Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Measures of nutrition status and health for weight-inclusive patient care: A narrative review

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

First body fat reference curves for Macedonian children and adolescents: the MAKFIT study

Introduction

Introduction: childhood obesity is a worldwide chief health problem. Along with body mass index, body fat percentile values can also be used to predict future cardiovascular and metabolic health risks. Objective: the study's aim is to define the percentile values and curves about the fat tissue percentage through which the childhood and adolescent overweight/obesity in the Republic of North Macedonia will be diagnosed. Methods: the research was conducted on a sample of 15,075 children and adolescents aged six to 14 years (7,627 boys and 7,448 girls). Body fat percentage was established by bioelectrical impedance. The LMS method was used in percentile values and curves' construction. Results: the boys' 50th percentile curve shows that the body fat percentage average value has a slight growth from seven to ten years of age, but after their 10th it begins to drop continuously until the age of 14 years. At the same time, the girls' body fat percentage average value increases continuously from six to 14 years of age. Conclusion: since body mass index cannot always establish body fat content, the direct assessment of body fat by bioelectrical impedance would be of great advantage for pediatric and clinical decisions. Therefore, the study provides referent percentile norms for the body fat percentage of healthy Macedonian children and adolescents. For this purpose, a practical and clinically applicable method was used. The obtained referent percentile norms can be useful in assessing overweight and obesity in Macedonian children and adolescents.

Age-Related Differences in Body Fat and Fitness of Firefighters Participating in a Health and Wellness Program

ABSTRACT

Lockie, RG, Dulla, JM, Higuera, D, Ross, K, Orr, RM, Dawes, JJ, and Ruvalcaba, TJ. Age-related differences in body fat and fitness of firefighters participating in a health and wellness program. J Strength Cond Res 38(6): 1127-1135, 2024-Fitness tends to decline, whereas body fat increases, with age, which could impact firefighter occupational performance later in their careers. Health and wellness program participation could reduce these age-related changes. Archival data from 270 firefighters (258 men and 12 women) from a health and wellness program were analyzed. Data included body mass index; body fat percentage (BF%); waist circumference (WC); waist-to-hip ratio (WHR); sit and reach; grip strength; absolute and relative predicted 1 repetition maximum (1RM) leg press; crunches; push-ups; and estimated maximal aerobic capacity (V̇o2max). Firefighters were grouped by age ≤29 (n = 29); 30-34 (n = 44); 35-39 (n = 38); 40-44 (n = 39); 45-49 (n = 48); 50-54 (n = 42); and 55+ (n = 30) years. A univariate analysis of covariance, with sex as a covariate and Bonferroni's post hoc adjustment, determined between-group differences. Effect sizes (d) were calculated. Key results included that the 55+ group had higher BF% and WC compared with the 3 youngest groups (p ≤ 0.002; d = 0.86-1.08). The 50-54 group had higher BF% than the 30-34 group (p = 0.010; d = 0.77). The 55+ group had a greater WHR, lower grip strength, and completed fewer crunches and push-ups than most younger groups (p ≤ 0.05; d = 0.60-1.32). The 50-54 and 55+ groups had a lower 1RM leg press and V̇o2max compared with the younger groups (p ≤ 0.009; d = 0.77-1.79). The program appeared generally effective, with limited differences in groups below 49 years of age. Greater disparities in fat mass and fitness tended to occur in the older groups (50-54, 55+ groups). The data highlighted that older firefighters were participating in the optional program, which could lead to better health outcomes.

Bioelectrical Impedance Analysis Detects Body Fat Changes After Surgical Subcutaneous Fat Removal

Background: The risk and metabolic effects of obesity are determined by the distribution of fat throughout the body. It has been proposed that the distribution of abdominal fat is more closely related to the metabolic risks of obesity. High prevalence of overweight and obesity has thereby contributed to an increased uptake of surgical subcutaneous fat removal (SSFR) procedures. The goal of this study was to determine whether bioelectrical impedance analysis (Tanita system) can be used to detect the removal of excess abdominal subcutaneous fat tissue during SSFR when studying the metabolic effects of such procedures. Methods: Study population comprised patients who received body contouring procedures at the Hamad General Hospital's plastic surgery department between November 2020 and December 2022. To evaluate the factors of interest, subjects were prospectively followed up at two time points: within 1 week before the surgery and within 1-2 weeks thereafter. The following factors were measured: body weight, body fat percentage, body fat mass, body mass index (BMI), fat-free mass, estimated muscle mass, total body water, visceral fat score, and basal metabolic rate. Results: In total, 22 patients were included in the study. The two visits' medians for height, weight, BMI, fat percent (fat%), fat mass, visceral fat rating, and Doi's weighted average glucose (dwAG) were compared. Only in the case of Tanita fat% and fat mass, were the preoperative and postoperative medians significantly different. Furthermore, there was no association between these Tanita measures and dwAG or homeostatic model assessment (HOMA; insulin resistance [IR]) changes (before and after surgery). Tanita measures overestimated fat loss, as seen by the mountain plot and Bland-Altman plot agreement methods. Conclusions: Our findings indicated that the only two Tanita measures exhibited meaningful early associations with the amount of tissue excised which were fat mass and fat% differences. Although dwAG and HOMA-IR are not impacted immediately postsurgery, a trend was seen that suggested improvements in those parameters, even though the changes are not clinically significant.

Association of Physiological Performance, Physical Fitness, and Academic Achievement in Secondary School Students

This study aimed to compare the physiological performance and physical fitness based on the academic achievement levels of secondary school students and to explore the effect of gender on the relationship between physiological performance, physical fitness, and academic achievement. In this cross-sectional study, 304 children aged 13-14 years were recruited. To assess physical fitness, students performed a 20 m sprint test, a pro-agility test, a one-mile endurance run/walk test, and a countermovement jump test. At the end of the one-mile endurance run/walk test, the estimated VO2peak value of the participants was calculated. The physiological performance of the students was determined by measuring their resting heart rate and blood pressure. Students were grouped into three categories based on their academic achievement levels. The assessment of academic achievement considered their scores from the previous academic year. The scores were divided into three levels: poor (average score of 69 points or less), average (scores ranging from 70 to 84 points), and good (scores of 85 points or higher). The study revealed a notable disparity among students' VO2Max measurements based on their academic achievement (F = 8.938, p < 0.001, η2 = 0.056). However, we observed that the group with poor academic achievement displayed lower diastolic blood pressure values than the groups with average and good performances. Finally, no significant gender differences were evident in the relationship between academic achievement and any of the physical and physiological parameters.

Comprehensive evaluation of body composition in a wide age range of Iranian adults using bioelectrical impedance analysis: Tehran Lipid and Glucose Study

OBJECTIVE

To evaluate sex- and age-stratified body composition (BC) parameters in subjects with wide age range of 20-79 years.

DESIGN

Cross-sectional.

SETTING

Participants of Tehran Lipid and Glucose Study (TLGS).

PARTICIPANTS

Two thousand nine hundred seventy participants met our inclusion criteria. They were divided into five age groups, and BC parameters were analysed based on sex and age using a bioelectrical impedance analyser (BIA).

RESULT

The mean age of the participants was 42·1 ± 12·5 years, and 54 % of them were males. The mean BMI was 26·7 ± 3·7 kg/m2. Obesity indices were significantly higher in females (P < 0·001); however, skeletal muscle mass (SMM) and fat-free mass (FFM) were significantly higher in males (P < 0·001). Both SMM and FFM decreased significantly after the age of 50 years. Obesity indices significantly increased from the age group of 20-29 to 30-39 years in males and the age groups of 30-39 to 40-49 years and 40-49 to 50-59 years in females. The fat mass ratio (fat mass/SMM) showed two peaks in both sexes (after the ages of 30 and 50 years in males and 40 and 50 years in females). A strong correlation was found between BMI and percentage of body fat (r = 0·823 in females v. r = 0·768 in males).

CONCLUSION

This is the first community-based study in the MENA region identifying sex- and age-stratified BC values using BIA. Our findings can be used as a reference for comparison in appropriate settings.

The physiological and physical benefits of two types of concurrent training: a randomized controlled trial

BACKGROUND

It is widely acknowledged that aerobic exercise and strength training are crucial components of most workout programs. However, there is no consensus as to whether the effectiveness of exercises is affected by the sequence in which they are performed. Therefore, the overarching aim of the study was to understand the optimal order of two types of concurrent training program for 13 weeks by comparing the effectiveness of the training on body composition, predicated maximal oxygen uptake (VO2max), dynamic respiratory parameters and muscle strength in healthy middle-aged people.

METHODS

Thirty-three middle-aged individuals, who were categorized as moderately active based on their responses to International Physical Activity Questionnaires, underwent random allocation. The participants were randomly assigned into two groups: the Strength Training followed by Aerobic Training group (SAG, n = 16) and the Aerobic Training followed by Strength Training group (ASG, n = 17). Body composition, aerobic endurance, respiratory parameters, and upper and lower strength were assessed at baseline and after (post-test) a 13-week intervention. The chi-square test and the independent t-test were used to compare sociodemographic variables between the groups. A 2 × 2 analysis of variance (ANOVA) with repeated measures (group x measurement) was conducted. The study was retrospectively registered on clinicaltrials.gov in May of 2023 (clinicaltials.gov identifier: NCT05862415; in 04/25/2023).

RESULTS

Findings showed no significant differences between the group in the VO2max, FVC or FEV1 (F = 1.122, 0.028, 0.06, 2.483; p > 0.05, respectively). Intragroup analysis revealed changes in PEF compared to baseline in the ASG (F = 5.895; p < 0.05). Increases were observed in all strength parameters for both training programs.

CONCLUSIONS

The concurrent training effect on muscle composition, oxygen consumption and muscle strength specifically 1RM, in middle-aged individuals are equivocal, regardless of the exercise order. The results indicate that both exercise sequences can elicit similar benefits in terms of cardiovascular fitness, muscular strength, and endurance. This lack of difference suggests that the order of exercise does not play a significant role in determining the effectiveness of the workout or the subsequent physiological adaptations. CLINICALTIALS.

GOV IDENTIFIER

NCT05862415. Date of registration: 04/25/2023.

Effectiveness and Safety of Remote Cardiac Rehabilitation for Patients After Acute Coronary Syndrome

Cardiac rehabilitation improves cardiovascular outcomes in patients after acute coronary syndrome (ACS). Recently there has been a growing interest in remote cardiac rehabilitation (RCR) programs. We aimed to evaluate the effectiveness of RCR compared with center-based cardiac rehabilitation (CBCR). This is an observational study including patients after hospital admission for ACS. The study group included patients at low-to-moderate risk for cardiovascular complications who were referred for RCR. The control group included patients at similar risk who participated in CBCR. The primary end points were the improvement of at least 10% to 25% in exercise capacity after 6 months of cardiac rehabilitation. Included were 305 patients who completed 6 months of cardiac rehabilitation. Of them, 107 patients participated in RCR and 198 in CBCR. RCR patients were younger and more frequently males. Improvement of ≥10% in exercise capacity after 6 months was achieved more frequently in patients participating in RCR compared with CBCR (69.3% and 55% respectively, p = 0.03). A similar trend was observed for improvement of ≥25% in exercise capacity after 6 months (33.8% and 22.7% in RCR and CBCR, respectively, p = 0.05). While weight reduction and the increase in muscle mass were similar in the 2 groups, fat percent reduction was significantly greater in the RCR compared with the CBCR (2.5% and 1.4% respectively, p <0.005). We conclude that RCR program is an effective and safe option for low-risk patients after hospital admission for ACS. It enables optimizing the utilization of this important service for patients with coronary artery disease.

Body composition measured by multi-frequency bioelectrical impedance following creatine supplementation

BACKGROUND

Acute fluid ingestion increases estimated body fat percentage (BF%) measurements by single frequency (SF-BIA) and multi-frequency bioelectrical impedance (MF-BIA). It is unknown if MF-BIA accurately measures total BF% and total body water (TBW) after creatine supplementation, which causes fluid retention, and resultant increases in fat-free mass and TBW. The purpose of this study was to analyze the effect of creatine supplementation on body composition and TBW measured through a popular MF-BIA device (InBody 770).

METHODS

Thirteen male and 14 female subjects (18-22 years) completed one week of creatine monohydrate (0.3 g/kg body weight) or maltodextrin. Pre- and post-supplementation body composition measurements included dual-energy X-ray absorptiometry (DEXA), SF-BIA measured by an Omron HBF-306C device, and MF-BIA measured by an InBody 770 device to measure BF%, fat free mass (FFM), and fat mass (FM). Additionally, intracellular water (ICW), extracellular water (ECW), and TBW were estimated by MF- BIA.

RESULTS

FFM increased more in the creatine group than the placebo group measured by all body composition modes (1.2 kg, 1.9 kg, and 1.1 kg increase for SF-BIA, MF-BIA, and DEXA respectively, P<0.05). Creatine supplementation resulted in a 2% increase (P<0.05) in TBW measured by MF-BIA (40.4±9.5 to 41.2±9.6 kg).

CONCLUSIONS

One week of creatine supplementation increased TBW as detected by the InBody 770 device. Changes in body composition that occurred due to the increase in TBW were detected as an increase in FFM measured by SF-BIA, MF-BIA, and DEXA.

The effect of acute hydration on body composition assessed by multi-frequency and single-frequency bioelectrical impedance

BACKGROUND

Multi-frequency bioelectrical impedance (MF-BIA) provides an estimate of total body water. However, it is unknown if MF-BIA detects body water increases due to acute hydration, thus affecting the validity of MF-BIA body composition measurements. The purpose of this study was to compare the effects of pre-testing fluid ingestion on body composition estimation using single-frequency bioelectrical impedance (SF-BIA) and MF-BIA.

METHODS

Thirty-nine subjects (20 male, 19 female) were tested for body composition using DXA, SF-BIA and MF-BIA before and after consumption of 2 L of water.

RESULTS

Hydration significantly increased fat percentage in men and women for MF-BIA (+2.1±0.7% for men, +2.6±0.7% for women) and SF-BIA (+1.3±0.7% for men, +2.1±0.9% for women). Additionally, hydration significantly increased fat-free mass (FFM) for DXA (+1.4±0.8 kg for men, +1.7±0.4 kg for women) and SF-BIA (+0.5±0.6 kg) in men. Hydration significantly increased fat mass (FM) for all modes (DXA +0.3±0.3 kg, MF-BIA +2.0±0.7 kg, SF-BIA +1.3±0.6 kg) in males, and only for MF-BIA (+2.2±0.3 kg) and SF-BIA (+1.7±0.5 kg) in females. Increases in FM were highest for MF-BIA for both males and females. Total body water was unchanged in males and significantly decreased with acute hydration in females.

CONCLUSIONS

MF-BIA improperly categorizes increased mass due to acute hydration as fat mass, resulting in an increase in measured body fat percentage. These findings confirm the need to standardize hydration status for body composition measurements using MF-BIA.

A Research Note Investigating the Leg Tuck and Plank With Potential Impacts for Occupational Testing

ABSTRACT

Gonzalez, SM, Withrow, KL, Rubin, DA, Lynn, SK, Dawes, JJ, Orr, RM, and Lockie, RG. A research note investigating the leg tuck and plank with potential impacts for occupational testing. J Strength Cond Res 37(10): 2076-2079, 2023-The U.S. Army recently replaced the leg tuck with the plank in their physical ability testing. There has been limited analysis of whether these 2 tests correlate, have any relationships with body composition and strength, or are sex-neutral. Forty-nine civilian college students (28 males, 21 females) were recruited as surrogates for tactical personnel. The following were measured: height, body mass, body fat percentage (BF%), and muscle mass percentage (MM%) measured through bioelectrical impedance analysis, grip strength, leg tuck, and plank. Independent t -tests were calculated to determine between-sex differences for all variables ( p < 0.05). Partial correlations controlling for sex were used to compute relationships between the leg tuck, plank, and other variables. Stepwise regression controlling for sex derived predictive relationships for the leg tuck and plank. Males were taller, had greater body mass, MM%, and were superior in grip strength and the leg tuck; females had greater BF%. There were no significant between-sex differences for the plank. The leg tuck correlated with BF%, MM%, grip strength, and the plank ( r = ±0.333-0.524). In addition to the leg tuck, the plank correlated with BF% ( r = -0.288). The leg tuck was predicted by sex, grip strength, and the plank (adjusted r2 = 0.662). No variables predicted the plank. As there were no between-sex differences and sex was not a plank predictor, it appears this test minimized sex differences on task performance in civilians. However, the leg tuck and plank likely measure different qualities; further research is needed on job task relationships.

Analysis of Genetic and MRI Changes, Blood Markers, and Risk Factors in a Twin Pair Discordant of Progressive Supranuclear Palsy

Background and Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease, a tauopathy, which results in a wide clinical spectrum of neurological symptoms. The diagnosis is mostly based on clinical signs and neuroimaging; however, possible biomarkers for screening have been under investigation, and the role of the gut microbiome is unknown. The aim of our study was to identify potential blood biomarkers and observe variations in the gut microbiome within a PSP discordant monozygotic twin pair. Materials and Methods: Anthropometric measurements, neuropsychological tests, and the neurological state were evaluated. Blood was collected for metabolic profiling and for the detection of neurodegenerative and vascular biomarkers. Both the gut microbiome and brain MRI results were thoroughly examined. Results: We found a relevant difference between alpha-synuclein levels and moderate difference in the levels of MMP-2, MB, Apo-A1, Apo-CIII, and Apo-H. With respect to the ratios, a small difference was observed for ApoA1/SAA and ApoB/ApoA1. Using a microbiome analysis, we also discovered a relative dysbiosis, and the MRI results revealed midbrain and frontoparietal cortical atrophy along with a reduction in overall brain volumes and an increase in white matter lesions in the affected twin. Conclusions: We observed significant differences between the unaffected and affected twins in some risk factors and blood biomarkers, along with disparities in the gut microbiome. Additionally, we detected abnormalities in brain MRI results and alterations in cognitive functions.

Assessing the reliability and cross-sectional and longitudinal validity of fifteen bioelectrical impedance analysis devices

The purpose of this investigation was to expand upon the limited existing research examining the test-retest reliability, cross-sectional validity and longitudinal validity of a sample of bioelectrical impedance analysis (BIA) devices as compared with a laboratory four-compartment (4C) model. Seventy-three healthy participants aged 19-50 years were assessed by each of fifteen BIA devices, with resulting body fat percentage estimates compared with a 4C model utilising air displacement plethysmography, dual-energy X-ray absorptiometry and bioimpedance spectroscopy. A subset of thirty-seven participants returned for a second visit 12-16 weeks later and were included in an analysis of longitudinal validity. The sample of devices included fourteen consumer-grade and one research-grade model in a variety of configurations: hand-to-hand, foot-to-foot and bilateral hand-to-foot (octapolar). BIA devices demonstrated high reliability, with precision error ranging from 0·0 to 0·49 %. Cross-sectional validity varied, with constant error relative to the 4C model ranging from -3·5 (sd 4·1) % to 11·7 (sd 4·7) %, standard error of the estimate values of 3·1-7·5 % and Lin's concordance correlation coefficients (CCC) of 0·48-0·94. For longitudinal validity, constant error ranged from -0·4 (sd 2·1) % to 1·3 (sd 2·7) %, with standard error of the estimate values of 1·7-2·6 % and Lin's CCC of 0·37-0·78. While performance varied widely across the sample investigated, select models of BIA devices (particularly octapolar and select foot-to-foot devices) may hold potential utility for the tracking of body composition over time, particularly in contexts in which the purchase or use of a research-grade device is infeasible.

Reduced body cell mass and functions in lower extremities are associated with mild cognitive impairment and Alzheimer's dementia

This study examined the alterations of segmental body composition in individuals with Alzheimer's pathology (AD), including mild cognitive impairment (MCI) and dementia. A multifrequency bioimpedance analysis (BIA) was used to provide segmental water and impedance variables from 365 cognitively normal (CN), 123 MCI due to AD, and 30 AD dementia participants. We compared the BIA variables between the three groups, examined their correlations with neuropsychological screening test scores, and illustrate their 95% confidence RXc graphs. AD dementia participants were older, more depressive, and had worse cognitive abilities than MCI due to AD and CN participants. Although the BIA variables showed weak partial correlations with the cognitive test scores, we found patterns of an increasing water content in lean mass, increasing extra to intracellular water ratio, and decreasing reactance and phase angle in the lower extremities with effect sizes ranging from 0.26 to 0.51 in the groups of MCI and dementia due to AD compared with CN individuals. The RXc graphs upheld the findings with a significant displacement downward and toward the right, dominantly in the lower extremities. Individuals with AD pathology exhibit a reduced body cell mass or cell strength, an abnormal cellular water distribution, and an overhydration status in lean mass, especially in the lower extremities.

Towards visceral fat estimation at population scale: correlation of visceral adipose tissue assessment using three-dimensional cross-sectional imaging with BIA, DXA, and single-slice CT

Background

In terms of assessing obesity-associated risk, quantification of visceral adipose tissue (VAT) has become increasingly important in risk assessment for cardiovascular and metabolic diseases. However, differences exist in the accuracy of various modalities, with a lack of up-to-date comparison with three-dimensional whole volume assessment.

Aims

Using CT or MRI three-dimensional whole volume VAT as a reference, we evaluated the correlation of various commonly used modalities and techniques namely body impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA) as well as single slice CT to establish how these methods compare.

Methods

We designed the study in two parts. First, we performed an intra-individual comparison of the 4558 participants from the UK Biobank cohorts with matching data of MRI abdominal body composition, DXA with VAT estimation, and BIA. Second, we evaluated 174 CT scans from the publicly available dataset to assess the correlation of the commonly used single-slice technique compared to three-dimensional VAT volume.

Results

Across the UK Biobank cohort, the DXA-derived VAT measurement correlated better (R² 0.94, p<0.0001) than BIA (R² 0.49, p<0.0001) with reference three-dimensional volume on MRI. However, DXA-derived VAT correlation was worse for participants with a BMI of < 20 (R² = 0.62, p=0.0013). A commonly used single slice method on CT demonstrated a modest correlation (R² between 0.51 - 0.64), with best values at L3- and L4 (R² L3 = 0.63, p<0.0001; L4 = 0.64, p<0.0001) compared to reference three-dimensional volume. Combining multiple slices yielded a better correlation, with a strong correlation when L2-L3 levels were combined (R² = 0.92, p<0.0001).

Conclusion

When deployed at scale, DXA-derived VAT volume measurement shows excellent correlation with three-dimensional volume on MRI based on the UK Biobank cohort. Whereas a single slice CT technique demonstrated moderate correlation with three-dimensional volume on CT, with a stronger correlation achieved when multiple levels were combined.

Effect of including a dietary supplement of raisins, a food rich in polyphenols, on cognitive function in healthy older adults; a study protocol for a randomized clinical trial

BACKGROUND

Polyphenols have been shown to be effective against many chronic diseases, including neurodegenerative diseases. Specifically, the consumption of raisins, being a food rich in polyphenols, has been attributed with neuroprotective benefits. Therefore, our main objective is to evaluate the effect of including 50 g of raisins in the diet daily for 6 months, on the improvement of cognitive performance, cardiovascular risk factors and markers of inflammation in a population of older adults without cognitive impairment.

METHODS

Design and intervention: This study will be a randomized controlled clinical trial of two parallel groups. Each subject included in the study will be randomly assigned to one of two study groups: control group (no supplement), intervention group (50 g of raisins daily during 6 months).

STUDY POPULATION

The participants will be selected by consecutive sampling in the Primary Care consultations of urban health centers in Salamanca and Zamora (Spain), taking into account the selection criteria.

STUDY VARIABLES

Two visits will be made, baseline and at 6 months. Cognitive performance will be evaluated (Mini-Mental State Examination test, Rey Auditory Verbal Learning Test, verbal fluency and montreal cognitive assessment (Moca)). It will also be analyzed the level of physical activity, quality of life, activities of daily living, energy and nutritional composition of the diet, body composition, blood pressure, heart rate, markers of inflammation and other laboratory tests of clinical relevance (glycaemia, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides). In addition, sociodemographic data, personal and family history, medication use and alcohol and tobacco consumption will be collected.

DISCUSSION

In this project, it is intended to contribute to minimize the problems derived from cognitive deterioration in older people.

TRIAL REGISTRATION

ClincalTrials.gov Identifier: NCT04966455 Registration date: July 1, 2021.

Association of Bioelectrical Impedance Phase Angle with Physical Performance and Nutrient Intake of Older Adults

In recent years, the phase angle (PhA) as a raw bioelectrical impedance analysis variable has gained attention to assess cell integrity and its association to physical performance in either sports-related or clinical settings. However, data on healthy older adults are scarce. Therefore, data on body composition, physical performance and macronutrient intake from older adults (n = 326, 59.2% women, 75.2 ± 7.2 years) were retrospectively analyzed. Physical performance was evaluated by the Senior Fitness Test battery, gait speed, timed up and go and handgrip strength. Body composition was determined by the BIA and dual-energy X-ray absorptiometry (from a subgroup of n = 51). The PhA was negatively associated with the timed up and go test and age (r = -0.312 and -0.537, p < 0.001), and positively associated with the 6 min walk test, 30 s chair stand, handgrip strength, gait speed and physical performance score (r = 0.170-0.554, p < 0.05), but not protein intake (r = 0.050, p = 0.386). Hierarchical multiple regression analysis showed that especially age, sex, BMI, but also the PhA predicted the performance test outcomes. In conclusion, the PhA seems to be an interesting contributor to physical performance, but sex- and age-specific norm values still need to be determined.

Body fat and components of sarcopenia relate to inflammation, brain volume and neurometabolism in older adults

Obesity and sarcopenia are associated with cognitive impairments at older age. Current research suggests that blood biomarkers may mediate this body-brain crosstalk, altering neurometabolism and brain structure eventually resulting in cognitive performance changes. Seventy-four older adults (60-85 years old) underwent bio-impedance body composition analysis, handgrip strength measurements, 8-Foot Up-and-Go (8UG) test, Montreal Cognitive Assessment (MoCA), blood analysis of interleukin-6 (IL-6), kynurenine, and insulin-like growth factor-1 (IGF-1), as well as brain magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (¹H-MRS), estimating neurodegeneration and neuroinflammation. Normal fat% or overweight was associated with larger total gray matter volume compared to underweight or obesity in older adults and obesity was associated with higher N-acetylaspartate/Creatine levels in the sensorimotor and dorsolateral prefrontal cortex. Muscle strength, not muscle mass/physical performance, corresponded to lower kynurenine and higher N-acetylaspartate/Creatine levels in the dorsal posterior cingulate and dorsolateral prefrontal cortex. The inflammatory and neurotrophic blood biomarkers did not significantly mediate these body-brain associations. This study used a multimodal approach to comprehensively assess the proposed mechanism of body-brain crosstalk.

Fat tissue is a poor predictor of 1 year outcomes after total knee arthroplasty: A secondary analysis of a randomized clinical trial

BACKGROUND AND OBJECTIVE

Obesity may increase the risk of adverse events after total knee arthroplasty (TKA). Although body mass index (BMI) is commonly used in categorizing obesity, its accuracy is limited. Body fat percentage (BFP) might indicate adiposity status and predict arthroplasty-related outcomes better than BMI. We investigated whether BFP is predictive of TKA-related outcomes.

METHODS

In this secondary analysis, BFP was measured preoperatively from 294 participants of a randomized trial that investigated the effects of tourniquet and anesthesia methods on TKA. Data concerning in-hospital assessments and events were collected. Knee range of motion (ROM) was measured, the Brief Pain Inventory-short form and Oxford Knee Score questionnaires were used to collect data on patient-reported pain and function, and the 15-dimensional health-related questionnaire was used to assess quality of life preoperatively and 3 and 12 months postoperatively. The patients reported satisfaction to TKA 3 and 12 months postoperatively. Data concerning infectious and thromboembolic events within 90 postoperative days and revision surgery, manipulation under anesthesia, and mortality within 1 year were collected. A separate post hoc analysis was performed for 399 participants to assess the effects of BMI on the respective outcomes.

RESULTS

A 1-unit increase in BFP affected the ROM by -0.37° (95% confidence interval (CI) = -0.60 to -0.13) 12 months after surgery. BFP was not significantly associated with the operation time or adverse events. However, the number of most adverse events remained too low for adjusted analysis. A 1-unit increase in BMI increased the operation time by 0.57 min (95% CI = 0.10 to 1.04) and affected the ROM by -0.47° (95% CI = -0.74 to -0.20) 12 months postoperatively. Neither BFP nor BMI was significantly associated with acute pain, pain management, length of stay, or with pain, function, quality of life, or satisfaction to TKA at 12 months after surgery.

CONCLUSIONS

BFP seems to be a poor predictor of in-hospital results and of patient-reported outcomes 1 year after TKA.

TWITTER HANDLE

In this secondary analysis of a randomized trial, body fat percentage was poorly predictive of clinical outcomes during hospital stay and of patient-reported outcomes 1 year after TKA.

Taste Function in Adult Humans from Lean Condition to Stage II Obesity: Interactions with Biochemical Regulators, Dietary Habits, and Clinical Aspects

Differences in gustatory sensitivity, nutritional habits, circulating levels of modulators, anthropometric measures, and metabolic assays may be involved in overweight (OW) development. The present study aimed at evaluating the differences in these aspects between 39 OW (19 female; mean age = 53.51 ± 11.17), 18 stage I (11 female; mean age = 54.3 ± 13.1 years), and 20 II (10 female; mean age = 54.5 ± 11.9) obesity participants when compared with 60 lean subjects (LS; 29 female; mean age = 54.04 ± 10.27). Participants were evaluated based on taste function scores, nutritional habits, levels of modulators (leptin, insulin, ghrelin, and glucose), and bioelectrical impedance analysis measurements. Significant reductions in total and subtests taste scores were found between LS and stage I and II obesity participants. Significant reductions in total and all subtests taste scores were found between OW and stage II obesity participants. Together with the progressive increase in plasmatic leptin levels, insulin, and serum glucose, decrease in plasmatic ghrelin levels, and changes in anthropometric measures and nutritional habits along with body mass index, these data for the first time demonstrated that taste sensitivity, biochemical regulators, and food habits play a parallel, concurring role along the stages evolving to obesity.

[Assessment of low muscle mass and strength in a control population]

Introduction

Background and aims: low muscle mass (LMM) conditions the nutritional status of an individual and has implications for quality of life and prognosis. The aim of this study was to evaluate body composition and determine normal values in the diagnosis of LMM in a control group of healthy individuals. Methods: a cross-sectional study of healthy volunteers aged 18 to 45 years with body mass index (BMI) < 30 kg/m2. A descriptive study was performed including demographic, clinical, anthropometric, and body composition variables (by bioimpedance, TANITA MC 780 MA; TANITA, Tokyo, Japan), stratified by age, sex and BMI. Values corresponding to -1/-2 standard deviations (SD) were determined to consider low muscle mass/function. Results: we included 67 patients, 71,60 % women, with a median age of 28.29 (IQR 4.05) years. Males presented higher weight, BMI, fat-free mass (FFM), muscle mass (MM), appendicular lean mass (ALM), appendicular lean mass index (ALMI), and dynamometry values when compared to females. The -1/-2 SD values of the various muscle parameters were determined according to sex. Conclusion: this study determined normal LMM values in healthy and young people, and the most commonly used indexes to express it, which will allow the diagnosis of LMM in disease-related situations using the corresponding -2 DS value.

User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records

BACKGROUND

Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps.

OBJECTIVE

Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition.

METHODS

We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared.

RESULTS

Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass.

CONCLUSIONS

We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass.

Impact of Urinary Incontinence on Physical Function and Respiratory Muscle Strength in Incontinent Women: A Comparative Study between Urinary Incontinent and Apparently Healthy Women

Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.

Effects of vestibular rehabilitation on body composition and daily-living physical activity in chronic unilateral vestibular hypofunction

BACKGROUND

Unilateral vestibular hypofunction (UVH) may lead to modifications on metabolism and body composition. Vestibular rehabilitation (VR) demonstrated its effectiveness in ameliorating balance function and several other daily-living aspects.

OBJECTIVES

The aim of this study was to evaluate metabolic composition, by means of bioelectrical impedance analysis (BIA) and daily activity, with the use of a wrist-worn movement tracker, in UVH participants before and after VR, and to compare data with a healthy control group (CG) of adults.

METHODS

46 UVH and 60 CG participants underwent otoneurological testing, self-report and performance questionnaires, BIA, and wore a device tracking daily movement and energy expenditure for one full day; this was performed before and after VR.

RESULTS

UVH participants demonstrated a significant (p = 0.008) increase in muscle mass after VR, and, when compared to CG, no differences were present with respect to visceral fat and muscle mass. UVH adults reported a significant increase in energy expenditure spent in movement (p = 0.008) and during the day (p = 0.009), daily number of strides (p = 0.009) and calories spent in sweeping (p = 0.009) and stairing (p = 0.008).

CONCLUSIONS

Results from this study show that VR provided an improvement of metabolic function and body composition of people with UVH, possibly by contrasting structural modifications in neural pathways stemming from the vestibular nuclei and connected to autonomous function.

The impact of COVID-19 pandemic on cardiac rehabilitation of patients following acute coronary syndrome

BACKGROUND

Cardiac rehabilitation improves prognosis and symptoms in cardiac patients. In 2020, due to the COVID-19 pandemic, cardiac rehabilitation services were temporarily suspended between April and August. We aimed to investigate the effect of cardiac rehabilitation suspension during the COVID-19 pandemic on patients' exercise capacity and metabolic parameters.

METHODS

Included were patients undergoing cardiac rehabilitation following hospital admission for ACS. Exercise capacity, weight and body fat percentage were compared between baseline, pre- and post-lockdown visits.

RESULTS

A total of 281 patients participated in the cardiac rehabilitation program prior to its suspension. Of them, only 198 (70%) patients returned to the program on its renewal and were included in the analysis. Exercise capacity improved significantly in the pre-lockdown stress test compared to baseline. However, there was a significant decrease in exercise capacity in the post compared to pre-lockdown test (8.1±6.3 and 7.1±2.1 METs in pre- and post-lockdown measurements, respectively, p<0.001). Of the 99 (50%) of patients that demonstrated at least 10% improvement in exercise capacity in the pre-lockdown test, 48(48.5%) patients returned to their baseline values in the post-lockdown test. Post-lockdown assessment demonstrated a significant weight gain (80.3 and 81.1kg, in pre- and post-lockdown measurements, respectively, p<0.001) as well as an increase in visceral fat level and body fat percentage.

CONCLUSIONS

Cardiac rehabilitation suspension for 4 months during COVID-19 pandemic caused a significant reduction in exercise capacity and increased weight and body fat percent. These findings highlight the importance of remote cardiac rehabilitation services that can continue uninterrupted in times of pandemic.

The Effects of Traditional versus Ability-Based Physical Training on the Health and Fitness of Custody Assistant Recruits

This study investigated traditional training (TT) versus ability-based training (ABT) in custody assistant recruits. Retrospective analysis was conducted on two recruit classes who completed an 8-week academy. The TT group (18 males, 13 females) followed a physical training model where recruits completed the same exercises with the same intensity; the ABT group (17 males, 12 females) had exercises tailored towards their ability. Pre- and post-academy, recruits were assessed in: body mass; body fat percentage (BF%); resting heart rate (RHR); blood pressure (BP); waist circumference (WC); waist-to-hip ratio (WHR); grip strength; push-ups; sit-ups; YMCA step test recovery HR; 201-m run; and 2.4-km run. Independent samples t-tests evaluated between-class pre-test differences, with significance set at p ≤ 0.05. Paired samples t-tests (p ≤ 0.05) detected within-group training changes. Change scores were calculated for each variable; independent samples t-tests (p ≤ 0.05) compared change scores between groups. The TT group had lower BF%, BP, and WC; and were superior in sit-ups and the 2.4-km run before training. After academy, the TT recruits improved WHR, grip strength, recovery HR, 201-m run, and 2.4-km run, but increased diastolic BP. The ABT recruits decreased BF%, RHR, and WC, and improved push-ups, sit-ups, recovery HR, 201-m run, and the 2.4-km run. ABT recruits had greater positive changes in BF%, RHR, diastolic BP, and sit-ups. TT and ABT recruits generally experienced favorable fitness changes; the degree of positive change tended to be greater for ABT recruits for select tests. Coupled with the diastolic BP increase for TT recruits, this may provide evidence for ABT.

Body Composition and Fitness Characteristics of Firefighters Participating in a Health and Wellness Program: Relationships and Descriptive Data

This study investigated body composition and fitness test relationships from firefighters participating in a health and wellness program and categorized firefighters according to population norms relative to sex and age. Data from 270 firefighters (men = 258, women = 12) were analyzed, including body composition (body mass index [BMI], body fat percentage [BF%], waist circumference [WC], waist-to-hip ratio) and fitness (sit-and-reach, grip strength, leg press, crunches, push-ups, maximal aerobic capacity [V̇O2max]) tests. Mann-Whitney U-test analysis (p < 0.05) showed that male firefighters had a greater WC, WHR, grip strength and leg press. Female firefighters had a greater BF% and better sit-and-reach. Partial correlations controlling for sex indicated 22/24 correlations between body composition and fitness were significant (r = -0.143--0.640). ~52% of firefighters were overweight, and 25% were Obesity Class I-III. ~76% had an increased risk of cardiovascular disease (CVD) considering BMI and WC. ~22% were fatter than average-to-overfat considering BF%. Most firefighters (73-94%) were good-to-excellent in sit-and-reach, grip strength, and push-ups; average-to-well above average in crunches; average-to-above average in leg press; and had good-to-superior V̇O2max. Although most firefighters had better fitness compared to the general population, many had increased CVD risk. The data highlighted the need for comprehensive approaches to improving firefighter health and decreasing CVD risk.

Safety and efficacy of exercise training in children and adolescents with congenital heart disease: A systematic review and descriptive analysis

BACKGROUND

While exercise training is beneficial in the prevention and management of many chronic diseases, the role of exercise training in children and adolescents with congenital heart disease is less understood. We sought to determine the safety and efficacy of exercise training in children and adolescents with congenital heart disease.

METHODS

We conducted a systematic search of the following databases: PubMed, CINAHL, EMBASE, Web of Science and SportDiscus. We included randomised controlled trials that incorporated an exercise intervention compared with a non-exercising comparator group and examined safety and efficacy in children and adolescents with congenital heart disease. A descriptive analysis of the included trials was then conducted.

RESULTS

A total of 9 articles from 6 trials (642 participants with varying conditions and disease severity) were included. Significant variability of study participants and outcomes were observed across the trials. No adverse events linked to the exercise interventions were stated. The articles reported numerous positive changes to clinically relevant fitness measures. Exercise capacity improved with exercise training in 3 of 4 trials in which it was measured. Cardiorespiratory fitness showed improvements in 3 of 4 trials. Neuromuscular fitness increased in 1 of 2 trials. Physiological and metabolic parameters were improved, and negative changes were not observed to several clinically important measures (e.g. muscular oxygenation, cardiac measures) in 2 of 2 trials. Physical activity increased in 1 of 3 trials. No articles reported on changes in measures of body composition. Outcomes are varied with little consensus on measurements or assessment methods.

CONCLUSIONS

Exercise training appears to be safe and efficacious for improving physical fitness in children and adolescents with congenital heart disease who have been appropriately screened by their medical team. However, the certainty of the evidence for these findings is low to moderate.

A new anthropometric model for body composition estimation: Comparison with a bioelectrical impedance consumer device

Background

The present study refers to an anthropometric model, Dahlmann-Body-Analysis (DBA), based on formerly developed weight-height-frame tables. Including the anthropometric variable abdomen circumference (AC), a further differentiation into muscularity and fat mass could be realized. This enables to calculate the individual percentage fat mass (%FM), providing a cost-effective method for epidemiological studies. The present work sets out to investigate, whether %FM computed by the DBA model compares to BIA measurements, notably under conditions of heavy obesity.

Subjects/methods

In 103 adults (37 males, 66 females, age 42.5 ± 12.5 years, BMI 38.2 ± 4.8 kg/m²) %FM was estimated by a tetrapolar BIA device and compared to results derived by the DBA system. Bland-Altman and simple linear regression analyses were used to determine agreement between methods.

Results

The mean %FM estimates of men (women) ± standard deviation were 36.1 ± 4.8 (49.7 ± 4.5) for BIA and 36.7 ± 4.2 (49.1 ± 4.9) for DBA measurements. Pearson correlation coefficients (r) and Lin’s concordance correlation coefficient (CCC) were r = 0.86 and CCC = 0.84 for men and r = 0.85 and CCC = 0.83 for women, respectively. Bland-Altman plot showed limits of agreement between DBA and BIA %FM that ranged from 5.5% to -4.3% for men and 4.6% to– 5.7% for women, respectively. Correlations between values measured by both methods were high and the observed confidence interval (SD of the difference between DBA and BIA result multiplied by 2) was low. No systematic error was found. The DBA system overestimates FM by 0.63 ± 4.98 (2SD) % for men and underestimates FM by -0.56 ± 5.28 (2SD) % for women, respectively, compared to the BIA results. The result for both genders is -0.066 ± 5.17 (2SD) %FM. Over all, there is a strong concordance and reproducibility between the DBA and BIA data sets.

Conclusions

The implementation of the abdomen circumference (AC) into the DBA model as a proxy for body fat (%FM) resulted in a strong concordance with BIA measurements. These findings indicate that the DBA model may reflect the body shape of severely obese white European patients with regard to body composition.

Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial

BACKGROUND

Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only.

METHODS

Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas.

INTERVENTIONS

(a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72).

MAIN OUTCOMES AND MEASURES

Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24.

RESULTS

A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = -0.8; 95% confidence interval [CI] = -1.7, -0.1), diastolic blood pressure (Δ = -4.8; 95% CI = -5.5, -4.1), BMI (Δ = -1.7; 95% CI = -2.0, -1.4), weight (Δ = -1.7; 95% CI = -2.0, -1.4), waist circumference (Δ = -2.6; 95% CI = -5.0, -0.2), glucose (Δ = -10.3; 95% CI = -19.0, -1.6), insulin (Δ = -2.9; 95% CI = -5.3, -0.4), HbA1c (Δ = -0.2; 95% CI = -0.4, -0.05;), triglycerides (Δ = -48.9; 95% CI = -81.0, -16.9), IL-6 (Δ = -1.2; 95% CI = -2.5, -0.005), and the 10-year risk of acute coronary events (Δ = -4.9; 95% CI = -9.5, -0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = -11.9; 95% CI = -21.8, -2.0). Group differences at week 24 were found for weight (Δ = -2, 7; 95% CI = -4.8, -0.5), BMI (Δ = -1.0; 95% CI = -1.8, -0.3), glucose (Δ = -7.7; 95% CI = -13.5, -1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred.

CONCLUSIONS

A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term.

Smell Impairment in Stage I-II Obesity: Correlation with Biochemical Regulators and Clinical Aspects

OBJECTIVE

To evaluate the differences in olfactory sensitivity, nutritional habits, levels of modulators of feeding and smell, bioelectrical impedance analysis (BIA) measures and metabolic assays between two groups of participants with stage I and II obesity and reciprocal relationships between these parameters.

METHODS

Eighteen participants with stage I (11 female; mean age = 54.3 ± 13.1 years) and 20 participants with stage II (10 female; mean age = 54.5 ± 11.9) obesity underwent a food frequency questionnaire and Sniffin' Sticks® test battery, anthropometric parameters, and BIA measurements as well as metabolic assays (including plasma levels of leptin, insulin, ghrelin, glucose, insulin-like growth factor-1 [IGF-1] and usual laboratory parameters).

RESULTS

The stage II obesity participants demonstrated significant higher levels of insulin and leptin and lower levels of ghrelin and IGF-1, a reduction in odor identification (OI) and in total olfactory score, and an increase in visceral and total fat percentage. Among a mosaic of multiple correlations, ghrelin was found to positively correlate with OI and leptin negatively with odor discrimination.

CONCLUSION

The present study expands the notions positing the olfactory perception - and its connections with metabolic cues, foods habits and BIA measures - changes across the two most important obesity stages. This could ameliorate clinical and research deepening of obesity-related olfactory behavior with possible consequences on diagnosis, treatment and prevention of onset and development of obesity, thus opening possible future strategies involving multidisciplinary contributions.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2022.

Estimation of Maximum Shoulder and Elbow Joint Torques Based on Demographics and Anthropometrics

Repetitive movements that involve a significant shift of the body's center of mass can lead to shoulder and elbow fatigue, which are linked to injury and musculoskeletal disorders if not addressed in time. Research has been conducted on the joint torque individuals can produce, a quantity that indicates the ability of the person to carry out such repetitive movements. Most of the studies surround gait analysis, rehabilitation, the assessment of athletic performance, and robotics. The aim of this study is to develop a model that estimates the maximum shoulder and elbow joint torque an individual can produce based on anthropometrics and demographics without taking a manual measurement with a force gauge (dynamometer). Nineteen subjects took part in the study which recorded maximum shoulder and elbow joint torques using a dynamometer. Sex, age, body composition parameters, and anthropometric data were recorded, and relevant parameters which significantly contributed to joint torque were identified using regression techniques. Of the parameters measured, body mass index and upper forearm volume predominantly contribute to maximum torque for shoulder and elbow joints; coefficient of determination values were between 0.6 and 0.7 for the independent variables and were significant for maximum shoulder joint torque (P<0.001) and maximum elbow joint torque (P<0.005) models. Two expressions illustrated the impact of the relevant independent variables on maximum shoulder joint torque and maximum elbow joint torque, using multiple linear regression. Coefficient of determination values for the models were between 0.6 and 0.7. The models developed enable joint torque estimation for individuals using measurements that are quick and easy to acquire, without the use of a dynamometer. This information is useful for those employing joint torque data in biomechanics in the areas of health, rehabilitation, ergonomics, occupational safety, and robotics. Clinical Relevance- The rapid estimation of arm joint torque without the direct force measurement can help occupational safety with the prevention of injury and musculoskeletal disorders in several working scenarios.

Segmental Bioimpedance Variables in Association With Mild Cognitive Impairment

Objective

To examine the changes in body composition, water compartment, and bioimpedance in mild cognitive impairment (MCI) individuals.

Methods

We obtained seven whole-body composition variables and seven pairs of segmental body composition, water compartment, and impedance variables for the upper and lower extremities from the segmental multi-frequency bioelectrical impedance analysis (BIA) of 939 elderly participants, including 673 cognitively normal (CN) people and 266 individuals with MCI. Participants’ characteristics, anthropometric information, and the selected BIA variables were described and statistically compared between the CN participants and those with MCI. The correlations between the selected BIA variables and neuropsychological tests such as the Korean version of the Mini-Mental State Examination and Seoul Neuropsychological Screening Battery – Second Edition were also examined before and after controlling for age and sex. Univariate and multivariate logistic regression analyses with estimated odds ratios (ORs) were conducted to investigate the associations between these BIA variables and MCI prevalence for different sexes.

Results

Participants with MCI were slightly older, more depressive, and had significantly poorer cognitive abilities when compared with the CN individuals. The partial correlations between the selected BIA variables and neuropsychological tests upon controlling for age and sex were not greatly significant. However, after accounting for age, sex, and the significant comorbidities, segmental lean mass, water volume, resistance, and reactance in the lower extremities were positively associated with MCI, with ORs [95% confidence interval (CI)] of 1.33 (1.02–1.71), 1.33 (1.03–1.72), 0.76 (0.62–0.92), and 0.79 (0.67–0.93), respectively; with presumably a shift of water from the intracellular area to extracellular space. After stratifying by sex, resistance and reactance in lower extremities remained significant only in the women group.

Conclusion

An increase in segmental water along with segmental lean mass and a decrease in body cell strength due to an abnormal cellular water distribution demonstrated by reductions in resistance and reactance are associated with MCI prevalence, which are more pronounced in the lower extremities and in women. These characteristic changes in BIA variables may be considered as an early sign of cognitive impairment in the elderly population.

Effects of Walking Football During Ramadan Fasting on Heart Rate Variability and Physical Fitness in Healthy Middle-Aged Males

This study aimed to investigate the effect of a walking football (WF) program during Ramadan fasting (RF) on heart rate variability (HRV) indices, body composition, and physical fitness in middle-aged males. Thirty-one healthy sedentary men were randomized to WF (n = 18) and control (n = 13) groups. Both groups participated in RF. The WF group were involved in a training program (small-sided games) of three sessions a week during RF. The time and frequency domains of HRV, body composition, handgrip, lumbar strength, Modified Agility Test (MAT), and 6-minute walk test (6MWT) were measured before Ramadan (BR), during Ramadan (DR), and after Ramadan (AR). We reported that RF has significantly altered some parameters of HRV DR; the mean HR decreased while the mean RR, LF, and HF increased. WF had a significant effect on HRV and mean HR DR compared with BR and AR decreased while mean RR, HF and LF increased. DR, body mass decreased in both groups, while body mass index (BMI) decreased and lean mass increased only in WF group. Lower body mass and BMI levels were reported AR only in WF group. Physical capacity improved AR, compared with BR, only in the WF group with longer distance in 6MWT, shorter time(s) in MAT, and higher lumbar strength levels. We conclude that RF increases parasympathetic system activity. WF practice during RF is safe and might improve body composition, physical fitness, autonomic cardiac function, and physical fitness in middle-aged males.

Pre-diabetes, diabetes and fluctuations of glucose tolerance after gestational diabetes mellitus: 5-year follow-up of a contemporary, prospective study in Germany

INTRODUCTION

Ten years ago, Germany started offering screening for gestational diabetes mellitus (GDM) to all pregnant women. This approach revealed more but also, on average, less severe cases of GDM than the risk-based screening practiced previously. We now examined the incidence of pre-diabetes and diabetes following a GDM diagnosis in the era of universal screening in Germany and compared our results with studies in the previous period. Additionally, we examined the year-to-year fluctuations of glucose tolerance after a pregnancy complicated by GDM.

RESEARCH DESIGN AND METHODS

We report 5-year follow-up data from 202 women in the prospective, monocenter, postpartum study PPSDiab. Consecutive recruitment took place in Munich, Germany between 2011 and 2016. In the study, we conducted yearly examinations that included anthropometrics, laboratory chemistry and oral glucose tolerance testing.

RESULTS

During the first 5 years post partum, 111 (55%) and 12 (6%) of the women developed pre-diabetes and type 2 diabetes, respectively, while 2 (1%) developed type 1 diabetes. Impaired fasting glucose (IFG) was the most common first manifestation of disturbed glucose tolerance, followed by impaired glucose tolerance (IGT), the combination of IFG and IGT, and diabetes. Glucose tolerance did not deteriorate steadily in most women but fluctuated from year to year.

CONCLUSIONS

In our analysis, the incidence of diabetes, both type 1 and type 2, after GDM diagnosed in universal screening was substantially lower than in studies from the previous period of risk-based screening. Nevertheless, the high incidence of pre-diabetes we observed after GDM still confirms the importance of this diagnosis as a risk marker. Additionally, we documented frequent fluctuations of glucose tolerance from 1 year to the next. Therefore, a single postpartum glucose tolerance test, as currently practiced in routine care, may be insufficient for reliable risk stratification after GDM.

Commercial Devices Provide Estimates of Energy Balance with Varying Degrees of Validity in Free-Living Adults

BACKGROUND

The challenges of accurate estimation of energy intake (EI) are well-documented, with self-reported values 12%-20% below expected values. New approaches rely on gold-standard assessments of the other components of energy balance, energy expenditure (EE) and energy storage (ES), to estimate EI.

OBJECTIVES

The purpose of this study was to evaluate the validity, repeatability, and measurement error of consumer devices when estimating energy balance in a free-living population.

METHODS

Twenty-four healthy adults (14 women, 10 men; mean ± SD age: 30.7 ± 8.2 y) completed two 14-d assessment periods, including assessments of EE and ES using gold-standard [doubly labeled water (DLW) and DXA] and commercial devices [Fitbit Alta HR activity monitor (Alta) and Fitbit Aria wireless body composition scale (Aria)], and of EI by dietician-administered recalls. Accuracy and validity were assessed using Spearman correlation, interclass correlation, mean absolute percentage error, and equivalency testing. We also applied linear measurement error modeling including error in gold-standard devices and within-subject repeated-measures design to calibrate consumer devices and quantify error.

RESULTS

There was moderate to strong agreement for EE between the Fitbit Alta and DLW at each time point (rs = 0.82 and 0.66 for Times 1 and 2, respectively). There was weak agreement for ES between the Fitbit Aria and DXA (rs = 0.15 and 0.49 for Times 1 and 2, respectively). Correlations between methods to assess EI ranged from weak to strong, with agreement between the DXA/DLW-calculated EI and dietary recalls being the highest (rs = 0.63 for Time 1 and 0.73 for Time 2). Only EE from the Fitbit Alta at Time 1 was equivalent to the DLW value using equivalency testing.

CONCLUSIONS

Commercial devices provide estimates of energy balance in free-living adults with varying degrees of validity compared to gold-standard techniques. EE estimates were the most robust overall, whereas ES estimates were generally poor.

No association of natural killer cell number and function in peripheral blood with overweight/obesity and metabolic syndrome in a cohort of young women

AIM

To reexamine the associations of NK cell number and function in the peripheral blood with overweight/obesity and the metabolic syndrome in a large, well-phenotyped human cohort.

METHODS

Cross-sectional analysis of 273 women in the PPSDiab Study; measurement of absolute and relative number of NK cells in peripheral blood, and of functional parameters CD69 positivity and cytotoxicity against K562 cells; group comparison of NK cell characteristics between lean, overweight, and obese participants, as well as metabolic syndrome scores of 0, 1, 2, and ≥3; Spearman correlation analyses to clinical parameters related to the metabolic syndrome.

RESULTS

We found no differences in NK cell number and function between lean, overweight, and obese women (relative NK cell number (median (Q1-Q3), [%]) 5.1(2.6-9.4) vs. 4.8 (2.9-8.4) vs. 3.8 (1.7-7.8), p = 0.187; absolute NK cell number [106 /L]: 86.9 (44.6-188.8) vs. 92.6 (52.5-154.6) vs. 85.9 (44-153.8), p = 0.632; CD69+ [%]: 27.2 (12.9-44.3) vs. 37.6 (13.2-52.8) vs. 33.6 (16.3-45), p = 0.136; cytotoxicity [%]: 11.0 (7.1-14.5) vs. 8.5 (6.4-13.2) vs. 11.3 (8.7-14.2), p = 0.094), as well as between different metabolic syndrome scores. Nonesterified fatty acids correlated with absolute and relative NK cell number and cytotoxicity (ρ [p-value]: 0.142 [0.021], 0.119 [0.049], and 0.131 [0.035], respectively). Relative NK cell number further correlated with high-density lipoprotein cholesterol (0.144 [0.018]) and cytotoxicity with 2 h glucose in oral glucose tolerance testing (0.132 [0.034]). CD69 positivity correlated with body fat (0.141 [0.021]), triglycerides (0.129 [0.033]), and plasma leptin (0.155 [0.010]). After correction for multiple testing, none of the associations remained significant.

CONCLUSION

In the present study, we observed no associations of NK cell number and function in the peripheral blood with overweight/obesity and the metabolic syndrome. Extreme phenotypes of obesity and the metabolic syndrome might have caused differing results in previous studies. Further analyses with a focus on compartments other than peripheral blood may help to clarify the relation between NK cells and metabolic diseases.

Accuracy of Waist Circumference Measurement using the WHO versus NIH Protocol in Predicting Visceral Adiposity Using Bioelectrical Impedance Analysis among Overweight and Obese Adult Filipinos in a Tertiary Hospital

Objectives

The study aimed to compare the performance of weight circumference (WC) measurement using the World Health Organization (WHO) versus National Institutes of Health (NIH) protocol in identifying visceral adiposity, and to determine the association of WC with cardiometabolic risk factors among overweight and obese adult Filipinos.

Methodology

A retrospective study involving 221 subjects (99 males, 122 females) evaluated at an outpatient weight intervention center of a tertiary hospital. The WC was measured at the superior border of the iliac crest (WC-NIH) and midway between the lowest rib and the iliac crest (WC-WHO) for each patient. Using visceral fat rating (VF) derived via bioelectrical impedance analysis (BIA) as reference standard, diagnostic accuracy tests for both protocols (using cut-offs of ≥90 cm in males and ≥80 cm in females) were done. Cardiometabolic parameters were also obtained, and binary logistic regression was performed to determine associations with WC.

Results

Among males, WC-WHO had 96% sensitivity (95% CI 88.8%-99.2%) and 25% specificity (95% CI 9.77%-46.7%) while WC-NIH had 94.7% sensitivity (95% CI 86.9%-98.5%) and 29.2% specificity (95% CI 12.6%-51.1%) to predict high VF >12. Among females, WC-WHO had 100% sensitivity (95% CI 90%-100%) and 24.1% specificity (95% CI 15.6%-34.5%) while WC-NIH had 100% sensitivity (95% CI 90%-100%) and 4.6% specificity (95% CI 1.3%-11.4%). Prevalence of high VF was significantly greater among males – 75.8% (95% CI 66.1%-83.8%) vs. 28.7% (95% CI 20.9%-37.6%) in females (p<0.001). Among females, WC-NIH tended to have higher measurements than WC-WHO by an average of 4.67 cm. Females with WC-WHO measurements of at least 80 cm were approximately four times more likely to have low (<50 mg/dL) HDL levels (cOR 3.82, p=<0.05), even after adjusting for age (aOR 3.83, p=<0.05).

Conclusion

WC measurement using the WHO and NIH protocols were both highly sensitive but had low specificity in predicting high VF estimated via BIA among overweight and obese adult Filipinos in this study. WC-NIH measurements tended to be higher among the females, which may affect classification of central obesity when using this protocol. WC ≥80 cm measured using the WHO protocol was associated with low HDL levels among female subjects. Prospective studies conducted among the general Filipino population are recommended to verify these findings.

Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction

We investigated physiological responses and exercise capacity in sedentary young smokers during sub-maximal and maximal test and its impact on dyspnea and exercise intolerance. Fifty sedentary male smokers and non-smokers (age: 24 ± 1 years., weight: 71 ± 9 kg, height: 177.3 ± 4.8 cm, body mass index: 22.6 ± 2.5 kg/m2) underwent two visits with pulmonary function tests, breathing pattern, and inspiratory capacity measurement at rest and during sub-maximal and maximal exercise. Smokers show reduced exercise capacity during six minutes walk test (6-MWT) with decreased walked distance (p < 0.001) and inspiratory capacity (p < 0.05). During cardiopulmonary exercise test (CPET), smokers had higher minute ventilation VE for a given submaximal intensity (p < 0.05) and lower minute ventilation at maximal exercise (p < 0.001). End expiratory lung volume was significantly lower in sedentary smokers at rest (p < 0.05), at ventilatory threshold during exercise (p < 0.05), but not during peak exercise. End inspiratory lung volume was significantly lower in smokers at rest (p < 0.05) and ventilatory threshold (p < 0.05). Cigarette smoking alters lung function during submaximal and maximal exercise. This alteration is manifested by the development of dynamic hyperinflation contributing to exercise capacity limitation.

Precision and accuracy of bioelectrical impedance analysis devices in supine versus standing position with or without retractable handle in Caucasian subjects

BACKGROUND & AIMS

Bioelectrical impedance analysis (BIA) could be facilitated in subjects who are able to stand by using scales without (BIA_std4) or with a retractable handle (BIA_std8), provided that they are as precise as BIA devices commonly used in the supine position in the hospital setting (BIA_sup). This observational prospective cross-sectional study aimed to compare the precision and accuracy of BIA_std4, BIA_std8 and BIA_sup in a Caucasian population.

METHODS

Fat mass percentage (FM%) was measured in 160 healthy Caucasian subjects (80 men/80 women) aged 20-60 years, with a body mass index (BMI) ≥18.5 and < 30 kg/m², using the HAGRID Body Fat Scales (Huawei Technologies Co., Ltd., China) in BIA_std4 or BIA_std8 mode, and the Nutriguard-M (Data Input GmbH, Germany) as BIA_sup. Intra-unit and inter-unit precisions of each device were evaluated by calculating the coefficients of variation (CV%) of 3 measurements with 3 different units of each device. Inter-device precisions were evaluated with Pearson correlations, Bland-Altman plots, and repeated measures ANOVA followed by post-hoc Bonferroni tests. Accuracy of these BIA devices was estimated in a subgroup of 16 subjects, using comparison with dual-energy X-ray absorptiometry (DXA).

RESULTS

The study population was 40 ± 12 years old, with a body height and weight of 171 ± 10 cm and 72.2 ± 11.5 Kg, respectively. All three devices were very precise with intra-unit CV% of 0.5%, 0.9%, and 0.3% and inter-unit CV% of 0.5%, 1.1%, and 0.4% for BIA_std4, BIA_std8 and BIA_sup, respectively. Inter-device precision was ±2.1% for BIA_std4/BIA_sup, ±1.9% for BIA_std8/BIA_sup, and ±1.3% for BIA_std8/BIA_std4. Bland-Altman plots showed bias ±1.96 SD of 0.3 ± 5.2% for BIA_std4/BIA_sup, -0.4 ± 4.5% for BIA_std8/BIA_sup and -0.6 ± 3.1% for BIA_std8/BIA_std4. Compared to DXA, all three devices tended to underestimate FM% in men with low BMI, while only BIA_std4 and BIA_std8 tended to overestimate FM% in women with high BMI. FM% measurement accuracy was ±2.6% for BIA_sup/DXA, ±3.3% for BIA_std4/DXA, and ±3.4% for BIA_std8/DXA.

CONCLUSIONS

Both BIA_std4 and BIA_std8 show a good intra- and inter-unit precision close to BIA_sup, making them suitable for rapid body composition assessment in non-bedridden subjects. However, all these three devices should not be used interchangeably, because BIA_std4 and BIA_std8 tend to accentuate FM% changes during body composition monitoring compared to BIA_sup and DXA.

TRIAL REGISTRATION

ClinicalTrial.gov no. NCT04504799.

How Does Time Spent Working in Custody Influence Health and Fitness Characteristics of Law Enforcement Officers?

This study investigated the influence of time spent working in custody on the health and fitness of law enforcement officers (LEOs). Retrospective analysis was conducted on data from 48 male and 12 female LEOs, divided into groups based upon time spent working custody: LEO ≤ 24 (≤24 months; n = 15); LEO 2547 (25-47 months; n = 24); and LEO 48+ (≥48 months; n = 21). The following were measured: body mass index (BMI); fat mass percentage; waist-to-hip ratio (WHR); resting heart rate (RHR); blood pressure; grip strength; sit-and-reach; push-ups; sit-ups; and YMCA step test recovery heart rate (HR). A univariate ANCOVA (controlling for sex and age) with Bonferroni post hoc determined significant between-group differences. Select assessments were compared to normative data. The LEO 48+ group completed fewer sit-ups than the LEO 2547 group (p = 0.006); there were no other significant between-group differences. Forty-nine LEOs were overweight or obese according to BMI; 52 were fatter than average or above; 27 had a WHR that increased cardiovascular disease risk. Forty-three LEOs had very poor RHR; 52 had elevated blood pressure. Forty-eight LEOs had average-to-very poor step test recovery HR. Irrespective of time spent working in custody, personnel should be physically active to maintain health and fitness and, where possible, engage in formal strength training and conditioning.

Changes in daily energy expenditure and movement behavior in unilateral vestibular hypofunction: Relationships with neuro-otological parameters

The vestibular system has been found to affect energy homeostasis and body composition, due to its extensive connections to the brainstem and melanocortin nuclei involved in regulating the metabolism and feeding behavior. The aim of this study was to evaluate - by means of a wrist-worn physical activity tracker and bioelectrical impedance analysis (BIA) - the energy expenditure (EE) in resting (REE) and free-living conditions and movement behavior in a group of chronic unilateral vestibular hypofunction (UVH) patients when compared with a control group (CG) of healthy participants. Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video-Head Impulse Test [vHIT] for studying vestibulo-ocular reflex [VOR] and static posturography testing [SPT]), and EE and movement measurements and self-report (SRM) andperformance measures (PM). As well as significant (p < 0.001) changes in SPT variables (area and path length) and SRM/PM, UVH participants also demonstrated significantly (p < 0.001) lower values in REE, movement EE, hours/day spent upright, number of strides and distance covered and total daily EE (p = 0.007) compared to the CG. UVH patients consumed significantly lower Kcal/min in sweeping (p = 0.001) and walking upstairs and downstairs (p < 0.001) compared to the CG. Multiple correlations were found between free-living and resting EE and neuro-otological parameters in UVH participants. Since the melanocortin system could be affected along the central vestibular pathways as a consequence of chronic vestibular deafferentation, data collected by reliable wearables could reflect the phenomena that constitute an increased risk of falls and sedentary lifestyle for patients affected by UVH, and could improve rehabilitation stages.

Impact of rural versus urban setting on kidney markers: a cross-sectional study in South-Kivu, DRCongo

Background

Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been conducted in urban settings. They relied on GFR estimated from serum creatinine alone and on the inexpensive, convenient urinary dipstick to assess proteinuria. The dipstick for proteinuria has not been directly compared with the gold standard albumin-to-creatinine ratio (ACR) in a large-sized study in SSA. We hereby assessed the influence of rural versus urban location on the level, interpretation, and diagnostic performance of proteinuria dipstick versus ACR.

Methods

In a cross-sectional population-based study of CKD in both urban (n = 587) and rural (n = 730) settings in South-Kivu, Democratic Republic of Congo (DRC), we assessed the prevalence, performance (sensitivity, specificity, positive predictive value and negative predictive value) and determinants of a positive dipstick proteinuria as compared with albuminuria (ACR). Albuminuria was subdivided into: A1 (< 30 mg/g creatinine), A2 (30 to 299 mg/g creatinine) and A3 (≥ 300 mg/g creatinine).

Results

The overall prevalence of positive dipstick proteinuria (≥ 1+) was 9.6 % (95 % CI, 7.9–11.3) and was higher in rural than in urban residents (13.1 % vs. 4.8 %, p < 0.001), whereas the prevalence of albuminuria (A2 or A3) was similar in both sites (6 % rural vs. 7.6 % urban, p = 0.31). In both sites, dipstick proteinuria ≥ 1 + had a poor sensitivity (< 50 %) and positive predictive value (< 11 %) for the detection of A2 or A3. The negative predictive value was 95 %. Diabetes [aOR 6.12 (1.52–24.53)] was a significant predictor of A3 whereas alkaline [aOR 7.45 (3.28–16.93)] and diluted urine [aOR 2.19 (1.35–3.57)] were the main predictors of positive dipstick proteinuria.

Conclusions

ACR and dipstick proteinuria have similar positivity rates in the urban site whereas, in the rural site, dipstick was 2-fold more often positive than ACR. The poor sensitivity and positive predictive value of the dipstick as compared with ACR makes it unattractive as a screening tool in community studies of CKD in SSA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02431-w.

Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement

BACKGROUND

Frailty is a multidimensional syndrome that affects mortality after aortic valve replacement (AVR). Malnutrition is often associated with the development of frailty. However, data regarding the association of frailty with nutritional status and underlying endocrinological dysregulation in patients with severe aortic valve stenosis are limited.

OBJECTIVES

We aimed to systematically screen for frailty and malnutrition, to evaluate for underlying endocrinological disorders and inflammation, and to assess the ability of these parameters to predict outcomes after AVR.

METHODS

Our study included 373 patients undergoing transcatheter and surgical AVR. Frailty was assessed using the Fried Frailty Phenotype (FFP), Essential Frailty Toolset, Lawton-Brody, and Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF) and Controlling Nutritional Status. Outcomes of interest were 30-day and one-year mortality.

RESULTS

The prevalence of frailty ranged from 6.4% to 65.7% and malnutrition from 5.9% to 10.5%, depending on the evaluation tool. Both parameters were associated with higher levels of cortisol and parathormone as well as lower levels of IGF-1, testosterone, DHEAS, and c-reactive protein. Malnutrition was associated with increased 30-day mortality, and both frailty and malnutrition with increased one-year mortality. In a multivariate analysis, malnutrition measured by the MNA-LF (OR: 2.32 [95%CI: 1.19-4.53], p = 0.01) and frailty as assessed by the FFP (OR: 1.42 [95%CI: 1.02-1.96], p = 0.03) were independent predictors of one-year mortality.

CONCLUSION

The prevalence of frailty and malnutrition varies significantly depending on the assessment tool. Both syndromes share common endocrinological alterations. Frailty and malnutrition are independent risk factors for mortality after AVR.

Performing nutrition assessment remotely via telehealth

Performing nutrition assessment remotely via telehealth is a topic of significant interest given the global pandemic in 2020 that has necessitated physical distancing and virtual communications. This review presents an evidence-based approach to conducting nutrition assessments remotely. The authors present suggestions for adaptations that can be used to perform a remote nutrition-focused physical exam. Direct-to-consumer technologies that can be used in remote nutrition assessment are discussed and compared. Practice tips for conducting a telehealth visit are also presented. The aim of this publication is to provide interdisciplinary clinicians a set of guidelines and best practices for performing nutrition assessments in the era of telehealth.

Inflammation-related plasma protein levels and association with adiposity measurements in young adults

Obesity-related inflammation is associated with cardiovascular, metabolic, and pulmonary diseases. The aim of this study was to demonstrate associations between adiposity measurements and levels of inflammation-related plasma proteins in a population of young adults. Subjects from a population-based birth cohort with a mean age of 22.5 years were included in the study population (n = 2074). Protein levels were analyzed using the Olink Proseek Multiplex Inflammation panel. Percentage body fat (%BF) and visceral fat rating (VFR) measurements were collected using Tanita MC 780 body composition monitor. Linear regression of standardized values was used to investigate associations. Potential effect modifications by sex and BMI category were assessed. Of 71 investigated proteins, 54 were significantly associated with all adiposity measurements [%BF, body mass index (BMI), VFR and waist circumference]. Among proteins associated with %BF, seven showed a larger or unique association in overweight/obese subjects and three showed a significant effect modification by sex. Fourteen proteins more strongly associated with VFR in females compared to males. Adipose-associated systemic inflammation was observed in this young adult population. Sex and adiposity localization influenced some of the associations. Our results highlight specific proteins as suitable biomarkers related to adiposity.

Risk of Iron Overload in Obesity and Implications in Metabolic Health

Excessive adiposity is associated with several metabolic perturbations including disturbances in iron homeostasis. Increased systemic inflammation in obesity stimulates expression of the iron regulatory hormone hepcidin, which can result in a maldistribution of bodily iron, which may be implicated in metabolic dysfunction. This study aimed to investigate the effect of adiposity and any associated inflammation on iron homeostasis and the potential implications of dysregulated iron metabolism on metabolic health. Analyses are based on a subsample from the cross-sectional Irish National Adult Nutrition Survey (2008–2010) (n = 1120). Ferritin status and risk of iron overload were determined based on established WHO ferritin ranges. Participants were classed as having a healthy % body fat or as having overfat or obesity based on age- and gender-specific % body fat ranges as determined by bioelectrical impedance. Biomarkers of iron status were examined in association with measures of body composition, serum adipocytokines and markers of metabolic health. Excessive % body fat was significantly associated with increased serum hepcidin and ferritin and an increased prevalence of severe risk of iron overload amongst males independent of dietary iron intake. Elevated serum ferritin displayed significant positive associations with serum triglycerides and markers of glucose metabolism, with an increased but non-significant presentation of metabolic risk factors amongst participants with overfat and obesity at severe risk of iron overload. Increased adiposity is associated with dysregulations in iron homeostasis, presenting as increased serum hepcidin, elevated serum ferritin and an increased risk of iron overload, with potential implications in impairments in metabolic health.

Skeletal Muscle Mass and Fat Mass Relationships With Physical Fitness Test Performance in Law Enforcement Recruits Before Academy

ABSTRACT

Lockie, RG, Carlock, BN, Ruvalcaba, TJ, Dulla, JM, Orr, RM, Dawes, JJ, and McGuire, MB. Skeletal muscle mass and fat mass relationships with physical fitness test performance in law enforcement recruits before academy. J Strength Cond Res 35(5): 1287-1295, 2021-The purpose of this study was to analyze relationships between skeletal muscle mass percentage (SMM%) and fat mass percentage (FM%) relative to fitness test performance in law enforcement recruits. Retrospective analysis was conducted on 338 recruits (271 men and 67 women) from 4 academy classes. Skeletal muscle mass percentage and FM% were measured using cost-effective and practical bioelectrical impedance analysis (BIA) equipment that used hand and foot placement. The fitness tests included grip strength; vertical jump; 75-yard pursuit run; 2-kg medicine ball throw (MBT); push-ups and sit-ups completed in 60 seconds; and the 20-m multistage fitness test. Partial correlations controlling for sex-derived relationships between SMM%, FM%, and the tests. Recruits were split into quartile groups for SMM% and FM% (group 1 had the lowest SMM% or highest FM% and group 4 the highest SMM% or lowest FM%). A 1-way multivariate analysis of variance (MANOVA), with sex as a covariate and Bonferroni post-hoc, compared between-group results. Skeletal muscle mass percentage correlated with all fitness tests expect for MBT; FM% with all but grip strength and MBT (r = ±0.107-0.293). Greater SMM% or lesser FM% tended to relate to better fitness test performance. The MANOVA data indicated groups 3 and 4 (better SMM% or FM% profiles) exhibited superior fitness than group 1 (poorest SMM% or FM% profile) (p ≤ 0.048). Recruits should ideally increase SMM% and decrease FM% before academy to optimize fitness training and testing performance, although specific guidelines should be agency specific. Staff could use BIA to monitor body composition during academy to indicate how recruits are tolerating training.

Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients

Periods of fasting and refeeding may reduce cardiometabolic risk elevated by Western diet. Here we show in the substudy of NCT02099968, investigating the clinical parameters, the immunome and gut microbiome exploratory endpoints, that in hypertensive metabolic syndrome patients, a 5-day fast followed by a modified Dietary Approach to Stop Hypertension diet reduces systolic blood pressure, need for antihypertensive medications, body-mass index at three months post intervention compared to a modified Dietary Approach to Stop Hypertension diet alone. Fasting alters the gut microbiome, impacting bacterial taxa and gene modules associated with short-chain fatty acid production. Cross-system analyses reveal a positive correlation of circulating mucosa-associated invariant T cells, non-classical monocytes and CD4⁺ effector T cells with systolic blood pressure. Furthermore, regulatory T cells positively correlate with body-mass index and weight. Machine learning analysis of baseline immunome or microbiome data predicts sustained systolic blood pressure response within the fasting group, identifying CD8⁺ effector T cells, Th17 cells and regulatory T cells or Desulfovibrionaceae, Hydrogenoanaerobacterium, Akkermansia, and Ruminococcaceae as important contributors to the model. Here we report that the high-resolution multi-omics data highlight fasting as a promising non-pharmacological intervention for the treatment of high blood pressure in metabolic syndrome patients.

Nutritional modification including fasting has been shown to reduce cardiometabolic risk linked to western diet. Here the authors show implementation of fasting resulted in alterations to the intestinal microbiota, and circulating immune cells, improving blood pressure and body weight in patients with metabolic syndrome.