Long-term depot specific changes in adipose tissue after treatment of acromegaly

CONTEXT

Patients with active acromegaly present a decreased adipose tissue (AT) mass, and short-term studies show that treatment leads to AT depot-specific gain. However, it remains unclear if the increase is persistent in the long-term perspective and/or is sex-dependent.

DESIGN

To characterize the depot-specific changes of AT after treatment of acromegaly and identify contributing factors.

METHODS

Adipose tissue, including visceral (VAT), subcutaneous (SAT), and total (TAT), and android to gynoid ratio (A/G ratio) were measured by dual energy X-ray absorptiometry at diagnosis (n = 62), and after treatment at short-term (median (IQR) 1.9 (1.5-2.3)) and long-term 5.5 (3.9-9.5) years, and correlated to clinical and biochemical measurements. Growth hormone (GH), insulin-like growth factor 1 (IGF-1), glucose and HbA1c levels, gonadal status, and the presence of diabetes mellitus were recorded. Remission status was assessed at the long-term visit (IGF-1/ULN ≤ 1.3). Differences in the temporal course of AT from baseline to short- and long-term follow-up according to sex, diabetes, gonadal, and remission status were evaluated by mixed model analysis, adjusted for age.

RESULTS

Despite a stable body mass index, VAT and A/G ratio increased at both time points, whereas SAT mainly increased at short-term, plateauing afterwards (P < .05 for all). Visceral adipose tissue and A/G ratio were higher in men (P = .035 and P < .001), and the A/G ratio increased more than in women (P = .003). Glucose and HbA1c decreased short-term (P < .05) and remained stable at long-term. The increase in AT depots correlated with the decrease of disease activity at long-term. Remission status had no effect on changes in AT mass during follow-up.

CONCLUSION

Treatment of acromegaly leads to an increase in AT mass in a depot- and sex-specific manner both at short-term and long-term follow-up. Glucose metabolism improves rapidly after disease control and persists.

Effect of β-casein A1 or A2 milk on body composition, milk intake, and growth in Holstein, Simmental, and crossbred dairy calves of both sexes

The aim of this study was to compare the effects of feeding homozygous β-casein A1 or A2 milk, on the body composition, milk intake, and growth of German Holstein (GH), German Simmental (GS), and crossbred dairy calves of both sexes during the first 2 weeks of life. A total of 104 calves (n = 54 female - f and n = 50 male - m) from the breed groups GH (n = 23), GS (n = 61), and crossbred GH x GS (CR; n = 20) were evaluated. Calves were weighed after birth and received colostrum ad libitum. On the second day, calves were alternately housed in pairs in double-igloo systems according to their random birth order and received either A1 milk (n = 52; 27 f / 25 m) or A2 milk (n = 52; 27 f / 25 m). They were offered 7.5 L/day, and the individual actual total milk intake (TMI) was recorded. Daily energy-corrected milk intake was also calculated based on the milk composition (fat and protein). Fecal scores were recorded daily. On d 15, visceral adipose tissue (VAT) volume was assessed by open magnetic resonance imaging (MRI) and dual-energy x-ray absorptiometry (DXA). In addition, fat and lean mass (g), as well as bone mineral content (g) and bone mineral density (g/cm2), were determined by DXA. The body composition, milk intake, and growth were similar between the 2 types of milk in the first 2 weeks of life. Female calves had more VAT and fat mass, but less lean mass than male calves. GH and CR calves had more VAT and less lean mass than GS calves. Male calves were heavier than female calves after birth and on d 15. The average days with diarrhea and diarrhea occurrence were similar between calves fed A1 and A2 milk and between both sex groups. GS calves presented slightly more days with diarrhea and increased odds of having diarrhea compared with GH calves, not differing from CR.

Bone mineral density after exercise training in patients with chronic kidney disease stages 3 to 5: a sub-study of RENEXC-a randomized controlled trial

Background

We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3-5 not on kidney replacement therapy (KRT).

Methods

A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry.

Results

Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD (P < .001), the balance group (BG) increased total body T score (P < .05) and total body Z score (P < .005). Total body ΔT score was negative in the SG and unchanged in the BG (P < .005). Total body ΔZ score was negative in the SG and positive in the BG (P < .001). The proportion of progressors measured by ΔT (P < .05) and ΔZ scores (P < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores.

Conclusions

Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT.

Association of body fat and muscle tissue parameters with fatty liver disease identified by ultrasound

AIMS

To examine the association between body fat and muscle parameters and FLD in individuals of Chinese descent.

METHODS

A total of 515 participants who underwent routine check-ups between November 2019 and August 2021 were reviewed. Based on ultrasound performance, the subjects were categorized into the non-FLD group and the FLD group. The prevalence of FLD in sex subgroups was analyzed using logistic regression to calculate the odds ratios (ORs) of body composition parameters with adjustment for confounders.

RESULTS

A total of 262 males and 253 females aged 20-84 years were reviewed. In both males and females, higher fat mass index (FMI) (OR: 1.989 for males vs. 1.389 for females), fat mass percent (FM%) (OR: 1.253 for males vs. 1.149 for females), visceral adipose tissue (VAT) (OR: 1.002 for males vs. 1.002 for females), and body mass index (BMI) (OR: 1.530 for males vs. 1.247 for females)were associated with increased ORs of FLD while higher lean mass percent (LM%) (OR: 0.839 for males vs. 0.856 for females)was associated with decreased ORs of FLD. Despite accounting for confounding factors, the associations remained present. Logistic regression of the quartiles of the indices showed associations with the prevalence of FLD. The trends still existed even after adjusting for confounders.

CONCLUSION

Independently of age, lipid profiles and other confounders, lower VAT, FM, FMI, FM% and BMI tended to be associated with a lower prevalence of FLD, while lower LM% trended to be associated with a higher prevalence of FLD in both sexes of the general population.

A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry

To investigate whether there is an influence on the results of lumbar spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) under three different hip flexion angles (90°, 45°, 0° of hip flexion). We collected a total of 60 outpatients, including 44 females (56.4 ± 5.7 years) and 16 males (50.2 ± 13.7 years). The DXA results of the lumbar spine were scanned and analyzed in three different positions with hip flexion of 90°, 45°, and 0°. We found that there was no significant difference in the area of interest, bone mineral content, BMD, and vertebral body height of the lumbar vertebral body measured by DXA in three hip flexion positions of 90°, 45°, and 0°; Pearson's correlation analysis showed that lumbar BMD in hip flexion 90° was correlated with it in hip flexion 45° (r = 0.998, P＜0.01) and in hip flexion 0° (r = 0.996, P＜0.01) respectively. There was no statistically significant difference in the diagnosis of BMD between 90° and 45° hip flexion (P = 0.903), which was the same as 90° and 0° hip flexion (P = 0.822). Therefore, we conclude that different hip flexion angles can be used in lumbar BMD detection by DXA, which is beneficial to patients who have difficulty in hip flexion, especially for elderly patients with osteoporosis.

Qualitative Classification of Proximal Femoral Bone Using Geometric Features and Texture Analysis in Collected MRI Images for Bone Density Evaluation

The aim of this study was to use geometric features and texture analysis to discriminate between healthy and unhealthy femurs and to identify the most influential features. We scanned proximal femoral bone (PFB) of 284 Iranian cases (21 to 83 years old) using different dual-energy X-ray absorptiometry (DEXA) scanners and magnetic resonance imaging (MRI) machines. Subjects were labeled as "healthy" (T-score > -0.9) and "unhealthy" based on the results of DEXA scans. Based on the geometry and texture of the PFB in MRI, 204 features were retrieved. We used support vector machine (SVM) with different kernels, decision tree, and logistic regression algorithms as classifiers and the Genetic algorithm (GA) to select the best set of features and to maximize accuracy. There were 185 participants classified as healthy and 99 as unhealthy. The SVM with radial basis function kernels had the best performance (89.08%) and the most influential features were geometrical ones. Even though our findings show the high performance of this model, further investigation with more subjects is suggested. To our knowledge, this is the first study that investigates qualitative classification of PFBs based on MRI with reference to DEXA scans using machine learning methods and the GA.

Increased total daily energy expenditure in mild to moderate ALS: greater contribution from physical activity energy expenditure than hyper-metabolism

Objective: It is unknown whether the relative contribution to energy imbalance in amyotrophic lateral sclerosis (ALS) is due to decreased energy intake, or increased energy expenditure from hyper-metabolism and/or physical activity, or both. Methods: We studied 10 free-living sporadic ALS subjects with mild to moderate disease and 10 matched healthy controls to address this question. We estimated energy intake by 24-h recall in ALS subjects and three-day food diary in all. We estimated body composition by dual energy X-ray absorptiometry and resting metabolic rate by indirect calorimetry; and measured total daily energy expenditure (TEE) and physical activity-energy expenditure using doubly labeled water. Results: Daily energy intake was no different between ALS subjects and controls. Despite lower fat-free mass, unadjusted TEE was higher in ALS subjects than controls (2844 ± 319 vs. 2505 ± 261 kcal/d, p = 0.005 by paired t-test). Compared to controls, hyper-metabolism occurred in 80% of ALS subjects. Physical activity-energy expenditure was higher in ALS subjects than controls (718 ± 262 kcal/d vs. 487 ± 196 kcal/d, p = 0.04). In controls, energy intake matched TEE; in ALS subjects TEE was higher than energy intake. Conclusions: We found higher TEE in ALS subjects than controls, with larger contribution to difference from physical activity-energy expenditure than hyper-metabolism. Although daily energy intake in ALS subjects was similar to that in controls, they were unable to compensate for increased energy needs. To accurately determine energy balance and optimize nutrition in ALS, future studies should consider measuring energy intake, energy expenditure, and physical activity.

Prediction of bone mineral density in CT using deep learning with explainability

Bone mineral density (BMD) is a key feature in diagnosing bone diseases. Although computational tomography (CT) is a common imaging modality, it seldom provides bone mineral density information in a clinic owing to technical difficulties. Thus, a dual-energy X-ray absorptiometry (DXA) is required to measure bone mineral density at the expense of additional radiation exposure. In this study, a deep learning framework was developed to estimate the bone mineral density from an axial cut of the L1 bone on computational tomography. As a result, the correlation coefficient between bone mineral density estimates and dual-energy X-ray absorptiometry bone mineral density was .90. When the samples were categorized into abnormal and normal groups using a standard (T-score = - 1.0 ), the maximum F1 score in the diagnostic test was .875. In addition, it was identified using explainable artificial intelligence techniques that the network intensively sees a local area spanning tissues around the vertebral foramen. This method is well suited as an auxiliary tool in clinical practice and as an automatic screener for identifying latent patients in computational tomography databases.

Assessment of Standing Multi-Frequency Bioimpedance Analyzer to Measure Body Composition of the Whole Body and Limbs in Elite Male Wrestlers

We investigated differences in body composition measurements for the whole body and limb segments in elite male wrestlers between results of multi-frequency bioelectrical impedance analyses (MF_BIA) and dual energy X-ray absorptiometry (DXA). Sixty-six elite male wrestlers from Taiwan were recruited. Wrestlers' body fat percentage (PBF_WB), whole body fat-free mass (FFM_WB), whole body lean soft tissue mass (LSTM_WB), and fat-free mass of arms, legs and trunk (FM_Arms, FFM_Legs, FFM_Trunk) were measured by MF_BIA and DXA, and analyzed using Pearson correlation coefficient and Bland-Altman plot. Correlations of FFM_WB, LSTM_WB, and PBF_WB between devices were 0.958, 0.954, and 0.962, respectively. Limits of agreement (LOA) of Bland-Altman plot were -4.523 to 4.683 kg, -4.332 to 4.635 kg and -3.960 to 3.802%, respectively. Correlations of body composition parameters FFM_Arms, FFM_Legs and FFM_Turnk between devices in each limb segment were 0.237, 0.809, and 0.929, respectively; LOAs were -2.877 to 2.504 kg, -7.173 to -0.015 kg and -5.710 to 0.777 kg, respectively. Correlation and consistency between the devices are high for FFM, LSTM and PBF but relatively low for limb segment FFM. MF_BIA may be an alternative device to DXA for measuring male wrestlers' total body composition but limb segment results should be used cautiously.

Body composition in amyotrophic lateral sclerosis subjects and its effect on disease progression and survival

BACKGROUND

Motor neuron degeneration and malnutrition alter body composition in amyotrophic lateral sclerosis (ALS). Resulting losses of weight, fat mass (FM), and fat-free mass (FFM) shorten survival. Nutritional management relies on body weight or BMI; neither reliably indicates malnutrition nor differentiates body compartments.

OBJECTIVES

We aimed to 1) develop an equation to compute FM and FFM using clinical data, validated against DXA; and 2) examine the effect of computed FM and FFM on disease course and survival.

METHODS

We studied 364 ALS patients from 3 cohorts. In Cohort #1 we used logistic regression on clinical and demographic data to create an equation (test cohort). In Cohort #2 we validated FM and FFM computed using this equation against DXA (validation cohort). In Cohort #3, we examined the effect of computed body composition on disease course and survival.

RESULTS

In Cohort #1 (n = 29) the model incorporated sex, age, BMI, and bulbar-onset to create an equation to estimate body fat: % body fat = 1.73 - [19.80*gender (1 if male or 0 if female)] + [0.25*weight (kg)] + [0.95*BMI (kg/m2)] - (5.20*1 if bulbar-onset or *0 if limb-onset). In Cohort #2 (n = 104), body composition using this equation, compared to other published equations, showed the least variance from DXA values. In Cohort #3 (n = 314), loss of body composition over 6 mo was greater in males. Adjusted survival was predicted by low baseline FM (HR: 1.39; 95% CI: 1.07, 1.80), and loss of FM (HR: 1.87; 95% CI: 1.30, 2.69) and FFM (HR: 1.73; 95% CI: 1.20, 2.49) over 6 mo.

CONCLUSIONS

Our equation broadens the traditional nutritional evaluation in clinics and reliably estimates body composition. Measuring body composition could target FM as a focus for nutritional management to ensure adequate energy intake and complement measures, such as the ALS functional rating scale-revised score and forced vital capacity, currently used.

A 2-year prospective clinical and bone density evaluation, with a subset undergoing radiostereometric analysis, using the Absolut cemented stem

Background

Total hip arthroplasty (THA) is common though the investigation of new prostheses requires a practical, step‐wise introduction. This study reports the 2‐year clinical results and periprosthetic bone mineral density (BMD) changes, along with a subset undergoing Radiostereometric analysis (RSA), in patients undergoing primary cemented THA using a new highly polished, double tapered, collarless femoral stem (Absolut).

Methods

Between August 2013 and December 2016, 47 patients with a mean age of 74.2 years (range 36–89) underwent 51 THAs with the Absolut. All patients underwent clinical assessment pre‐surgery and at 6 weeks, 3, 12 and 24 months using the Oxford and Harris Hip Scores, as well as Dual Energy X‐ray Absorptiometry (DEXA) to assess BMD within 2–4 weeks post‐surgery, 12 and 24 months. RSA was undertaken in a patient subset (the first n = 30) early post‐surgery (1–2 days) and 3, 12 and 24 months.

Results

All clinical scores significantly improved (p < 0.05). RSA revealed a mean subsidence of 0.78 mm at 3 months, 1.23 mm at 12 months and 1.51 mm at 24 months. Anterior–posterior and medial‐lateral translation was negligible. A significant increase (p = 0.020) in BMD was observed in Gruen zone 1, though no significant changes were observed for any other zone up until 2 years. Two patients acquired an early post‐operative deep vein thrombosis that were treated accordingly and resolved, with no further complications or re‐operations.

Conclusion

The Absolut cemented femoral stem demonstrated good outcomes, BMD changes consistent with sound prosthesis integration and patterns of post‐operative micromotion observed in other successful cemented stems.

Deficits in the Functional Muscle-Bone Unit in Youths with Fontan Physiology

OBJECTIVE

To determine whether dual energy X-ray absorptiometry (DXA), a clinically available tool, mirrors the magnitude of deficits in trabecular and cortical bone mineral density (BMD) demonstrated on peripheral quantitative computed tomography in youth with Fontan physiology.

STUDY DESIGN

We aimed to describe DXA-derived BMD at multiple sites and to investigate the relationship between BMD and leg lean mass, a surrogate for skeletal muscle loading. Subjects with Fontan (n = 46; aged 5-20 years) underwent DXA in a cross-sectional study of growth and bone and muscle health as described previously. Data from the Bone Mineral Density in Childhood Study were used to calculate age-, sex-, and race-specific BMD z-scores of the whole body, lumbar spine, hip, femoral neck, distal one-third radius, ultradistal radius, and leg lean mass z-score (LLMZ).

RESULTS

Fontan BMD z-scores were significantly lower than reference at all sites-whole body, -0.34 ± 0.85 (P = .01); spine, -0.41 ± 0.96 (P = .008); hip, -0.75 ± 1.1 (P < .001); femoral neck, -0.73 ± 1.0 (P < .001); distal one-third radius, -0.87 ± 1.1 (P < .001); and ultradistal radius. -0.92 ± 1.03 (P < .001)-as was LLMZ (-0.93 ± 1.1; P < .001). Lower LLMZ was associated with lower BMD of the whole body (R² = 0.40; P < .001), lumbar spine (R² = 0.16; P = .005), total hip (R² = 0.32; P < .001), femoral neck (R² = 0.47; P < .001), and ultradistal radius (R² = 0.35; P < .001).

CONCLUSIONS

Patients with Fontan have marked deficits in both cortical (hip, distal one-third radius) and trabecular (lumbar spine, femoral neck, ultradistal radius) BMD. Lower LLMZ is associated with lower BMD and may reflect inadequate skeletal muscle loading. Interventions to increase muscle mass may improve bone accrual.

Body composition assessment in children with inflammatory bowel disease: A comparison of different methods

AIM

To assess different techniques to measure body composition in paediatric patients with inflammatory bowel disease using dual energy X-ray absorptiometry as a reference method. We hypothesised that a three-compartment model may demonstrate superiority over other methods as skinfold thickness equations and bioelectrical impedance analysis.

METHODS

Body composition was assessed using skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model. Data obtained with these methods were compared to the results obtained by dual energy X-ray absorptiometry. Statistical analysis was performed using Spearman's correlation and Bland-Altman's limits of agreement method.

RESULTS

Twenty-one paediatric patients with inflammatory bowel disease were included: 11 females and 10 males; mean age for the entire group: 14.3 years, range 12-16 years. In children with inflammatory bowel disease, skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model showed reliable measurements with small differences in the percentage of total body fat and good limits of agreements.

CONCLUSION

The assessment of body composition using bioelectrical impedance analysis provides a valid and accurate method in children with inflammatory bowel disease as compared to dual energy X-ray absorptiometry. In the future, superiority of 3-compartment model in research and clinical settings of nutritional intervention and disease status in children with inflammatory bowel disease remains to be demonstrated.

Evaluation of Obesity Cutoff Values in Hispanic Adults: Derivation of New Standards

The diagnostic accuracy of clinical-based body composition methods such as body mass index (BMI), waist circumference (WC), bioimpedance analysis (BIA), and dual energy X-ray absorptiometry (DXA) has yet to be evaluated in Hispanic adults. Moreover, it has also been suggested that previously established obesity cutoff values may need adjusting.

PURPOSE

The primary aim of this study was to investigate the diagnostic accuracy of BMI, WC, BIA, and DXA for obesity classification in Hispanic adults. The secondary aim was to internally derive obesity cutoff values producing equal sensitivity and specificity for the respective tests.

METHODS

Hispanic females (n = 101) and males (n = 90) volunteered to participate in this study (18-45 years). Body fat percentage was estimated with BIA, DXA, and a 4-compartment (4C) model. Obesity-defined criteria was employed as follows: (Body fat percentage ≥ 25% and 35% and WC ≥ 102cm and 88cm for males and females, respectively; BMI ≥ 30 kg/m²). A 4C model was used as a criterion to evaluate BMI, WC, DXA, and BIA.

RESULTS

Sensitivity of DXA and BIA (74.1%-96.9%) was greater than BMI and WC (25.8%-51.9%) when using previously established standards. However, specificity was poor for DXA (<70%), but considered good to excellent for BMI, WC, and BIA (83.1%-96.6%) when using previously established standards. Internally derived cutoff values improved sensitivity for BMI and WC (74.2%-81.5%) and improved specificity for DXA (>80.0%).

CONCLUSION

The internally derived cutoff values, producing identical sensitivity, and specificity, were developed and shown to improve the diagnostic performance of the body composition methods compared to previously established obesity cutoff standards. Consequently, the internally derived obesity cutoff values are recommended for use by allied health professionals in clinical practice when equal sensitivity and specificity is desired.

Discovery Genome-Wide Association Study of Body Composition in 4,386 Adults From the UK Biobank's Pilot Imaging Enhancement Study

Body composition (fat, skeletal muscle and bone mass) is an important determinant of overall health and risk of endocrine disorders such as type 2 diabetes and osteoporosis. Although diet and physical activity are strongly implicated, body composition is also heritable. We conducted a discovery genome-wide association study on 31 phenotypes from the three-compartment body composition model (fat, lean and bone mass) in a set of 4 386 individuals (n = 2 109 males, n = 2 294 females) from the UK Biobank pilot imaging enhancement program that underwent a dual energy X-ray absorptiometry (DXA) scan for assessment of body composition and genetic screening. From 6 137 607 imputed single nucleotide polymorphisms (SNPs) we identified 17 body composition loci (P<5.0 x 10-8). GWAS from the combined dataset identified four statistically significant SNPs (rs7592270, rs145972737, rs13212044, rs77772562). In sex-stratified GWAS, 10 male specific SNPs across all traits were identified and five female specific SNPs. Of the 17 SNPs, six were in or close to a gene where there was a plausible functional connection. Three SNPs (rs7592270, rs77772562 and rs7552312) were correlated with obesity phenotypes, one SNP (rs2236705) with lean phenotypes and two with bone mass phenotypes (rs112098641 and rs113380185). These results highlight candidate genes and biological pathways related to body composition, including glucose metabolism and estrogen regulation, that are of interest to replicate in future studies.

[Agreement analysis and result calibration by ordinary least product regression between bioelectrical impedance analysis and dual energy X-ray absorptiometry]

OBJECTIVE

To analyze agreement of body fat percentage measured by bioelectrical impedance analysis(BIA) and dual energy X-ray absorptiometry(DXA) in Chinese adults, and to calibrate BIA measurement by ordinary least product regression(OLP).

METHODS

Volunteers aged 18-65 were recruited to measure total body fat percentage and trunk fat percentage by BIA(Tanita BC-601 F) and DXA(Hologic Discovery QDR), respectively. Agreement between the two methods was compared by OLP. Bootstrap method was used to do the internal validation of the calibration equation. The calibration effect was verified by the agreement analysis of the calibrated BIA result and the DXA result.

RESULTS

Before calibration, all 95%CIs of the intercepts of the OLP regression lines did not include 0, and all 95%CIs of the slopes of the OLP regression lines did not include 1. 00. After calibration, all 95% CIs of the intercepts of the OLP regression lines included 0, and all 95% CIs of the slopes included 1. 00.

CONCLUSION

There are fixed bias and proportion bias between BIA and DXA in measuring total body fat percentage and trunk fat percentage in Chinese men and women. Calibration should be considered when body fat percentage is measured by BIA.

Keel Bone Damage in Laying Hens-Its Relation to Bone Mineral Density, Body Growth Rate and Laying Performance

Simple Summary

Keel bone damage is an important welfare issue for laying hens. Four lines of laying hens, differing in phylogenetic origin and laying rate kept in single cages or a floor housing system were weighed and deformities of the keel bone were evaluated regularly between 15 and 69 weeks of age. Deformities, fractures and the bone mineral density of the keels were assessed after hens were euthanized. We analyzed the relationship between bone mineral density and total egg number as well as body growth. Hens kept in cages showed more deformities, but fewer fractures and a lower bone mineral density of the keel bone than did floor-housed hens. Keel bones of white-egg layers had a lower mineral density and were more often deformed compared with brown-egg layers. Keel bones were more often broken in hens of the layer lines with a high laying rate compared to the lines with a moderate laying rate. Laying rate and adult body weight had an effect on the keel bone mineral density. The study contributes to the understanding of factors causing keel bone damage in laying hens. It showed that the bone mineral density greatly affects keel bone deformities.

Abstract

Keel bone damage is an important animal welfare problem in laying hens. Two generations of four layer lines, differing in phylogenetic background and performance level and kept in single cages or floor pens were weighed and scored for keel bone deformities (KBD) during the laying period. KBD, keel bone fractures (KBF) and the bone mineral density (BMD) of the keels were assessed post mortem. For BMD, relationships to laying performance and body growth were estimated. Caged hens showed more deformities, but fewer fractures and a lower BMD of the keel bone than floor-housed hens. White-egg layers had a lower BMD (0.140–0.165 g/cm²) and more KBD than brown-egg layers (0.179–0.184 g/cm²). KBF occurred more often in the high-performing lines than the moderate-performing ones. However, in the high-performing lines, BMD was positively related to total egg number from 18 to 29 weeks of age. The adult body weight derived from fitted growth curves (Gompertz function) had a significant effect (p < 0.001) on keels’ BMD. The study contributes to the understanding of predisposing factors for keel bone damage in laying hens. It showed that the growth rate has a rather subordinate effect on keels’ BMD, while the BMD itself greatly affects KBD.

Performance of Bioelectrical Impedance and Anthropometric Predictive Equations for Estimation of Muscle Mass in Chronic Kidney Disease Patients

Background: Patients with chronic kidney disease (CKD) are vulnerable to loss of muscle mass due to several metabolic alterations derived from the uremic syndrome. Reference methods for body composition evaluation are usually unfeasible in clinical settings.

Aims: To evaluate the accuracy of predictive equations based on bioelectrical impedance analyses (BIA) and anthropometry parameters for estimating fat free mass (FFM) and appendicular FFM (AFFM), compared to dual energy X-ray absorptiometry (DXA), in CKD patients.

Methods: We performed a longitudinal study with patients in non-dialysis-dependent, hemodialysis, peritoneal dialysis and kidney transplant treatment. FFM and AFFM were evaluated by DXA, BIA (Sergi, Kyle, Janssen and MacDonald equations) and anthropometry (Hume, Lee, Tian, and Noori equations). Low muscle mass was diagnosed by DXA analysis. Intra-class correlation coefficient (ICC), Bland-Altman graphic and multiple regression analysis were used to evaluate equation accuracy, linear regression analysis to evaluate bias, and ROC curve analysis and kappa for reproducibility.

Results: In total sample and in each CKD group, the predictive equation with the best accuracy was AFFM_Sergi (men, n = 137: ICC = 0.91, 95% CI = 0.79–0.96, bias = 1.11 kg; women, n = 129: ICC = 0.94, 95% CI = 0.92–0.96, bias = −0.28 kg). AFFM_Sergi also presented the best performance for low muscle mass diagnosis (men, kappa = 0.68, AUC = 0.83; women, kappa = 0.65, AUC = 0.85). Bias between AFFM_Sergi and AFFM_DXA was mainly affected by total body water and fat mass. None of the predictive equations was able to accurately predict changes in AFFM and FFM, with all ICC lower than 0.5.

Conclusion: The predictive equation with the best performance to asses muscle mass in CKD patients was AFFM_Sergi, including evaluation of low muscle mass diagnosis. However, assessment of changes in body composition was biased, mainly due to variations in fluid status together with adiposity, limiting its applicability for longitudinal evaluations.

Carcass and Primal Composition Predictions Using Camera Vision Systems (CVS) and Dual-Energy X-ray Absorptiometry (DXA) Technologies on Mature Cows

This study determined the potential of computer vision systems, namely the whole-side carcass camera (HCC) compared to the rib-eye camera (CCC) and dual energy X-ray absorptiometry (DXA) technology to predict primal and carcass composition of cull cows. The predictability (R²) of the HCC was similar to the CCC for total fat, but higher for lean (24.0%) and bone (61.6%). Subcutaneous fat (SQ), body cavity fat, and retail cut yield (RCY) estimations showed a difference of 6.2% between both CVS. The total lean meat yield (LMY) estimate was 22.4% better for CCC than for HCC. The combination of HCC and CCC resulted in a similar prediction of total fat, SQ, and intermuscular fat, and improved predictions of total lean and bone compared to HCC/CCC. Furthermore, a 25.3% improvement was observed for LMY and RCY estimations. DXA predictions showed improvements in R² values of 26.0% and 25.6% compared to the HCC alone or the HCC + CCC combined, respectively. These results suggest the feasibility of using HCC for predicting primal and carcass composition. This is an important finding for slaughter systems, such as those used for mature cattle in North America that do not routinely knife rib carcasses, which prevents the use of CCC.

Short-Term Precision Error of Bone Strain Index, a New DXA-Based Finite Element Analysis Software for Assessing Hip Strength

Bone Strain Index (BSI) is a new finite element analysis tool applied to hip dual energy X-ray absorptiometry scans. The aim of this study was to assess the short-term precision error of BSI on the proximal femur, both on a phantom and patients. The International Society for Clinical Densitometry guidelines were followed for short-term precision error assessment. Dual energy X-ray absorptiometry measurements were performed on an anthropomorphic femur phantom that was scanned twice for 30 times, for a total of 60 scans. For the in vivo part, 30 subjects were scanned twice. BSI precision error was compared to that of bone mineral density (BMD). Both for the phantom and the in vivo study BSI reproducibility was lower compared to that of BMD, as the precision error of BSI resulted 3 times higher compared to that BMD. For phantom measurements, the highest precision value was that of total femur (TF) BMD (coefficient of variation [CoV] = 0.63%, reproducibility = 98.24%), while the lowest precision was the femoral neck (FN) BSI (CoV = 3.08%, reproducibility = 91.48%). Similarly, for the in vivo study, the highest precision was found at TF BMD (CoV = 1.36%, reproducibility = 96.22%), while the lowest value of precision was found for FN BSI (CoV = 4.17%, reproducibility = 88.46%). Reproducibility at TF was always better compared to that of the FN. BSI precision error was about 3 times higher compared to BMD, confirming previous results of lumbar spine BSI. The main source of variability of this new software is related to patient positioning.

Low Bone Mineral Density at Initial Diagnosis in Children and Adolescents with Graves' Disease

Previous studies have reported reduced bone mineral density (BMD) in patients with hyperthyroidism. We assessed the association of BMD in children and adolescents with Graves' disease (GD) after correcting for potential confounders affecting BMD such as age, sex, and pubertal status. Forty-four children and adolescents with GD and 172 age- and sex-matched healthy controls were enrolled in this study. We analyzed auxological features, BMD, and levels of thyroid hormone, thyroid-stimulating hormone, and thyroid autoantibodies. We measured BMD by dual-energy X-ray absorptiometry at the time of diagnosis in all patients. The mean age of all patients with GD (9 boys and 32 girls) was 12.1 ± 2.2 years (range, 7.0-16.0). Their initial mean free T4 and thyroid-stimulating hormone levels were 3.51 ± 1.56 ng/dL and 0.04 ± 0.03 IU/L, respectively. The mean BMD Z-scores of the lumbar spine (LS), femoral neck, and total body less head of patients with GD were significantly lower than those of control subjects. Eleven patients (26.8%) had low bone density (LS BMD Z-scores < -2.0). To identify correlations of patient characteristics with BMD Z-scores at each site, alkaline phosphatase had a significant negative correlation with BMD Z-scores at LS and femoral neck, but not total body less head (r = -0.441; p = 0.004 and r = -0.351; p = 0.025, respectively). Children and adolescents with newly diagnosed GD had lower bone mass than their healthy peers. These results suggest that BMD measurement at initial evaluation may be necessary in this population.

Bioelectrical Impedance Phase Angle and Its Determinants in Patients with Classic Congenital Adrenal Hyperplasia

BACKGROUND

Patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH21OHD) have increased fat mass and metabolic alterations. The bioelectrical impedance phase angle (PhA) is an indicator of cellular integrity in several diseases. This study aimed to determine the influence of adiposity levels, sex, CAH21OHD, pubertal development, body composition, and treatment on the PhA of patients with CAH21OHD.

METHODS

Forty girls and 30 boys with CAH21OHD aged 15.3 ± 5.8 years were evaluated. Sexual maturation was assessed by a pediatrician. The PhA was assessed using bioelectrical impedance, percentage of fat mass (% FM), and lean soft tissue (LST) with dual-energy X-ray absorptiometry. Adiposity levels were compared using % FM tertiles and body mass index (BMI). Glucocorticoid dosage was converted using hydrocortisone dose equivalent (HDE).

RESULTS

No differences were found in the PhA values among the clinical form (p = 0.103), BMI (p = 0.498), and % FM (p = 0.654) groups. High PhA values were observed in boys (p = 0.011) and postpubertal (p < 0.001) patients. LST, HDE, and height in girls (r² = 0.68, p < 0.001) and age, HDE, and FM in boys (r² = 0.82, p < 0.001) determined the PhA variations. BMI explained 14% (p = 0.032) of the PhA variations, whereas LST, height, HDE, and FM (kg) explained 66% (p < 0.001) in the prepubertal, pubertal, and postpubertal groups, respectively.

CONCLUSION

LST determined the PhA variations in girls and the postpubertal group. Age and BMI were determinants in boys and the pre- and pubertal groups, respectively.

The Effects of Ivacaftor on Bone Density and Microarchitecture in Children and Adults with Cystic Fibrosis

CONTEXT

Cystic fibrosis (CF) transmembrane conductance (CFTR) dysfunction may play a role in CF-related bone disease (CFBD). Ivacaftor is a CFTR potentiator effective in improving pulmonary and nutritional outcomes in patients with the G551D-CFTR mutation. The effects of ivacaftor on bone health are unknown.

OBJECTIVE

To determine the impact of ivacaftor on bone density and microarchitecture in children and adults with CF.

DESIGN

Prospective observational multiple cohort study.

SETTING

Outpatient clinical research center within a tertiary academic medical center.

PATIENTS OR OTHER PARTICIPANTS

Three cohorts of age-, race-, and gender-matched subjects were enrolled: 26 subjects (15 adults and 11 children) with CF and the G551D-CFTR mutation who were planning to start or had started treatment with ivacaftor within 3 months (Ivacaftor cohort), 26 subjects with CF were not treated with ivacaftor (CF Control cohort), and 26 healthy volunteers.

INTERVENTIONS

All treatments, including Ivacaftor, were managed by the subjects' pulmonologists.

MAIN OUTCOME MEASURES

Bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT), areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) and bone turnover markers at baseline, 1, and 2 years.

RESULTS

Cortical volume, area, and porosity at the radius and tibia increased significantly in adults in the Ivacaftor cohort. No significant differences were observed in changes in aBMD, trabecular microarchitecture, or estimated bone strength in adults or in any outcome measures in children.

CONCLUSIONS

Treatment with ivacaftor was associated with increases in cortical microarchitecture in adults with CF. Further studies are needed to understand the implications of these findings.

[Discuss about Key Issues of Dual Energy X-ray Absorptiometry Evaluation]

The Dual energy X-ray absorptiometry is the most commonly used for measuring bone mineral density. This method involves core clinical functions, phantom and database. This article discusses the three key issues of dual energy X-ray absorptiometry evaluation, including core clinical functions, phantom and database. This article aims at helping manufacturers to scientifically carry out relevant processes during research and development and also manufacturers may refer to this article when they apply for registration.

Factors Associated With Bone Density Monitoring While on Antiosteoporosis Treatment in Routine Clinical Practice: A Registry-Based Cohort Study

The role for bone mineral density (BMD) monitoring while on antiosteoporosis therapy remains controversial. The current study used population-based registries to identify factors associated with BMD monitoring in women within 5 yr of receiving antiosteoporosis treatment vs treatment without monitoring in routine clinical practice. The analytical dataset consisted of women age 40 yr and older at baseline receiving antiosteoporosis therapy: 6877 with BMD monitoring (mean interval 3.2 yr) and 6747 without BMD monitoring. There was a significant negative secular trend in BMD monitoring during the study period (p < 0.001). Multivariable logistic regression demonstrated that parental hip fracture, glucocorticoid and aromatase inhibitor use, and lower baseline BMD were independently and positively associated with BMD monitoring. Individuals with increasing age, greater body mass index, smoking, rheumatoid arthritis, later calendar year, diabetes, rural residency, lower income, and greater comorbidity score were less likely to undergo monitoring. A shorter monitoring interval (<23 mo) was strongly associated with glucocorticoid and aromatase inhibitor use. In conclusion, our study identifies factors associated with BMD monitoring over 5 yr in patients receiving antiosteoporosis therapy.

Diagnostic Value of Anthropometric Measurements for Familial Partial Lipodystrophy, Dunnigan Variety

CONTEXT

Familial partial lipodystrophy, Dunnigan variety (FPLD2) is a rare autosomal dominant disorder resulting from LMNA causal variants, which is characterized by loss of subcutaneous fat from the extremities and predisposition to metabolic complications. The diagnostic value of various anthropometric measurements for FPLD2 remains unknown.

OBJECTIVE

To determine specificity and sensitivity of anthropometric measurements for the diagnosis of FPLD2.

METHODS

We measured skinfold thickness and regional body fat by dual energy X-ray absorptiometry (DXA) in 50 adult females and 6 males with FPLD2 at UT Southwestern and compared their data with the sex- and age-matched controls from the National Health and Nutrition Examination Survey (NHANES) 1999-2010. We further compared data from 1652 unaffected females from the Dallas Heart Study and 23 females with FPLD2 from the National Institutes of Health with the NHANES data.

RESULTS

The DXA-derived lower limb fat (%) had the best specificity (0.995) and sensitivity (1.0) compared with the upper limb fat, truncal fat, the ratio of lower limb to truncal fat, and triceps skinfold thickness for adult females with FPLD2. The lower limb fat below 1st percentile of NHANES females had a false-positive rate of 0.0054 and a false negative rate of 0. The diagnostic value of anthropometric parameters could not be determined for males with FPLD2 due to small sample size.

CONCLUSIONS

The lower limb fat (%) is the best objective anthropometric measure for diagnosing FPLD2 in females. Women with below the 1st percentile lower limb fat should undergo genetic testing for FPLD2, especially if they have metabolic complications.

Bone mineral density and fractures in congenital adrenal hyperplasia: Findings from the dsd-LIFE study

BACKGROUND

In patients with congenital adrenal hyperplasia (CAH) type and doses of glucocorticoids used as well as sex hormone secretion during puberty have important actions on bone mineral density (BMD) in adulthood.

AIM

To evaluate BMD in adult CAH patients depending on current glucocorticoid therapy and on androgen levels in adulthood and at age 16 years.

METHODS

We included 244 CAH patients from the dsd-LIFE cohort (women n = 147, men n = 97; salt-wasting n = 148, simple-virilizing n = 71, nonclassical n = 25) in which BMD and bloods were available. Clinical and hormonal data at age 16years were retrieved from patients' files.

RESULTS

Simple-virilizing women showed lower BMD compared to salt-wasting women at trochanter (0.65 ± 0.12 vs 0.75 ± 0.15 g/cm² ; P < .050), whole femur T-score (-0.87 ± 1.08 vs -0.16 ± 1.24; P < .05) and lumbar T-score (-0.81 ± 1.34 vs 0.09 ± 1.3; P < .050). Fracture prevalence did not differ significantly between the CAH groups. Prednisolone vs. hydrocortisone only therapy caused worse trochanter Z-score (-1.38 ± 1.46 vs -0.47 ± 1.16; P < .050). In women lumbar spine, BMD correlated negatively with hydrocortisone-equivalent dose per body surface (r²  = 0.695, P < .001). Furthermore, BMI at age 16years correlated positively with lumbar spine T-score (r²  = 0.439, P = .003) and BMD (r²  = 0.420, P = .002) in women. The androstenedione/testosterone ratio at age 16years correlated positively with lumbar spine Z-score in women (r²  = 0.284, P = .024) and trochanter Z-score in men (r²  = 0.600, P = .025).

CONCLUSION

Higher glucocorticoid doses seemed to cause lower BMD especially in women. Prednisolone appeared to have more detrimental effects on BMD than hydrocortisone. Higher glucocorticoid doses (lower androstenedione/testosterone ratio) during adolescence may cause lower BMD in adulthood.

The Effect of 12 Weeks of β-Hydroxy-β-Methyl-Butyrate Supplementation after Liver Transplantation: A Pilot Randomized Controlled Study

Sarcopenia is a frequent complication in liver transplant (LT) recipients. β-hydroxy-β-methyl-butyrate (HMB) has the potential to increase muscle-performance and tropism. Our study aims at evaluating the effect on muscle mass and functioning, and the safety of 12 weeks of HMB supplementation in patients after LT. This is a pilot, randomized study. Male patients undergoing LT were randomly assigned to the HMB or control group. A diet interview, anthropometry and body composition by dual energy X-ray absorptiometry (DEXA) were performed at enrollment (T0), after 12 weeks (T1) and after 12 months (T12). Twenty-two liver transplant male patients were enrolled in the study: 12 in the HMB group and 10 as the control group. At enrollment, demographic, clinical and nutritional data were similar. According to the appendicular skeletal muscle index, sarcopenia was present in 50% of patients. The appendix skeletal muscle mass index (ASMI) showed a significant increase at T1 and T12 in HMB patients, but not in controls. The mid-arm muscle-circumference and hand grip strength also increased at T1 and T12 versus T0 only in the HMB group. No side effects were reported in either group. The study showed a positive effect of HMB in the recovery of muscle mass and strength after LT. HMB supplement in patients after LT was safe and well tolerated.

Comparison of selected body composition parameters in women using DXA and anthropometric method

Background

An excessive accumulation of the adipose tissue in women's organism is a frequent and important medical problem which should be monitored. The aim of this study was to explore correlations between the selected parameters of body composition assessed using DXA and anthropometric methods.

Materials and Methods

The study group consisted of 50 women aged 51-85. Both adipose mass and fat-free mass were assessed with the DXA method, and the nutritional status of the participants was evaluated with the anthropometric methods.

Results

The mean body mass index (BMI) value assessed with the DXA method amounted to 28.4 (±5.12). The Spearman's Rho correlation indicated the presence of a moderate association (0.27-0.50) between: (1) right arm lean and the circumference of the arm (P = 0.020), forearm (P = 0.011), and transverse cross-section of the arm (P = 0.020), (2) right leg fat and circumference of the thigh (P = 0.003), shin (P = 0.009), and also the musculature index of the lower extremity (P = 0.034), (3) visceral adipose tissue (VAT) mass and BMI (P = 0.050), Waist to HeightRatio (WtHR) (P = 0.031), (4) Android fat and WHtR (P = 0.044), and (5) gynoid fat and Škerlj index (P = 0.025).

Conclusion

The selected parameters assessed with DXA were significantly correlated with the selected parameters assessed with anthropometric methods. WHtR anthropometric parameter is significantly correlated with DXA parameters: VAT mass, gynoid region % fat and android region % fat.

The Relationship between Imaging-Based Body Composition Analysis and the Systemic Inflammatory Response in Patients with Cancer: A Systematic Review

Background and aim: Cancer is the second leading cause of death globally. Nutritional status (cachexia) and systemic inflammation play a significant role in predicting cancer outcome. The aim of the present review was to examine the relationship between imaging-based body composition and systemic inflammation in patients with cancer. Methods: MEDLINE, EMBASE, Cochrane Library and Google Scholar were searched up to 31 March 2019 for published articles using MESH terms cancer, body composition, systemic inflammation, Dual energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), ultrasound sonography (USS) and computed tomography (CT). Studies performed in adult patients with cancer describing the relationship between imaging-based body composition and measures of the systemic inflammatory response were included in this review. Results: The literature search retrieved 807 studies and 23 met the final eligibility criteria and consisted of prospective and retrospective cohort studies comprising 11,474 patients. CT was the most common imaging modality used (20 studies) and primary operable (16 studies) and colorectal cancer (10 studies) were the most commonly studied cancers. Low skeletal muscle index (SMI) and systemic inflammation were consistently associated; both had a prognostic value and this relationship between low SMI and systemic inflammation was confirmed in four longitudinal studies. There was also evidence that skeletal muscle density (SMD) and systemic inflammation were associated (9 studies). Discussion: The majority of studies examining the relationship between CT based body composition and systemic inflammation were in primary operable diseases and in patients with colorectal cancer. These studies showed that there was a consistent association between low skeletal muscle mass and the presence of a systemic inflammatory response. These findings have important implications for the definition of cancer cachexia and its treatment.

Metabolic bone disease in patients diagnosed with inflammatory bowel disease from Spain

BACKGROUND

The objective of this study was to analyse the prevalence of metabolic bone disease (MBD) in a cohort of Southern European patients with inflammatory bowel disease (IBD) and to identify associated risk factors in this population.

METHODS

We conducted a retrospective, both cross-sectional and longitudinal study of MBD, assessed by dual energy X-ray absorptiometry (DXA), among patients diagnosed with IBD and previously recognized risk factors for this complication from two referral Spanish institutions.

RESULTS

A total of 612 patients (58.6% diagnosed with Crohn's disease) were included. Mean (SD) age was 44.9 (14.7) years; 71.7% of patients received at least one tapered dosage of corticosteroids before first DXA. MBD and osteoporosis were diagnosed in 66.4% and 21.4% of patients, respectively. At baseline, male gender, menopause and ulcerative colitis were found as independent risks factors for osteoporosis, whereas age, more than three IBD-related hospitalizations and previous steroid treatment were found as independent risks factors for MBD. A total of 261 patients had at least a second DXA and were included in the longitudinal study; median follow up was 56.4 months. Logistic regression model identified menopause, ulcerative colitis and baseline lumbar DXA T-score value, but not steroid treatment, as risk factors for worsening ⩾1 SD in follow-up DXA T-score. According to guidelines, all patients under treatment with corticosteroids received calcium and vitamin D supplements.

CONCLUSION

MBD is a frequent complication in south-European IBD patients. Routine evaluation of bone density when risk factors are present, as well as calcium plus D vitamin prophylaxis in patients under corticosteroid treatment should be recommended.

Progressive Sublesional Bone Loss Extends into the Second Decade After Spinal Cord Injury

OBJECTIVE

The rate of areal bone mineral density (aBMD) loss at the knee (distal femur (DF) and proximal tibia ) and hip (femoral neck (FN) and total hip (TH)) was determined in persons with traumatic spinal cord injury (SCI) who were stratified into subgroups based on time since injury (TSI).

DESIGN

Cross-sectional retrospective review.

SETTING

Department of Veterans Affairs Medical Center and Private Rehabilitation Hospital.

PARTICIPANTS

Data on 105 individuals with SCI (TSI ≤12 months, n = 19; TSI 1-5 years, n = 35; 6-10 years, n = 19; TSI 11-20 years, n = 16; TSI >20 years, n = 15) and 17 able-bodied reference (AB_ref) controls.

INTERVENTIONS

NA Main Outcome Measures: The knee and hip aBMD values were obtained by dual energy X-ray absorptiometry (GE Lunar iDXA) using standard clinical software for the proximal femur employed in conjunction with proprietary research orthopedic knee software applications. Young-normal (T-score) and age-matched (Z-scores) standardized scores for the FN and TH were obtained using the combined GE Lunar/National Health and Nutrition Examination Survey (NHANES III) combined reference database.

RESULTS

When groups were stratified and compared as epochs of TSI, significantly lower mean aBMD and reference scores were observed as TSI increased, despite similar mean ages of participants among the majority of TSI epoch subgroups. Loss in aBMD occurred at the distal femur (DF), proximal tibia (PT), FN, and TH with 46%, 49%, 32%, and 43% of the variance in loss, respectively, described by the exponential decay curves with a time to steady state (t_ss) occurring at 14.6, 11.3, 14, and 6.2 years, respectively, after SCI.

CONCLUSIONS

Sublesional bone loss after SCI was marked and occurred as an inverse function of TSI. For aBMD at the hip and knee, t_ss extended into the second decade after SCI.

Assessment of fat-free mass from bioelectrical impedance analysis in men and women with Prader-Willi syndrome: cross-sectional study

We have recently shown that population-specific formulae are required to estimate fat-free mass (FFM) from bioelectrical impedance analysis (BIA) in obese women with Prader-Willi syndrome (PWS) matched by age and percent fat mass (FM) to non-PWS women. The present cross-sectional study was aimed at developing generalised BIA equations that could be used in PWS subjects independently of sex and FM. We used dual-energy X-ray absorptiometry to measure FFM and BIA to measure whole-body impedance at 50 kHz (Z₅₀) in 34 women and 21 men with PWS. The impedance index, that is, height (cm)²/Z₅₀ (Ω), explained 77% (BCa-bootstrapped 95% CI 65 to 85%) of the variance of FFM with a root mean squared error of the estimate of 3.7 kg (BCa-bootstrapped 95% CI 3.2 to 4.5 kg). BIA can be used to estimate FFM in obese and non-obese PWS men and women by means of population-specific equations.

The assessment of skeletal status in young patients with Turner syndrome by 2 densitometric techniques: Phalangeal quantitative ultrasound and dual energy X-ray absorptiometry

BACKGROUND

Studies using dual energy X-ray absorptiometry (DXA) demonstrate a reduction in bone mineral density (BMD) in children and adolescents with Turner syndrome (TS). However, these studies do not take into account changes in bone size, which influence BMD in the case of short-statured patients. Phalangeal quantitative ultrasound (phQUS) measurements have shown an ability to reveal changes due to skeletal growth, aging, and bone and mineral disorders. There is limited data on bone mineral status in girls with TS assessed by 2 different techniques, i.e., DXA and phQUS.

OBJECTIVES

The aim of this study was to investigate the potential negative impact of TS on bone status and to assess whether densitometric values were related to former fractures.

MATERIAL AND METHODS

In 43 TS girls aged 5-18 years, we evaluated bone status by 2 different densitometric techniques, DXA and phQUS.

RESULTS

The mean lumbar spine areal bone mineral density (LS aBMD) Z-score was significantly lower than 0 (the hypothetical mean) compared to the reference population (p < 0.001). The mean LS aBMD height-adjusted Z-score did not differ significantly from 0. The amplitude-dependent speed of sound (Ad-SoS) Z-score was significantly lower than 0 compared with a Polish reference population. There were no significant differences between fractured and fracture-free patients as regards Ad-SoS Z-score and LS aBMD height-adjusted Z-score.

CONCLUSIONS

Girls with TS have normal bone density adjusted for height, but significantly decreased phQUS values. Neither DXA nor phalangeal Ad-SoS can identify young TS patients with former fractures.

Corrigendum: The Gambian Bone and Muscle Ageing Study: Baseline Data From a Prospective Observational African Sub-Saharan Study

[This corrects the article on p. 219 in vol. 8, PMID: 28912754.].

Osteoporosis Therapy With Denosumab in Organ Transplant Recipients

OBJECTIVE

Osteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove limited for patients with impaired renal function. An alternative therapy option is offered by denosumab, a monoclonal antibody that targets receptor activator of nuclear factor kappa-B ligand.

PATIENTS AND METHODS

We evaluated 63 patients with osteoporosis (23 males and 40 females, age 56.4 ± 13.1 years) following solid organ transplantation (15 diabetic patients after simultaneous transplantation of the kidney and pancreas, 34 patients after kidney transplantation, and 14 patients with liver grafts). Osteoporosis was diagnosed according to standard DEXA examination using the Lunar Prodigy apparatus. Transplanted patients with impaired renal function were treated for osteoporosis of the lumbar spine (L-spine) and/or proximal femur with calcium and vitamin D supplementation and 60 mg of denosumab every 6 months between the years 2012 and 2017. The mean duration of the therapy was 1.65 ± 0.7 years.

RESULTS

After denosumab therapy, L-spine T-scores improved across the whole group, ranging from -2.7 ± 0.09 to -1.8 ± 1.0 (p < 0.001). T-score values for the proximal femur increased from -2.5 ± 0.8 to -2.0 ± 0.7 after the therapy (p < 0.01). We observed only a mild, statistically insignificant improvement in distal forearm T-scores. The mean increase in L-spine bone mineral density (BMD) was 11.5 ± 6.2% in subjects with osteoporosis at this site and 10.4 ± 6.1% in the case of all patients. BMD of the proximal femur increased by 10.4 ± 8.3% in patients with osteoporosis and by 7.5 ± 7.3% in all patients. Denosumab therapy decreased the prevalence of osteoporosis in the L-spine from 75 to 27% (p < 0.001) and proximal femur osteoporosis from 54 to 36% (p < 0.05). Denosumab therapy reduced elevated levels of osteocalcin and beta-crosslaps (βCTX) in comparison with baseline levels (p < 0.001) across the whole group of graft recipients.

CONCLUSION

Denosumab therapy was well-tolerated and improved bone density in our group of solid organ transplant recipients. The indications are that denosumab could be a viable therapeutic option for transplanted patients with osteoporosis, especially in those with renal function impairment or bisphosphonate intolerance.

Prevalence of Metabolic Syndrome Markers among Women at 1-year Postpartum as per Prepregnancy Body Mass Index Status: A Longitudinal Study

INTRODUCTION

Maternal body composition (BC) changes during lactation. Increased prepregnancy obesity is associated with poor obstetric outcomes. The aim was to study changes in maternal BC postpartum (PP) to 1-year PP with reference to their prepregnancy body mass index (BMI) status.

METHODS

The study design was a 1-year follow-up study. Sixty-five apparently healthy primiparous women (28.6 ± 3.4 years delivered full-term infants) were randomly selected from December 2010 to June 2013 and postclassified on the basis of their prepregnancy BMI status. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, and BC at total body (dual energy X-ray absorptiometry, GE, Lunar DPX) were collected using standardized protocols.

RESULTS

Forty-one women were classified in Group A with normal prepregnancy BMI (20.4 ± 2.0 kg/m²) and 24 women in Group B with overweight/obese (OW/OB) prepregnancy BMI (26.1 ± 1.9 kg/m²). At 1 year, 75% of women returned to normal BMI in Group A, whereas all 100% of women from Group B remained in OW category at 1-year PP. Nearly 43% of Group B women showed the presence of at least two metabolic syndrome risk factors as compared to 36% in Group A at 1 year.

CONCLUSION

Women with OW/OB prepregnancy BMI accumulated higher visceral fat with a higher prevalence of metabolic risk factors at 1-year PP. Our study underlines the importance of maintaining BMI status in reference range in reproductive years.

Bone Mineral Density According to Dual Energy X-ray Absorptiometry is Associated with Serial Serum Alkaline Phosphatase Level in Extremely Low Birth Weight Infants at Discharge

BACKGROUND

To examine bone mineral density in extremely low birth weight infants at discharge and investigate whether serial measurements of serum alkaline phosphatase (ALP) and phosphate can predict bone mineralization.

METHODS

The individuals were 70 preterm infants. Serum calcium, phosphate, and ALP were measured at weekly intervals during admission in extremely low birth weight infants (mean gestational age, 25.3±2.1 weeks; birth weight, 812.8±141.1 g). Bone mineral apparent density (BMAD) of the lumbar spine was prospectively evaluated by dual energy X-ray absorptiometry at discharge (n=70).

RESULTS

BMAD was classified as poor (< 25^th percentile) at < 0.014 g/cm³, fair (25^th-75^th percentile) at < 0.014-0.021 g/cm³, and good (> 75^th percentile) at > 0.021 g/cm³, based on the distribution of BMAD values in infants with noncomplicated courses of prematurity (n=43). In a further multivariate analysis, the number of total parenteral nutrition days, phosphate at 2 postnatal weeks and 3 postnatal weeks, and ALP at 4 postnatal weeks and 5 postnatal weeks had an impact on bone mineral density at the lumbar spine, independent of gestational age and body weight. Peak ALP activities exceeding 650 IU/L revealed low bone mineral density with 80% sensitivity and 64% specificity (AUC, 0.70; p=0.005).

CONCLUSION

Serial measurements of serum ALP and phosphate are associated with decreased bone mineralization by dual energy X-ray absorptiometry at discharge in extremely low birth weight infants.

Effects of clinical reanalysis in dual energy X-ray absorptiometry reports

Objectives

This study aims to assess poor positioning rates of patients during X-ray and the accuracy of the analysis.

Patients and methods

In this study, we reanalyzed 323 dual energy X-ray absorptiometry (DXA) reports, by evaluating the scan images for proper patient positioning and scan analysis. We reviewed reports, according to a checklist prepared considering the proposals of Watts and The International Society for Clinical Densitometry official positions for 2013 (which were the same as in 2015). At least two remaining vertebrae were used to derive new bone mineral density and new T-scores.

Results

Positioning failures were found in 64.7% of the spine X-rays, 60.5% of the hip X-rays, and 83.9% of X-rays of both regions. A total of 112 (34.7%) spinal DXA images needed new T-score adjustments. T-scores and bone mineral density differed between the first reports and the clinician reanalysis (p<0.001).

Conclusion

The error rate in DXA reports was higher than expected. Clinician analysis of DXA reports are important. To obtain a quality DXA report, all healthcare professionals should be trained and reminded about this topic.

Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored?

OBJECTIVE

To study the association between body composition measures and menstrual status in a large sample of adult patients with a history of anorexia nervosa and to calculate the predicted probability of resumption of menstrual function. Furthermore, to establish whether fat percentage is superior to body mass index in predicting the resumption of menses.

METHOD

One hundred and thirteen adult women with a history of anorexia nervosa underwent a dual energy X-ray absorptiometry (DXA) scan and completed questionnaires regarding medication prescription and menstrual function.

RESULTS

Fifty percent of patients were expected to resume their menstrual function at a body mass index of 19 kg m^-2 or a fat percentage of 23%. Twenty-five percent of patients were expected to resume their menstrual function at body mass index 14 kg m^-2 or fat percentage 11%. Fat percentage and body mass index were equally capable of predicting the resumption of menses.

DISCUSSION

Fat percentage and body mass index were positive predictors of the resumption of menses, however, body composition measured by dual energy X-ray absorptiometry was not superior to body mass index in predicting menstrual recovery, which is of great clinical relevance as body mass index is easier and cheaper to obtain. Body composition measures only account for one of numerous factors involved in the resumption of menses. Regression models based on our data had a R² value of 0.14, indicating that only 14% of the variation in menstrual recovery could be explained by the variables included. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:370-377).

The Gambian Bone and Muscle Ageing Study: Baseline Data from a Prospective Observational African Sub-Saharan Study

The Gambian Bone and Muscle Ageing Study is a prospective observational study investigating bone and muscle ageing in men and women from a poor, subsistence farming community of The Gambia, West Africa. Musculoskeletal diseases, including osteoporosis and sarcopenia, form a major part of the current global non-communicable disease burden. By 2050, the vast majority of the world's ageing population will live in low- and middle-income countries with an estimated two-fold rise in osteoporotic fracture. The study design was to characterise change in bone and muscle outcomes and to identify possible preventative strategies for fracture and sarcopenia in the increasing ageing population. Men and women aged ≥40 years from the Kiang West region of The Gambia were recruited with stratified sampling by sex and age. Baseline measurements were completed in 488 participants in 2012 who were randomly assigned to follow-up between 1.5 and 2 years later. Follow-up measurements were performed on 465 participants approximately 1.7 years after baseline measurements. The data set comprises a wide range of measurements on bone, muscle strength, anthropometry, biochemistry, and dietary intake. Questionnaires were used to obtain information on health, lifestyle, musculoskeletal pain, and reproductive status. Baseline cross-sectional data show preliminary evidence for bone mineral density and muscle loss with age. Men had greater negative differences in total body lean mass with age than women following adjustments for body size. From peripheral quantitative computed tomography scans, greater negative associations between bone outcomes and age at the radius and tibia were shown in women than in men. Ultimately, the findings from The Gambian Bone and Muscle Ageing Study will contribute to the understanding of musculoskeletal health in a transitioning population and better characterise fracture and sarcopenia incidence in The Gambia with an aim to the development of preventative strategies against both.

Effectiveness of alendronate for bone disorder after gastrectomy for gastric cancer

BACKGROUND

Routine therapy of metabolic bone disorder (MBD) after gastrectomy for gastric cancer has not been established yet. We have reported that administering an active vitamin D3 agent to patients who had undergone gastrectomy for gastric cancer improved MBD. Recently, the usefulness of alendronate, an osteoclast inhibitor, has been reported for MBD. Here we report the effects of alendronate for MBD after gastrectomy for gastric cancer.

METHODS

Dual energy X-ray absorptiometry was performed consequently in 14 patients, who had been gastrectomized for gastric cancer and survived more than 5 years without recurrence, to evaluate the MBD and compared before and after treatment. The 14 patients were divided into two groups: in group VD3, 1 μg/d of alfacalcidol, an active vitamin D3 agent, was administered; and in group ALN, 5 mg/d or 35 mg/wk of alendronate or both alfacalcidol and alendronate were administered. These drugs had been administered to the patients for > 2 years, and the patients were followed up.

RESULTS

After 12 months, dual energy X-ray absorptiometry revealed that bone mineral density and T score were significantly increased in group ALN. Changes in serum bone-specific alkaline phosphatase after 24 months were -9.1 μg/L in the ALN group and 3.75 μg/L in the VD3 group, showing a significant difference (p = 0.02). No serious adverse events were observed in either group.

CONCLUSION

These results showed the usefulness of alendronate and alendronate+activated vitamin D3 combination therapy, suggesting that these treatments might prevent postgastrectomic MBD.

Adverse bone health and abnormal bone turnover among perinatally HIV-infected Asian adolescents with virological suppression

OBJECTIVES

This study aimed to determine the prevalence of low bone mass and assess its relationship with abnormal bone turnover among HIV-infected Asian adolescents.

METHODS

A multicentre, cross-sectional study was conducted at four paediatric HIV centres in Thailand and Indonesia. Perinatally HIV-infected adolescents aged 10-18 years receiving antiretroviral therapy (ART) with virological suppression (HIV RNA < 400 copies/mL) were enrolled. Study assessments included lumbar spine (L2-L4) dual-energy X-ray absorptiometry and measurement of bone turnover markers. Bone mineral density (BMD) and bone mineral apparent density (BMAD) Z-scores were calculated based on Thai normative age- and sex-matched references. Low bone mass was defined as BMD or BMAD Z-scores ≤ -2.

RESULTS

Of 396 participants, 57% were female. The median age was 15.0 [interquartile range (IQR) 13.3-16.9] years, and 73% were in Tanner stage 3-5. At enrolment, the median CD4 T-cell count was 734 (IQR 581-907) cells/μL, and 37% were on protease inhibitor (PI)-based regimens. The overall prevalence of lumbar spine BMD and BMAD Z-scores ≤ -2 were 16.4% and 8.3%, respectively. Z-scores were lower with older age, female sex, body mass index (BMI) <5th percentile, boosted PI exposure and CD4 T-cell percentage < 15% before ART initiation. Increased bone turnover markers were inversely associated with BMD and BMAD Z-scores.

CONCLUSIONS

Low bone mass was linked to older age, female sex, low BMI, boosted PI exposure, and poor immunological status before ART commencement in our cohort of perinatally HIV-infected Asian adolescents. Dysregulation of bone turnover was associated with bone demineralization. Screening for low bone mass should be implemented to identify individuals who might benefit from interventions to preserve bone health.

Bone mineral density profile among post-menopausal women in Manipur: a hospital-based study

AIM

To study the bone mineral density (BMD) profile in post-menopausal women and to examine the role of various socio-demographic, clinical, laboratory and radiological factors in predicting fracture risk in these patients.

METHODS

This cross-sectional study recruited consenting postmenopausal women presenting with some form of pain complaints, such as joint pain, body ache, low back pain and so on. A structured questionnaire was used to collect socio-demographic details. Height and weight were measured and BMI (body mass index) was calculated. Dual energy X-ray absorptiometry was performed in three sites: lumbar spine (LS), femoral neck (FN) and trochanteric region (TR) to assess BMD. Serum levels of calcium, phosphorus and alkaline phosphatase were collected.

RESULTS

There were 107 patients. Mean age was 59.70 ± 9.02 years and mean age at menopause was 46.37 ± 4.48 years. Fracture history was present in 25/107 (23.36%). Mean BMI observed was 25.34 ± 3.73. Women with fracture history had statistically significant differences in six factors, namely age, years since menopause, BMI and T-score measurements at LS, FN and TR (P < 0.05). Multivariate logistic regression analysis for these six variables revealed that no factor was independently associated with fracture risk, but those patients who had abnormal T-scores in all three regions had significant history of fracture (P = 0.04).

CONCLUSIONS

Age, age since menopause, BMI, and BMD T-score measurements at LS, FN and TR individually predict fracture risk, but none remain significant when all factors are considered together. Patients with abnormal BMD T-scores in all three sites more often gave histories of fractures. Further studies are warranted.

Awareness of osteoporosis in postmenopausal Indian women: An evaluation of Osteoporosis Health Belief Scale

Context:

The level of awareness about osteoporosis in postmenopausal women who are the common sufferers.

Aims:

This study aims to evaluate the level of awareness in postmenopausal women using the Osteoporosis Health Belief Scale (OHBS).

Settings and Design:

Osteoporosis has emerged as a common health problem in geriatric population. A proactive role needs to be played for preventing its consequences. Before initiating any preventive measures, an evaluation of awareness level of the target population is necessary. The questionnaire-based study design was used for this study.

Subjects and Methods:

A questionnaire (OHBS)-based study in 100 postmenopausal women in Chandigarh was conducted. The bone mineral density (BMD) was measured in each case by dual energy X-ray absorptiometry. Height, weight, and body mass index (BMI) of the participants were noted.

Statistical Analysis Used:

Statistical analysis was conducted to evaluate any correlation between the various components of the OHBS and the BMD.

Results:

No statistically significant difference was noted in the seven component parameters of OHBS among the normal, osteopenic, and osteoporotic women suggesting that the health belief regarding susceptibility is not much different between the three groups of the study population. A statistically significant difference between the mean BMI of normal and osteoporotic population was noted.

Conclusions:

The results show that there is a great deficit in the awareness level of postmenopausal Indian women regarding osteoporosis. Most of the women were unaware of the condition and the means to prevent it. The study emphasizes that health care professionals have lot of ground to cover to decrease the incidence of osteoporosis and its associated health problem.

Mandibular bone mineral density in patients with Behçet's disease

OBJECTIVES

Behçet's disease (BD) is a chronic, recurring vasculitis of unknown etiology. Patients with BD may use a lot of medications associated with the clinical symptoms. Drugs that are used in the treatment of BD may cause bone loss. The aims of the current study were to compare the bone mineral density (BMD) values between BD and healthy volunteers and describe the effect of disease duration on mandibular BMD.

MATERIALS AND METHODS

The study comprised 30 healthy volunteers (15 males and 15 females, mean age 35.50±6.80 years) and 45 patients with BD (24 males and 21 females, mean age 38.93±8.93 years). The BD group was subdivided according to disease duration (0-5, 6-10, and >10 years). The BMD value of the mandibular body was determined by the dual energy X-ray absorptiometry technique.

RESULTS

The mean mandibular body BMD values were 1.294±0.21 g/cm(2) in the control group and 1.216±0.22 g/cm(2) in the BD patients, although there was no statistically significant difference. The BMD was observed to decrease with increased disease duration but not to a statistically significant degree.

CONCLUSION

The results of this study showed that although the BMD value decreased as the duration of the disease increased, no statistically significant difference was found between the BD patients and the healthy control group.

Experimental investigation of bone mineral density in Thoroughbreds using quantitative computed tomography

Bone mineral density (BMD) is one of the indications of the strength and health. BMD measured by quantitative computed tomography (QCT) was compared with that measured by dual energy X-ray absorptiometry (DXA) and radiographic bone aluminum equivalence (RBAE). Limbs were removed from horses that had been euthanized for reasons not associated with this study. Sixteen limbs (left and right metacarpals and metatarsals) from 4 horses were used to compare BMD as measured by QCT with those measured by DXA and RBAE. There was a strong correlation between BMD values measured by QCT and those measured by DXA (R²=0.85); correlation was also observed between values obtained by QCT and those obtained by RBAE (R²=0.61). To investigate changes in BMD with age, 37 right metacarpal bones, including 7 from horses euthanized because of fracture were examined by QCT. The BMD value of samples from horses dramatically increased until 2 years of age and then plateaued, a pattern similar to the growth curve. The BMD values of bone samples from horses euthanized because of fracture were within the population range, and samples of morbid fracture were not included. The relationship between BMD and age provides a reference for further quantitative studies of bone development and remodeling. Quantitative measurement of BMD using QCT may have great potential for the evaluation of bone biology for breeding and rearing management.

Association between muscle mass and adipo-metabolic profile: a cross-sectional study in older subjects

Background

Sarcopenia, the decrease in muscle mass and function, may lead to various negative health outcomes in elderly. The association among sarcopenia with adiposity and metabolic markers has rarely been studied in the elderly population, with controversial results. The aim of this study is to evaluate this relationship in older subjects.

Methods

A cross-sectional study was conducted in 290 elderly patients, focusing on the possible association between muscle mass loss, assessed by relative skeletal muscle mass (RSMM), and an adipo-metabolic profile (AMP) defined by adiposity and metabolic biochemical markers. Measurements of body composition were assessed by dual energy X-ray absorptiometry. Biochemical parameters, such as albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, C-reactive protein, and homocysteine and its related markers (folate and vitamin B12) were measured. Using canonical correlation analysis and structural equation modeling, an individual score of AMP was created and correlated with RSMM.

Results

The AMP–RSMM correlation was equal to +0.642 (95% confidence interval, +0.512 to +0.773; P<0.001). Hence, a negative association between sarcopenia severity and adiposity/metabolic biochemical markers was highlighted.

Conclusion

This study contained a novel way to examine the relationship between the variables of interest based on a composite index of adiposity and metabolic conditions. Results shed light on the orientation and magnitude of adiposity and metabolic markers in preventing muscle mass loss. There might be a protective effect of adiposity, compatible with the “obesity paradox.”

Inhaled corticosteroids and bone mineral density at school age: a follow-up study after early childhood wheezing

OBJECTIVE

The aim of the study was to evaluate the association between previous use of ICS and bone mineral density (BMD) at school age in a cohort followed after early childhood wheezing.

METHODS

As part of a prospective follow-up study after hospitalization for wheezing at <24 months of age, BMD was measured in 89 children at 12.3 (median) years of age. Data on ICS use were collected by interviewing the parents, and this was supplemented with data from patient records. Cumulative doses and the duration of ICS use were calculated. Areal BMD (BMDareal , g/cm(2) ) was measured by dual energy X-ray absorptiometry (DXA), and apparent volumetric BMD (aBMDvol , g/cm(3) ) was calculated, for the lumbar spine and femoral neck. Weight, height and pubertal stage were recorded.

FINDINGS

Age, sex, and pubertal stage were significantly associated with BMDareal and aBMDvol of the lumbar spine and BMDareal of the femoral neck. The regular use of ICS for >6 months at age <6 years was associated with a lower BMD of the lumbar spine. A lower BMDareal and aBMDvol of the femoral neck were associated with higher cumulative doses of ICS at age 0-12.3 (median) years. The results were robust to adjustment for age, sex, pubertal stage, height, weight, and use of systemic steroids.

CONCLUSION

ICS use during childhood may be related to a decrease in BMD at late school age. It is important to use the lowest possible ICS dose that maintains adequate asthma control.

Assessment of fat-free mass from bioelectrical impedance analysis in obese women with Prader-Willi syndrome

BACKGROUND

Fat-free mass (FFM) is lower in obese subjects with Prader-Willi syndrome (PWS) than in obese subjects without PWS. FFM prediction equations developed in non-PWS subjects may, thus, not work in PWS subjects.

AIM

To test whether the estimation of FFM from bioelectrical impedance analysis (BIA) in PWS subjects requires population-specific equations.

METHODS

Using dual-energy X-ray absorptiometry, this study measured FFM in 27 PWS and 56 non-PWS obese women and evaluated its association with the impedance index at 50 kHz (ZI50), i.e. the ratio between squared height and whole-body impedance at 50 kHz.

RESULTS

At the same level of ZI50, PWS women had a lower FFM than non-PWS women. However, when PWS-specific equations were used, FFM was accurately estimated at the population level. An equation employing a dummy variable coding for PWS status was able to explain 85% of the variance of FFM with a root mean squared error of 3.3 kg in the pooled sample (n = 83).

CONCLUSION

Population-specific equations are needed to estimate FFM from BIA in obese PWS women.