siglo XXI; IMSS; México D.F. México
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Green tea supplementation benefits body composition and improves bone properties in obese female rats fed with high-fat diet and caloric restricted diet. Nutr Res 2015; 35:1095-105. [PMID: 26525915 DOI: 10.1016/j.nutres.2015.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/15/2022]
Abstract
This study investigated the effects of green tea polyphenols (GTP) supplementation on body composition, bone properties, and serum markers in obese rats fed a high-fat diet (HFD) or a caloric restricted diet (CRD). Forty-eight female rats were fed an HFD ad libitum for 4 months, and then either continued on the HFD or the CRD with or without 0.5% GTP in water. Body composition, bone efficacy, and serum markers were measured. We hypothesized that GTP supplementation would improve body composition, mitigate bone loss, and restore bone microstructure in obese animals fed either HFD or CRD. CRD lowered percent fat mass; bone mass and trabecular number of tibia, femur and lumbar vertebrae; femoral strength; trabecular and cortical thickness of tibia; insulin-like growth factor-I and leptin. CRD also increased percent fat-free mass; trabecular separation of tibia and femur; eroded surface of tibia; bone formation rate and erosion rate at tibia shaft; and adiponectin. GTP supplementation increased femoral mass and strength (P = .026), trabecular thickness (P = .012) and number (P = .019), and cortical thickness of tibia (P < .001), and decreased trabecular separation (P = .021), formation rate (P < .001), and eroded surface (P < .001) at proximal tibia, and insulin-like growth factor-I and leptin. There were significant interactions (diet type × GTP) on osteoblast surface/bone surface, mineral apposition rate at periosteal and endocortical bones, periosteal bone formation rate, and trabecular thickness at femur and lumbar vertebrate (P < .05). This study demonstrates that GTP supplementation for 4 months benefited body composition and improved bone microstructure and strength in obese rats fed with HFD or HFD followed by CRD diet.
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Canapari CA, Barrowman N, Hoey L, Walker SW, Townsend E, Tseng BS, Katz SL. Truncal fat distribution correlates with decreased vital capacity in Duchenne muscular dystrophy. Pediatr Pulmonol 2015; 50:63-70. [PMID: 24644236 DOI: 10.1002/ppul.23004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder associated with progressive muscle weakness and respiratory failure. Oral corticosteroids are the mainstay of treatment, but are associated with obesity with a central distribution. This study is designed to determine the relationship between body mass index, central adiposity, and lung function in subjects with DMD. METHODS Retrospective fat distribution data was obtained in boys with DMD from studies using dual X-ray absorptiometry (DXA). Fat distribution data was reviewed at two tertiary academic institutions and compared with concurrent height, weight, body mass index (BMI), measures of lung function, and sleep study data when available. Truncal fat mass used as a measure of central adiposity. RESULTS Forty-four subjects (age 12.0 ± 3.4 years) were included. Mean BMI was 22.1 ± 5.9 kg/m(2) . Sixty-eight percent (30 patients) were on corticosteroid therapy. Truncal fat mass percentage was inversely correlated with forced vital capacity (% predicted FVC) (Pearson coefficient -0.37, P = 0.01). Linear regression showed that truncal fat distribution, but not total fat mass, age or corticosteroid use negatively predicted FVC (r(2) = 0.24, P = 0.048). BMI had a positive effect (P = 0.04). However, fat distribution did not predict the rate of change of lung function in a smaller sample. Fat distribution, BMI, or age did not predict measures of sleep disordered breathing. CONCLUSIONS Truncal fat distribution is a significant predictor of lower vital capacity in boys with DMD, whereas BMI has a positive effect.
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Affiliation(s)
- Craig A Canapari
- Yale New Haven Children's Hospital, Yale University, New Haven, Connecticut
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Elliott SA, Davidson ZE, Davies PSW, Truby H. A bedside measure of body composition in Duchenne muscular dystrophy. Pediatr Neurol 2015; 52:82-7. [PMID: 25301226 DOI: 10.1016/j.pediatrneurol.2014.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/28/2014] [Accepted: 08/06/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND In clinical practice, monitoring body composition is a critical component of nutritional assessment and weight management in boys with Duchenne muscular dystrophy. We aimed to evaluate the accuracy of a simple bedside measurement tool for body composition, namely bioelectrical impedance analysis, in boys with Duchenne muscular dystrophy. METHODS Measures of fat-free mass were determined using a bioelectrical impedance analysis machine and compared against estimations obtained from a reference body composition model. Additionally, the use of raw impedance values was analyzed using three existing predictive equations for the estimation of fat-free mass. Accuracy of bioelectrical impedance analysis was assessed by comparison against the reference model by calculation of biases and limits of agreement. RESULTS Body composition was measured in 10 boys with Duchenne muscular dystrophy, mean age 9.01 ± 2.34 years. The bioelectrical impedance analysis machine values of fat-free mass were on average 2.3 ± 14.1 kg higher than reference values. Limits of agreement (based on 95% confidence interval of the mean) were -7.4 to 2.9 kg. There was a significant correlation between the mean fat-free mass and difference in fat-free mass between the bioelectrical impedance analysis machine and the reference model (r = -0.86; P = 0.02) suggesting that the bias was not consistent across the range of measurements. The most accurate predictive equation for the estimation of fat-free mass using raw impedance values was the equation by Pietrobelli et al. (mean difference, -0.7 kg; 95% limits of agreement, -3.5 to 2.0 kg). CONCLUSIONS In a clinical setting, where a rapid assessment of body composition is advantageous, the use of raw impedance values, combined with the equation by Pietrobelli et al., is recommended for the accurate estimation of fat-free mass, in boys with Duchenne muscular dystrophy.
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Affiliation(s)
- Sarah A Elliott
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Zoe E Davidson
- Department of Nutrition and Dietetics, Southern Clinical School, Monash University, Clayton, Victoria, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Helen Truby
- Department of Nutrition and Dietetics, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
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Rodríguez-Cruz M, Sanchez R, Escobar RE, Cruz-Guzmán ODR, López-Alarcón M, Bernabe García M, Coral-Vázquez R, Matute G, Velázquez Wong AC. Evidence of Insulin Resistance and Other Metabolic Alterations in Boys with Duchenne or Becker Muscular Dystrophy. Int J Endocrinol 2015; 2015:867273. [PMID: 26089900 PMCID: PMC4452344 DOI: 10.1155/2015/867273] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 01/29/2023] Open
Abstract
Aim. Our aim was (1) to determine the frequency of insulin resistance (IR) in patients with Duchenne/Becker muscular dystrophy (DMD/BMD), (2) to identify deleted exons of DMD gene associated with obesity and IR, and (3) to explore some likely molecular mechanisms leading to IR. Materials and Methods. In 66 patients with DMD/BMD without corticosteroids treatment, IR, obesity, and body fat mass were evaluated. Molecules involved in glucose metabolism were analyzed in muscle biopsies. Results show that 18.3%, 22.7%, and 68% were underweight, overweight, or obese, and with high adiposity, respectively; 48.5% and 36.4% presented hyperinsulinemia and IR, respectively. Underweight patients (27.3%) exhibited hyperinsulinemia and IR. Carriers of deletions in exons 45 (OR = 9.32; 95% CI = 1.16-74.69) and 50 (OR = 8.73; 95% CI = 1.17-65.10) from DMD gene presented higher risk for IR than noncarriers. We observed a greater staining of cytoplasmic aggregates for GLUT4 in muscle biopsies than healthy muscle tissue. Conclusion. Obesity, hyperinsulinemia, and IR were observed in DMD/BMD patients and are independent of corticosteroids treatment. Carriers of deletion in exons 45 or 50 from DMD gene are at risk for developing IR. It is suggested that alteration in GLUT4 in muscle fibers from DMD patients could be involved in IR.
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Affiliation(s)
- Maricela Rodríguez-Cruz
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
- *Maricela Rodríguez-Cruz:
| | - Raúl Sanchez
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
| | - Rosa E. Escobar
- Servicio de Electrodiagnóstico y Distrofia Muscular, Instituto Nacional de la Rehabilitación, México, DF, Mexico
| | - Oriana del Rocío Cruz-Guzmán
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
| | - Mardia López-Alarcón
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
| | - Mariela Bernabe García
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
| | - Ramón Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Delegación Miguel Hidalgo, 11340 México City, Mexico
- Subdirección de Enseñanza e Investigación, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502 (2 Piso), Colonia Del Valle, Delegación Benito Juárez, 03100 México City, Mexico
| | - Guadalupe Matute
- Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Apartado Postal C-029 C. S.P.I. “Coahuila”, Coahuila No. 5, Colonia Roma, 06703 México, DF, Mexico
| | - Ana Claudia Velázquez Wong
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, México, DF, Mexico
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King WM, Kissel JT, Visy D, Goel PK, Matkovic V. Skeletal health in Duchenne dystrophy: Bone-size and subcranial dual-energy X-ray absorptiometry analyses. Muscle Nerve 2014; 49:512-9. [DOI: 10.1002/mus.23963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/02/2012] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Wendy M. King
- Department of Neurology; Wexner Medical Center, The Ohio State University; 395 West 12th Avenue Columbus Ohio 43210 USA
| | - John T. Kissel
- Department of Neurology; Wexner Medical Center, The Ohio State University; 395 West 12th Avenue Columbus Ohio 43210 USA
| | - Diane Visy
- Bone and Mineral Metabolism Laboratory; Department of PM&R, The Ohio State University; Columbus Ohio USA
| | - Prem K. Goel
- Department of Statistics; The Ohio State University; Columbus Ohio USA
| | - Velimir Matkovic
- Bone and Mineral Metabolism Laboratory; Department of PM&R, The Ohio State University; Columbus Ohio USA
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West NA, Yang ML, Weitzenkamp DA, Andrews J, Meaney FJ, Oleszek J, Miller LA, Matthews D, DiGuiseppi C. Patterns of growth in ambulatory males with Duchenne muscular dystrophy. J Pediatr 2013; 163:1759-1763.e1. [PMID: 24103921 DOI: 10.1016/j.jpeds.2013.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/31/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide weight-for-age, height-for-age, and body mass index-for-age growth reference standards for ambulatory, steroid-naïve males, ages 2-12 years, with Duchenne muscular dystrophy (DMD) and to compare these growth curves to the 2000 Centers for Disease Control and Prevention growth charts for boys, which serve as references of physical size and growth for the general male pediatric population in the US. STUDY DESIGN Through a multi-state population-based surveillance of individuals with muscular dystrophy, a total of 1877 weight and 1544 height measurements ascertained during 1985-2010 from 513 males with DMD were obtained retrospectively from medical record review. Cases were classified as DMD if loss of ambulation occurred before the 12th birthday or, if younger than 12 years and still ambulating, the earliest symptoms of dystrophinopathy occurred before the 6th birthday. Each growth chart was constructed using 5 percentiles: 10th, 25th, 50th, 75th, and 90th. Smoothing procedures were applied in 2 stages to the irregular plots of the empirical percentile values. RESULTS A set of growth curves, derived from a large cohort of male youth with DMD, are presented. These curves demonstrate that DMD males are shorter and tend to the extremes of weight and body mass index compared with the general male pediatric population in the US. CONCLUSION Charts representing the pattern of growth in ambulatory, steroid-naïve males with DMD can facilitate monitoring of growth and early detection of unusual growth patterns. Use of these growth standards also will assist in monitoring responses to corticosteroid treatment.
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Affiliation(s)
- Nancy A West
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
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Talma H, Chinapaw MJM, Bakker B, HiraSing RA, Terwee CB, Altenburg TM. Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error. Obes Rev 2013; 14:895-905. [PMID: 23848977 DOI: 10.1111/obr.12061] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 12/21/2022]
Abstract
Bioelectrical impedance analysis (BIA) is a practical method to estimate percentage body fat (%BF). In this systematic review, we aimed to assess validity, responsiveness, reliability and measurement error of BIA methods in estimating %BF in children and adolescents.We searched for relevant studies in Pubmed, Embase and Cochrane through November 2012. Two reviewers independently screened titles and abstracts for inclusion, extracted data and rated methodological quality of the included studies. We performed a best evidence synthesis to synthesize the results, thereby excluding studies of poor quality. We included 50 published studies. Mean differences between BIA and reference methods (gold standard [criterion validity] and convergent measures of body composition [convergent validity]) were considerable and ranged from negative to positive values, resulting in conflicting evidence for criterion validity. We found strong evidence for a good reliability, i.e. (intra-class) correlations ≥0.82. However, test-retest mean differences ranged from 7.5% to 13.4% of total %BF in the included study samples, indicating considerable measurement error. Our systematic review suggests that BIA is a practical method to estimate %BF in children and adolescents. However, validity and measurement error are not satisfactory.
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Affiliation(s)
- H Talma
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Shen CL, Zhu W, Gao W, Wang S, Chen L, Chyu MC. Energy-restricted diet benefits body composition but degrades bone integrity in middle-aged obese female rats. Nutr Res 2013; 33:668-76. [DOI: 10.1016/j.nutres.2013.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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McDonald CM, Henricson EK, Abresch RT, Han JJ, Escolar DM, Florence JM, Duong T, Arrieta A, Clemens PR, Hoffman EP, Cnaan A. The cooperative international neuromuscular research group Duchenne natural history study--a longitudinal investigation in the era of glucocorticoid therapy: design of protocol and the methods used. Muscle Nerve 2013; 48:32-54. [PMID: 23677550 PMCID: PMC4147958 DOI: 10.1002/mus.23807] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 12/21/2022]
Abstract
UNLABELLED Contemporary natural history data in Duchenne muscular dystrophy (DMD) is needed to assess care recommendations and aid in planning future trials. METHODS The Cooperative International Neuromuscular Research Group (CINRG) DMD Natural History Study (DMD-NHS) enrolled 340 individuals, aged 2-28 years, with DMD in a longitudinal, observational study at 20 centers. Assessments obtained every 3 months for 1 year, at 18 months, and annually thereafter included: clinical history; anthropometrics; goniometry; manual muscle testing; quantitative muscle strength; timed function tests; pulmonary function; and patient-reported outcomes/health-related quality-of-life instruments. RESULTS Glucocorticoid (GC) use at baseline was 62% present, 14% past, and 24% GC-naive. In those ≥6 years of age, 16% lost ambulation over the first 12 months (mean age 10.8 years). CONCLUSIONS Detailed information on the study methodology of the CINRG DMD-NHS lays the groundwork for future analyses of prospective longitudinal natural history data. These data will assist investigators in designing clinical trials of novel therapeutics.
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Affiliation(s)
- Craig M McDonald
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of California, Davis, 4860 Y Street, Suite 3850, Sacramento, California 95817, USA.
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Bayram E, Topcu Y, Karakaya P, Bayram MT, Sahin E, Gunduz N, Yis U, Peker O, Kurul SH. Correlation between motor performance scales, body composition, and anthropometry in patients with Duchenne muscular dystrophy. Acta Neurol Belg 2013; 113:133-7. [PMID: 22975832 DOI: 10.1007/s13760-012-0125-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/08/2012] [Indexed: 12/21/2022]
Abstract
The aim of this study is to investigate the relationship between body composition, anthropometry, and motor scales in patients with Duchenne muscular dystrophy (DMD). Twenty six patients with DMD were evaluated by Expanded Hammersmith Functional Motor Scale (HFMSE), gross motor function classification system (GMFCS), multifrequency bioelectrical impedance analysis, and anthropometric measurements. Seventeen healthy children served as control group. There were 26 patients with a mean age of 9.5 ± 4.8 years. Ages and anthropometric measurements did not differ between groups. Of the 26 patients, nine were level I, seven were level II, two were level III, seven were level IV, and one was level V, according to the GMFCS. Despite the similar percentage of total body water, extracellular water/intracellular water ratio was significantly elevated in DMD patients (p = 0.001). Increased values of fat percentage and body fat mass index (BFMI) correlated positively with elevated GMFCS levels (r = 0.785 and 0.719 respectively). Increased fat-free mass index (FFMI) correlated negatively with elevated GMFCS levels (r = -0.401). Increased fat percentage and BFMI correlated negatively with HFMSE scores (r = -0.779 and -0.698, respectively). Increased values of FFMI correlated positively with HFMSE scores. There was also a negative correlation between increased skin fold measurements from triceps and scapula and HFMSE scores (r = -0.618 and -0.683, respectively). Increased skin fold values from the same regions correlated positively with elevated GMFCS levels (r = 0.643 and 0.712, respectively). Significant body composition changes occur in patients with DMD. Anthropometric and multifrequency bioelectrical impedance analyses measurements show good correlation between motor function scales. These results may also be helpful to evaluate the effects of new treatment strategies.
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Shen CL, Cao JJ, Dagda RY, Chanjaplammootil S, Lu C, Chyu MC, Gao W, Wang JS, Yeh JK. Green tea polyphenols benefits body composition and improves bone quality in long-term high-fat diet-induced obese rats. Nutr Res 2012; 32:448-57. [PMID: 22749181 DOI: 10.1016/j.nutres.2012.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 12/11/2022]
Abstract
This study investigates the effects of green tea polyphenols (GTPs) on body composition and bone properties along with mechanisms in obese female rats. Thirty-six 3-month-old Sprague Dawley female rats were fed either a low-fat (LF) or a high-fat (HF) diet for 4 months. Animals in the LF diet group continued on an LF diet for additional 4 months, whereas those in the HF diet group were divided into 2 groups: with GTP (0.5%) or without in drinking water, in addition to an HF diet for another 4 months. Body composition, femur bone mass and strength, serum endocrine and proinflammatory cytokines, and liver glutathione peroxidase (GPX) protein expression were determined. We hypothesized that supplementation of GTP in drinking water would benefit body composition, enhance bone quality, and suppress obesity-related endocrines in HF diet-induced obese female rats and that such changes are related to an elevation of antioxidant capacity and a reduction of proinflammatory cytokine production. After 8 months, compared with the LF diet, the HF diet increased percentage of fat mass and serum insulin-like growth factor I and leptin levels; reduced percentage of fat-free mass, bone strength, and GPX protein expression; but had no effect on bone mineral density and serum adiponectin levels in the rats. Green tea polyphenol supplementation increased percentage of fat-free mass, bone mineral density and strength, and GPX protein expression and decreased percentage of fat mass, serum insulin-like growth factor I, leptin, adiponectin, and proinflammatory cytokines in the obese rats. This study shows that GTP supplementation benefited body composition and bone properties in obese rats possibly through enhancing antioxidant capacity and suppressing inflammation.
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Affiliation(s)
- Chwan-Li Shen
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX 79430-8115, USA.
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Skalsky AJ, Han JJ, Abresch RT, McDonald CM. Regional and whole-body dual-energy X-ray absorptiometry to guide treatment and monitor disease progression in neuromuscular disease. Phys Med Rehabil Clin N Am 2011; 23:67-73, x. [PMID: 22239875 DOI: 10.1016/j.pmr.2011.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Dual-energy x-ray absorptiometry (DEXA) is a safe, noninvasive, inexpensive tool for managing patients with neuromuscular diseases. Regional and whole-body DEXA can be used to guide clinical treatments, such as determining body composition to guide nutritional recommendations, as well as to monitor disease progression by assessing regional and whole-body lean tissue mass. DEXA can also be used as an outcome measure for clinical trials.
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Affiliation(s)
- Andrew J Skalsky
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital and Health Center, San Diego, CA 92123, USA.
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Sproule DM, Montgomery MJ, Punyanitya M, Shen W, Dashnaw S, Montes J, Dunaway S, Finkel R, Darras B, Vivo DCD, Kaufmann P. Thigh muscle volume measured by magnetic resonance imaging is stable over a 6-month interval in spinal muscular atrophy. J Child Neurol 2011; 26:1252-9. [PMID: 21572051 DOI: 10.1177/0883073811405053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Changes in thigh muscle volume over 6 months were assessed using magnetic resonance imaging in 11 subjects aged 6 to 47 years with spinal muscular atrophy (4 type 2 and 7 type 3; 4 ambulatory and 3 nonambulatory). Muscle volume with normal and abnormal signal was measured using blinded, semiautomated analysis of reconstructed data. Volumes at baseline and 6 months were correlated with clinical function at each epoch. There was minimal increase in normal (0.3 ± 1.4 mL/cm) and total (0.1 ± 1.3 mL/cm) muscle. Muscle volume correlated closely with clinical function. Minimal interval change in muscle volume is consistent with the established clinical history of minimal disease progression over intervals shorter than 1 year. Relative constancy of muscle volume estimation and correlation with established functional measures suggest a role for segmental magnetic resonance imaging as a biomarker of treatment effect in future therapeutic trials.
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Affiliation(s)
- Douglas M Sproule
- Division of Pediatric Neurosciences, Department of Neurology, SMA Clinical Research Center, Columbia University Medical Center, New York, NY 10032-3791, USA.
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Nosek MA, Robinson-Whelen S, Hughes RB, Petersen NJ, Taylor HB, Byrne MM, Morgan R. Overweight and obesity in women with physical disabilities: associations with demographic and disability characteristics and secondary conditions. Disabil Health J 2011; 1:89-98. [PMID: 21122716 DOI: 10.1016/j.dhjo.2008.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 04/09/2007] [Accepted: 07/13/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND This cross-sectional study was designed to examine weight in association with demographic and disability characteristics and secondary conditions in a sample of community living women with physical disabilities. METHODS 443 predominantly ethnic minority women with physical disabilities were recruited through public and private health clinics and community organizations. They completed questionnaires including measures of body mass index and a health conditions checklist. RESULTS Data showed that nearly three-quarters of the sample were overweight (26.6%) or obese (47.6%) with 14% extremely obese. Obesity was highest among middle aged women (aged 45-54, 52.7%; aged 55-64, 52.5%; compared to aged 18-44, 37.8%; or aged ≥65, 39.1%). Black (84.0%) and Hispanic women (83.8%) were more likely to be overweight or obese compared to non-Hispanic white women (56.7%). Women with joint and connective tissue diseases and women with more extensive functional limitations were more likely to have excess weight. Disability factors were more strongly associated with excess weight than demographic factors other than age. Weight classification was significantly related to whether or not the women had ever had diabetes or blood pressure problems. Diabetes was reported 4 times as often as among women in general (36.3% versus 8.9%), and hypertension nearly twice as often (56.2% versus 30.9%). CONCLUSIONS These findings indicate extremely high rates of overweight and obesity in women with physical disabilities, a growing population greatly in need of effective weight management interventions. Overweight and obesity in combination with disability in women was associated with disproportionately high rates of diabetes and hypertension.
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Affiliation(s)
- Margaret A Nosek
- Center for Research on Women with Disabilities, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
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Sproule DM, Punyanitya M, Shen W, Dashnaw S, Martens B, Montgomery M, Montes J, Battista V, Finkel R, Darras B, De Vivo DC, Kaufmann P. Muscle volume estimation by magnetic resonance imaging in spinal muscular atrophy. J Child Neurol 2011; 26:309-17. [PMID: 20929908 DOI: 10.1177/0883073810380457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thigh muscle volume was assessed using magnetic resonance imaging in 16 subjects with spinal muscular atrophy. Scans were successful for 14 of 16 subjects (1 type 1, 6 type 2, and 7 type 3) as young as 5.7 years. Muscle volume with normal and abnormal signal was measured using blinded, semiautomated analysis of reconstructed data. Results were compared with segmental lean mass estimated by dual-energy X-ray absorptiometry and correlated with clinical and electrophysiological measures of disease severity. Muscle volume was reduced with abnormal signal quality. Test-retest reliability (r = .99) and correlation with dual-energy X-ray absorptiometry (r = .91) were excellent. Type 2 subjects had lower volume (3.5 ± 1.6 vs 6.3 ± 2.8 mL/cm height; P = .06) and higher percentage of muscle with abnormal signal (68% ± 20% vs 47% ± 27%; P = .14) than type 3. Reproducibility, tolerability, and strong correlation with clinical measures make magnetic resonance imaging a candidate biomarker for clinical research.
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Affiliation(s)
- Douglas M Sproule
- Division of Pediatric Neurosciences, Department of Neurology, SMA Clinical Research Center, Columbia University Medical Center, New York, New York 10032-3791, USA.
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Sproule DM, Montes J, Dunaway SL, Montgomery M, Battista V, Shen W, Punyanitya M, De Vivo DC, Kaufmann P. Bioelectrical impedance analysis can be a useful screen for excess adiposity in spinal muscular atrophy. J Child Neurol 2010; 25:1348-54. [PMID: 20388937 DOI: 10.1177/0883073810365185] [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: 11/15/2022]
Abstract
Accurate, noninvasive measures of body composition are needed for management of patients with spinal muscular atrophy. Fat mass index (fat mass/height(2) in kg/m(2)) was measured in 16 subjects with spinal muscular atrophy using 5 bioelectrical impedance analysis equations and compared with a reference method, dual-energy x-ray absorptiometry. The machine default equation, validated by Cordain, was the primary analysis. Fat mass index calculated by impedance measures differed by between -2.5 kg/m(2) and 1.7 kg/m(2) from the reference mean (8.3 ± 5.0 kg/m(2)). The Cordain equation provided the smallest difference (-0.4 ± 2.0 kg/m(2)), with correlation coefficient of 0.92. The Cordain equation showed high sensitivity (85.7%) and specificity (100%) for prediction of ''at risk for overweight'' (fat mass index > 85th percentile for age and gender). Although insufficiently accurate for use as a research tool, bioelectrical impedance can have application as a well-tolerated, noninvasive, easily used screening tool for excess adiposity in patients with spinal muscular atrophy.
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Affiliation(s)
- Douglas M Sproule
- Division of Pediatric Neurosciences, Department of Neurology, SMA Clinical Research Center, Columbia University Medical Center, New York, New York 10032-3791, USA.
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Abstract
Major advances in the fields of medical science and physiology, molecular genetics, biomedical engineering, and computer science have provided individuals with muscular dystrophy (MD) with more functional equipment, allowing better strategies for improvement of quality of life. These advances have also allowed a significant number of these patients to live much longer. As progress continues to change management, it also changes patients' expectations. A comprehensive medical and rehabilitative approach to management of aging MD patients can often fulfill expectations and help them enjoy an enhanced quality of life.
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Caromano FA, Tanaka C, João SMA, Kamisaki AP, Yano KC, Ide MR. Correlação da massa e porcentagem de gordura com a idade na distrofia muscular de Duchenne. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: A Distrofia Muscular de Duchenne (DMD) é uma desordem genética, caracterizada pela perda progressiva e irreversível da musculatura esquelética. OBJETIVO: Este estudo objetiva correlacionar a porcentagem e a massa de gordura com a idade em pacientes com DMD. METODOLOGIA: Foram selecionados 68 indivíduos com idades entre 5 e 20 anos, com diagnóstico molecular de certeza para DMD, residentes na cidade de São Paulo. Todos foram submetidos à mensuração do peso e altura e também ao teste de análise de composição corporal com o uso da bioimpedância, no período da manhã, todas no mesmo dia. RESULTADOS E DISCUSSÃO: Os resultados foram analisados agrupando os indivíduos em quartis de idade e mostraram um índice de massa corpóreo (IMC) de 21 ± 8 kg/m². Assim, observou-se que, com a idade e o grau de sedentarismo imposto pela doença, houve um acúmulo de gordura corporal e perda de massa magra. CONCLUSÃO: São necessários mais estudos relacionados às características nutricionais desses indivíduos, para que se esclareçam melhor os efeitos da doença e da alimentação no ganho de porcentagem e massa de gordura.
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Mok E, Letellier G, Cuisset JM, Denjean A, Gottrand F, Hankard R. Assessing change in body composition in children with Duchenne muscular dystrophy: anthropometry and bioelectrical impedance analysis versus dual-energy X-ray absorptiometry. Clin Nutr 2010; 29:633-8. [PMID: 20427103 DOI: 10.1016/j.clnu.2010.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 02/24/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS To compare the ability of bioelectrical impedance analysis (BIA) and skinfold thickness (ST) measurements to estimate changes in body composition in Duchenne muscular dystrophy (DMD). METHODS A secondary analysis was performed on 26 ambulatory DMD boys aged 3-11 y selected for a randomised trial of glutamine supplementation. We assessed fat free mass (FFM) and percentage fat mass (%FM) by BIA (monofrequency (50kHz) unit), ST measurements and a criterion method, dual-energy X-ray absorptiometry (DXA), and repeated these measures 5 mo later at 3 outpatient clinical investigation centers in France. RESULTS When compared with DXA reference method, ST overestimated change in FFM (P<0.01), whereas BIA estimates did not differ from DXA. Concordance plots revealed that when compared with DXA, ST overestimated the increase in FFM (mean: 0.6 kg; 95% CI: 0.17 to 0.99) which led to an underestimation in %FM change (mean: -1.4%; 95% CI: -2.6 to -0.2), whereas BIA estimated change in FFM (mean: -0.05 kg; 95% CI: -0.39 to 0.29) and %FM (mean: 1.3%; 95% CI: -0.06 to 2.7) more accurately. CONCLUSIONS BIA method can be used to follow changes in nutritional status of ambulatory DMD children or to evaluate treatment efficacy.
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Affiliation(s)
- Elise Mok
- INSERM Centre D'Investigation Clinique 802, CHU de Poitiers, Poitiers, France
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Casteels K, Fieuws S, van Helvoirt M, Verpoorten C, Goemans N, Coudyzer W, Loeckx D, de Zegher F. Metformin therapy to reduce weight gain and visceral adiposity in children and adolescents with neurogenic or myogenic motor deficit. Pediatr Diabetes 2010; 11:61-9. [PMID: 19496972 DOI: 10.1111/j.1399-5448.2009.00512.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this randomized, placebo-controlled study was to explore the effect of metformin in children with a neurogenic or myogenic motor deficit, who are therefore prone to develop overweight, adiposity, and insulin resistance. Study participants (n = 42) had a mean age of 15.5 yr, a short stature (height -2.4 SD), a relatively high BMI (+1.7 SD), and a high body fat fraction (41.9% or +2.8 SD). Abdominal CT confirmed the high fat mass and disclosed a high fraction of visceral fat. As expected, insulin resistance was increased. As compared to placebo, metformin intake for 6 months exerted an insulin sensitizing effect and lowered weight (mean difference of 2 kg within 6 months, p = 0.007) and BMI (p = 0.016). Weight loss appeared to be primarily due to loss of visceral fat ( approximately 20% vs. placebo; p < 0.0001). Results were similar across diagnostic subgroups. In conclusion, metformin treatment for 6 months was associated with a rise in insulin sensitivity and with a reduction of visceral adiposity in children and adolescents with a primary muscle disorder or with a neural tube defect. These findings suggest that insulin resistance underpins, at least partly, the overweight and visceral adiposity of these patients, who are not necessarily obese.
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Skalsky AJ, Han JJ, Abresch RT, Shin CS, McDonald CM. Assessment of regional body composition with dual-energy X-ray absorptiometry in Duchenne muscular dystrophy: Correlation of regional lean mass and quantitative strength. Muscle Nerve 2009; 39:647-51. [DOI: 10.1002/mus.21212] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Palmieri B, Sblendorio V, Ferrari A, Pietrobelli A. Duchenne muscle activity evaluation and muscle function preservation: is it possible a prophylactic strategy? Obes Rev 2008; 9:121-39. [PMID: 18034791 DOI: 10.1111/j.1467-789x.2007.00423.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Duchenne muscular dystrophy yields pervasive and progressive muscle mass loss. In the current measures relating to the monitoring of disease progression the following are relevant (i): the type of scale used, (ii) the clinical significance of the attribute being measured and (iii) the mathematical properties of the data provided. The high prevalence of obesity at an early stage of this pathology could result not only from reduced physical activity, but also from low resting energy expenditure, abnormal nutrient utilization or overfeeding. This muscle weakness may be attenuated by regular low-intensity exercise. However, there is a critical lack of data to support appropriate exercise prescription. Because inappropriate activity may exacerbate the dystrophic process, a systematic analysis of muscle function to determine potential exercise load thresholds to avoid injury in dystrophic mice and dogs, and then in humans is recommended.
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Affiliation(s)
- B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.
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Dopler Nelson M, Widman LM, Abresch RT, Stanhope K, Havel PJ, Styne DM, McDonald CM. Metabolic syndrome in adolescents with spinal cord dysfunction. J Spinal Cord Med 2007; 30 Suppl 1:S127-39. [PMID: 17874698 PMCID: PMC2031992 DOI: 10.1080/10790268.2007.11754591] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of components of the metabolic syndrome in adolescents with spinal cord injury (SCI) and spina bifida (SB), and their associations with obesity in subjects with and without SCI and SB. METHODS Fifty-four subjects (20 SCI and 34 SB) age 11 to 20 years with mobility impairments from lower extremity paraparesis were recruited from a hospital-based clinic. Sixty able-bodied subjects who were oversampled for obesity served as controls (CTRL). Subjects were categorized as obese if their percent trunk fat measured by dual x-ray absorptiometry (DXA) was > 30.0% for males and > 35.0% for females. Ten SCI, 24 SB, and 19 CTRL subjects were classified as obese. Fasting serum samples were collected to determine serum glucose, insulin, and lipid concentrations. Metabolic syndrome was defined as having > or =3 of the following components: (a) obesity; (b) high-density lipoprotein (HDL) <45 mg/dL for males; <50 mg/dL for females; (c) triglycerides 2100 mg/dL; (d) systolic or diastolic blood pressure > or =95th percentile for age/ height/gender, and (e) insulin resistance determined by either fasting serum glucose 100-125 mg/dL; fasting insulin > or =20 microU /mL; or homeostasis model assessment of insulin resistance > or = 4.0. RESULTS Metabolic syndrome was identified in 32.4% of the SB group and 55% of the SCI group. Metabolic syndrome occurred at a significantly higher frequency in obese subjects (SB = 45.8%, SCI = 100%, CTRL = 63.2%) than nonobese subjects (SB = 0%, SCI = 10%, CTRL = 2.4%). CONCLUSIONS The prevalence of metabolic syndrome in adolescents with SB/SCI is quite high, particularly in obese individuals. These findings have important implications due to the known risks of cardiovascular diseases and diabetes mellitus associated with metabolic syndrome in adults, particularly those with spinal cord dysfunction.
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Affiliation(s)
| | - Lana M Widman
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
| | - Richard Ted Abresch
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
- Please address correspondence to Richard T. Abresch, MS, Department of Physical Medicine and Rehabilitation, University of California, Davis, MED: PM&R, TB 191, One Shields Avenue, Davis, CA 95616; phone: 530.752.9085; fax: 530.752.3468 (e-mail: )
| | - Kimber Stanhope
- University of California Department of Nutrition, Davis, California
| | - Peter J Havel
- University of California Department of Nutrition, Davis, California
| | - Dennis M Styne
- University of California Davis Department of Pediatrics, Davis, California
| | - Craig M McDonald
- University of California Davis Department of Physical Medicine & Rehabilitation, Davis, California
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Hoffman AJ, Jensen MP, Abresch RT, Carter GT. Chronic Pain in Persons with Neuromuscular Disease. Phys Med Rehabil Clin N Am 2005; 16:1099-112, xii. [PMID: 16214063 DOI: 10.1016/j.pmr.2005.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Amy J Hoffman
- Department of Rehabilitation Medicine, Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA
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