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Tandan R, Levy EA, Howard DB, Hiser J, Kokinda N, Dey S, Kasarskis EJ. Body composition in amyotrophic lateral sclerosis subjects and its effect on disease progression and survival. Am J Clin Nutr 2022; 115:1378-1392. [PMID: 35108352 PMCID: PMC9071423 DOI: 10.1093/ajcn/nqac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Motor neuron degeneration and malnutrition alter body composition in amyotrophic lateral sclerosis (ALS). Resulting losses of weight, fat mass (FM), and fat-free mass (FFM) shorten survival. Nutritional management relies on body weight or BMI; neither reliably indicates malnutrition nor differentiates body compartments. OBJECTIVES We aimed to 1) develop an equation to compute FM and FFM using clinical data, validated against DXA; and 2) examine the effect of computed FM and FFM on disease course and survival. METHODS We studied 364 ALS patients from 3 cohorts. In Cohort #1 we used logistic regression on clinical and demographic data to create an equation (test cohort). In Cohort #2 we validated FM and FFM computed using this equation against DXA (validation cohort). In Cohort #3, we examined the effect of computed body composition on disease course and survival. RESULTS In Cohort #1 (n = 29) the model incorporated sex, age, BMI, and bulbar-onset to create an equation to estimate body fat: % body fat = 1.73 - [19.80*gender (1 if male or 0 if female)] + [0.25*weight (kg)] + [0.95*BMI (kg/m2)] - (5.20*1 if bulbar-onset or *0 if limb-onset). In Cohort #2 (n = 104), body composition using this equation, compared to other published equations, showed the least variance from DXA values. In Cohort #3 (n = 314), loss of body composition over 6 mo was greater in males. Adjusted survival was predicted by low baseline FM (HR: 1.39; 95% CI: 1.07, 1.80), and loss of FM (HR: 1.87; 95% CI: 1.30, 2.69) and FFM (HR: 1.73; 95% CI: 1.20, 2.49) over 6 mo. CONCLUSIONS Our equation broadens the traditional nutritional evaluation in clinics and reliably estimates body composition. Measuring body composition could target FM as a focus for nutritional management to ensure adequate energy intake and complement measures, such as the ALS functional rating scale-revised score and forced vital capacity, currently used.
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Affiliation(s)
- Rup Tandan
- Department of Neurological Sciences, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- General Clinical Research Center, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
| | - Evan A Levy
- Department of Neurological Sciences, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- General Clinical Research Center, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
| | - Diantha B Howard
- General Clinical Research Center, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- The Northern New England Clinical and Translational Research Network, Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- Maine Medical Center Research Institute, Portland, ME, USA
| | - John Hiser
- General Clinical Research Center, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- The Northern New England Clinical and Translational Research Network, Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- Maine Medical Center Research Institute, Portland, ME, USA
| | - Nathan Kokinda
- General Clinical Research Center, University of Vermont Medical Center and Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- The Northern New England Clinical and Translational Research Network, Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA
- Maine Medical Center Research Institute, Portland, ME, USA
| | - Swatee Dey
- Department of Neurology, University of Kentucky, Lexington, KY, USA
- General Clinical Research Center, University of Kentucky, Lexington, KY, USA
| | - Edward J Kasarskis
- Department of Neurology, University of Kentucky, Lexington, KY, USA
- General Clinical Research Center, University of Kentucky, Lexington, KY, USA
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Monterroso J, Dittus K, Crocker A, Kokinda N, O'Brien P. Effects of strength training intervention in breast cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kim Dittus
- University of Vermont Medical Center, Burlington, VT
| | | | - Nathan Kokinda
- University of Vermont College of Nursing and Health Sciences, Burlington, VT
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Dittus KL, Lakoski SG, Savage PD, Kokinda N, Toth M, Stevens D, Woods K, OʼBrien P, Ades PA. Exercise-based oncology rehabilitation: leveraging the cardiac rehabilitation model. J Cardiopulm Rehabil Prev 2015; 35:130-9. [PMID: 25407596 PMCID: PMC4342296 DOI: 10.1097/hcr.0000000000000091] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The value of exercise and rehabilitative interventions for cancer survivors is increasingly clear, and oncology rehabilitation programs could provide these important interventions. However, a pathway to create oncology rehabilitation has not been delineated. Community-based cardiac rehabilitation (CR) programs staffed by health care professionals with experience in providing rehabilitation and secondary prevention services to individuals with coronary heart disease are widely available and provide a potential model and location for oncology rehabilitation programs. Our purpose was to outline the rehabilitative needs of cancer survivors and demonstrate how oncology rehabilitation can be created using a CR model. METHODS We identify the impairments associated with cancer and its therapy that respond to rehabilitative interventions. Components of the CR model that would benefit cancer survivors are described. An example of an oncology rehabilitation program using a CR model is presented. RESULTS Cancer survivors have impairments associated with cancer and its therapy that improve with rehabilitation. Our experience demonstrates that effective rehabilitation services can be provided utilizing an existing CR infrastructure. Few adjustments to current CR models would be needed to provide oncology rehabilitation. Preliminary evidence suggests that cancer survivors participating in an oncology rehabilitation program experience improvements in psychological and physiologic parameters. CONCLUSIONS Utilizing the CR model of rehabilitative services and disease management provides a much needed mechanism to bring oncology rehabilitation to larger numbers of cancer survivors.
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Affiliation(s)
- Kim L Dittus
- Department of Internal Medicine, Vermont Center on Behavior and Health, (Drs Dittus, Lakoski, and Ades), Department of Rehabilitation and Movement Science (Mr Kokinda), Department of Internal Medicine and Molecular Physiology and Biophysics (Dr Toth), and Department of Internal Medicine (Dr O'Brien), University of Vermont, Burlington; and Fletcher Allen Health Care (Mr Savage, Ms Stevens, and Ms Woods)
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