Limitations of body mass index for counseling individuals with unilateral lower extremity amputation

The Response of the Amputee Athlete Heart to Chronic Core Exercise: A Study on Hematological and Biochemical Parameters, and N-Terminal Pro Brain Natriuretic Peptide

Background and Objectives: mortality and morbidity due to cardiovascular causes are frequently experienced in amputees. Research on the effects of chronic exercise on biomarkers and cardiac damage indicators in these individuals is limited. The aim of this study was to investigate the effects of a core training program on brain natriuretic-related peptide, as well as hematological and biochemical parameters in amputee soccer players. Materials and Methods: The participants were randomly allocated to the following two groups: a core exercise group (CEG) and a control group (CG). While the CG continued routine soccer training, the CEG group was included in a core exercise program different from this group. During the study, routine hemogram parameters of the participants, various biochemical markers, and the concentration of brain natriuretic-related peptide (NT-pro-BNP) were analyzed. Results: after the training period, notable improvements in various hematological parameters were observed in both groups. In the CEG, there were significant enhancements in red blood cell count (RBC), hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular hemoglobin (MCH) values. Similarly, the CG also showed substantial improvements in RBC, HCT, mean corpuscular volume (MCV), MCHC, MCH, red cell distribution width-standard deviation (RDW-SD), platelet-to-lymphocyte ratio (PLCR), mean platelet volume (MPV), and platelet distribution width (PDW). Moreover, in the CEG, serum triglycerides (TG) and maximal oxygen uptake (MaxVO2) exhibited significant increases. Conversely, TG levels decreased in the CG, while high-density lipoprotein (HDL), low-density lipoprotein (LDL), and MaxVO2 levels demonstrated substantial elevations. Notably, the N-terminal pro-brain natriuretic peptide (BNP) levels did not undergo significant changes in either the CEG or the CG following the core exercise program (p > 0.05). However, in the CEG, a meaningful positive correlation was observed between NT-pro-BNP and creatine kinase (CK) levels before and after the core exercise program. Conclusions: the findings emphasized the potential benefits of core training in enhancing specific physiological aspects, such as erythrocyte-related parameters and lipid metabolism, as well as aerobic capacity. Furthermore, the observed correlation between NT-pro-BNP and CK levels in the CEG provides intriguing insights into the unique physiological adaptations of amputee athletes.

Long-Term Health Outcomes of Limb Salvage Compared with Amputation for Combat-Related Trauma

BACKGROUND

There are little long-term health data, particularly in terms of body composition and development of metabolic syndromes, to help surgeons to guide the decision between limb salvage and amputation in patients with limb-threatening trauma. The purpose of this study was to compare long-term health outcomes after high-energy lower-extremity trauma between patients who underwent attempted flap-based limb salvage or amputation.

METHODS

We performed a retrospective review of servicemembers with a minimum 10-year follow-up who underwent flap-based limb salvage followed by unilateral amputation or continued limb salvage after combat-related, lower-extremity trauma between 2005 and 2011. Patient demographic characteristics, injury characteristics, and health outcomes including body mass index (BMI) and development of metabolic disease (e.g., hyperlipidemia, hypertension, heart disease, and diabetes) were compared between treatment cohorts. Adjusted BMIs were calculated for the amputation cohort to account for lost surface area. We performed multivariable and propensity score analysis to determine the likelihood of developing obesity or metabolic disease.

RESULTS

In this study, 110 patients had available long-term follow-up (mean, 12.2 years) from the time of the injury. Fifty-six patients underwent limb salvage and 54 patients underwent unilateral amputation. There was no difference in preinjury BMI (p = 0.30). After adjusting for limb loss, the amputation cohort had a trend toward higher BMIs at ≥1 years after the injury, a higher rate of obesity, and a greater increase in BMI from baseline after the injury. The development of metabolic comorbidities was common after both amputation (23 [43%] of 54) and limb salvage (27 [48%] of 56). With the numbers available, we were unable to demonstrate a difference in risk for the development of hypertension, hyperlipidemia, diabetes, heart disease, or any comorbidity other than obesity (p > 0.05).

CONCLUSIONS

Amputations may be medically necessary and may decrease pain, improve mobility, and/or expedite return to activity compared with limb salvage after similar injuries. However, limb loss may negatively impact metabolic regulation and may contribute to a higher risk of obesity despite beneficial effects on mobility.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Evaluation of electrocardiographic parameters in amputee football players

OBJECTIVE

The present study aimed to compare electrocardiographic (ECG) parameters of amputee football players (AF) with football players without disability (FP) and sedentary individuals without disability (SI).

METHODS

A total of 32 participants (AF = 9, FP = 11, SI = 12) were included in the study. ECG parameters including P-wave amplitude, P-wave duration, PR interval, QRS duration, RR interval, QT interval, corrected-QT interval (QTc), ST segment duration, Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were assessed in all the study participants by using a 12-lead ECG device. OneWay ANOVA Test was used for statistical analysis.

RESULTS

Of all ECG parameters, P-wave amplitude and QTc were significantly higher in the AF group in comparison to FP and SI groups. QRS duration was found to be lower in the AF group when compared to FP and SI groups. Myocardial repolarization parameters including Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were similar between groups, as were other parameters such as P-wave duration, PR interval, RR interval, QRS duration and QT interval.

CONCLUSION

It was found that some ECG parameters of amputee football players differ from those with non-disabled players and non-disabled sedentary individuals. These different parameters were within normal limits.

Effects of chronic core training on serum and erythrocyte oxidative stress parameters in amputee football players

Objective: The positive impact of aerobic exercise on blood oxidative stress parameters is well documented. However, the effect of core exercises on these parameters in amputee football players (AF) remains unclear. Therefore, this study aims to investigate the impact of core exercises on blood oxidative stress parameters in this population. Methods: Experimental method was adopted in the study. Eleven elite AF players participated in the study. The participants were divided randomly into two groups a core exercise group (CEG) and a control group (CG). Blood measurements were taken before and after the 8-week core exercise program. Blood measurements included erythrocyte Total Oxidant Status (eTOS), erythrocyte Total Antioxidant Status (eTAS), erythrocyte oxidative stress index (eOSI), serum nitric oxide (sNO), serum Total Oxidant Status (sTOS), serum Total Antioxidant Status (sTAS), serum oxidative stress index (sOSI), serum total thiol (sTT), serum native thiol (sNT), and serum disulfide (sDS) parameters were studied. Results: According to the results of the study, a significant difference was found between the 0th and eighth week pre-aerobic training load (ATL) sTOS (p = .028) values of CEG values. A significant difference was found in sTOS (p = .028) and sOSI (p = .028) values after the 0th and eighth-week pre-ATL. A significant difference was found in the sTOS (p = .043) and sOSI values (p = .043) of CG at week 0th and eighth-week pre-ATL. Conclusion: Overall, the results suggest that core exercises had a positive effect on blood oxidative stress parameters in AF players by reducing blood total oxidant levels.

Introduction to Limb Deficiency for the Pediatrician

Owing to the lack of trained professionals in amputee care, the pediatrician is often required to assist in the care of children with limb deficiencies. An overview of the causes and epidemiology of limb deficiency is provided, as well as an evaluation and diagnostic workup. Important considerations for surgical interventions are discussed and an introduction to prosthetic prescribing and care of the amputee is described. Common overuse syndromes and mental health issues are also reviewed. Finally, resources for funding of prosthetic devices, as well as support and education for clinicians and families are provided.

Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)—general concepts, indications, acquisition, and analysis

Objective

To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence.

Materials and methods

This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans.

Conclusion

Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.

Overweight and erythrocyte polyunsaturated fatty acid changes in menopause

Lipid disorders have been implicated in overweight and menopause. However, evidence on lipidomic analysis of fatty acids in erythrocytes of menopausal women is scarce. The aim of this study was to investigate the relationship between the body mass index within or beyond 5 years of menopause and erythrocyte fatty acid profile. This case-control study was conducted on out of 37 menopausal women total patients, 22 with body mass index ≥ 25 and 12 matched controls (body mass index <25). Experimental procedures were performed on the blood through robotic equipment for isolation of erythrocyte and cell membrane fatty acids were analyzed by using gas-liquid chromatography. Results showed that erythrocyte membranes did not change significantly in lipid composition between case and control group. However, the percentage of women who had a physiological content of saturated fatty acids was lower in case than in control group, and the percentage of women who had a physiological content of monounsaturated fatty acids and polyunsaturated fatty acids was lower in control than in case group. Woman with BMI>25 and non-physiological content of fatty acids, were richer in percentage of saturated fatty acids and poorer of monounsaturated fatty acids and polyunsaturated fatty acids than women with BMI<25. The percentage of physiological n-6/n-3 polyunsaturated ratio was lower in women with BMI>25 than in women with BMI<25. Interestingly, the percentage of patients that had physiological values of lipids beyond 5 years of menopause increased in comparison patients within 5 years of menopause. Notably, n-6/n-3 polyunsaturated fatty acids physiological ratio beyond 5 years of menopause increased in both case and control patients, indicating normalization over time. In conclusion erythrocytes fatty acids composition may be related to the body mass index and to the time from menopause.