Screening for protein energy wasting in children with chronic kidney disease using dual energy x-ray absorptiometry as an additional tool

BACKGROUND

The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW.

METHODS

Thirty CKD and 20 healthy children (1-18 years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8 g/dl, cholesterol < 100 mg/dl, or CRP > 3 mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal-one parameter positive in 2/4 categories; standard-one parameter positive in 3/4 categories; or modified-standard plus height < 2 SD.

RESULTS

Twenty children with CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) children with PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01).

CONCLUSIONS

PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKD who were negative for other markers could represent subclinical PEW.

L-shaped association between lean body mass to visceral fat mass ratio with hyperuricemia: a cross-sectional study

BACKGROUND

Insufficient attention has been given to examining the correlation between body composition and hyperuricemia, leading to inconsistent findings. The primary objective of this research is to explore the association between lean body mass index (LMI), visceral fat mass index (VFMI), and hyperuricemia. A specific emphasis will be placed on assessing the link between the ratio of lean body mass to visceral fat mass (LMI/VFMI) and hyperuricemia.

METHODS

The present study employed a cross-sectional design and involved a total of 9,646 individuals who participated in the National Health and Nutrition Examination Survey (NHANES). To explore the associations among the variables, logistic and linear regressions were employed. Additionally, subgroup analyses and sensitivity analyses were conducted based on various characteristics.

RESULTS

The results showed that LMI was positively associated with hyperuricemia (for Per-SD: OR = 1.88, 95%CI: 1.75, 2.01; for quartiles [Q4:Q1]: OR = 5.37, 95%CI: 4.31, 6.69). Meanwhile, VFMI showed a positive association with hyperuricemia (for Per-SD: OR = 2.02, 95%CI: 1.88, 2.16; for quartiles [Q4:Q1]: OR =8.37, 95%CI: 6.70, 10.47). When considering the effects of In LMI/VFMI, an L-shaped negative association with hyperuricemia was observed (for Per-SD: OR = 0.45, 95%CI: 0.42, 0.49; for quartiles [Q4:Q1]: OR = 0.16, 95%CI: 0.13, 0.20). Subgroup and sensitivity analyses demonstrated the robustness of this association across different subgroups. Additionally, the segmented regression analysis indicated a saturation effect of 5.64 for the In LMI/VFMI with hyperuricemia (OR = 0.20, 95%CI: 0.17, 0.24). For every 2.72-fold increase of In LMI/VFMI, the risk of hyperuricemia was reduced by 80%.

CONCLUSION

The LMI/VFMI ratio is non-linearly associated with serum uric acid. Whether this association is causal needs to be confirmed in further longitudinal studies or Mendelian randomization.

Lean body mass and the cardiorespiratory phenotype: An ethnic-specific relationship in Hans Chinese women and men

BACKGROUND

Lean body mass (LBM) and the functional capacity of cardiovascular (CV) and respiratory systems constitute a female-specific relationship in European-American individuals. Whether this recent finding be extrapolated to the world's largest ethnic group, that is, Hans Chinese (HC, a population characterized by low LBM), is unknown.

METHODS

Healthy HC adults (n = 144, 50% ♀) closely matched by sex, age and physical activity were included. Total and regional (leg, arm and trunk) LBM and body composition were measured via dual-energy X-ray absorptiometry. Cardiac structure, stiffness, central/peripheral haemodynamics and peak O2 consumption (VO2peak) were assessed via transthoracic echocardiography and pulmonary gas analyses at rest and during exercise up to peak effort. Regression analyses determined the sex-specific relationship of LBM with cardiac and aerobic phenotypes.

RESULTS

Total and regional LBM were lower and body fat percentage higher in women compared with men (P < 0.001). In both sexes, total LBM positively associated with left ventricular (LV) mass and peak volumes (r ≥ 0.33, P ≤ 0.005) and negatively with LV end-systolic and central arterial stiffness (r ≥ -0.34, P ≤ 0.004). Total LBM strongly associated with VO2peak (r ≥ 0.60, P < 0.001) and peak cardiac output (r ≥ 0.40, P < 0.001) in women and men. Among regional LBM, leg LBM prominently associated with the arterio-venous O2 difference at peak exercise in both sexes (r ≥ 0.43, P < 0.001). Adjustment by adiposity or CV risk factors did not modify the results.

CONCLUSIONS

LBM independently determines internal cardiac dimensions, ventricular mass, distensibility and the capacity to deliver and consume O2 in HC adults irrespective of sex.

Relationship of Left Ventricular Mass to Lean Body Mass in the Obese Pediatric Population

Our primary aim was to investigate the relationship between LVM and anthropometric measures including lean body mass (LBM) in obese pediatric subjects compared to normal weight controls. A retrospective chart review identified subjects 2-18 years old who were normotensive and had normal echocardiograms between 1995 and 2020 at Boston Children's Hospital. LVM was calculated with the 5/6 area length rule from 2D echocardiograms. LBM was calculated with equations derived from dual-energy X-ray absorptiometry. Of the 2217 subjects who met inclusion criteria, 203 were obese and 2014 had normal weight. The median age was 11.9 (2.0-18.9); 46% were female. The median LVM was 94.5 g (59.3-134.3) in obese subjects vs. 78.0 g (51.5-107.7) in controls. The median LBM was 37.2 kg (18.9-50.6) in obese subjects vs. 30.5 kg (17.6-40.8) in controls. In control and obese subjects, LBM had the strongest correlation to LVM (R2 0.86, P < 0.001) and (R2 0.87, P < 0.001), respectively. There was at most a modest correlation between tissue Doppler velocity z-scores and LV mass, and the largest was Septal E' z-score in obese subjects (r = - 0.31, P = 0.006). In this cohort, LBM was found to have the strongest relationship to LVM in obese subjects. The largest correlation between tissue Doppler velocity z-scores and LV mass was Septal E' z-score. Future studies will evaluate which measurements are more closely aligned with clinical outcomes in obese children.

The Physiological Effects of Weight-Cycling: A Review of Current Evidence

PURPOSE OF REVIEW

There is a common perception among the public that yo-yo dieting, defined as repeated cycles of weight loss followed by weight regain, results in accumulation of fat in the body and lower metabolic rate, thus hindering subsequent attempts to lose weight. We evaluated the effects of weight-cycling on body weight and body mass index (BMI), body composition including fat mass (FM) and lean body mass (LBM), and resting metabolic rate (RMR), by systematically reviewing existing scientific literature.

RECENT FINDINGS

Twenty-three cross-sectional and cohort studies (including subjects with a history of weight-cycling compared to those without such history) and interventional studies (evaluating physiological effects during one or more cycles of weight loss and regain) were identified, conducted in generally healthy adults across various age groups, races, and both genders, who had normal weight, overweight, or obesity. Eighteen studies investigated the association between weight-cycling and body weight or BMI, and thirteen of them found no significant association. Fifteen out of twenty studies also found no increase in FM, and none of eighteen studies found a decrease in LBM. Twelve out of fourteen studies reported no adverse changes in RMR either. The overwhelming majority of evidence suggests that weight-cycling (yo-yo effect) is not associated with any adverse effects in body weight, body composition, and metabolic rate. Accordingly, healthy individuals who struggle with overweight or obesity should not be discouraged from repeated attempts to lose the excess weight.

The Chinese cardiorespiratory and circulatory system at work in women and men: a case-control study

Background

The physiology of prominent prognostic factors in the cardiorespiratory system remains unchartered in the world's largest ethnic group: Hans Chinese (HC). This study assessed and contrasted the fundamental variables in HC and European-American (EA) individuals.

Methods

Healthy HC and EA adults (n = 140, 43% ♀) closely matched by age, sex and physical activity were included. Body composition (DXA) and haematological variables (haemoglobin mass, blood volume (BV)) were measured at rest. Pulmonary O2 uptake (VO2) measurements along with cycle ergometry designed for accurate transthoracic echocardiography were implemented to assess cardiorespiratory structure/function up to peak effort.

Findings

HC presented with higher body fat and lower lean body mass (LBM) percentage than EA irrespective of sex (P ≤ 0.014). BV did not differ whereas blood haemoglobin concentration was lower in HC compared with EA, particularly in females (P = 0.009). Myocardial diastolic and overall function at rest was enhanced in HC versus EA (P < 0.001). During exercise, heart volumes and output per unit of body size did not differ between ethnicities, whereas larger heart volumes per unit of LBM were found in HC versus EA in females (P ≤ 0.003). At high exercise intensities, VO2 (-16%) and the arteriovenous O2 difference (-28%) were markedly reduced in HC compared with EA in females (P ≤ 0.024). In males, no physiological difference between HC and EA was observed during exercise.

Interpretation

Notwithstanding lower LBM, HC are characterised by similar BV and cardiac capacity but reduced peak VO2 than EA in females, partly explained by low ethnic-specific blood O2 carrying capacity.

Funding

Early Career Scheme (106210224, to D.M.) and Seed Fund (104006024, to D.M.).

Combining proteins with n-3 PUFAs (EPA + DHA) and their inflammation pro-resolution mediators for preservation of skeletal muscle mass

The optimal feeding strategy for critically ill patients is still debated, but feeding must be adapted to individual patient needs. Critically ill patients are at risk of muscle catabolism, leading to loss of muscle mass and its consequent clinical impacts. Timing of introduction of feeding and protein targets have been explored in recent trials. These suggest that "moderate" protein provision (maximum 1.2 g/kg/day) is best during the initial stages of illness. Unresolved inflammation may be a key factor in driving muscle catabolism. The omega-3 (n-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are substrates for synthesis of mediators termed specialized pro-resolving mediators or SPMs that actively resolve inflammation. There is evidence from other settings that high-dose oral EPA + DHA increases muscle protein synthesis, decreases muscle protein breakdown, and maintains muscle mass. SPMs may be responsible for some of these effects, especially upon muscle protein breakdown. Given these findings, provision of EPA and DHA as part of medical nutritional therapy in critically ill patients at risk of loss of muscle mass seems to be a strategy to prevent the persistence of inflammation and the related anabolic resistance and muscle loss.

Predicted Body Composition Against COVID-19: A Potential Digital Health Strategy

This study focused on the associations between predicted lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), and body fat mass index (BFMI) with the 2019 coronavirus disease (COVID-19). A nationwide population-based non-underweight cohort of 2,037,714 participants underwent two consecutive biennial health screening examinations, with changes in predicted body composition indices estimated using a multivariable-adjusted logistic regression model. Increased LBMI and ASMI were associated with a lower COVID-19 risk among men who became obese. In COVID-19 patients, increased LBMI, ASMI, and BFMI were associated with a higher risk of extracorporeal membrane oxygenation among obese men.

The impact of obesity on static and proactive balance and gait patterns in sarcopenic older adults: an analytical cross-sectional investigation

Background

Obesity is increasingly recognized as a significant factor in the susceptibility of older adults to falls and related injuries. While existing literature has established a connection between obesity and reduced postural stability during stationary stances, the direct implications of obesity on walking dynamics, particularly among the older adults with sarcopenia, are not yet comprehensively understood.

Objective

Firstly, to investigate the influence of obesity on steady-state and proactive balance, as well as gait characteristics, among older adults with sarcopenic obesity (SO); and secondly, to unearth correlations between anthropometric characteristics and balance and gait parameters in the same demographic.

Methods

A cohort of 42 participants was categorized into control (CG; n = 22; age = 81.1 ± 4.0 years; BMI = 24.9 ± 0.6 kg/m²) and sarcopenic obese (SOG; n = 20; age = 77.7 ± 2.9 years; BMI = 34.5 ± 3.2 kg/m²) groups based on body mass index (BMI, kg/m²). Participants were assessed for anthropometric data, body mass, fat and lean body mass percentages (%), and BMI. Steady-state balance was gauged using the Romberg Test (ROM). Proactive balance evaluations employed the Functional Reach (FRT) and Timed Up and Go (TUG) tests. The 10-m walking test elucidated spatiotemporal gait metrics, including cadence, speed, stride length, stride time, and specific bilateral spatiotemporal components (stance, swing, 1st and 2nd double support, and single support phases) expressed as percentages of the gait cycle.

Results

The time taken to complete the TUG and ROM tests was significantly shorter in the CG compared to the SOG (p < 0.05). In contrast, the FRT revealed a shorter distance achieved in the SOG compared to the CG (p < 0.05). The CG exhibited a higher gait speed compared to the SOG (p < 0.05), with shorter stride and step lengths observed in the SOG compared to the CG (p < 0.05). Regarding gait cycle phases, the support phase was longer, and the swing phase was shorter in the SOG compared to the CG group (p < 0.05). LBM (%) showed the strongest positive correlation with the ROM (r = 0.77, p < 0.001), gait speed (r = 0.85, p < 0.001), TUG (r = -0.80, p < 0.001) and FRT (r = 0.74, p < 0.001).

Conclusion

Obesity induces added complexities for older adults with sarcopenia, particularly during the regulation of steady-state and proactive balance and gait. The percentage of lean body mass has emerged as a crucial determinant, highlighting a significant impact of reduced muscle mass on the observed alterations in static postural control and gait among older adults with SO.

Shifts in energy allocation and reproduction in response to temperature in a small precocial mammal

BACKGROUND

Species adjust to changes in temperature and the accompanying reduction in resource availability during the annual cycle by shifts in energy allocation. As it gets colder, the priority of energy allocation to maintenance increases and reproduction is reduced or abandoned.

RESULTS

We studied whether and how young female guinea pigs (Cavia porcellus) adjust even under ad libitum food conditions growth, storage of fat reserves and reproduction when kept at 5 °C versus 15 °C, and how offspring born into these conditions compensate during development to independence. Reproducing females grew less in the cold. Their lower weight resulted largely from less fat storage whereas growth in fat free mass was about the same for both groups. The increased need for thermoregulation diminished fat storage most likely due to the development of more brown fat tissue. Reproductive activity did not differ between groups in terms of litter frequency, mass and size. However, females in 5 °C weaned pups later (around day 25) than females in 15 °C (around day 21). Later weaning did not make up for the higher energy expenditure of pups in cold conditions leading to slower growth and less fat storage. Female pups born into the cold matured later than those born in 15 °C. Investment in reproduction continued but allocation to individual pups declined.

CONCLUSIONS

In more thermally demanding conditions female guinea pigs - even under ad libitum food abundance - transfer the higher costs of maintenance and reproduction largely to offspring.

Association between lean body mass to visceral fat mass ratio and bone mineral density in United States population: a cross-sectional study

BACKGROUND

Studies have explored the correlation between body composition and bone mineral density (BMD), but there has yet to be a consensus. Thus, the present study aims to comprehensively investigate the association between lean body mass, adipose tissue, and BMD.

METHODS

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) with 11,227 subjects. Multiple linear regression, smoothed curve fitting, threshold, and saturation effect analysis were used to explore the association between lean body mass, visceral fat mass, and BMD. Also, we used the lean body mass to visceral fat mass ratio (Log LM/VFM) as a proxy variable to analyze its association with BMD alone.

RESULTS

After adjusting for potential confounding factors, the results showed a positive correlation between lean mass and total BMD (for continuous: β = 0.078, P < 0.001; for quartile: β = 0.138, P < 0.001), while visceral fat mass was negatively correlated (for continuous: β = -0.027, P < 0.001; for quartile: β = -0.065, P < 0.001). A positive correlation was observed when the alternative variable Log LM/VFM was analyzed separately for its association with BMD (for continuous: β = 0.034, P < 0.001; for quartile: β = 0.084, P < 0.001). In addition, subgroup analyses for gender, age, body mass index, hypertension, and diabetes showed that all subgroups except the diabetes subgroup showed a substantial degree of robustness (P < 0.05). The smoothed curve fitting showed a nonlinear relationship between Log LM/VFM and BMD, and there was a threshold effect with a critical value of 2.60.

CONCLUSION

Maintaining a proper ratio of lean body mass and visceral fat mass is beneficial for increasing BMD.

Pilot study on the effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on body composition in children with acute lymphoblastic leukemia: randomized clinical trial

BACKGROUND

N-3 polyunsaturated fatty acids (LCPUFA-ω3), particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) might have beneficial effects on lean mass and fat mass synthesis.

OBJECTIVE

To investigate the effect of LCPUFA-ω3 supplementation on body composition changes in children with acute lymphoblastic leukemia (ALL) at remission and three months (3 mo) after supplementation.

METHODS

This randomized controlled trial enrolled 72 children (3-13 y) with newly diagnosed ALL (placebo group [500 mg sunflower oil]: 36 patients; LCPUFA-ω3 group [225 mg DHA, 45 mg EPA]: 36 patients). LCPUFA-ω3 was administered at 0.100 g/kg of body weight/day for 3 mo. Both groups were provided with an oral milkshake supplement.

MAIN OUTCOMES AND MEASURES

Body composition was measured at diagnosis, remission, and 3 months after supplementation by dual-energy X-ray absorptiometry (DXA). Red blood cell fatty acid analyses were performed with gas chromatography. Student's t test compared the percentage changes in body weight, total body fat percentage (TBFP), and lean body mass (LBM) between the groups. The Mann-Whitney U test was used to compare the groups, and the Friedman range test and Wilcoxon signed rank test were used for intratreatment comparisons. Spearman correlation coefficients were calculated for LBM and erythrocyte LCPUFA-ω3 content.

RESULTS

LBM decreased significantly in both groups. This loss was greater in the placebo group than in the LCPUFA-ω3 group at remission (p = 0.044) and at 3 months of supplementation (p = 0.039). There were significant and progressive increases in DHA and EPA concentrations in the LCPUFA-ω3 group (p < 0.001). LBM at remission was directly correlated with increased DHA (r = 0.487, p = 0.034) and EPA (r = 0.499, p = 0.030) erythrocytes in the LCPUFA-ω3 group.

CONCLUSION

At ALL diagnosis and during the first three months of treatment, 100 mg/kg of body weight/d DHA and EPA decreased LBM loss and allowed the incorporation of fatty acids into cell membranes (clinicaltriasl.gov #: NCT01051154).

Early administration of postoperative BCAA-enriched PPN may improve lean body mass loss in gastric cancer patients undergoing gastrectomy

BACKGROUND

It has been reported that weight loss or lean body mass (LBM) loss after gastrectomy for gastric cancer is associated with prognosis and nutritional support alone is insufficient to prevent LBM loss. Branched-chain amino acids (BCAA) play an important role in muscle catabolism, however their clinical effects on suppression of LBM loss in gastric cancer patients undergoing gastrectomy remains elusive. In this current study, we investigated the effect of our original PPN regimen including BCAA (designated to BCAA-regimen) on LBM loss.

METHODS

We conducted a randomized controlled trial (RCT) at a single institution where patients undergoing gastrectomy were assigned to either receive a five-day early postoperative course of the BCAA-regimen (BCAA group) or conventional nutrition. The primary endpoint was the % reduction in LBM at postoperative day 7. The secondary endpoints included the % reduction in LBM at 1 and 3 months postsurgery.

RESULTS

At postoperative day 7, LBM loss in the BCAA group tended to be lower than in the control group (0.16% vs. 1.7%, respectively; P = 0.21), while at 1 month postsurgery, LBM loss in the BCAA group was significantly different to that of the control group (- 0.3% vs. 4.5%, respectively; P = 0.04). At 3 months postgastrectomy, however, LBM loss was similar between the BCAA and the control groups.

CONCLUSION

Our RCT clinical trial clarified that early administration of the postoperative BCAA regimen improved LBM loss at 1 month after surgery in gastric cancer patients undergoing gastrectomy.

The association of intrauterine and postnatal growth patterns and nutritional status with toddler body composition

BACKGROUND

Growth patterns may be indicative of underlying changes in body composition. However, few studies have assessed the association of growth and body composition in poorly resourced regions experiencing the double-burden of malnutrition exists. Thus, the aims of this study were to investigate the association of intrauterine and postnatal growth patterns with infant body composition at 2 years in a middle-income country.

METHODS

Participants were from the International Atomic Energy Agency Multicentre Body Composition Reference study. Fat mass (FM), fat free mass (FFM), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (%FM) were measured in 113 infants (56 boys and 57 girls), from Soweto, South Africa, using deuterium dilution from 3 to 24 months. Birthweight categories were classified using the INTERGROWTH-21 standards as small (SGA), appropriate (AGA), and large-for gestational age (LGA). Stunting (> -2 SDS) was defined using the WHO child growth standards. Birthweight z-score, conditional relative weight and conditional length at 12 and 24 mo were regressed on body composition at 24 mo.

RESULTS

There were no sex differences in FM, FFM, FMI and FFMI between 3 and 24 mo. SGA and AGA both had significantly higher %FM than LGA at 12 mo. LGA had higher FM at 24 mo. Children with stunting had lower FM (Mean = 1.94, 95% CI; 1.63-2.31) and FFM (Mean = 5.91, 95% CI; 5.58-6.26) at 12 mo than non-stunting, while the reverse was true for FFMI (Mean = 13.3, 95% CI; 12.5-14.2) at 6 mo. Birthweight and conditionals explained over 70% of the variance in FM. CRW at both 12 and 24 mo was positively associated with FM and FMI. CRW at 12 mo was also positively associated with FMI, while CH at 24 mo was negatively associated with both FFMI and FMI in boys.

CONCLUSION

Both LGA and SGA were associated with higher body fat suggesting that both are disadvantaged nutritional states, likely to increase the risk of obesity. Growth patterns through infancy and toddler period (1-2 years) are indicative of body fat, while growth patterns beyond infancy are less indicative of fat-free mass.

Sex-Specific Accumulated Oxygen Deficit During Short- and Middle-Distance Swimming Performance in Competitive Youth Athletes

INTRODUCTION

Since sex-specific accumulated oxygen deficit (AOD) during high-intensity swimming remains unstudied, this study aimed to assess AOD during 50, 100, and 200 m front-crawl performances to compare the responses between sexes and analyse the effect of lean body mass (LBM).

METHODS

Twenty swimmers (16.2 ± 2.8 years, 61.6 ± 7.8 kg, and 48.8 ± 11.2 kg LBM-50% males) performed 50, 100, and 200 m to determine accumulated oxygen uptake (V̇O_2Ac). The swimmers also performed an incremental test from which five submaximal steps were selected to estimate the oxygen demand (V̇O_2demand) from the V̇O₂ versus velocity adjustment. V̇O₂ was sampled using a gas analyser coupled with a respiratory snorkel. AOD was the difference between V̇O_2demand and V̇O_2Ac, and LBM (i.e. lean mass not including bone mineral content) was assessed by dual-energy X-ray absorptiometry (DXA).

RESULTS

A two-way ANOVA evidenced an AOD increase with distance for both sexes: 19.7 ± 2.5 versus 24.9 ± 5.5, 29.8 ± 8.0 versus 36.5 ± 5.8, and 41.5 ± 9.4 versus 5.2 ± 11.9 ml × kg^-1, respectively, for 50, 100, and 200 m (with highest values for females, P < 0.01). Inverse correlations were observed between LBM and AOD for 50, 100, and 200 m (r = - 0.60, - 0.38 and - 0.49, P < 0.05). AOD values at 10 and 30 s elapsed times in each trial decreased with distance for both sexes, with values differing when female swimmers were compared to males in the 200 m trial (at 10 s: 2.6 ± 0.6 vs. 3.4 ± 0.6; and at 30 s: 7.9 ± 1.7 vs. 10.0 ± 1.8 ml × kg^-1, P < 0.05).

CONCLUSION

LBM differences between sexes influenced AOD values during each trial, suggesting that reduced muscle mass in female swimmers plays a role on the higher AOD (i.e. anaerobic energy) demand than males while performing supramaximal trials.

Skeletal muscle fiber composition may modify the effect of nutrition on body composition in young females

BACKGROUND AND AIM

The aim of this study was to investigate the hypothesis that healthy, normal-weight females with greater proportions and sizes of the oxidative muscle fibers would also be characterized by a healthier body composition compared with individuals with increased glycolytic fibers, even if both follow similar nutritional plans.

METHODS AND RESULTS

Vastus lateralis muscle fiber-type composition, body composition through dual-energy X-ray absorptiometry, and dietary intakes through questionnaire were evaluated in twenty-two young, healthy, non-obese females (age: 21.3±1.8yrs, body mass: 67.5±6.2 kg, body height: 1.66±0.05m, body mass index (BMI): 24.2±2.6  kg m^-2). The participants were allocated into two groups according to their type I muscle fibers percentage [high (HI) and low (LI)]. The participants of the LI group were characterized by significantly higher body mass, fat mass, BMI, and cross-sectional and percentage cross-sectional area (%CSA) of type IIx muscle fibers compared with participants of the HI group (p < 0.021). In contrast, the HI group was characterized by higher cross-sectional and %CSA of type I muscle fibers compared with the LI group (p < 0.038). Significant correlations were observed between body fat mass, lean body mass, total energy intake, fat energy intake, and %CSAs of type I and IIx muscle fibers (r: -0.505 to 0.685; p < 0.05).

CONCLUSION

In conclusion, this study suggests that muscle fiber composition is an important factor that at least partly could explain the observed differential inter-individual responses of the body composition to nutrition in female individuals. Increased %CSAs of type I muscle fibers seem to act as a protective mechanism against obesity and favor a healthier body composition, neutralizing the negative effect of increased caloric fats intake on body composition, probably because of their greater oxidative metabolic properties and fat utilization capacities. In contrast, female individuals with low type I and high type IIx %CSAs of type I seem to be more metabolically inflexible and dietinduced obesity prone, even if they consume fewer total daily calories and fats.

Protocol for the SEHNeCa randomised clinical trial assesing Supervised Exercise for Head and Neck Cancer patients

OBJECTIVES

To evaluate the effectiveness of an innovative supervised exercise programme to mitigate the loss of lean body mass, functional capacity and quality of life in people with head and neck cancer, as well as to identify the optimal moment to apply it, before or after radiotherapy treatment, compared with the prescription of a physical activity plan carried out autonomously.

METHODS

Patients with squamous cell carcinoma of the head and neck (n = 144), treated with radiotherapy, will be randomly assigned to one of 3 comparison groups: pre-radiotherapy supervised exercise, post-radiotherapy supervised exercise and autonomous exercise, stratifying by human papillomavirus infection and previous surgery. The exercise programme will be carried out in 36 sessions over 12 weeks, combining moderate and high intensity strength and aerobic exercises. The main outcome variable is the change in lean body mass at 6 months measured by bioimpedance, while secondary variables are functional capacity, symptoms, quality of life and adverse effects. Longitudinal generalised mixed models will be used for the analyses of the repeated measurements at 3, 6, and 12 months after baseline.

CONCLUSIONS

The pilot study supports the feasibility and safety of the project. However, as the programme progressed, attendance at the sessions decreased. Strategies will be necessary for increasing attendance, as well as involving the patient in their recovery and other incentives. Follow-up after treatment to assess acute/late toxicity will enable us to know the response to both the exercise programme and its adherence.

TRIAL REGISTRATION

NCT04658706 Date and version identifier: March 1, 2023. Version 1.1.

The association between meat consumption and muscle strength index in young adults: the mediating role of total protein intake and lean mass percentage

PURPOSE

The aim of this study was to analyse the associations between the consumption of different types of meat and the muscle strength index (MSI) and to examine whether this relationship is mediated by total protein intake (TPI) and lean mass percentage (LM%) in young adults.

METHODS

We conducted a cross-sectional study with first-year university students from Castilla-La Mancha, Spain. Different types of meat consumption (total, red, processed, and white and fish) were separately evaluated using a Food-Frequency Questionnaire. MSI was determined from the handgrip and standing long jump tests. ANCOVA models were used to test the mean differences in MSI by categories of meat consumption. Serial multiple mediation models were used to explore the mediating role of TPI and LM% in the relationship between meat consumption and MSI. All analyses were adjusted for age, sex, and socioeconomic level, identified through a directed acyclic graph. Additional analyses were performed with a small subsample including alcohol intake, tobacco smoking, physical activity, cardiorespiratory fitness, and total energy intake as covariates in the multiple mediation models.

RESULTS

A total of 230 students (mean age 21.1 ± 2.1 years, 66.5% women) were included in the analysis. Young adults with higher meat consumption (total, red, and white and fish) had higher MSI adjusted means than their peers with lower meat consumption (p < 0.05). These associations did not remain after controlling for TPI and LM%. In adjusted mediation analyses, a significant indirect effect was observed through TPI and LM% in the associations between each of the types of meat consumption and MSI. In the additional analyses, a greater effect of white and fish meat consumption on muscle strength through mediation of TPI and LM% was reported compared to red or processed meat consumption, and no significant effects were observed between processed meat consumption and MSI.

CONCLUSION

Higher consumption of total, red, and white and fish meat was associated with increased MSI in young adults. TPI and LM% mediated this relationship.

Efficacy and tolerability of a specific blend of amino acids in patients with anorexia nervosa treated in a hospital setting: study protocol for a randomized controlled trial

BACKGROUND

Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet done on patients with anorexia nervosa (AN) who regain weight with specialized intensive treatment. The present study aims to evaluate the efficacy of supplementation with EAA on the change in lean body mass (LBM) and other physical and psychological outcomes in patients with AN who are undergoing specialist treatment for eating disorders.

METHODS

This is a 13-week randomized, double-blind, placebo-controlled study. Patients will be randomized to either a mixture of a complex blend of EAA and intermediates of the tricarboxylic acid (TCA) cycle (citrate, malate, succinate) supplementation (or placebo) upon admission at the intensive residential and day-hospital treatment for eating disorders. Ninety-two participants with AN aged 16-50 years will be recruited from a specialized intensive treatment of eating disorders. Double-blind assessment will be conducted at baseline (T0) and the end of the 13 weeks of treatment (T1). The study's primary aim is to evaluate the efficacy of supplementation with EAA and TCA intermediates on the change in lean body mass (LBM) with weight restoration in patients with AN who are undergoing specialist treatment for eating disorders. The secondary aims of the study are to assess the effect of dietary supplementation on physical fitness, weight restoration, modification of AN and general psychopathology, and psychosocial impairment.

DISCUSSION

The study's results will inform researchers and clinicians on whether supplementing a mixture of EAA and TCA cycle intermediates will improve the increase of LBM and other important physical and psychological outcomes in patients with AN who regain weight with specialized intensive treatment.

TRIAL REGISTRATION

NCT, NCT05290285. Registered on 22 March 2022.

Predictors of response to anamorelin in gastrointestinal cancer patients with cachexia: a retrospective study

PURPOSE

Anamorelin, a ghrelin receptor agonist, has recently been approved for gastric, pancreatic, and colorectal cancer patients with cachexia in Japan. However, only few studies have investigated the predictors of response to anamorelin in clinical settings. Thus, our study aimed to investigate the predictors of the response, in addition to its efficacy and safety.

METHODS

The clinical outcomes of 20 patients were evaluated during administration. They were divided into two groups based on lean body mass, responders and non-responders, and their clinical characteristics were compared.

RESULTS

The mean ± standard error (SE) variations at 12 weeks in lean body mass and handgrip strength were 2.63 ± 0.79 kg and - 1.53 ± 1.20 kg, respectively. The mean ± SE variations at 8 weeks in fasting blood glucose and hemoglobin A1c were 32.88 ± 13.77 mg/dL and 0.90 ± 0.18%, respectively. Total protein, albumin, transferrin, and prognostic nutritional index at baseline were significantly higher in responders (n = 8) than in non-responders (n = 12), whereas the neutrophil/lymphocyte and C-reactive protein/albumin ratios at baseline were significantly higher in non-responders than in responders.

CONCLUSION

The study confirmed the efficacy and safety of anamorelin and identified nutritional or systemic inflammatory markers as predictors of anamorelin response in advanced gastrointestinal cancer patients.

Nutrition, body composition and physical activity have differential impact on the determination of lipidemic blood profiles between young females with different blood cholesterol concentrations

INTRODUCTION

This cross-sectional study explored whether nutrition, body composition, and physical activity energy expenditure (PAΕΝ) have a differential impact on lipidemic blood profiles among young females with different blood cholesterol concentrations.

METHODS

One hundred thirty-five young female students (N = 135) were allocated into three groups according to their blood cholesterol concentrations (Chol): (A) Normal [NL; Chol: < 200 mg·dL^-1; n = 56 Age: 21.4 ± 2.6 yrs, Body Mass Index (BMI): 22.1 ± 2.0 kg·m^-2], (B) Borderline (BL; Chol: ≥200 mg·dL^-1 and <240 mg·dL^-1; n = 44 Age: 21.6 ± 2.5 yrs, BMI: 24.2 ± 3.1 kg·m^-2) and (C) High level (HL; Chol: ≥240 mg·dL^-1; n = 35 Age: 22.5 ± 2.4 yrs, BMI: 28.9 ± 2.1 kg·m^-2). Body composition [bioelectrical impedance analysis including lean body mass (LBM) and body fat mass], nutritional intake (recall questionnaire), daily physical activity energy expenditure through activity trackers and resting blood lipids concentrations were evaluated.

RESULTS

Multiple linear regression analyses revealed that in the NL group, lean mass, daily PAΕΝ and daily energy balance were the determinant parameters of blood lipidemic profiles (B: -0.815 to 0.700). In the BL group, nutrition, body composition and daily physical activity energy expenditure exhibited similar impacts (B: -0.440 to 0.478). In the HL group, nutritional intake and body fat mass determined blood lipidemic profile (B: -0.740 to 0.725).

CONCLUSION

Nutrition, body composition and daily PAΕΝ impact on blood lipids concentration is not universal among young females. In NL females, PAEN, energy expenditure and LBM are the strongest determinants of blood lipids, while in HL females, nutritional intake and body fat mass are. As PAΕΝ increases, the importance of nutrition and body fat decreases, and vice versa.

Pubertal increment in insulin resistance is negatively related to lumbar bone mineral density in 18-year-old males

Transient insulin resistance seen during puberty is expected to favour body growth, but our results show that increment in insulin resistance even in physiological ranges during puberty might compromise lumbar spine bone mineral density accrual independently of body composition parameters, and therefore adult bone quality might be challenged.

INTRODUCTION

Insulin resistance (IR) might have a compromising effect on growing bone, and therefore adult bone quality might be challenged. The aim of the present study was to identify whether increases in IR during puberty contribute to bone mineral characteristics in males independently of body composition parameters.

METHODS

This is a retrospective cohort-based longitudinal observational study. Data from 85 subjects were included. Boys were studied annually during their pubertal years (12 years at baseline) and at follow-up at the age of 18 years. Anthropometry, bone age, fasting blood samples, body composition, total body, and lumbar spine bone mineral characteristics were measured. Insulin resistance was determined by homeostatic model assessment of IR (HOMA-IR). Multiple regression analysis was performed to determine the effect of changes in HOMA-IR during pubertal years as a longitudinal predictor to fixed bone mineral outcome variables at the age of 18 years. All models were adjusted to potential clinically justified confounding variables.

RESULTS

After adjustment to baseline bone indices and body composition-related predictors, the pubertal increment in the HOMA-IR was a negative independent predictor of lumbar spine bone mineral areal density (β =  - 0.202, p = 0.005) and lumbar spine bone mineral apparent density (β =  - 0.235, p = 0.005) in 18-year-old males.

CONCLUSIONS

Pubertal increment in IR has a potential diminishing effect on lumbar spine bone mineral density accrual independently of body composition parameters. Further studies are needed to clarify whether monitoring HOMA-IR during puberty may identify subjects at increased risk of low peak bone mass and possible osteoporosis in the future.

The effect of the exercise environment and the level of involvement on bone mineral health

INTRODUCTION

This study aimed to compare athletes practicing exercise in different environments with non-active young and elderly men and women regarding bone mineral density (BMD), hypothesizing that BMD values differ between athletes according to the environment of exercise practice, but those training in a low-gravitational environment have no different stimuli to BMD increasing if compared with healthy peers experiencing reduced exercise involvement, whatever the age group and sex.

MATERIALS AND METHODS

104 participants of both sexes were selected according to the environment of exercise practice [swimmers (N = 26) and judo fighters (N = 26)], and exercise level of involvement [non-active young (N = 26) and older adults (N = 26)]. Dual-energy X-ray absorptiometry provided BMD, lean mass, and fat mass (FM) for the whole body (WB), upper (UL), and lower limbs (LL).

RESULTS

For the BMD in WB, UL and LL no effects of group and sex were observed (p > 0.05). Post-hoc analyses detected higher values of BMD in UL for female swimmers compared to non-active older adults (p < 0.05), while judo fighters showed higher BMD in WB, UL, and LL than other participants whatever the sex (p < 0.01). Lower FM was observed for WB, UL, and LL when swimmers and judo fighters were compared to non-active young and older female peers (p < 0.01).

CONCLUSION

The findings emphasized that BMD stimuli with swimming are reduced when compared to judo, and despite the stimuli in swimming is not distinguishable from that affecting BMD in WB, UL and LL of non-active young, it is effective in differing BMD in UL among non-active older for women.

Allograft function and muscle mass evolution after kidney transplantation

BACKGROUND

Advanced chronic kidney disease is associated with muscle wasting, but how glomerular filtration rate (GFR) recovery after kidney transplantation is associated with muscle mass is unknown.

METHODS

We took advantage of the simultaneous measurement of GFR (using iohexol plasma clearance; ioGFR) and creatinine excretion rate (a surrogate marker of muscle mass; CER) performed 3 months after transplantation and at a later time point at our institution to investigate the interplay between allograft function, muscle mass, and outcome in kidney transplant recipients.

RESULTS

Between June 2005 and October 2019, 1319 successive kidney transplant recipients (mean age 50.4 ± 14.6; 38.7% female) underwent GFR measurement at our institution 3 months after kidney transplantation. CER (CER₃ ) and ioGFR (ioGFR₃ ) were 7.7 ± 2.6 μmol/min and 53 ± 17.1 mL/min/1.73 m² , respectively. Multivariable analysis identified female gender, older donor and recipient age, reduced body mass index, coronary disease, dialysis history, proteinuria, and reduced ioGFR₃ as independent predictors of low CER₃ (ioGFR₃ : β coefficient 0.19 [95% confidence interval 0.14 to 0.24]). A total of 1165 patients had a subsequent CER measurement after a median follow-up of 9.5 months. Of them, 373 (32%) experienced an increase in CER > 10%, while 222 (19%) showed a CER decrease of more than 10%. Multivariable analysis adjusted for CER₃ and other confounders identified ioGFR₃ as an independent predictor of CER at follow-up (β coefficient 0.11 [95% confidence interval 0.07 to 0.16]). In multivariable Cox analysis, reduced CER at 3 months or at follow-up were consistently associated with mortality (hazard ratio [95% confidence interval] at 3 months: 0.82 [0.74 to 0.91]; at follow-up: 0.79 [0.69 to 0.99]) but not with graft loss.

CONCLUSIONS

Glomerular filtration rate recovery is a determinant of muscle mass variation after kidney transplantation. Early interventions targeting muscle mass gain may be beneficial for kidney transplant recipients.

Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis

BACKGROUND

Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD.

PURPOSE

To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC).

METHODS

Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use).

RESULTS

Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD.

CONCLUSION

Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.

Impact of anthropometric factors on outcomes in atrial fibrillation patients: analysis on 10 220 patients from the European Society of Cardiology (ESC)-European Heart Rhythm Association (EHRA) EurObservational Research Programme on Atrial Fibrillation (EORP-AF) general long-term registry

AIM

To investigate the association of anthropometric parameters [height, weight, body mass index (BMI), body surface area (BSA), and lean body mass (LBM)] with outcomes in atrial fibrillation (AF).

METHODS AND RESULTS

Ten-thousand two-hundred twenty patients were enrolled [40.3% females, median age 70 (62-77) years, followed for 728 (interquartile range 653-745) days]. Sex-specific tertiles were considered for the five anthropometric variables. At the end of follow-up, survival free from all-cause death was worse in the lowest tertiles for all the anthropometric variables analyzed. On multivariable Cox regression analysis, an independent association with all-cause death was found for the lowest vs. middle tertile when body weight (hazard ratio [HR] 1.66, 95%CI 1.23-2.23), BMI (HR 1.65, 95%CI 1.23-2.21), and BSA (HR 1.49, 95%CI 1.11-2.01) were analysed in female sex, as well as for body weight in male patients (HR 1.61, 95%CI 1.25-2.07). Conversely, the risk of MACE was lower for the highest tertile (vs. middle tertile) of BSA and LBM in males and for the highest tertile of weight and BSA in female patients. A higher occurrence of haemorrhagic events was found for female patients in the lowest tertile of height [odds ratio (OR) 1.90, 95%CI 1.23-2.94] and LBM (OR 2.13, 95%CI 1.40-3.26).

CONCLUSIONS

In AF patients height, weight, BMI, BSA, and LBM were associated with clinical outcomes, with all-cause death being higher for patients presenting lower values of these variables, i.e. in the lowest tertiles of distribution. The anthropometric variables independently associated with other outcomes were also different between male and female subjects.

Variations induced by body weight and background lesion normalization in standardized uptake value estimated by F18-FDG PET/CT

AIM

This work aims to study the impact of different SUV variants in terms of mean and maximum measures as well as various normalization methods with respect to body weight, body mass index, body surface area, and lean body mass in patients with lymphoma.

METHODS

Sixty-nine patients (34 male-35 female) were retrospectively selected. All patients had undergone F18-FDG PET/CT using the standard imaging protocol. In the first part of this study, SUVmean and SUVmax of patients' lesions and three background sites including liver, aorta, and muscle were determined. Then, the normalization of lesion SUV to body weight and body background sites was performed. The ratio of lesion SUVmax to body background sites (muscle, aorta, and liver) SUVmax was determined in addition to the ratio of lesion SUVmean to body background sites SUVmean. The second part of the study included the calculations of the body mass index (BMI), body surface area (BSA), and lean body mass (LBM). The normalization of lesion, liver, aorta, and muscle SUV to BMI, BSA, and LBM was calculated and compared to each other.

RESULTS

After performing the appropriate statistical calculations, the results showed that there is a significant difference in SUV measurements between the three background sites. Lesions normalized to the liver were significantly lower than those normalized to aorta and muscle and the results also showed a higher magnitude of lesions normalized to muscle in comparison to the aorta. The SUVmax and SUVmean normalized to different body weight indices showed the lowest variation with BSA and BMI while being increasingly higher with lean body mass using the two methods James and Janmahasatian, respectively, and then highest with body weight.

CONCLUSION

The SUVmax and SUVmean showed lower variance in comparison to other background regions. Less variation was also remarkable in SUVmean normalized to BSA and Janma lean mass and also when SUVmax is normalized to James lean body mass. The SUVmax normalized to lean (i.e., James) as well as SUVmean normalized to lean (i.e., Janma) and BSA showed a significant independence with body weight.

Zoledronic Acid for prevention of bone and muscle loss after BAriatric Surgery (ZABAS)-a study protocol for a randomized controlled trial

Background

Bariatric surgery has adverse effects on the muscular-skeletal system with loss of bone mass and muscle mass and an increase in the risk of fracture. Zoledronic acid is widely used in osteoporosis and prevents bone loss and fracture. Bisphosphonates may also have positive effects on skeletal muscle. The aim of this study is to investigate the effects of zoledronic acid for the prevention of bone and muscle loss after bariatric surgery. 

Methods/design

This is a randomized double-blind placebo-controlled study. Sixty women and men with obesity aged 35 years or older will complete baseline assessments before randomization to either zoledronic acid (5 mg in 100 ml isotonic saline) or placebo (100 ml isotonic saline only) 3 weeks before surgery with Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG). Follow-up assessments are performed 12 and 24 months after surgery. The primary outcome is changes in lumbar spine volumetric bone mineral density (vBMD) assessed by quantitative computed tomography (QCT). Secondary bone outcomes are changes in proximal femur vBMD assessed by QCT. Changes in cortical and trabecular bone microarchitecture and estimated bone strength will be assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). Cortical material bone strength at the mid-tibia diaphysis will be assessed using microindentation and fasting blood samples will be obtained to assess biochemical markers of bone turnover and calcium metabolism. 

Secondary muscle outcomes include whole body lean mass assessed using dual-energy X-ray absorptiometry. Dynamometers will be used to assess handgrip, shoulder, ankle, and knee muscle strength. Short Physical Performance Battery, 7.6-m walking tests, 2-min walking test, and a stair climb test will be assessed as biomarkers of physical function. Self-reported physical activity level is assessed using International Physical Activity Questionnaire (IPAQ).

Discussion

Results from this study will be instrumental for the evidence-based care of patients undergoing bariatric surgery.

Trial registration

ClinicalTrials.gov NCT04742010. Registered on 5 February 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06766-z.

The effect of aspartame and sucralose intake on body weight measures and blood metabolites: role of their form (solid and/or liquid) of ingestion

The ingestion of non-caloric sweeteners (NCS) from food and/or drink was intended to reduce caloric intake without compromising palatability. However, the inconclusive relation between NCS and body weight may partially relate to their form of ingestion (solid or liquid). Thus, two paralleled experiments (aspartame and sucralose) were conducted. In each, Sprague Dawley rats (7-week-old male) were randomly divided into four groups. In Expt 1, aspartame (0·05 %) was added to the diet (AD) or drinking water (AW) or both diet and water (ADW), and a control group (C) was given a non-sweetened diet with plain water. In Expt 2, sucralose (0·016 %) was similarly provided in the diet (SD) or drinking water (SW) or both diet and water (SDW), with a control group (C). All rats had free access to food and water for 7 weeks. Energy intake, body weight and body composition were monitored and blood metabolites were determined. Results showed that aspartame ingestion significantly increased body weight and fat mass mainly due to an increase in energy efficiency. The effect was related to the amount rather than the form of ingestion. Additionally, aspartame ingestion was associated with glucose intolerance. Sucralose ingestion had a similar impact to that of aspartame though to a lesser extent. In conclusion, 7-week ingestion of aspartame and sucralose had adverse effects on body measures that were not related to the form of ingestion.

Association between zinc and body composition: An integrative review

BACKGROUND

Zinc deficiency is related to lean body mass reduction, fat deposition, and obesity. Zinc acts in catalytic, structural, and regulatory functions, being an essential micronutrient to humans. It is crucial for maintaining lean body mass, synthesizing nucleic acids and proteins, and forming new tissues. Pre-existing zinc deficiency may contribute to obesity due to its relationship with fat deposition associated with short stature. This integrative review aims to analyze the association between zinc and body composition, hitherto very poorly established in previous studies.

MATERIAL AND METHODS

The electronic databases utilized in this review were PubMed and Web of Science. We identified titles and abstracts from 1178 articles relating to zinc and body composition that were published in the last ten years. After duplicates were removed, the reference lists of relevant reviews were checked, and 47 articles were obtained by manual search.

MAIN FINDINGS AND CONCLUSIONS

The articles were transversal or longitudinal studies, clinical trials, randomized controlled trials, reviews, systematic reviews, and meta-analysis. Although there was heterogeneity among the methodologies, the existence of an association between zinc and body composition was predominant among the studies. All articles concluded that zinc had positive effects on proteogenesis. Moreover, zinc metabolism is dysregulated in obese individuals, whose mechanisms remain controversial.

Changes in predicted lean body mass, appendicular skeletal muscle mass, and body fat mass and cardiovascular disease

BACKGROUND

Little is known about the association of changes in two body components, muscle and fat mass, with the risk of cardiovascular disease (CVD) among young adults. We investigated the association of changes in predicted lean body mass index (LBMI), appendicular skeletal muscle mass index (ASMI), and body fat mass index (BFMI) with the development of CVD among young adults.

METHODS

This nationwide, population-based cohort study included 3 727 738 young adults [2 406 046 (64.5%) men and 1 321 692 (35.5%) women] aged 20-39 years without a previous history of CVD who underwent two health screening examinations during 2009-2010 and 2011-2012. Using validated and robust prediction equations, we calculated the changes in predicted LBMI, ASMI, and BFMI from the first to the second examinations.

RESULTS

The mean (SD) age was 32.2 (4.9) years, and 2 406 046 (64.5%) of the participants were men. A total of 23 344 CVD events were detected during 22 257 632 person-years of follow-up. Each 1 kg/m² increase in predicted LBMI and ASMI change was associated with a reduced risk of CVD among men [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI) 0.82-0.91; aHR: 0.76, 95% CI 0.69-0.82, respectively] and women (aHR: 0.77, 95% CI 0.63-0.95; aHR: 0.75, 95% CI 0.59-0.96). Each 1 kg/m² increase in predicted BFMI change was associated with an increased risk of CVD among men (aHR: 1.16, 95% CI 1.10-1.22) and women (aHR: 1.32, 95% CI 1.06-1.65). In both sexes, decreases in predicted LBMI and ASMI were associated with greater CVD risk, and decreased predicted BFMI was associated with a reduced CVD risk. Those who maintained their BMI between -1 and +1 kg/m² also had a decreased risk of CVD per 1 kg/m² increase in predicted LBMI and ASMI change among men (aHR: 0.86, 95% CI 0.80-0.92; aHR: 0.85, 95% CI 0.76-0.95) and women (aHR: 0.62, 95% CI 0.47-0.83; aHR: 0.59, 95% CI 0.44-0.80) and had a greater risk of CVD per 1 kg/m² increase in predicted BFMI change among men (aHR: 1.17, 95% CI 1.10-1.25) and women (aHR: 1.64, 95% CI 1.20-2.23). Regardless of changes in weight, such as from normal to obese or vice versa, these results were consistent.

CONCLUSIONS

Among young adults, increased predicted muscle mass or decreased predicted fat mass were associated with a reduced risk of development of CVD. Decreased predicted muscle mass or increased predicted fat mass were associated with an elevated risk of development of CVD.

Intermittent fasting and continuous energy restriction result in similar changes in body composition and muscle strength when combined with a 12 week resistance training program

Purpose

The objective of this study was to compare the effects of 12 weeks of resistance training combined with either 5:2 intermittent fasting or continuous energy restriction on body composition, muscle size and quality, and upper and lower body strength.

Methods

Untrained individuals undertook 12 weeks of resistance training plus either continuous energy restriction [20% daily energy restriction (CERT)] or 5:2 intermittent fasting [~ 70% energy restriction 2 days/week, euenergetic consumption 5 days/week (IFT)], with both groups prescribed a mean of ≥ 1.4 g of protein per kilogram of body weight per day. Participants completed 2 supervised resistance and 1 unsupervised aerobic/resistance training combination session per week. Changes in lean body mass (LBM), thigh muscle size and quality, strength and dietary intake were assessed.

Results

Thirty-four participants completed the study (CERT = 17, IFT = 17). LBM was significantly increased (+ 3.7%, p < 0.001) and body weight (− 4.6%, p < 0.001) and fat (− 24.1%, p < 0.001) were significantly reduced with no significant difference between groups, though results differed by sex. Both groups showed improvements in thigh muscle size and quality, and reduced intramuscular and subcutaneous fat assessed by ultrasonography and peripheral quantitative computed tomography (pQCT), respectively. The CERT group demonstrated a significant increase in muscle surface area assessed by pQCT compared to the IFT group. Similar gains in upper and lower body strength and muscular endurance were observed between groups.

Conclusion

When combined with resistance training and moderate protein intake, continuous energy restriction and 5:2 intermittent fasting resulted in similar improvements in body composition, muscle quality, and strength. ACTRN: ACTRN12620000920998, September 2020, retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-022-02804-3.

Predicted Fat Mass, Lean Body Mass, and Risk of Hypertension: Results from a Chinese Male Cohort Study

INTRODUCTION

Few studies have deciphered whether lean body mass (LBM) or fat mass (FM) is predominantly responsible for the body mass index (BMI)-hypertension association. This study aimed to assess the associations of predicted LBM and FM with hypertension risk among Chinese male adults.

METHODS

A prospective cohort study was conducted among 2,812 male participants free of hypertension in the Fangchenggang Area Males Health and Examination Survey in 2009. We performed multivariable Cox models and restricted cubic spline to examine the associations of predicted LBM and FM and BMI with hypertension, and to further explore the mediating roles of lipid and glycemic traits in the relationship between predicted FM and blood pressure.

RESULTS

Of 1,238 participants included in the cohort study, 306 (24.8%) hypertension cases were identified during a median follow-up of 3.8 years, with an incidence rate of 7.0 per 100 person-years. A positive linear-shaped association was consistently observed between BMI and hypertension (p for trend <0.001). Multivariable-adjusted Cox models including predicted LBM and FM observed a positive association between predicted FM and hypertension. Compared with those in the lowest quartile of predicted FM, men in the highest quartile had a hazard ratio (HR) of 1.83 (95% confidence interval (CI): 1.13-2.97) for hypertension. The HR per standard deviation increase of BMI and predicted FM was 1.11 (95% CI: 1.04-1.19) above 23.1 kg/m2 and 1.05 (95% CI: 1.02-1.15) above 14.6 kg, respectively. However, predicted LBM was not associated with hypertension. In addition, high-density lipoprotein cholesterol (HDL-c) and fasting blood glucose (FBG) mediated the relationship of predicted FM with systolic blood pressure, with a mediation ratio of 37.1% and 8.2%, respectively. Furthermore, total cholesterol (TC) and triglyceride (TG) positively mediated the association of predicted FM with diastolic blood pressure, with a mediation ratio of 9.5% and 9.9%, respectively.

CONCLUSION

Higher predicted FM might play a central role in the positive linear relationship of the BMI-hypertension association in Chinese male adults, and the link from predicted FM to blood pressure was partially mediated by TC, TG, HDL-c, and FBG.

Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient-reported outcomes in pancreatic cancer cachexia

BACKGROUND

Advanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health-related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide-based formula to improve weight stability and patient-reported outcomes (PROs) in advanced PDAC patients with cachexia.

METHODS

This was a single-institution, single-arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18 years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6 months from screening. The study intervention included three 28 day cycles of a semi-elemental peptide-based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3 months (Cycle 3), defined as weight change less than 0.1 kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3 month study period.

RESULTS

Thirty-six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67 years (SD 9.3), 43.8% male. Among evaluable patients (n = 16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P = 0.01) and appendicular lean mass (0.45, SD: 0.6, P = 0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P = 0.03], appetite (MD: 27.4, P = 0.02), and global health scores (MD: 13.3, P = 0.05) as well as for NIH PROMIS t-scores for depression (MD: -10.4, P = 0.006) and pain interference (MD: -7.5, P = 0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached.

CONCLUSIONS

Our findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.

Glycine increases fat-free mass in malnourished haemodialysis patients: a randomized double-blind crossover trial

BACKGROUND

Protein energy wasting is associated with negative outcome in patients under chronic haemodialysis (HD). Branched-chain amino acids (BCAAs) may increase the muscle mass. This post hoc analysis of a controlled double-blind randomized crossover study assessed the impact of BCAAs on nutritional status, physical function, and quality of life.

METHODS

We included 36 chronic HD patient features of protein energy wasting as plasma albumin <38 g/L, and dietary intakes <30 kcal/kg/day and <1 g protein/kg/day. Patients received either oral BCAA (2 × 7 g/day) or glycine (2 × 7 g/day) for 4 months (Period 1), followed by a washout period of 1 month, and then received the opposite supplement (Period 2). The outcomes were lean body mass measured by dual-energy X-ray absorptiometry, fat-free mass index measured by bioelectrical impedance, resting energy expenditure, dietary intake and appetite rating, physical activity and function, quality of life, and blood parameters. Analyses were performed by multiple mixed linear regressions including type of supplementation, months, period, sex, and age as fixed effects and subjects as random intercepts.

RESULTS

Twenty-seven patients (61.2 ± 13.7 years, 41% women) were compliant to the supplementations (consumption >80% of packs) and completed the study. BCAA did not affect lean body mass index and body weight, but significantly decreased fat-free mass index, as compared with glycine (coeff -0.27, 95% confidence interval -0.43 to -0.10, P = 0.002, respectively). BCAA and glycine intake had no effect on the other clinical parameters, blood chemistry tests, or plasma amino acids.

CONCLUSIONS

Branched-chain amino acid did not improve lean body mass as compared with glycine. Unexpectedly, glycine improved fat-free mass index in HD patients, as compared with BCAA. Whether long-term supplementation with glycine improves the clinical outcome remains to be demonstrated.

An association between the physical activity level and skeletal muscle mass index in female university students with a past exercise habituation

OBJECTIVES

This study aims to investigate the association between skeletal muscle mass index (SMI) and physical activity among female university students who had exercise habituation in junior and high school.

METHODS

The body composition of 120 Japanese female students was measured using the bioelectrical impedance analysis (BIA) method, and their physical activity level (PAL) was measured using a factorial method. Based on the 'Dietary Reference Intakes for Japanese' (DRIs-J), according to the Ministry of Health, Labour and Welfare, PAL (24-h energy consumption/basal metabolic rate) classifications were defined as low-PAL (PAL < 1.6), moderate-PAL (1.6 ≤ PAL < 1.9), and high-PAL (1.9 ≤ PAL < 2.2), respectively.

RESULTS

Individuals with low-PAL had a significantly lower SMI, especially for the lower limb muscles, than individuals with moderate-PAL or higher. More than 50% of the individuals with currently low-PAL corresponded or tended to correspond to the SMI cut-off value defined by the Asian Working Group for Sarcopenia or the 2017 National Health and Nutrition Survey of Japan. Therefore, more than half of the female students with currently low-PAL, even those with an exercise habituation in the past, corresponded to the cut-off value for muscle loss in sarcopenia diagnosis, particularly in the lower limbs.

CONCLUSIONS

These results suggest that it is important to maintain a moderate or higher level of physical activity in the DRIs-J classification, even for young women who used to exercise in the past, to maintain muscle mass accordingly.

Associations between Spanish children's physical activity and physical fitness with lean body mass: The CALINA study

The present study investigated the associations between physical activity (PA) and physical fitness (PF) with lean body mass (LBM) and evaluated whether PA mediates the association between PF and LBM. 279 children (150 boys) aged 7.5 ± 0.3 years participated in the study. PA was assessed by accelerometry and PF with handgrip and the standing long jump test. Total lean soft tissue mass index (TLSTMI), muscle cross-sectional area index (MCSAI), and fat-free mass index (FFMI) were evaluated using dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, and bioimpedance analysis, respectively.Total (β = 0.247) and vigorous PA (β = 0.143) were associated with TLSTMI in girls. In boys, total (β = 0.337), light (β = 0.290), vigorous (β = 0.200), and moderate-vigorous PA (β = 0.189) were associated with TLSTMI. Total PA was associated with FFMI (β = 0.299). Handgrip strength does not mediate the relationship between total PA and TLSTMI. Positive associations were found between handgrip strength and TLSTMI, MCSAI, and FFMI in both girls and boys.In children, there is a positive association between total and vigorous PA with TLSTMI. Handgrip strength does not mediate the relationship between total PA and TLSTMI. It was associated with TLSTMI, MCSAI, and FFMI.

Both lean and fat body mass associate with blood pressure

High body mass index (BMI) is known to be associated with elevated blood pressure (BP). The present study aims to determine the relative importance of the two components of BMI, fat mass and lean body mass index, on BP levels. We assessed body composition with bioimpedance and performed 24 hour ambulatory BP measurements in 534 individuals (mean age 61 ± 3 years) who had no cardiovascular medication. Fat mass index and lean mass index were calculated analogously to BMI as fat mass or lean body mass (kg) divided by the square of height (m²). Both fat mass index and lean mass index showed a positive, small to moderate relationship with all 24 hour BP components independently of age, sex, smoking, and leisure-time physical activity. There were no interaction effects between fat mass index and lean mass index on the mean BP levels. Adult lean body mass is a significant determinant of BP levels with an equal, albeit small to moderate magnitude as fat mass. Relatively high amount of muscle mass may not be beneficial to cardiovascular health.

The association between body composition, leptin levels and glucose dysregulation in youth with cystic fibrosis

BACKGROUND

Optimization of nutritional status is recommended in patients with cystic fibrosis (CF) given the association between lower body mass index (BMI) and poor clinical outcomes. However, higher BMI and body fat correlate with glucose impairment and higher leptin levels in the general population. Differences in body composition and leptin levels between the categories of glucose tolerance were assessed in youth with CF and healthy controls.

METHODS

In a cross-sectional study, 59 adolescents and young adults with CF and 15 healthy controls matched by age and gender, underwent body composition analysis using dual energy X-ray absorptiometry (DXA) and a 2-hour oral glucose tolerance test (OGTT). Measures of insulin sensitivity, β-cell insulin secretion and fasting leptin levels were obtained.

RESULTS

Of the participants with CF, 62% were classified as abnormal glucose tolerant and 22% with cystic fibrosis related diabetes (CFRD). Patients with CFRD had a lower fat mass index (FMI) z-score, wt z-score and leptin levels compared to the control group (-1.86 vs. - 0.59, p=0.01; -1.86 vs 0.44, p=<0.001 and 7.9 vs vs. 27.7 µg/L, p=0.01). Leptin correlated positively with FMI z-score, BMI, weight z-score and indices of insulin secretion. FMI z-score correlated positively with higher insulin resistance (HOMA-IR), and lower insulin sensitivity (Matsuda index) (r=0.31; p =0.01 and r=-0.29; p=0.02, respectively) in the CF group.

CONCLUSIONS

This study shows that despite new therapeutic strategies, youth with CF have lower body fat, weight z-score and leptin levels, particularly in subjects with early onset CFRD.

Appropriate dose of levothyroxine replacement therapy for hypothyroid obese patients

Background

Athyreotic patients require a daily levothyroxine (LT4) doses of 1.6-1.8 mcg/kg of actual body weight (BW) to achieve normal thyroid stimulating hormone (TSH) levels. Lean body mass (LBM) calculation may be a more accurate determination of LT4 dose in obese patients. Previous studies were mainly investigated in Caucasians and LBM is markedly different between various ethnic groups. We aim to identify the optimal dose of LT4 replacement therapy in hypothyroid Thai patients including obese subjects.

Methods

We retrospectively reviewed the medical records of Thai adults with hypothyroidism at the thyroid clinic. Patients had been received LT4 (Brand: Euthyrox) at a stable dose ≥ 75 mcg/day for at least 1 year. Patients with thyroid cancer, pregnant, and lactating women were excluded. LBM was calculated by the Hume formula.

Results

Two hundred patients (80% females) with a mean age of 48.6 ± 14.8 years and a body mass index (BMI) of 24.5 ± 4.6 kg/m² were included. Daily LT4 dose/kg of actual BW according to BMI 18.5-24.9, 25-29.9, and ≥ 30 kg/m² were 1.67 ± 0.27, 1.51 ± 0.28 and 1.39 ± 0.34 mcg/kg, respectively. In contrast, LT4 dose/kg of LBM were 2.31 ± 0.39, 2.35 ± 0.45 and 2.36 ± 0.51 mcg/kg, respectively.

Conclusions

LBM is considered a better indicator for calculating an appropriate LT4 replacement dose than actual BW in hypothyroid obese Thai patients. The recommended daily dose of LT4 is 2.3 mcg/kg of LBM that could be applied for all ranges of BMI.

Postural orientation, what to expect in youth athletes? A cohort study on data from the Malmö Youth Sport Study

BACKGROUND

Studies investigating postural orientation in uninjured youth athletes are scarce. Understanding how postural orientation during functional performance tests change with age in uninjured athletes has the potential to enhance awareness of changes in performance after injury and to set realistic goals for injured athletes. Thus, the aim of this study was to explore postural orientation during functional tasks at early adolescence, and changes in postural orientation from early to middle adolescence and relate this to sex, type of sport and right leg lean body mass (RLLBM).

METHODS

In this cohort study 144 (38% female) youth athletes (mean age 13.5 years, SD 0.3) were included at baseline and 86 of these at follow up 2 years later. Four functional performance tests were visually evaluated for Postural Orientation Errors (POEs) with an ordinal scale, ranging from 0 (good) to 2 (poor), yielding a maximum total POE score of 51, and RLLBM by dual energy X-ray absorptiometry.

RESULTS

Improvements were observed in the total POE score from baseline to follow-up, median difference - 10 and - 7 (p < 0.001) for female and male athletes, respectively. At follow-up, female athletes had lower total POE score (median 18) than males (median 24) (p = 0.01). There were no differences in POE scores between sports type (team, individual, aesthetic) (p = 0.20-0.98) and no relationship between total POE score and RLLBM (r_s = 0.09, p = 0.42).

CONCLUSIONS

POEs appear to be quite common in young athletic population, but improvements are achieved over time. At mid-adolescence, female athletes seem to have less POEs than males. Neither sport type nor RLLBM seem to influence postural orientation.

Detraining Effects on Musculoskeletal Parameters in Early Postmenopausal Osteopenic Women: 3-Month Follow-Up of the Randomized Controlled ACTLIFE Study

Periods of absence from supervised group exercise while maintaining physical activity might be a frequent pattern in adults' exercise habits. The aim of the present study was to determine detraining effects on musculoskeletal outcomes after a 3-month detraining period in early post-menopausal, osteopenic women. Due to the COVID-19 pandemic, we terminated the 18-month randomized controlled ACTLIFE exercise intervention immediately after the 13-month follow-up assessment. This put an abrupt stop to the high-intensity aerobic and resistance group exercise sessions undertaken three times per week by the exercise group (EG: n = 27) and the gentle exercise program performed once per week for the attention control group (CG: n = 27); but both groups were permitted to conduct individual outdoor activity for the 3-month lock-down period. Study endpoints were lean body mass (LBM), bone mineral density (BMD) at the lumbar spine (LS), maximum hip-/leg extension strength and power. Detraining-induced reductions of LBM, hip/leg strength and power (but not BMD-LS) were significantly greater (p < 0.001 to p = 0.044) compared with the CG. Significant exercise effects, i.e. differences between EG and CG, present after 13 months of exercise, were lost after 3 months of detraining for LBM (p = 0.157) and BMD-LS (p = 0.065), but not for strength (p < 0.001) and power (p < 0.001). Of note, self-reported individual outdoor activities and exercise increased by about 40% in both groups during the lock-down period. Three months' absence from a supervised group exercise protocol resulted in considerable detraining effects for musculoskeletal parameters. Thus, exercise programs for adults should be continuous rather than intermittent.Trial registration number: ClinicalTrials.gov: NCT04420806, 06.05.2020.

Muscle hypertrophy in cancer patients and survivors via strength training. A meta-analysis and meta-regression

BACKGROUND

Muscle wasting has a negative effect on treatment toxicity and cancer prognosis. Resistance training appears to be a promising approach to counteract the loss of muscle mass.

METHODS

Pubmed, Cochrane Library, SportDiscus and CINAHL. Randomized controlled resistance training trials with cancer survivros where eligible if lean body mass (LBM) or muscle mass were assessed.

RESULTS

A total of 34 trials were included into the primary analysis. Compared to the control individuals, the intervention groups show a superiority in LBM of 0.85 kg (95 % CI = 0.26-1.43, p = .004). Isolated, the participants in the intervention groups show an increase in LBM of 0.51 kg (95 % CI = -0.05-1.06, p = .072); the control groups displayed a decrease of -0.59 kg (95 % CI= -1.04 to 0.06, p = .078). Supervision displayed an mediating role.

CONCLUSIONS

Resistance training can counteract the loss of muscle mass in cancer patients. Especially in a supervised setting.

Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study

BACKGROUND

Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage.

AIM

To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.

METHODS

Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm²/(height in m²) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.

RESULTS

Median age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).

CONCLUSION

Neither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.

Comparison of the effect of soya protein and whey protein on body composition: a meta-analysis of randomised clinical trials

Essential amino acids (EAA) promote the process of regulating muscle synthesis. Thus, whey protein that contains higher amounts of EAA can have a considerable effect on modifying muscle synthesis. However, there is insufficient evidence regarding the effect of soya and whey protein supplementation on body composition. Thus, we sought to perform a meta-analysis of published randomised clinical trials that examined the effect of whey protein supplementation and soya protein supplementation on body composition (lean body mass, fat mass, body mass and body fat percentage) in adults. We searched PubMed, Scopus and Google Scholar, up to August 2020, for all relevant published articles assessing soya protein supplementation and whey protein supplementation on body composition parameters. We included all randomised clinical trials that investigated the effect of whey protein supplementation and soya protein supplementation on body composition in adults. Pooled means and standard deviations were calculated using random effects models. Subgroup analysis was applied to discern possible sources of heterogeneity. After excluding non-relevant articles, ten studies, with 596 participants, remained in this study. We found a significant increase in lean body mass after whey protein supplementation (weighted mean difference (WMD: 0·91; 95 % CI 0·15, 1·67; P = 0·019). We observed no significant change between whey protein supplementation and body mass, fat mass and body fat percentage. We found no significant change between soya protein supplementation and body composition parameters. Whey protein supplementation significantly improved body composition via increases in lean body mass, without influencing fat mass, body mass and body fat percentage.

Effect of temperature and/or sweetness of beverages on body composition in rats

Sweetened beverages are mainly consumed cold and various processes are activated in response to external temperature variations. However, the effect of internal temperature variations through the ingestion of cold beverages is far from clear. Two experiments were conducted to investigate the effect of beverage temperature on body composition. Sprague-Dawley rats (5-6-week-old males) had free access to food and beverage for 8 weeks. Energy intake, body weight and body composition were monitored. In Expt 1, two groups of rats (n 9) consumed water at room temperature (NW about 22°C) or cold (CW about 4°C). In Expt 2, rats were offered room-temperature (N) or cold (C) sweetened water (10 % sucrose CSu (n 7) and NSu (n 8); or 0·05 % acesulfame K CAk (n 6) and NAk (n 8)) for 12 h, followed by plain water. Our results show that in Expt 1, CW had higher lean body mass (P < 0·001) and lower body fat gain (P = 0·004) as compared with NW. In Expt 2, body weight (P = 0·013) and fat (P ≤ 0·001) gains were higher in the non-energetic sweetened groups, while lean body mass was not affected by the type of sweeteners or temperature. In conclusion, cold water ingestion improved lean body mass gain and decreased fat gain because of increased energy expenditure, while non-energetic sweetener (acesulfame K) increased body fat gain due to improved energy efficiency. Internal cold exposure failed to increase energy intake in contrast to that of external cold exposure.

Short-term intradialytic NMES targeting muscles of the legs improves the phase angle: A pilot randomized clinical trial

PURPOSE

Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to attenuate muscle atrophy when physical activity is not possible. Thus, we hypothesized that intradialytic NMES would attenuate the loss leg lean mass and improve the phase angle in patients undergoing hemodialysis (HD).

METHODS

A randomized controlled trial was performed with twenty-one adult HD patients (n = 8 F, n = 13 M; 45.8 ± 10.6 y) randomly assigned to usual care (control group, n = 11; 4F/7M) or to the NMES group (n = 10; 4F/6M). NMES was applied bilaterally at the origin and insertion points of the quadriceps or gastrocnemius muscles for 40 min during each HD session (3x/wk for one month). Pre-and post-intervention, we measured leg lean mass using dual-energy x-ray absorptiometry and phase angle using bioelectrical impedance analysis.

RESULTS

NMES did not change leg lean mass compared to the control group. Phase angle increased in the NMES compared to the control group (Δ: +0.71 ± 0.27° vs. -0.46 ± 0.23°, p = 0.004) with interaction time x treatment (ANOVA p = 0.004).

CONCLUSION

Short-term intradialytic NMES targeting muscles of the legs improved the phase angle but did not change leg lean mass.

BRAZILIAN REGISTRY OF CLINICAL TRIALS UNDER THE CODE

RBR-98wzgn.

The effect of additional protein on lean body mass preservation in post-bariatric surgery patients: a systematic review

BACKGROUND

As result of bariatric surgery, patients are susceptible to protein deficiency which can result in undesirable lean body mass (LBM) loss. Consumption of high-protein diets or supplements could counteract this, but evidence about the effect is scarce. This paper systematically reviewed the literature to determine the effect of additional protein intake (≥60 g/day) on LBM preservation in post-bariatric patients.

METHODS

An electronic search of PubMed, EMBASE and the Cochrane Library was conducted. Studies were included if patients received a high-protein diet or protein supplements for at least one month, and LBM was assessed. The primary outcome was difference in mean LBM loss between the experimental (protein) and control group. Secondary outcomes were differences in body fat mass, total body water, body mass index and resting metabolic rate.

RESULTS

Two of the five included studies (n = 223) showed that consumption of proteins resulted in significant LBM preservation. Only one study reported a significant difference in the reduction of body fat mass and resting metabolic rate in favour of a high-protein diet, but none of the studies showed a significant difference in total body water loss or body mass index change between the two groups.

CONCLUSIONS

This paper showed inconclusive evidence for LBM preservation due to protein supplementation or a high-protein diet in post-bariatric patients. This outcome might be subjected to certain limitations, including a lack of blinding and a low compliance rate reported in the included studies. More specific and personalized recommendations regarding protein intake may need to be established by high quality research. Studies investigating the quantity (g/day) and quality (whey, casein or soy) of proteins are also needed.

Sex-related differences in accumulated O2 deficit incurred by high-intensity rowing exercise during childhood and adolescence

PURPOSE

The aims of the present study were to determine during childhood and adolescence (i) the effect of sex on non-oxidative energy production, quantified by the accumulated oxygen deficit (AOD), and (ii) the influence of AOD on high-intensity performance.

METHODS

Thirty-nine boys and 35 girls aged 10-17 years performed a 60 s all-out test on a rowing ergometer to determine AOD and mean power output (MPO). Multiplicative allometric modelling was used to assess the concurrent effects of lean body mass (LBM) and age on AOD.

RESULTS

AOD significantly increased with age in both sexes (p < 0.001) with boys exhibiting significantly higher AOD than girls from the age of 14 years (10-11.9 yr: 1.9 vs 1.9 L, 12-13.9 yr: 2.4 vs 2.7 L, 14-15.9 yr: 2.8 vs 4.6 L and 16-17.9 yr: 2.9 vs 5.2 L, in girls and boys respectively, p < 0.001). However, a sex difference was no longer significant when AOD was analysed using an allometric model including age and LBM (p = 0.885). Finally, significant correlations were found between AOD and MPO in boys and girls but with lower evidence in girls (r² = 0.41 vs. 0.89).

CONCLUSION

Non-oxidative energy production increased more extensively in boys than girls from the age of 14 years. Age and LBM accounted for the sexual differentiation of AOD during childhood and adolescence. In addition, AOD was found to be a determinant factor of high-intensity performance, more particularly in boys.

Evaluation of SUVlean consistency in FDG and PSMA PET/MR with Dixon-, James-, and Janma-based lean body mass correction

PURPOSE

To systematically evaluate the consistency of various standardized uptake value (SUV) lean body mass (LBM) normalization methods in a clinical positron emission tomography/magnetic resonance imaging (PET/MR) setting.

METHODS

SUV of brain, liver, prostate, parotid, blood, and muscle were measured in 90 18F-FDG and 28 18F-PSMA PET/MR scans and corrected for LBM using the James, Janma (short for Janmahasatian), and Dixon approaches. The prospective study was performed from December 2018 to August 2020 at Shanghai East Hospital. Forty dual energy X-ray absorptiometry (DXA) measurements of non-fat mass were used as the reference standard. Agreement between different LBM methods was assessed by linear regression and Bland-Altman statistics. SUV's dependency on BMI was evaluated by means of linear regression and Pearson correlation.

RESULTS

Compared to DXA, the Dixon approach presented the least bias in LBM/weight% than James and Janma models (bias 0.4±7.3%, - 8.0±9.4%, and - 3.3±8.3% respectively). SUV normalized by body weight (SUVbw) was positively correlated with body mass index (BMI) for both FDG (e.g., liver: r = 0.45, p < 0.001) and PSMA scans (r = 0.20, p = 0.31), while SUV normalized by lean body mass (SUVlean) revealed a decreased dependency on BMI (r = 0.22, 0.08, 0.14, p = 0.04, 0.46, 0.18 for Dixon, James, and Janma models, respectively). The liver SUVbw of obese/overweight patients was significantly larger (p < 0.001) than that of normal patients, whereas the bias was mostly eliminated in SUVlean. One-way ANOVA showed significant difference (p < 0.001) between SUVlean in major organs measured using Dixon method vs James and Janma models.

CONCLUSION

Significant systematic variation was found using different approaches to calculate SUVlean. A consistent correction method should be applied for serial PET/MR scans. The Dixon method provides the most accurate measure of LBM, yielding the least bias of all approaches when compared to DXA.