Association Between Interleukin 6 and C-Reactive Protein Serum Levels and Body Composition Compartments and Components in Breast Cancer Survivors

Obesity is highly prevalent in breast cancer (BC) survivors. Adipose tissue promotes inflammation, affecting recurrence, morbidity, and quality of life. This study aimed to determine the relationship of body composition parameters with the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) in female BC survivors. Additionally, we evaluated the association of log-transformed serum concentrations of CRP and IL-6 with the appendicular skeletal lean mass index (ASMI). The results showed that CRP was positively associated with body fat percentage (BFP; β adjusted = .08, 95% CI: .02-.14) in all participants, and with fat mass index (FMI; β = .24, 95% CI: .08-.40) only in premenopausal women. IL-6 was positively associated with FMI (β adjusted = .16, 95% CI: .03-.29), while ASMI decreased as CRP levels increased (β adjusted = -.30, 95% CI: -.53 to -.06). Interventions to improve body composition in BC survivors should also consider the role of inflammatory markers in changes in body composition to avoid sarcopenic obesity (SO) and the risk of BC recurrence.

Assessment of the performance of the body mass index in diagnosing obesity in community-dwelling older adults in Latin American and Caribbean countries

BACKGROUND

The body mass index (BMI) ≥30 kg/m2 is the universally accepted cut-off point for defining obesity; however, its accuracy in classifying obesity in older adults is poorly understood.

OBJECTIVES

To assess the performance of the BMI cut-off point ≥30 kg/m2 in classifying obesity in older adults, using the fat mass index (FMI) and fat mass percentage (FM%) as reference criteria; and to establish region- and sex-specific BMI-based cut-off points to classify obesity in older adults.

METHODS

The present study is a secondary analysis derived from a cross-sectional project that included a sample of 1463 older adults from ten Latin American and Caribbean countries. Volunteers underwent total body water measurements using the deuterium dilution technique to determine FMI and FM%. Accuracy of the BMI and derived cutoff points was assessed by the area under the receiver operating characteristic curve (AUC).

RESULTS

The BMI cut-off point ≥30 kg/m2 had low sensitivity for classifying obesity in these older adults compared to the FMI and FM%. The AUC values for the optimal BMI-derived cut-off points showed an acceptable-to-outstanding discriminatory capacity in diagnosing obesity defined by the FMI. There was also a better balance between sensitivity and specificity than with the values obtained by a BMI ≥30 kg/m2 in older subjects in both regions.

CONCLUSION

The BMI cut-off point ≥30 kg/m2 had poor sensitivity for accurately diagnosing obesity in older adults from two regions. The region- and sex-specific BMI-derived cut-off points for defining obesity using the FMI are more accurate in classifying obesity in older men and women subjects from both regions.

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

BACKGROUND AND AIMS

Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults.

METHODS

This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression.

RESULTS

The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance.

CONCLUSIONS

RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

Greater male variability in daily energy expenditure develops through puberty

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

Predictive equations for fat mass in older Hispanic adults with excess adiposity using the 4-compartment model as a reference method

BACKGROUND

Predictive equations are the best option for assessing fat mass in clinical practice due to their low cost and practicality. However, several factors, such as age, excess adiposity, and ethnicity can compromise the accuracy of the equations reported to date in the literature.

OBJECTIVE

To develop and validate two predictive equations for estimating fat mass: one based exclusively on anthropometric variables, the other combining anthropometric and bioelectrical impedance variables using the 4C model as the reference method.

SUBJECTS/METHODS

This is a cross-sectional study that included 386 Hispanic subjects aged ≥60 with excess adiposity. Fat mass and fat-free mass were measured by the 4C model as predictive variables. Age, sex, and certain anthropometric and bioelectrical impedance data were considered as potential predictor variables. To develop and to validate the equations, the multiple linear regression analysis, and cross-validation protocol were applied.

RESULTS

Equation 1 included weight, sex, and BMI as predictor variables, while equation 2 considered sex, weight, height squared/resistance, and resistance as predictor variables. R2 and RMSE values were ≥0.79 and ≤3.45, respectively, in both equations. The differences in estimates of fat mass by equations 1 and 2 were 0.34 kg and -0.25 kg, respectively, compared to the 4C model. This bias was not significant (p < 0.05).

CONCLUSIONS

The new predictive equations are reliable for estimating body composition and are interchangeable with the 4C model. Thus, they can be used in epidemiological and clinical studies, as well as in clinical practice, to estimate body composition in older Hispanic adults with excess adiposity.

Determination of Fat-Free Mass Density and its Components in Older Hispanic Adults by In Vivo Methods

The densitometry method estimates body composition based on cadaver reference values, mainly the fat-free mass density value of 1.100 g/cm³. However, several changes in fat-free mass components by aging, ethnicity, and excess adiposity could influence their density and affect body composition estimations. The present study aimed to compare the mean fat-free mass component values in older Hispanic adults to cadaver reference values. This cross-sectional study included a sample of 420 subjects aged ≥60 yr from northern Mexico. Fat-free mass was determined by the four-compartment model using air displacement plethysmography, the deuterium dilution technique, and dual-energy X-ray absorptiometry for body density, aqueous and mineral fractions of body weight, respectively. A 1-sample t test was used to compare the fat-free mass density and aqueous, mineral, and residue fractions of fat-free mass from subjects in the study to the assumed cadaver reference values. The mean fat-free mass density value for the total sample of older Hispanic adults (1.096 ± 0.011 g/cm³) was significantly (p < 0.001) lower than the assumed value of 1.100 g/cm³, except in obese older men. The mean aqueous fraction of fat-free mass (74.8 ± 3.3%) was higher than the assumed value of 73.8%, and the mean residue fraction of fat-free mass value was lower (18.3 ± 3.4%) than the reference value of 19.4%. Indeed, only the mean mineral fraction of fat-free mass value (6.8 ± 0.8%) was similar to the reference value. In the total sample, all characteristic mean fat-free mass values in these older Hispanic adults differed from cadaver reference values, except the mineral fraction of fat-free mass value.

External validation of BIA equations to estimate appendicular skeletal muscle mass in older adults: Importance of the bias analysis and derivation of correction factors to achieve agreement

There are several equations based on bioelectrical impedance analysis (BIA) to estimate with high precision appendicular skeletal muscle mass (ASM). However, most of the external validation studies have reported that these equations are inaccurate or biased when applied to different populations. Furthermore, none of the published studies has derived correction factors (CFs) in samples of community-dwelling older adults, and none of the published studies have assessed the influence of the dual-energy X-ray absorptiometry (DXA) model on the validation process. This study assessed the agreement between six BIA equations and DXA to estimate ASM in non-Caucasian older adults considering the DXA model and proposed a CF for three of them. This analysis included 547 non-institutionalized subjects over 60 years old from the northwest of Mexico who were physically independent and without cognitive impairment: 192 subjects were measured using DXA Hologic, while 355 were measured by DXA Lunar. The agreement between each of the equations and DXA was tested considering the DXA model used as a reference method for the design of each equation, using the Bland and Altman procedure, a paired t test, and simple linear regression as objective tests. This process was supported by the differences reported in the literature and confirmed in a subsample of 70 subjects measured with both models. Only six published BIA equations were included. The results showed that four equations overestimated ASM_DXA, and two underestimated it (p < 0.001, 95% CI for Kim's equation:−5.86-−5.45, Toselli's:−0.51-−0.15, Kyle's: 1.43–1.84, Rangel-Peniche's: 0.32–0.74, Sergi's: 0.83–1.23, and Yoshida's: 4.16–4.63 kg). However, Toselli's, Kyle's and Rangel-Peniche's equations were the only ones that complied with having a homogeneous bias. This finding allowed the derivation of CFs, which consisted of subtracting or adding the mean of the differences from the original equation. After estimating ASM applying the respective CF, the new ASM estimations showed no significant bias and its distribution remained homogeneously distributed. Therefore, agreement with DXA in the sample of non-Caucasian was achieved. Adding valid CFs to some BIA equations allowed to reduce the bias of some equations, making them valid to estimate the mean values of ASM at group level.

Prevalence of overweight, obesity and central obesity and factors associated with BMI in indigenous yaqui people: a probabilistic cross-sectional survey

BACKGROUND

The Yaquis are an Indigenous group who inhabit in the state of Sonora in northwestern Mexico. This group has experienced changes in their lifestyle, moving from a traditional lifestyle to a more modern one, resulting in an increase of obesity and its comorbidities. However, few studies have been done in this group. The aim of this study was to determine the prevalence of overweight, obesity and central obesity and to identify the factors associated with body mass index (BMI) in a representative sample of Indigenous Yaqui people from Sonora, Mexico.

METHODS

A cross-sectional survey with multistage sampling was conducted among adults (N = 351) with residence in Yaqui traditional villages (Vícam, Pótam, Loma de Guamúchil, Loma de Bácum, Tórim, Ráhum, Huiribis or Belem). Anthropometric measurements were taken to diagnose overweight, obesity and central obesity. Food frequency and physical activity (PA) questionnaires designed for the Yaqui population were applied, as well as sociodemographic and clinical history questionnaires. The factors associated with BMI were assessed using multiple linear regression considering the complex design of the sampling.

RESULTS

The prevalence of overweight, obesity and central obesity in the population were 36.5%, 35.0% and 76.0%, respectively. Having higher values of the modernization index (β = 0.20, p = 0.049) was associated with a higher BMI, while having a higher consumption of a "prudent" dietary pattern (traditional dishes, fruits, vegetables and low-fat dairy) (β = -0.58, p = 0.009) and performing a greater number of hours per week of vigorous PA (β = -0.14, p = 0.017) were associated with a lower BMI.

CONCLUSIONS

The prevalence of the studied abnormalities is high. The evidence presented in this study suggests that interventions are needed and more research is required to determine the appropriate components of such interventions, in order to meet the needs of the Yaqui people.

Agreement between laboratory methods and the 4-compartment model in assessing fat mass in obese older Hispanic-American adults

BACKGROUND/OBJECTIVES

Densitometry (Siri's and Brožek's equations), hydrometry (by the deuterium dilution technique), and dual-energy X-ray absorptiometry (DXA) are three methods for estimating body composition. However, because they are all based on certain assumptions, they may not be applicable to aged and obese subjects due to changes in their body composition. Hence, the validity of these "laboratory methods" could be affected in obese older people. The main aim was to assess the agreement between densitometry, hydrometry, and DXA with the 4-compartment (4C) model to estimate fat mass (FM) in obese older Hispanic-American adults. As secondary goals, we explored whether the bias in densitometry and hydrometry results could be improved by modifying the assumptions regarding fat-free mass (FFM) density and hydration factor (HF) values, respectively. In the case of DXA, we explored the factors that contribute to bias.

SUBJECTS/METHODS

This is a cross-sectional study based on a sample of 171 obese subjects aged ≥60 years from 3 regions of northern Mexico. Body composition was assessed by the 4C model as the reference method and by all three laboratory methods. Agreement of the latter with the 4C model was probed by Bland and Altman analysis, a paired sample t-test, and simple linear regression analyses. In addition, the mean FFM density estimated in this sample, and HF values (published previously) of 0.737 and 0.753 for obese older Hispanic-American men and women, respectively, were considered as ethnic- and gender-specific values. These values were used to modify the densitometric and hydrometric equations in order to improve their bias. Finally, we tested whether the hydration status and indirect markers of adiposity are contributing factors to the bias of DXA using multiple linear regression analysis.

RESULTS

Siri's equation overestimated FM by 0.57 kg (p < 0.01), while Brožek's equation, hydrometry, and DXA underestimated it by 1.24 kg, 0.89 kg, and 0.79 kg (p < 0.01), respectively, compared to the 4C model. The bias in the densitometry and hydrometry results was eliminated by substituting the ethnic- and gender-specific values into the equations. Finally, we found that hip circumference contributes to the bias in DXA.

CONCLUSION

The densitometry, hydrometry, and DXA methods are not interchangeable with the 4C model for assessing fat mass in obese, older Hispanic-American adults. The lack of agreement could indicate that the assumptions of each method do not apply to this population.

Effectiveness of the Healthy Lifestyle Promotion Program for Yaquis with Obesity and Risk of Diabetes in the Short and Medium Term: A Translational Study

Type 2 diabetes (T2D) is a public health problem worldwide, and the main risk factor for its development is obesity. The Yaqui ethnic group of Sonora has serious obesity problems, resulting in an increased risk of T2D in its inhabitants. The objective of this study was to evaluate the effectiveness of a health promotion program on obesity parameters and cardiovascular risk factors in short- (6 months) and medium-term periods (12 months) in indigenous Yaquis of Sonora. The design is a translational clinical study of a single cohort with prepost intervention measurements in a sample of 93 subjects. The effectiveness of the program was evaluated by comparing obesity parameters, metabolic markers, and physical activity 6 and 12 months with those measured under basal conditions using a paired t-test or Wilcoxon rank-sum test. The short-term retention percentage was 58.0%. There was a decrease in body weight (Δ = -3.9 kg, p ≤ 0.05) and other obesity parameters, and an increase in physical activity and improvements in metabolic markers (p ≤ 0.05) was observed. Similar findings were obtained for the medium-term period; body weight loss was also -3.9 kg (p ≤ 0.05). The short and medium-term results of the program showed improvements in the obesity parameters and other cardiovascular risk factors of the participants. These results support the effectiveness of the program and its translation in this ethnic group.

The fat mass index, not the fat-free mass index, is associated with impaired physical performance in older adult subjects: Evidence from a cross-sectional study

BACKGROUND

Impaired physical performance (IPP) and physical disability (PD) are two serious public health problems in older adult populations worldwide. While studies show that changes in body composition are important risk factors for developing these conditions, there is little evidence that the fat-free mass (FFM) and fat mass (FM) indices (FFMI and FMI, respectively) are associated with IPP in older men and women. This study assessed the association among FFMI, FMI, and IPP using Short Physical Performance Battery (SPPB) in Mexican men and women aged over 60 years.

METHODS

This cross-sectional study included 217 older people (men 34.6%, women 65.4%; 60-92 years). FFM and FM were assessed by dual X-ray absorptiometry, assuming a two-compartment model. FFM and FM were adjusted by height squared and the indices were obtained. After assessment of physical performance by SPPB, subjects with scores ≤6 were classified as having IPP. Associations were tested by multiple logistic regression analysis in separated models.

RESULTS

IPP prevalence was 14.3%. Women were affected more than men. Regression analysis showed no significant association between FFMI and IPP, but FMI was strongly-associated, as for each unit increase in FMI, the risk of IPP rose significantly (OR: 1.14), and this result remained significant after adjusting for age, comorbidity, polypharmacy, and the appendicular skeletal muscle mass index (OR: 1.23; p ≤ 0.001). These results emphasize the importance of preventing increases in FM and avoiding overweight and obesity in older men and women.

Quality evaluation of low fat bologna-type meat product with a nutritional profile designed for the elderly

The objective of this work was to evaluate the quality of a bologna-type meat product designed for the elderly. Treatments were: control, without addition of cranberries (C), prunes (P), pecan nuts (N) or flaxseed (F); NP, with 5% N+5% P; FC, with 5% F+5% C; NC, with 5% N+5% C; FP, with 5% F+5% P. These formulations resulted in a product with high protein, low SFA and high antioxidant activity. Treatments with pecan nuts had higher MUFA while those with flaxseed had higher polyunsaturated fatty acids (PUFA). Treatments with pecan nuts and flaxseed had higher PUFA/SFA ratios, but only those with flaxseed had very low n6/n3 ratios when compared to the control. Although treatments showed acceptable scores (>5.4), they were lower than the control. A combination of these non-traditional ingredients could be used to develop a meat product for older adults to provide a better nutritional profile with acceptable sensory properties.

[EFFECT OF OVERWEIGHT AND OBESITY ON THE EQUILIBRIUM TIME, BUT NO IN THE TOTAL BODY WATER AND BODY COMPOSITION COMPARTMENTS IN WOMEN SUBJECTS OVER 60 YEARS OF AGE]

INTRODUCTION

aging and obesity cause changes in water exchange rate, which could affect the equilibrium time of deuterium oxide (2H2O).

OBJECTIVE

to assess the effect of overweight and obesity on the equilibrium time of the stable isotope deuterium in saliva samples of older adults.

METHODS

a sample of 18 women over 63 years with a body mass index (BMI) of 20.8 to 40.5 kg/m2 were included. A basal saliva sample was took and immediately a dose of 30 g of 2H2O was administered orally. Saliva samples at 2, 2.5, 3, 3.5 and 4 hours post-dose were taken. Deuterium in saliva samples were analyzed by Fourier Transform Infrared spectroscopy technique.

RESULTS

the average in equilibrium time (plateau) in women of normal BMI (18.5-24.9 kg/m2) was 3.6 ± 0.2 hours, which was statistically different to those obtained in the group with overweight (25-29.9 kg/m2) and obese (>30 kg/m2) of 2.9 ± 0.4 hours and 2.8 ± 0.4 hours, respectively (p0.05).

CONCLUSION

obesity had an effect on the equilibrium times; however, did not affect the calculation of total body water and body composition in this older women adult group.

Nutrient-rich dairy proteins improve appendicular skeletal muscle mass and physical performance, and attenuate the loss of muscle strength in older men and women subjects: a single-blind randomized clinical trial

Background

At present, it is unknown whether the use of nutrient-rich dairy proteins improves the markers of sarcopenia syndrome. Therefore, our proposal was to investigate whether adding 210 g of ricotta cheese daily would improve skeletal muscle mass, handgrip strength, and physical performance in non-sarcopenic older subjects.

Subjects and methods

This was a single-blind randomized clinical trial that included two homogeneous, randomized groups of men and women over 60 years of age. Participants in the intervention group were asked to consume their habitual diet but add 210 g of ricotta cheese (IG/HD + RCH), while the control group was instructed to consume only their habitual diet (CG/HD). Basal and 12-week follow-up measurements included appendicular skeletal muscle mass (ASMM) by dual-energy X-ray absorptiometry, handgrip strength by a handheld dynamometer, and physical performance using the short physical performance battery (SPPB) and the stair-climb power test (SCPT). The main outcomes were relative changes in ASMM, strength, SPPB, and SCPT.

Results

ASMM increased in the IG/HD + RCH (0.6±3.5 kg), but decreased in the CG/HD (−1.0±2.6). The relative change between groups was statistically significant (P=0.009). The relative change in strength in both groups was negative, but the loss of muscle strength was more pronounced in CG/HD, though in this regard statistical analysis found only a tendency (P=0.07). The relative change in the balance-test scores was positive for the IG/HD + RCH, while in the CG/HD it was negative, as those individuals had poorer balance. In this case, the relative change between groups did reach statistical significance.

Conclusion

The addition of 210 g of ricotta cheese improves ASMM and balance-test scores, while attenuating the loss of muscle strength. These results suggest that adding ricotta cheese to the habitual diet is a promising dietetic strategy that may improve the markers of sarcopenia in subjects without a pronounced loss of ASMM or sarcopenia.

Skeletal muscle mass indices in healthy young Mexican adults aged 20-40 years: implications for diagnoses of sarcopenia in the elderly population

BACKGROUND AND OBJECTIVES

Skeletal muscle and skeletal muscle indices in young adults from developing countries are sparse. Indices and the corresponding cut-off points can be a reference for diagnoses of sarcopenia. This study assessed skeletal muscle using dual-energy X-ray absorptiometry (DXA) in healthy male and female subjects aged 20-40 years and compared their appendicular skeletal muscle mass (ASM) and total-body skeletal muscle (TBSM) indices using certain cut-off points published in the literature.

METHODS

A sample of 216 healthy adults men and women from northwest Mexico was included. Body composition was assessed by DXA and several published DXA-derived skeletal muscle indices were compared.

RESULTS

Both, ASM and TBSM were higher in men compared to the women group (23.0 ± 3.4 versus 15.9 ± 1.6 kg; P < 0.05 and 26.5 ± 4.1 versus 16.9 ± 1.9 kg; P < 0.05, resp.). These differences were also valid for both indices. When derived cut-off points were compared with the most reported indices, significant differences were found.

INTERPRETATION AND CONCLUSION

Published cut-off points from Caucasians are higher than cut-off point derived in this sample of Mexican subjects. The new DXA-derived cut-off points for ASM proposed herein may improve diagnoses of sarcopenia in the geriatric Mexican population.

Association between insulin resistance and low relative appendicular skeletal muscle mass: evidence from a cohort study in community-dwelling older men and women participants

BACKGROUND

It has been hypothesized that insulin resistance plays a role in the development of the loss of skeletal muscle; however, no cohort studies on insulin resistance and low relative appendicular skeletal muscle mass (ASM) have been published to date. Thus, we examined whether insulin resistance is associated with low relative ASM after a 4.6-year follow-up period among apparently healthy older men and women participants.

METHODS

This is a combined retrospective-prospective cohort study, which includes 147 community-dwelling older men and women participants. ASM was measured by dual-energy x-ray absorptiometry at baseline and follow-up. Participants with a relative change in ASM below the sex-specific 15th value were classified as the low relative ASM group. Homeostatic model assessment was used to quantify insulin resistance. Logistic regression calculated odds ratios and 95% confidence intervals for development of low relative ASM, adjusted for covariates.

RESULTS

The loss of ASM in the low relative ASM and normal groups was -1.8kg and -0.35kg, respectively (p ≤ .05). The low relative ASM group was older and had higher insulin and homeostatic model assessment of insulin resistance values at baseline. The risk of developing low relative ASM at 4.6-year follow-up was 2.9 times higher (95% CI, 1.00-7.8; p = .04) among the participants with homeostatic model assessment of insulin resistance levels more than 2.3. After adjusting for age, the risk increased to 3.9 times higher (95% CI, 1.3-11.5; p = .03).

CONCLUSION

Insulin resistance was associated with low relative ASM at 4.6-year follow-up after accounting for several covariates in a cohort of apparently healthy, well-functioning young older men and women.

Insufficient amounts and inadequate distribution of dietary protein intake in apparently healthy older adults in a developing country: implications for dietary strategies to prevent sarcopenia

BACKGROUND

Both low dietary protein intake and inadequate distribution of protein over the three mealtimes have been reported in older Caucasian adults, but the association between protein intake at each meal and muscle mass has not been studied. The purpose of this study was to evaluate dietary protein intake and distribution by mealtimes, and to explore their association with appendicular skeletal muscle mass in apparently healthy older adults.

METHODS

This was a cross-sectional pilot study that included 78 people over the age of 60 years. Caloric and protein intake were estimated on the basis of three nonconsecutive 24-hour diet recalls and appendicular skeletal muscle mass by dual-energy X-ray absorptiometry.

RESULTS

Men consumed 13.4 g of protein/day more than women (P < 0.05). The estimated value of dietary protein intake was 0.9 g/kg/day. In this sample, 28% of subjects did not cover 100% of the dietary reference intake for protein. Lower consumption of dietary protein was found at breakfast and dinnertime compared with the recommended amount of 25-30 g (P < 0.05). Also, the study observed that appendicular skeletal muscle mass in men and women who consumed <25 g of protein at each mealtime was different from that found in the group that consumed >25 g of protein at one, two, or three mealtimes.

CONCLUSION

While protein intake was higher than current recommendations, it failed to achieve the values reported as necessary to prevent sarcopenia. In addition, there was under-consumption of protein per mealtime, especially at breakfast and dinner.

Physiological effects beyond the significant gain in muscle mass in sarcopenic elderly men: evidence from a randomized clinical trial using a protein-rich food

BACKGROUND

Sarcopenia is strongly associated with an inadequate intake of dietary protein. Dietary protein supplementation boosts muscle-protein synthesis and increases muscle mass in the elderly. This study tested whether adding a protein-rich food, ricotta cheese, to the habitual diet increased total appendicular skeletal muscle mass and strength in elderly people.

METHODS

Participants (n = 40), were sarcopenic elderly men and women over 60 years of age. Two comparison groups were formed at random and followed for 3 months: the intervention group received 210 g/day of ricotta cheese plus the habitual diet, while the control group followed the habitual diet with no additional intervention. Total appendicular skeletal muscle (TASM) was assessed by dual-energy X-ray absorptiometry, while strength was measured using a handheld dynamometer at baseline and after the intervention period. The primary outcomes were the percentage of relative change in TASM and strength.

RESULTS

The percentage of relative change in TASM was not significant between the groups after the intervention period. Muscle strength improved in the intervention group, but showed only a tendency towards significance (P = 0.06). Secondary analysis showed that the men in the intervention group gained 270 g in TASM compared to those in the control group, and improved their fasting insulin levels (P = 0.05), muscle strength, lean body mass in the arms, and body weight variables.

CONCLUSION

The results of this study indicate that a nutritional intervention using a high-quality protein food, specifically ricotta cheese, in order to increase the amount of protein intake might not be regarded as fully promising in elderly men and women with sarcopenia. However, the gender effects on muscle strength, lean tissue in the arms, homeostatic assessment of insulin resistance, and body weight detected in this study suggest that additional research is needed on elderly male subjects with sarcopenia.

[Estimation of body fat by DXA and the four compartment model in Mexican youth]

The objective of this study was to validate the estimation of body fat (%BF) by DXA (Dual-Energy X-Ray AbsorciomDPX-MD) against the four compartment model (4C) of body composition in 32 Mexican pubertal girls and boys (aged 9-14 y; F=16). The mean of the difference between DXA and 4C model was -3.5 %BF (p=0.171). The limits of agreement (95% = 2 SD) were +5% to -12%BF. The precision of estimated limits of y the confidence intervals were -1.9% to -5.1%BF (P = 0.050). The concordance correlation coefficient was p = 0.85. The test of accuracy for coincidence of slop intercepts between DXA and the 4C model showed no coincidence (p < 0.05). The precision by R2 explained 83% of the variance (SEE, 4.1%). The individual accuracy assess by the total error was 5.6%. The group mean accuracy by two way analysis of variance of body fat did not show interaction between method (DXA-4C model) and separate analysis of gender and overweight. However, there was an effect of method (p = 0.043) in the presence of overweight (p < 0.001). In conclusion, the estimation of percent of body fat by DXA was not precise and accurate in a group of Mexican children. However, results do not limit the utility of DXA for the measurements of body composition and its relation with health outcomes, especially in follow up studies.

Prevalence of malnutrition and associated metabolic risk factors for cardiovascular disease in older adults from Northwest Mexico

This cross-sectional study assessed the prevalence of malnutrition and several metabolic risk factors for cardiovascular disease in 287 apparently healthy older adults from Northwest Mexico. Also, the impact of overweight and obesity on metabolic risk factors was assessed. Nutritional status was determined using serum albumin levels and anthropometry. Vitamin status was also assessed. Metabolic risk factors for cardiovascular disease were evaluated. The prevalence of undernutrition was 15.3%. Also, vitamin E deficiency was common (18%). On the contrary, 44.9% of men and women were in overweight and 24% were obese. A 50.9% of the older adults had hypertension, 52.6% hypercholesterolemia (HC), 38.3% hypertriglyceridemia (HTG), 26.1% impaired fasting glucose and 26.1% impaired glucose tolerance (IGT). HC and low-density-lipoprotein-cholesterol (LDL-C) were significantly more prevalent in women than in men. Mean adjusted values of fasting glucose, high-density-lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C ratio > or = 5, triglycerides (TG) and diastolic blood pressure (DBP) were significantly higher in subjects with body mass index (BMI) > or = 25.0 kg/m(2). Undernutrition, obesity and vitamin E deficiency, as well as several metabolic risk factors for cardiovascular disease coexisted in this studied group. Overweight and obesity were the most prevalent findings. BMI > or = 25 kg/m(2) was the common factor explaining most of the metabolic abnormalities. However, due to the sample size and the design of the study, the results must be seen with caution and cannot be generalized.

[Validity of an equation based on anthropometry to estimate body fat in older adults]

A prediction equation to estimate body fat mass from skinfold thickness for healthy elderly was developed using a four compartmental (4C) model as criterion method. This study included 202 subjects = 60 y old. The measurements of total body water, bone mineral content and body density were included in the 4C model equation. Total sample was randomly partitioned. Sub-sample one was used to design the equations, which were applied in sub-sample two. Its accuracy and precision was evaluated by lineal regression analysis and the bias by Bland and Altman analysis and simple lineal regression. The best model included body mass, sex and the calf and triceps skinfolds thicknesses, with an R2, standard error of the estimate and Cp of 0.85, 3.2 and 3.2, respectively. When the equation was applied in sub-sample two, it was accurate and precise, it showed no significant deviation from the line of identity (the intercept was no significantly different from zero, P>0.05), and slope was different from cero (or similar to 1) (P<0.05). Fat mass by the equation accounted for 86% of the variability of the mean fat mass estimated by the 4C model, having a low standard error of the estimate (3.2 kg) and low pure error (3.1 kg). The new equation was accurate and precise as well as free of significant bias in men and women together and for separately. This equation can be a good option to estimate fat mass in elderly men and women with similar physical characteristics to subjects of this study, and it can be used in clinical and epidemiological studies in this growing group.

Body fat measurement by bioelectrical impedance and air displacement plethysmography: a cross-validation study to design bioelectrical impedance equations in Mexican adults

BACKGROUND

The study of body composition in specific populations by techniques such as bio-impedance analysis (BIA) requires validation based on standard reference methods. The aim of this study was to develop and cross-validate a predictive equation for bioelectrical impedance using air displacement plethysmography (ADP) as standard method to measure body composition in Mexican adult men and women.

METHODS

This study included 155 male and female subjects from northern Mexico, 20-50 years of age, from low, middle, and upper income levels. Body composition was measured by ADP. Body weight (BW, kg) and height (Ht, cm) were obtained by standard anthropometric techniques. Resistance, R (ohms) and reactance, Xc (ohms) were also measured. A random-split method was used to obtain two samples: one was used to derive the equation by the "all possible regressions" procedure and was cross-validated in the other sample to test predicted versus measured values of fat-free mass (FFM).

RESULTS AND DISCUSSION

The final model was: FFM (kg) = 0.7374 * (Ht2 /R) + 0.1763 * (BW) - 0.1773 * (Age) + 0.1198 * (Xc) - 2.4658. R2 was 0.97; the square root of the mean square error (SRMSE) was 1.99 kg, and the pure error (PE) was 2.96. There was no difference between FFM predicted by the new equation (48.57 +/- 10.9 kg) and that measured by ADP (48.43 +/- 11.3 kg). The new equation did not differ from the line of identity, had a high R2 and a low SRMSE, and showed no significant bias (0.87 +/- 2.84 kg).

CONCLUSION

The new bioelectrical impedance equation based on the two-compartment model (2C) was accurate, precise, and free of bias. This equation can be used to assess body composition and nutritional status in populations similar in anthropometric and physical characteristics to this sample.

Body composition by the four-compartment model: validity of the BOD POD for assessing body fat in mexican elderly

OBJECTIVE

The aims of this study were to validate BOD POD in a wide sample of healthy and independent Mexican elderly men and women subjects using the 4 compartment (4C) model as the reference method, and to evaluate the assumptions of the densitometric two-compartment (2C) model.

DESIGN

Cross-sectional study designed to assess body composition and validation of a method based on 2C model (BOD POD).

SETTING

Urban and rural regions of Sonora, Mexico.

SUBJECTS

Two hundred and two free-living subjects >or=60 years old were completed in this study.

METHODS

Body density and body fat were measured by the BOD POD, total body water by deuterium dilution and total body bone ash by dual energy X-ray absorptiometry. Body composition was determined using Baumgartner's equation.

RESULTS

Percent body fat by the 4C model was 31.2 and 42.5% in men and women, respectively (P<0.001). Group mean accuracy of body fat by BOD POD against that of the 4C model showed an effect of sex (P<0.001), but not the method (P=0.27). Results of individual accuracy showed no significant difference with the identity line and the slope was significantly different from zero or a slope similar to one. Precision assessed by model R (2) was high for all subjects and for men and women by separate. The standard error of the estimate was low for all and for men and women by separate. Bland and Altman analysis showed no significant bias.

CONCLUSION

The BOD POD technique is a valid and reliable method compared to the 4C model and it could be applied in subjects with similar physical and anthropometric characteristics to subjects of this study.

[Vitamin B12 and folate in non-institutionalized urban older people]

Vitamin B12 and folate deficiencies are the main nutritional determinants of hyperhomocysteinemia, which is an independent risk factor for cardiovascular diseases. There is scarce information about nutritional status on vitamin B12 and serum levels of folate in Mexican older people. The objective was to evaluate the nutritional status of vitamin B12 and folic acid concentration in non-institutionalized, urban elderly men and women subjects. One hundred volunteers over 60 years were included in this cross-sectional study. Serum levels of vitamin B12 and folate were measured. In addition some biochemical and anthropometric indicators were also evaluated. Considering serum values of vitamin, 30% had vitamin B12 deficiency, 52% normal status and 18% with high levels. None subjects had folic acid deficiency, by the contrary, a high proportion (62%) showed elevated levels in serum. There was an effect of sex on vitamin B12 status. Elderly men showed significantly lower levels of vitamin B12, and it was according with significant higher prevalence of vitamin B12 deficiency in this group as compared with the women group. The high proportion of vitamin B12 deficiency found in this study underline a possible public health problem and guarantee further survey-studies about vitamin B12 status and to explore causes and consequences of the deficiency. Finally, due the sample size and the design of the study, the results must be seen with caution and not try to generalize.

Total energy expenditure, resting metabolic rate and physical activity level in free-living rural elderly men and women from Cuba, Chile and México

OBJECTIVE

The objective of this study was to assess total energy expenditure (TEE), resting metabolic rate (RMR) and physical activity level (PAL), and to estimate energy requirements (ERs) in free-living elderly subjects from Cuba, Chile and Mexico.

DESIGN

Cross-sectional study designed to estimate ERs.

SETTING

Rural regions of Cuba, Chile and Mexico.

SUBJECTS

Forty subjects >60 years old were selected to participate in this study.

INTERVENTIONS

A dose of doubly labeled water (DLW) was administered and urine samples were collected in the following 12-14 days. From the isotopic analysis, TEE was derived. RMR was measured by indirect calorimetry.

RESULTS

TEE in Chilean (8.8+/-1.6 MJ/day) and Cuban (8.3+/-1.3 MJ/day) elderly was not different, and was higher for the Mexican group (9.5+/-1.5 MJ/day) (P < 0.0001). RMR was not different between countries. PAL and activity energy expenditure (AEE) were only different between Chile and Mexico (P < 0.002). For the three regions, overall PALs were 1.70+/-0.16 for male and 1.62+/-0.13 for female subjects (P < 0.02), and AEE was 3.05+/-0.66 and 2.27+/-0.66 MJ/day for male and female subjects, respectively (P < 0.001). Predictive equations (MJ/day) were RMR = 1.6447 + 0.05714 x weight (kg) + 0.449 sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.479) and TEE = 3.414 + 0.0795 x weight (kg) + 1.227 x sex (male = 1; female = 0) (R2 = 0.75; SEE = 0.668).

CONCLUSIONS

There were differences in TEE and PAL owing to sex and region. The average PAL in men was higher than the PAL reported either with factorial approach or with the DLW method in elderly. Predictive ER equations based on RMR and TEE gave very similar results to calculations from the 2004 FAO/WHO/UNU report.

Body Composition by Three-Compartment Model and Relative Validity of Some Methods to Assess Percentage Body Fat in Mexican Healthy Elderly Subjects

BACKGROUND

In Mexico, there is scarce information about the body composition in the elderly. Some researchers have measured body fat by anthropometry and bioelectrical impedance. These techniques are practical and can be used in the field; however, proper validation is required. This implies the use of accurate and precise methods. In the elderly, Siri's three-compartment (3C) model has been proposed as feasible alternative to the gold standard four-compartment model.

OBJECTIVE

To evaluate the body composition by the 3C model and the relative validity of densitometry and hydrometry methods to assess the percentage body fat (%BF) in 37 healthy Mexican elderly subjects.

METHODS

The body density was measured by air displacement plethysmography, total body water was evaluated by means of an isotopic dilution technique, and two different hydration factors were used to determine the fat-free mass. These measurements were used to calculate %BF by the 3C model. Accuracy and precision of the methods were tested by a two-way analysis of variance and regression procedures and bias by Bland and Altman analysis.

RESULTS

In men and women as a whole group, the %BF by the 3C model was 34.4 +/- 8.01. Women had higher values of %BF as compared with men (41.7 +/- 3.7 vs. 29.4 +/- 6.4; p < 0.0001). The regression procedures showed that air displacement plethysmography was accurate and precise only in women and in the whole group. Regression analyses of %BF by total body water (using both hydration factors) and 3C model showed that the intercepts were not different from zero and that the slopes were not different from 1.0 in men and women separately and as group.

CONCLUSION

In this study, the total-body water method revealed a good relative validity (accuracy, precision, and freedom from bias) as compared with the 3C model in men and women both separately and as a group and may be acceptable for the estimation of %BF in individuals or groups of healthy elderly subjects.

Body composition by hydrometry (deuterium oxide dilution) and bioelectrical impedance in subjects aged >60 y from rural regions of Cuba, Chile and Mexico

BACKGROUND

In Latin American and Caribbean countries such as Chile, Mexico and Cuba, the population over 60 y has increased steadily. In this age group, there is scarce information about body composition, particularly for those living in rural areas.

OBJECTIVE

The purpose of this study was to determine body composition in free-living and healthy elderly subjects >60 y from rural areas of Chile, Cuba and Mexico using deuterium oxide dilution and bioelectrical impedance (BIA) and to develop and cross-validate a predictive equation for this group of subjects by BIA for future use as a field technique.

SUBJECTS

The study included 133 healthy subjects (73 males and 60 females) >60 y from rural regions of Cuba, Chile and Mexico.

MEASUREMENTS

Total body water, body weight, height and other anthropometric and BIA variables (resistance and reactance) were measured.

METHODS

Total body water was determined by deuterium oxide dilution, and fat-free mass (FFM)/fat mass were derived from this measurement. The total sample was used in a split-sample internal cross-validation. BIA and other anthropometric variables were integrated to multiple regression model to design the best predictive equation, which was validated in the other sample. ANOVA, multiple regression and Bland and Altman's procedure were used to analyze the data.

RESULTS

Body weight, percentage of fat and fat-free mass were lower in the Cuban men and women compared with Chilean and Mexican men and women. The best predictive equation of the FFM was: FFM kg=(-7.71+(H(2)/R x 0.49)+(country or ethnicity x 1.12)+(body weight x 0.27)+(sex x 3.49)+(Xc x 0.13)), where H(2) is height(2) (cm); R is resistance (Omega); country: Chile=1, Mexico=2 and Cuba=3; sex: women=0 and men=1; body weight (kg) and Xc is reactance (Omega). R(2) was 0.944 and the root mean square error (RMSE) was 2.08 kg. The mean+/-s.d. of FFM prediction was 44.2+/-9.2 vs 44.6+/-10.1. The results of cross-validation showed no significant difference with the line of identity, showing that the predicted equation was accurate. The intercept (=-0.32) was not significantly different from zero (P=0.89) and the slope (=1.02) not significantly different from 1.0 (P>0.9). The R(2) was 0.86, RMSE=3.86 kg of FFM and the pure error was 3.83.

CONCLUSION

The new BIA equation is accurate, precise and showed good agreement. The use of this equation could improve the estimates of body composition for the elderly population for these regions, as well as enhancing the opportunity to conduct studies in the elderly population from Latin America.

[Anthropometry and body composition in persons over 60. The importance of physical activity]

OBJECTIVE

To measure anthropometric indicators of body composition by electric bioimpedence, as well as physical activity, blood glucose and arterial pressure in rural people over 60 years of age.

MATERIAL AND METHODS

A total of 54 subjects over 60 years old were selected by intentional non-probabilistic sampling. They were subjected to a standardized protocol to measure anthropometric indicators, body composition by electric bioimpedance (EBI), and physical activity was determined by an activity questionnaire. Arterial pressure and glucose tolerance levels were also measured. Analysis included Student's t test to detect differences by sex and the association of physical activity, body composition and other variables by simple linear regression and Pearson's correlation coefficient.

RESULTS

Physical activity correlated negatively with percent fat (r = -0.36; p = 0.007) and diastolic (r = -0.36; p = 0.006) and systolic blood pressure (r = -0.32; p = 0.018), and body mass index with post dose glucose (r = 0.31; p = 0.024).

CONCLUSIONS

Physical activity in this age group may have a favorable impact with respect to the mentioned health indicators.

[Energy requirements in active elderly individuals living in a rural region of Northwest Mexico]

The energy requirements in free-living elderly rural people were investigated by measuring physical activity level and basal energy expenditure using a physical activity questionnaire and indirect calorimetry, respectively. Approximately 65 different occupational and leisure activities over the previous 12 months were considered. Energy expenditure by physical activity was estimated using PAL for specific activities reported in the literature. All 65 the activities were considered to adapt the questionnaire. Reproducibility was evaluated by administering the questionnaire on two separate occasions within 3-4 week elapsed between them. It was found to be reliable for the study (Pearson correlation was r = 0.85; p < 0.05). The physical activity level of the women and men were 1.50 +/- 0.29 and 1.65 +/- 0.66, respectively (p < 0.05). The basal metabolic rate also differed between women and men (p < 0.05) with 5348 +/- 719 kJ/day and 6160 +/- 862 kJ/day, respectively. Similarly the total energy expenditure was different (p < 0.05) in women and men 8311 +/- 1610 kJ/day and 10,210 +/- 2268 kJ/day, respectively. Results indicate that the physical activity questionnaire presented can be an alternative methodology to estimate physical activity in free-living elderly people and together with indirect calorimetry measurements can be useful to estimate their energy expenditure and hence energy requirements.