Abnormal Body Composition Phenotypes Research Articles

Age-adjusted Charlson comorbidity index and its association with body composition and overall survival in patients with colorectal cancer.

To examine the relationship between the age-adjusted Charlson comorbidity index (A-CCI) with body composition and overall survival in patients newly diagnosed with colorectal cancer (CRC). In this cohort study, patients (≥ 18years old) with CRC were followed for 36months. Computed tomography images of the third lumbar were analyzed to determine body composition, including skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Phenotypes based on comorbidity burden assessed by A-CCI and body composition parameters were established. A total of 436 participants were included, 50% male, with a mean age of 61 ± 13.2years. Approximately half of the patients (50.4%) had no comorbidity, and the A-CCI median score was 4 (interquartile range: 3-6). A higher A-CCI score was a risk factor for 36-month mortality (HR = 3.59, 95% CI = 2.17-5.95). Low SMA and low SMD were associated with a higher A-CCI. All abnormal phenotypes (high A-CCI and low SMA; high A-CCI and low SMD; high A-CCI and high VAT) were independently associated with higher 36-month mortality hazard (adjusted HR 5.12, 95% CI 2.73-9.57; adjusted HR 4.58, 95% CI 2.37-8.85; and adjusted HR 2.36, 95% CI 1.07-5.22, respectively). The coexistence of comorbidity burden and abnormal body composition phenotypes, such as alterations in muscle or fat compartments, may pose an additional risk of mortality in patients newly diagnosed with CRC. Early assessment and management of these phenotypes could be crucial in optimizing outcomes in such patients.

Clinical impacts of sarcopenic obesity on chronic obstructive pulmonary disease: a cross-sectional study

BackgroundSarcopenia and obesity are two abnormal body composition phenotypes, and sarcopenic obesity (SO) is characterized by both low skeletal muscle mass (sarcopenia) and high adiposity (obesity). SO negatively influences the clinical status of patients with chronic obstructive pulmonary disease (COPD). However, the studies exploring the prevalence and clinical effects of SO in COPD patients are limited. Our study aimed to elucidate the prevalence and impact of SO on COPD patients.MethodsIn this cross-sectional study, the pulmonary function, St. George’s Respiratory Questionnaire, exercise tolerance, body composition, and serum levels of resistin and TNF-α were assessed in 198 COPD patients. The clinical value of serum resistin and TNF-α for predicting SO in patients with COPD was evaluated.ResultsIn the 198 patients with COPD, the prevalence rates of sarcopenia, obesity, and SO in COPD patients were 27.27%, 29.8%, and 9.6%, respectively. Patients with SO experienced more severe symptoms of dyspnea and worse health related quality of life. The expression of resistin increased in patients with SO compared to other patients. The AUC value of serum resistin level for predicting SO was 0.870 (95% CI: 0.799–0.940). BMI (OR: 1.474, 95% CI: 1.124–1.934) and resistin (OR: 1.001, 95% CI: 1.000-1.002) levels were independent risk factors of SO in patients with COPD in Multivariate analysis.ConclusionThe prevalence rates of SO in COPD patients was 9.6%. COPD accompanied by SO is significantly associated with worse pulmonary function and poor physical performance. Serum resistin may be a potential adjunct for predicting SO in COPD patients.

Prevalence and clinical implications of abnormal body composition phenotypes in patients with COVID-19: a systematic review

BackgroundThe impact of body composition (BC) abnormalities on COVID-19 outcomes remains to be determined. ObjectivesWe summarized the evidence on BC abnormalities and their relationship with adverse clinical outcomes in patients with COVID-19. MethodsA systematic search was conducted up until 26 September, 2022 for observational studies using BC techniques to quantify skeletal muscle mass (or related compartments), muscle radiodensity or echo intensity, adipose tissue (AT; or related compartments), and phase angle (PhA) in adults with COVID-19. Methodological quality of studies was assessed using the Newcastle-Ottawa Scale. A synthesis without meta-analysis was conducted to summarize the prevalence of BC abnormalities and their significant associations with clinical outcomes. ResultsWe included 62 studies (69.4% low risk of bias) with 12–1138 participants, except 3 studies with ≤490,301 participants. Using CT and different cutoff values, prevalence ranged approximately from 22% to 90% for low muscle mass, 12% to 85% for low muscle radiodensity, and 16% to 70% for high visceral AT. Using BIA, prevalence of high FM was 51%, and low PhA was 22% to 88%. Mortality was inversely related to PhA (3/4 studies) and positively related to intra- and intermuscular AT (4/5 studies), muscle echo intensity (2/2 studies), and BIA-estimated FM (2/2 studies). Intensive care unit (ICU) admission was positively related to visceral AT (6/7 studies) and total AT (2/3 studies). Disease severity and hospitalization outcomes were positively related to intra- and intermuscular AT (2/2 studies). Inconsistent associations were found for the rest of the BC measures and hospitalization outcomes. ConclusionsAbnormalities in BC were prevalent in patients with COVID-19. Although conflicting associations were observed among certain BC abnormalities and clinical outcomes, higher muscle echo intensity (reflective of myosteatosis) and lower PhA were more consistently associated with greater mortality risk. Likewise, high intra- and intermuscular AT and visceral AT were associated with mortality and ICU admission, respectively.This trial was registered at PROSPERO as CRD42021283031.

Fat mass to fat- free mass ratio and body composition in participants with chronic leg problems

Background & aim: Low fat-free mass (FFM) or high fat mass (FM) in older adults are abnormal body composition phenotypes associated with morbidity. The dual burden of excessive FM and low FFM may lead to a higher risk of cardiovascular and other diseases and disability and lower physical performance compared with individuals with normal body composition or low FFM or high FM alone. Both conditions lead to poorer health and can be identified by a high FM/FFM ratio. Because few studies have examined the effects of abnormal body composition using the FM/FFM ratio, the aim of this study is to determine the FM/FFM values by gender in patients with knee and hip pathologies and compare them with body composition parameters. This condition is important when surgery is required because abnormal body composition leads to an increase in infections and other postoperative complications. Methods: A total of 93 participants aged 64.71 ± 7.71 years in women and 65.9 ± 9.9 years in men with a body mass index (BMI) ≥25 kg/m2 were recruited from the Valdoltra Orthopaedic Hospital (Ankaran, Slovenia). The waist circumference (WC) and anthropometric data (BMI), as well as body composition data (FM, FFM, % of body water, estimated by bioelectrical impedance - BIA) were measured. In addition, the body composition phenotypes (FM/FFM ratio) were calculated. Results: The FM/FFM index was higher in females. The female group with FM/FFM (0.68) and those with a higher FM/FFM (0.92) correlated positively with WC. Male participants were excluded for further analysis because only two males had FM/FFM > 0.80. The FM/FFM of the remaining male participants was 0.53 ± 0.09. Conclusions: FM/FFM provide information on patient body composition and identify individuals at risk of body composition abnormalities in women only.

A large, multi-centre prospective study demonstrating high prevalence of malnutrition associated with reduced survival in ambulatory systemic anti-cancer therapy patients.

The nutritional status of cancer patients is highly variable, and known to impact on clinical outcomes. To date, no large study evaluating the nutritional status of Irish cancer patients has been reported. The aim of this study was to describe the nutritional status, using gold standard methods, of a large cohort of ambulatory oncology patients receiving Systemic Anti-Cancer Therapy and to assess the impact of abnormal body composition phenotypes on survival. A prospective study in adults undergoing Systemic Anti-Cancer Therapy for solid tumours enrolled patients between 2012 and 2016. Baseline details were collected incorporating demographics, cancer pathology, lifestyle, body composition (by computed tomography (CT), and inflammatory status. Skeletal muscle index (SMI) and mean muscle attenuation (MA) were obtained from CT images and categorised to low muscle mass and low MA using previously published sex specific cut points. Survival was monitored for a median of 25 months [IQR:10-46 months]. Survival analyses were conducted using multivariate Cox Proportional Hazards Models. Of 1015 patients recruited, 940 patients with an evaluable CT were included in this analysis. Median age was 64 years [IQR 55-71] and 56% were male. Colorectal cancer (28%) and gastro-oesophageal (16%) were the most common diagnoses and 58% of patients had stage IV disease. Despite 56% being overweight or obese (BMI >25kg/m2), 52% were weight losing and 17% had lost >10% body weight. Cancer Cachexia (CC) was present in 42%, 39% had low muscle mass (MM) (sarcopenia) and 45% had low MA. Overall, 73% of patients exhibited an abnormal body composition (BC) phenotype (≥1 of CC, low MM/MA). Overall survival was significantly lower in those with abnormal BC phenotype, independent of site, stage, sex, ECOG and mGPS (HR: 1.416 [95% CI: 1.069-1.875], p=0.015). Malnutrition and abnormal body composition phenotypes are common in cancer, but are often masked by adiposity. Appropriate screening and diagnostic tools should consider this co-presentation of overweight and obesity, alongside muscle depletion. Given that abnormal body composition phenotypes detectable only via CT are associated with reduced survival, these should be more widely employed to identify patients at risk of poor prognosis, and allow potentially more effective, early intervention.

Nutritional and immune impairments and their effects on outcomes in early pancreatic cancer patients undergoing pancreatoduodenectomy

Nutritional impairments are highly frequent in pancreatic cancer even in the early stages and have a significant impact on outcomes. The aim of this prospective study was to investigate immune and nutritional impairments, their interrelations and impacts on outcomes in an unselected cohort of patients scheduled for pancreatoduodenectomy due to suspicion of pancreatic cancer. All consecutive patients scheduled for pancreatoduodenectomy at Vilnius University Hospital Santaros Klinikos between January 2016 and November 2018 were recruited into the study according to the inclusion/exclusion criteria. Patients were randomly allocated into the groups of nutritional intervention with immunonutrition vs. control and stratified into the groups of pancreatic ductal adenocarcinoma (PDAC) vs. other pancreatic tumors. Nutritional evaluation included screening (NRS 2002), anthropometric measurements, bioelectrical impedance analysis and lumbar skeletal muscle index (LSMI). Inflammatory indicators were measured before and after surgery. Surgical outcomes were assessed 30 days postoperatively using Comprehensive Complication Index (CCI). Although increased nutritional risk was identified in 22.4% of patients, 41.4% were finally diagnosed with cachexia. While cachexia was predominantly diagnosed in underweight patients, sarcopenia was detected across all BMI categories and 11.7% of obese patients had sarcopenia. Decreased LSMI was identified in 52.5% of patients as compared to decreased phase angle in 39% of patients and decreased fat free mass index in only 3.4% of patients. Regression model indicate a large effect of nutritional indicators on CCI (R2 coefficient 71.1%). In comparison to patients with other pancreatic tumors, patients with PDAC had a characteristic pattern of increased systemic inflammation prior to surgery and decreased inflammation postoperatively (p=0.02). A high rate of nutritional impairments was identified in our cohort of patients with early pancreatic cancer, including abnormal body composition phenotypes. They produced negative effects on postoperative outcomes. The highest diagnostic rates were obtained with LSMI measurement, while the highest value for prognostication was attained with the inclusion of multiple objective nutritional state indicators.

Loss of adipose tissue mass during chemotherapy predicts reduced survival in patients with colorectal cancer treated with palliative intent

AbstractObesity is an established risk factor for colorectal cancer (CRC), however little is known about changes in body composition during chemotherapy and its impact on survival. The aim of this study was to examine in patients with CRC: (1) The prevalence of abnormal body composition phenotypes, (2) The impact of baseline body composition on overall survival, (3) Changes in body composition throughout treatment and its impact on overall survival.A prospective study of adult CRC patients undergoing chemotherapy between 2012–2016 was conducted. Longitudinal changes in body composition were examined using computed tomography (CT) images at two timepoints (interval 7 months, IQR: 5–9 months) using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cox proportional-hazards models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates – stage, age, sex, performance status & systemic inflammation.In total, 268 patients were recruited (66% male, mean age 63 years) and 51% were undergoing chemotherapy with a palliative intent. At baseline, 4% were underweight (BMI < 20 kg/m2), 38% had a normal BMI, and 58% were overweight/obese. Despite this, 38% had cancer cachexia, 34% were sarcopenic and 43% had low MA. Neither sarcopenia, sarcopenic obesity nor cachexia at baseline predicted survival. Over 100 days, 68% were muscle stable (± 1 kg), while 25% lost > 1 kg and 7% gained > 1 kg. Fat mass remained stable ± 1 kg in 49%, while 28% lost > 1 kg and 23% gained > 1 kg. When adjusted for known prognostic covariates, baseline BMI (20–25 kg/m2) in those having palliative chemotherapy was independently associated with reduced survival compared to those with BMI indicating overweight (BMI 25–30 kg/m2) [HR: 1.80 (95% CI: 1.04–3.14), p = 0.037]. In those undergoing chemotherapy with palliative intent, a loss of > 6.4% subcutaneous fat (Q1 SAT) over 100 days was predictive of poor survival versus those with small losses, remaining stable or gaining SAT (Q2-4), independent of changes in muscle mass [HR: 2.22 (95% CI: 1.07–4.62), p = 0.033].Patients with CRC, particularly those treated with a palliative intent, experience significant losses in muscle and fat mass during chemotherapy. Loss of SAT mass during palliative chemotherapy is prognostic of poor survival, independent of changes in muscle mass. Baseline BMI in the overweight range confers a survival advantage. Nutritional strategies to prevent or attenuate weight loss during chemotherapy are advisable especially in the context of advanced CRC.

Body composition and outcome in gastrointestinal cancer patients

In recent years it has been hypothesized that body composition alterations may influence the disease course of patients with gastrointestinal cancer. Several methodologies have been used in the past such as anthropometric measures and bioelectrical impedance to assess body composition. However, recently more sophisticated methodologies for body composition assessment have been explored such as ultrasound, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) image analysis. CT imaging is known to be highly specific and precise, since it has been shown to correlate closely with dual energy X-ray absorptiometry which is considered the gold standard for body composition evaluation. This technique further allows determination of cross-sectional areas of skeletal muscle tissue, subcutaneous and visceral adipose tissue and muscle attenuation (a marker of skeletal muscle fat infiltration). Cachexia is a prevalent condition in cancer patients and is defined as the ongoing loss of skeletal muscle mass, with or without the loss of fat mass [1]. Therefore nutritional screening (NS) has been considered mandatory, but recent research has shown that abnormal body composition phenotypes detected by CT analysis were misclassified by most NS tools, which clearly demonstrates the need for progress in nutritional screening of cancer patients [2]. CT scan imaging has demonstrated to be a breakthrough technique, mostly in cancer patients, since it has led to a better understanding of body composition phenotypes and their association with outcome. Recent studies suggest that differences in body composition may be involved in the variability of toxicity to ChT, and that information regarding body composition may be relevant for antineoplastic treatment planning. As compared to conventional prognostic factors, body composition seems to predict with the same or even better accuracy, long term survival and post-operative complications, among others. In fact, there is growing evidence that body composition phenotypes such as sarcopenia (decreased skeletal muscle tissue) is associated with postoperative complications [3], chemotherapy toxicity and response [4] and decreased survival [5]. Also, excess visceral adipose tissue and sarcopenic obesity have been associated with worse outcome [4]. Nonetheless, knowledge is lacking in regard to the effect of potential modifiable protective factors, such as dietary intake and exercise, on body composition alterations thereby improving final outcome. Bearing in mind that CT scan imaging is part of the clinical work up of gastrointestinal cancer patients, the opportunistic use of CT scan images for body composition assessment is feasible.

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

BackgroundNutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis).MethodsA prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria.ResultsA total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT‐identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007).ConclusionsHigh numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.

Fat mass to fat-free mass ratio reference values from NHANES III using bioelectrical impedance analysis

Low fat-free mass (FFM) or high fat mass (FM) are abnormal body composition phenotypes associated with morbidity. These conditions in combination lead to worse health outcomes, and can be identified by a high FM/FFM ratio. Here, we developed sex, age, and body mass index (BMI) stratified, population-based FM/FFM reference values using bioelectrical impedance analysis (BIA) measurements. White, non-Hispanic individuals aged 18-90 years old with data for weight, stature and BIA resistance measures from the third National Health and Nutrition Examination Survey (NHANES) III were included. Previously validated and sex-specific BIA prediction equations were used to calculate FM andFFM. FM/FFM values were generated at 5th, 50th and 95th percentiles for each sex, age (18-39.9, 40-59.9, 60-69.9 and 70-90 years), and BMI category (underweight, normal weight, overweight, class I/II and class III obesity). A total of 6372 individuals who had estimated FM and FFM values were identified (3366 females, 3006 males). Median values of FM/FFM were 0.24 and 0.40 for young (≤39.9 years) males and females with normal BMI, and 0.34 for males and 0.59 for females who were overweight. For elderly individuals aged >70 years, median FM/FFM for males and females were respectively 0.28 and 0.45 for those with normal BMI, and 0.37 and 0.61 for those in the overweight category. These FM/FFM reference values provide information on body composition characteristics that account for age, sex and BMI, which can be useful to identify individuals at risk for body composition abnormalities.

The use of magnetic resonance imaging to characterize abnormal body composition phenotypes in youth with Prader–Willi syndrome

IntroductionMagnetic resonance imaging (MRI) provides detailed assessment of body composition compartments. No studies have employed state-of-the-art MRI methods to accurately examine abdominal adipose tissue (AT) and skeletal muscle in youth with Prader–Willi syndrome (PWS). Therefore, this study aimed to describe AT distribution and skeletal muscle in the abdominal region of youth with PWS using MRI. MethodsAnthropometric measures and whole-abdominal T1-weighted MRI were performed in sixteen (5 males and 11 females) youth diagnosed with PWS, and seventeen (10 males and 7 females) youth who did not have PWS (controls). Volume of subcutaneous, visceral, intermuscular, and total AT, and skeletal muscle in the abdominal region were quantified using a semiautomatic procedure. Results were summarized using median and interquartile range (IQR, 25th–75th), and ANCOVA test was used (with age and sex as covariates) to examine differences in body composition compartments between PWS and control group. ResultsPWS group had similar age (10.5, 6.6–13.9 vs. 12.8, 10.0–14.4years; P=0.14) and BMI z-score (0.5, 0.2–1.3 vs. 0.2, −0.3 to 1.0; P=0.33) when compared with controls. Significant differences were observed in absolute volumes of total AT (PWS: 4.1, 2.0–6.6L; control: 2.9, 2.0–4.5L; P=0.01), subcutaneous AT (PWS: 2.8, 1.4–4.8L; control: 1.8, 1.1–3.2L; P=0.01), and intermuscular AT (PWS: 0.3, 0.1–0.4L; control: 0.3, 0.2–0.3L; P<0.005). Visceral AT/subcutaneous AT was lower in PWS (0.4, 0.3–0.5) compared to controls (0.5, 0.4–0.6), P=0.01. In addition, skeletal muscle volume was lower in PWS (1.5, 1.0–2.6L) compared to controls (3.1, 1.6–3.9L), P=0.03. Ratios of abdominal AT compartments to skeletal muscle were all higher in PWS compared to controls (all P<0.005). ConclusionsPWS youth have greater abdominal adiposity, particularly subcutaneous AT and intermuscular AT, and lower volume of skeletal muscle compared to controls. The decreased ratio of visceral AT/subcutaneous AT in youth with PWS suggests an improved metabolic profile for the level of adiposity present; however, elevated ratios of AT to skeletal muscle suggest a sarcopenic obesity-like phenotype, which could lead to worse health outcomes.

Body composition phenotypes and obesity paradox.

The obesity paradox is a highly controversial concept that may be attributed to methodological limitations related to its identification. One of the primary concerns is the use of BMI to define obesity. This index does not differentiate lean versus adipose tissue compartments (i.e. body composition) confounding health consequences for morbidity and mortality, especially in clinical populations. This review will describe the past year's evidence on the obesity paradox phenomenon, primarily focusing on the role of abnormal body composition phenotypes in explaining the controversies observed in the literature. In spite of the substantial number of articles investigating the obesity paradox phenomenon, less than 10% used a direct measure of body composition and when included, it was not fully explored (only adipose tissue compartment evaluated). When lean tissue or muscle mass is taken into account, the general finding is that a high BMI has no protective effect in the presence of low muscle mass and that it is the latter that associates with poor prognosis. In view of the body composition variability of patients with identical BMI, it is unreasonable to rely solely on this index to identify obesity. The consequences of a potential insubstantial obesity paradox are mixed messages related to patient-related prognostication.

The role of leptin in the pathophysiology of rheumatoid arthritis.

The past 20 years of research on leptin has provided important insights into its role in rheumatoid arthritis (RA). Leptin is one of the different adipokines produced by the adipose tissue that influences the endocrine system, energy homeostasis and the immune response in several ways. Leptin is known to have predominantly pro-inflammatory effects, especially in the setting of chronic inflammation. Animal models of arthritis have illustrated well the participation of leptin in the inflammatory response within the joints. In patients with RA, numerous studies have evaluated the concentrations of leptin in the bloodstream and/or the joint cavity, showing higher levels compared to control populations. Leptin has also been found to correlate with clinical or biological measurements of disease activity of RA. Conversely, the relationship between serum leptin and joint structural damage is less evident. Leptin may also promote the development of atherosclerosis in RA and may contribute to the cardiovascular consequences of the metabolic syndrome that coexists with RA. Indeed, leptin could be a link between inflammation, metabolic risk factors and cardiovascular diseases in RA. Finally, due to abnormal body composition phenotypes with an increased prevalence of obesity in RA, the therapeutic response to traditional DMARDs and/or biological agents may be attenuated. This review discusses the multiple interplays that have been described between leptin and the clinical, radiographic and therapeutic aspects of RA.

Diverse Abnormal Body Composition Phenotypes: Interaction Between Muscle, Fat, and Bone

Sarcopenia, obesity, and osteoporosis, the three disorders of body composition, are growing in prevalence. Osteoporosis and obesity were thought to be mutually exclusive conditions, as were sarcopenia and obesity. However, these disorders are commonly observed in the aging process and recent studies have indicated a potential interconnection among them with interaction between muscle, bone, and fat. Therefore, it would not be appropriate to discuss sarcopenia, obesity, and osteoporosis without bearing in mind the complex interactions of muscle, fat, and bone tissue. Due to the complicated interaction among them, the phenotypes have been given various names depending on the proposed cause or the combination of sarcopenia, obesity and osteoporosis. Therefore, we introduce new terms concerning the diverse phenotypes of body composition. In addition, this paper describes the interaction between muscle, fat and bone from a hormonal aspect and in terms of the whole body. Unraveling the link between muscle, fat, and bone at both the micro and macro level will elucidate the reasons for abnormal body composition phenotypes, and further enhance new therapeutic options for sarcopenia, obesity, and osteoporosis.

AB0211 Sarcopenia in patients with inflammatory arthritis

BackgroundSarcopenia is the progressive generalised loss of skeletal muscle and strength related to age and disease activity and is defined by appendicular skeletal mass/height squared (ASM/h2). Sarcopenia is common in...

Abnormal body composition phenotypes in Vietnamese women with early rheumatoid arthritis

To characterize body composition phenotypes using a dual-energy X-ray absorptiometry (DXA) method and to explore factors potentially contributing to alterations in body composition in Vietnamese women with early RA. A total of 105 women with early RA (disease duration ≤ 3 years) and 105 age-matched healthy women underwent physical examination, total and regional lean mass (LM) and fat mass (FM) with DXA. The 28-joint DAS (DAS-28) and disability using HAQ score, nutrition, physical activity and medications were recorded. Means of weight and BMI were similar in RA patients and controls, but means of total body and trunk FM in RA patients were higher: 19.1 vs 16.9 kg (P = 0.007) and 10.1 vs 8.1 kg (P = 0.01), respectively, and appendicular LM was lower: 12.9 vs 14.1 kg (P = 0.02). The proportion of unhealthy body composition phenotypes (sarcopenia, overfat and sarcopenic obesity) in RA patients was higher (P < 0.001) than in controls. DAS-28 score was positively correlated with total FM and fat distribution ratio, and HAQ score was inversely correlated with appendicular LM. These body composition changes were associated with RF seropositivity, HAQ and DAS-28 scores. Women with early RA had a significantly higher proportion of unhealthy body composition phenotypes, higher total and truncal FM and lower appendicular LM than controls. Disease activity and disability scores were associated with unhealthy body composition. These findings suggest that clinicians should encourage muscle strengthening and fat loss in RA patients to reduce their disability.

Abnormal body composition phenotypes in older rheumatoid arthritis patients: Association with disease characteristics and pharmacotherapies

To compare measures of body fat and lean mass and the prevalence of abnormal body composition phenotypes (sarcopenia, overfat, and sarcopenic obesity) in men and women with rheumatoid arthritis (RA) versus matched controls, and to explore the disease-related predictors of abnormal body composition in patients with RA. A total of 189 men and women with RA and 189 age-, sex-, and race-matched non-RA controls underwent dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. Continuous and categorical measures of body composition were compared between RA and control subjects by sex and according to categories of body mass index (BMI). Within the group of RA patients, demographic, lifestyle, and RA disease and treatment characteristics were compared for RA patients with healthy body composition versus those with abnormal body composition phenotypes. Compared with non-RA controls, RA status was significantly associated with greater odds of sarcopenia, overfat, and sarcopenic obesity in women, but not in men. Relative differences in body composition phenotypes between RA and control subjects were greatest for patients in the normal weight BMI category (<25 kg/m(2)). Among RA characteristics, increasing joint deformity, self-reported disability scores, C-reactive protein levels, rheumatoid factor seropositivity, and a lack of current treatment with disease-modifying antirheumatic drugs were significantly associated with abnormal body composition. Abnormal body composition phenotypes are overrepresented in patients with RA, particularly in those in the normal weight BMI range. RA-associated disease and treatment characteristics contribute to this increase in abnormal body composition.