Abnormal Body Composition Research Articles

AXIAL SARCOPENIA, SUBCUTANEOUS, ABDOMINAL VISCERAL AND PERICARDIAL ADIPOSITY IN HEART FAILURE WITH PRESERVED AND REDUCED EJECTION FRACTION

Abnormalities in body composition (subcutaneous adiposity, visceral adiposity, sarcopenia) can influence metabolic dysfunction and exercise capacity in heart failure. However, a comprehensive assessment of subcutaneous, abdominal visceral and pericardial fat, as well as skeletal muscle mass in heart

Serum Lipid and Leptin Concentrations in Patients with Sheehan Syndrome.

Background:Sheehan syndrome (SS) refers to the occurrence of hypopituitarism after parturition. Hypopituitary adults with growth hormone (GH) deficiency have abnormal body composition with increased fat mass. As leptin is secreted almost exclusively by fat cells and the circulating leptin level is proportional to total fat mass, it is expected that abnormal elevations of leptin concentrations are found in GH deficient hypopituitary patients. The present study was undertaken to evaluate the anthropometric, lipid and leptin levels in patients with SS.Materials and Methods:Thirty patients with SS and 30 age and body mass index (BMI) matched controls were part in this study. All patients were stable on conventional replacement therapy for at least 6 months before the study. The subjects underwent detail clinical, biochemical, and hormone analysis.Results:Patients with SS on conventional replacement therapy showed significantly higher mean triglyceride, total cholesterol, low density lipoprotein cholesterol and lower high density cholesterol concentrations. The leptin levels were significantly raised in the patients with SS on standard replacement therapy compared with controls. The difference was more marked in obese cases versus obese controls than in lean cases and controls (P = 0.001).Conclusion:SS, a cause of GH deficiency. Our study demonstrated that patients with SS have an abnormal lipid profile, and raised leptin levels as compared to age and BMI matched controls.

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.

Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and micronutrient deficiencies (MD) contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). COPD is a major health problem in Western Sydney. To study the pattern of BC and MD in patients admitted with an AECOPD to Western Sydney. The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with AECOPD in Western Sydney. A total of 94 patients was enrolled, 43% female, and the average age was 69.8 ± 8.2 years (SD). Admission spirometry revealed a mean spirometric ratio of 0.42 ± 0.14 (SD) and a severely reduced mean percentage FEV1 of predicted at 29.1% ± 11.6 (SD). A total of 51% of the population was overweight or obese, with an average body mass index of 25.9 ± 7.7 kg/m2 (SD). When fat-free mass (FFM) was also considered 23% were cachectic, 9% had muscle atrophy and 6% were semi-starved. Vitamin D deficiency (<50 nmol/L) was present in 53% and vitamin B12 deficiency (<222 pmol/L) was present in 31%. Anaemia was present in 30%, with 38% of these being iron deficient. Living status (alone or with family) was not associated with BC or micronutrient deficiencies (MD). Patients with ≥2 hospital admissions for AECOPD had a significantly lower mean B12 level (280.5 ± 143.0 pmol/L (SD) vs 360.5 ± 198.1 pmol/L (SD) P = 0.042). The malnutrition screening tool, a questionnaire-based assessment of malnutrition used by the local health area did not accurately predict patients with abnormal BC or those with >2 MD. In patients admitted with AECOPD, the majority of subjects were overweight or obese, with a low FFM. MD, in particular B12 and vitamin D, were common. Interventional studies addressing BC and MD are required to assess potential improvements in AECOPD-related morbidity and mortality.

Serum adipokines, adipose tissue measurements and metabolic parameters in patients with advanced radiographic knee osteoarthritis.

We conducted the present study to evaluate the serum levels of adipokines (leptin, total and high molecular adiponectin, resistin), a marker of cartilage breakdown (C2C), and ghrelin together with body composition in patients with knee osteoarthritis (OA). Fifty patients and 50 sex-matched healthy subjects (HS) were evaluated. Knee OA was scored according to the Kellgren-Lawrence (KL) grade. Body composition parameters including lean mass and measurements of fat mass (total fat, adiposity, fat in the android and gynoid regions, visceral fat and trunk/legs fat ratio) were obtained using dual energy X-ray absorptiometry. Most of the recruited patients (88%) had advanced knee OA with KL grade 3 or 4. The patients had higher body mass index than HS (p<0.0001). Serum leptin, high molecular adiponectin, resistin and ghrelin levels did not differ between patients and HS. Total adiponectin was higher in women with OA compared to women from the HS group (p=0.004). Total fat mass, adiposity and measurements of central adiposity (fat in the android region, trunk/lower limbs fat ratio and visceral fat) were increased in patients with knee OA (all p<0.05). Total adiponectin was borderline associated with the severity of OA. Our results show that total adiponectin is significantly increased in women with advanced knee OA. Independently of gender, patients with severe knee OA were characterized by a significant excess of fat with a distribution toward the visceral region. This abnormal body composition may contribute to the cardiometabolic profile that is described in patients with knee OA.

Diet quality and osteosarcopenic obesity in community-dwelling adults 50 years and older

ObjectivesTo examine the association between diet quality and osteosarcopenic obesity (OSO), low bone and muscle mass with concurrent high fat mass, in middle-aged and older adults. Study designData were from a cross-sectional study of 2579 men and 3550 women aged 50 years and older who completed the Korea National Health and Nutritional Examination Survey from 2008 to 2010. Main outcome measuresData were collected using 24-h dietary recall, and diet quality was determined by the Diet Quality Index-International (DQI-I), on which higher scores denote better quality. Body composition was evaluated by dual-energy x-ray absorptiometry. The association between dietary quality and the number of body composition abnormalities (including OSO) was analyzed by multinomial logistic regression, adjusting for covariates. ResultsIn women, after controlling for covariates, higher scores on the DQI-I were associated with a significantly lower number of phenotypes associated with adverse body composition. Those in the highest tertile group of DQI-I were less likely to have OSO compared with those in the lowest tertile (odds ratio=0.54, 95% confidence interval: 0.32–0.92). In men, DQI-I scores were not associated with the number of body composition abnormalities. ConclusionsMiddle-aged and older women who eat a healthier diet, as determined by a high DQI-I score, are less likely to have multiple body composition abnormalities.

Short term in vivo precision of whole body composition measurements on the Horizon A densitometer

Dual-energy X-ray absorptiometry (DXA) is increasingly being used to assess abnormalities in body composition associated with a wide variety of conditions including obesity, sarcopenia, diabetes, anorexia, human immunodeficiency virus lipodystrophy, malabsorption and neuromuscular disorders. The objective of this study was to determine the short-term invivo precision and least significant change in serial body composition measurements provided by the Hologic Horizon A densitometer as there is no published, peer reviewed body composition precision data on Horizon scanners in the medical literature. After acquiring two new Hologic Horizon A densitometers, short term precision scanning was performed on the two scanners using different groups of 30 volunteers, who had duplicate scans with all scans performed by the same operator. Using the International Society of Clinical Densitometry's advanced precision tool, the scan data were recorded and the coefficient of variation (CV) and least significant change (LSC) determined for total fat, lean and bone mineral content (BMC) and bone mineral density (BMD). Coefficients of variation of 0.78% and 0.77% were achieved for total fat (LSC at 95% confidence 2.15%) and 0.52% and 0.40% for total lean (LSC at 95% confidence 1.45% and 1.11%). These results indicate that the two Horizon A scanners in this study exceeded the minimum acceptable precision values by roughly a factor of four and are therefore capable of detecting small differences in lean and fat mass of 1-2% between two measurements at 95% confidence.

Hexarelin, a Growth Hormone Secretagogue, Improves Lipid Metabolic Aberrations in Nonobese Insulin-Resistant Male MKR Mice.

Despite the occurrence of dyslipidemia and its contribution to the development of insulin resistance in obese subjects, a growing number of studies have described abnormal lipid profiles among leaner persons. For example, individuals with an abnormal paucity or distribution of fat (lipodystrophy) develop severe insulin resistance, dyslipidemia, and hepatic steatosis. Deranged adipocyte metabolism and differentiation contribute to ectopic fat deposition and consequent development of insulin resistance. Growth hormone (GH) therapy has been shown to correct body composition abnormalities in some lipodystrophy patients. However, little is known about the effects of GH-releasing peptides in this regard. Hexarelin, a GH secretagogue, has recently been shown to have beneficial effects on fat metabolism via the CD36 receptor. In this study, the effects of twice daily intraperitoneal injections of hexarelin (200 μg/kg body weight) were examined in nonobese insulin-resistant MKR mice and corresponding wild-type FVB mice for 12 days. Hexarelin treatment significantly improved glucose and insulin intolerance and decreased plasma and liver triglycerides in MKR mice. These beneficial metabolic effects could be due to the improved lipid metabolism and enhanced adipocyte differentiation of white adipose tissue with hexarelin treatment. Interestingly, although food intake of hexarelin-treated MKR mice was significantly increased, this did not change total body weight. Moreover, hexarelin treatment corrected the abnormal body composition of MKR mice, as demonstrated by a decrease in fat mass and an increase in lean mass. Our results suggest a possible application of hexarelin in treatment of lipid disorders associated with the metabolic syndrome.

Bone, body composition and metabolic abnormalities after allogeneic hematopoietic stem cell transplantation during childhood

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Bone, body composition and metabolic abnormalities after allogeneic hematopoietic stem cell transplantation during childhood

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Objectives: Physical inactivity in end-stage renal disease (ESRD) patients is associated with increased mortality, and might be related to abnormalities in body composition (BC) and physical performance. It is uncertain to what extent starting dialysis influences the effects of ESRD on physical activity (PA). This study aimed to compare PA and physical performance between stage 5 chronic kidney disease (CKD-5) non-dialysis and dialysis patients, and healthy controls, to assess alterations in PA during the transition from CKD-5 non-dialysis to dialysis, and to relate PA to BC. Methods: For the cross-sectional analyses 44 CKD-5 non-dialysis patients, 29 dialysis patients, and 20 healthy controls were included. PA was measured by the SenseWear™ pro3. Also, the walking speed and handgrip strength (HGS) were measured. BC was measured by the Body Composition Monitor©. Longitudinally, these parameters were assessed in 42 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before the start of dialysis and 6 months thereafter. Results: PA was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. HGS was significantly lower in dialysis patients as compared to that in healthy controls. Walking speed was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. Six months after starting dialysis, activity related energy expenditure (AEE) and walking speed significantly increased. Conclusions: PA is already lower in CKD-5 non-dialysis patients as compared to that in healthy controls and does not differ from that of dialysis patients. However, the transition phase from CKD-5 non-dialysis to dialysis is associated only with a modest improvement in AEE.

Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome.

People with Down syndrome (DS) usually display reduced physical fitness (aerobic capacity, muscle strength and abnormal body composition), motor proficiency impairments (balance and postural control) and physical functional limitations. Exergames can be an appealing alternative to enhance exercise engagement and compliance, whilst improving physical fitness and motor function. This study aims to analyse the effects of a Wii-based exercise program on physical fitness, functional mobility and motor proficiency of adults with DS. Twenty-seven adults with DS were randomly allocated to an experimental group (Wii; n=14) or control group (n=13). Participants in the experimental group completed a 2-month Wii-based exercise program, with three 1-h sessions per week that included training games for aerobic endurance, balance and isometric strength. Participants completed assessments regarding anthropometric measures, physical fitness, functional mobility and motor proficiency. Mixed ANOVA analysis showed a significant group by time interaction for aerobic endurance, explosive leg power and flexibility. Independent samples t-test for change scores indicated significant between-group differences favouring the experimental group regarding speed of limb movement, trunk strength and functional mobility, as well as a trend towards significance on body weight. Mann-Whitney's U test for change scores demonstrated between-group differences favouring the experimental group for visceral fat as well as running speed and agility. Large within-group effect sizes were observed for explosive leg power (d=1.691), body weight (d=1.281), functional mobility (d=1.218), aerobic endurance (d=1.020), speed of limb movement (d=0.867) and flexibility (d=0.818) in the experimental group. Our findings suggest that Wii-based exercise can be an effective tool to improve physical fitness, functional mobility and motor proficiency of adults with DS, including crucial measures such as aerobic capacity and lower limb strength. Exergames using Wii Fit or other equipment can be appealing alternatives for adults with DS to engage in regular physical activity, preventing sedentary behaviour and decreasing the risk to develop cardiovascular diseases.

Estimation of glomerular filtration rate in cancer patients with abnormal body composition and relation with carboplatin toxicity.

Carboplatin clearance is correlated with glomerular filtration rate (GFR) and usually estimated with creatinine clearance using Cockcroft-Gault (CG) formula. Because plasma creatinine level is highly correlated with muscle mass, we hypothesized that an abnormal body composition with a low lean body mass (LBM) percentage [(LBM/weight)×100]may result in inadequate carboplatin dosing. Serum cystatin C is an alternative marker of GFR, not affected by muscle mass. We aimed to investigate the influence of total LBM and LBM percentage on GFR calculation, using creatinine (CrCl) or cystatin C (GFRcysC-creat) in cancer patients. Pretreatment serum creatinine and cystatin C were prospectively measured in consecutive patients. CrCl (CG formula), GFRcysC-creat (CKD-EPI creatinine-cystatin equation), and LBM (CT scan) were calculated. Severe thrombocytopenia post-carboplatin were analyzed. In 131 patients without renal insufficiency, LBM was correlated with creatinine (r=0.30, p<0.005) but not with cystatin C (r=-0.07, p=0.43). In patients with the lowest LBM percentage, the CrCl was significantly higher than GFRcysC-creat indicating an overestimation of GFR with creatinine (p=0.0004). In 24 patients treated with carboplatin AUC 5 (mg/mlmin)±paclitaxel, the risk of severe thrombocytopenia was associated with lower LBM percentage (p=0.0002) and higher CrCl/GFRcysC-creat ratio (p=0.006). By ROC analysis, the CrCl/GFRcysC-creat ratio threshold predicting severe thrombocytopenia was 1.23. A low LBM percentage increases the risk of inadequate GFR calculation by CG formula, and carboplatin overdosage with severe thrombocytopenia. High CrCl/GFRcysC-creat ratio allows the identification of these patients.

Editorial introductions

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS W. Joseph McCuneW. Joseph McCuneDr Joseph McCune is a graduate of Harvard College, and the University of Cincinnati Medical School, USA. Following residency at the University of Michigan, USA, and fellowship Brigham and Women's Hospital, USA, he joined the faculty of the University of Michigan, where he is the Michael and Marcia Klein Professor of Rheumatic Diseases and Director of the Lupus Program. Dr McCune has devoted much of his research career to systemic lupus. He reported the clinical and immunologic effects of monthly bolus cyclophosphamide for severe lupus using methods that were subsequently adopted as standard treatment for lupus nephritis and has since focused on improving the efficacy and safety of immunosuppressive therapy, including the use of leuprolide for ovarian protection in women receiving cyclophosphamide. His work in medical imaging helped establish the importance of MRI in neurological complications of lupus and rheumatoid arthritis, and he was the first to describe ultrasound imaging of articular cartilage. Current interests include the pathogenesis of cardiovascular disease in SLE, advanced MRI in SLE, and detailed population-based epidemiologic studies of the SLE in southeastern Michigan. Jon T. GilesJon T. GilesDr Giles's research interests are centered primarily within the inflammatory arthritides. Current projects center around understanding the inflammatory and non-inflammatory determinants of body composition abnormalities in rheumatoid arthritis and psoriatic arthritis, and their subsequent effects on health outcomes. Other current and past research involve the investigation of accelerated atherosclerosis and myocardial dysfunction in rheumatoid arthritis patients, understanding the determinants of rheumatoid arthritis-associated interstitial lung disease, and exploring the musculoskeletal side-effects of a class of medications used to suppress estrogen in women with certain forms of breast cancer. He is the recipient of grant support from the National Institutes of Health, the Arthritis Foundation, the Rheumatology Research Foundation, the Marianne Legato Foundation, and the Arthritis National Research Foundation.

Metabolic differences between short children with GH peak levels in the lower normal range and healthy children of normal height

ObjectiveSevere growth hormone deficiency (GHD) leads to several metabolic effects in the body ranging from abnormal body composition to biochemical disturbances. However, less is known regarding these parameters in short children with GH peak levels in the lower normal range during provocation tests. Our aim was to study the metabolic profile of this group and compare it with that of healthy children of normal height. DesignThirty-five pre-pubertal short children (<−2.5 SDS) aged between 7 and 10years, with peak levels of GH between 7 and 14μg/L in an arginine insulin tolerance test (AITT), were compared with twelve age- and sex-matched children of normal height. The metabolic profile of the subjects was analysed by blood samples, DEXA, frequently sampled intravenous glucose tolerance test, microdialysis and stable isotope examinations of rates of glucose production and lipolysis. ResultsThere were no overall significant metabolic differences between the groups. However, in the subgroup analysis, the short children with GH peaks <10μg/L had significantly lower fasting insulin levels which also correlated to other metabolic parameters. ConclusionThe short pre-pubertal children with GH peak levels between 7 and 14μg/L did not differ significantly from healthy children of normal height but subpopulations within this group show significant metabolic differences.

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.

Measurement of overweight and obesity an urban slum setting in sub-Saharan Africa: a comparison of four anthropometric indices.

BackgroundAs a result of both genetic and environmental factors, the body composition and topography of African populations are presumed to be different from western populations. Accordingly, globally accepted anthropometric markers may perform differently in African populations. In the era of rapid emergence of cardio-vascular diseases in sub-Saharan Africa, evidence about the performance of these markers in African settings is essential. The aim of this study was to investigate the inter-relationships among the four main anthropometric indices in measuring overweight and obesity in an urban poor African setting.MethodsData from a cardiovascular disease risk factor assessment study in urban slums of Nairobi were analyzed. In the major study, data were collected from 5190 study participants. We considered four anthropometric markers of overweight and obesity: Body Mass Index, Waist Circumference, Waist to Hip Ratio, and Waist to Height Ratio. Pairwise correlations and kappa statistics were used to assess the relationship and agreement among these markers, respectively. Discordances between the indices were also analyzed.ResultsThe weighted prevalence of above normal body composition was 21.6 % by body mass index, 28.9 % by waist circumference, 45.5 % by waist to hip ratio, and 38.9 % by waist to height ratio. The overall inter-index correlation was +0.44. Waist to hip ratio generally had lower correlation with the other anthropometric indices. High level of discordance exists between body mass index and waist to hip ratio. Combining the four indices shows that 791 (16.1 %) respondents had above normal body composition in all four indices. Waist circumference better predicted hypertension and hyperglycemia while waist to height ratio better predicted hypercholesterolemia.ConclusionsThere exists a moderate level of correlation and a remarkable level of discordance among the four anthropometric indices with regard to the ascertainment of abnormal body composition in an urban slum setting in Africa. Waist circumference is a better predictor of cardio-metabolic risk.

Association of Fluid Status and Body Composition with Physical Function in Patients with Chronic Kidney Disease.

BackgroundImpairment of physical function and abnormal body composition are the major presentations in patients with chronic kidney disease (CKD). The aim of this study is to investigate the relationship between body composition and physical function in CKD patients.MethodsThis cross-sectional study enrolled 172 of CKD stages 1–5 from February 2013 to September 2013. Handgrip strength (upper extremity muscle endurance), 30-second chair-stand test (lower extremity muscle endurance) and 2-minute step test (cardiorespiratory endurance) were used as indices of physical function. Body composition, including fluid status (extracellular water/total body water, ECW/TBW), lean tissue index (LTI), and fat tissue index (FTI), was measured using a bioimpedance spectroscopy method.ResultsAll patients with high ECW/TBW had lower handgrip strength and 30-second chair-stand than those with low ECW/TBW (P<0.001 and P = 0.002). CKD patients with high FTI had lower handgrip strength and 30-second chair-stand than those with low FTI (P<0.001 and P = 0.002). These patients with low LTI had lower handgrip strength than those with high LTI (P = 0.04). In multivariate analysis, high ECW/TBW was positively associated with decreased handgrip strength (β = -41.17, P = 0.03) in CKD patients. High FTI was significantly correlated with decreased times of 30-second chair-stand (β = -0.13, P = 0.01). There was no significant relationship between body composition and 2-minute step test.ConclusionsOur results show a significant association of impaired upper and lower extremity muscle endurance with high fluid status and fat tissue. Evaluation of body composition may assist in indentifying physical dysfunction earlier in CKD patients.

Association of serum vitamin D with osteosarcopenic obesity: Korea National Health and Nutrition Examination Survey 2008-2010.

BackgroundSerum vitamin D levels have been reported to be associated with individual components of body composition. However, the relationship between serum vitamin D and combined indices of adverse body composition is largely unknown. This cross‐sectional study examined the association between serum vitamin D and osteosarcopenic obesity in a nationally representative sample of middle‐aged and older adults.MethodsWe analysed the Korea National Health and Nutrition Examination Surveys (IV and V) conducted in 2008–2010, consisting of 5908 (2485 men, 3423 women) aged ≥ 50 years. Serum vitamin D levels were determined by radioimmunoassay, and body composition was evaluated by dual‐energy x‐ray absorptiometry. The association between serum vitamin D levels and the number of abnormalities in body composition, including osteosarcopenic obesity, a low bone and muscle mass with concurrent high fat mass, was analysed by multinomial logistic regression adjusting for covariates.ResultsIn men, after controlling for covariates, higher vitamin D levels were associated with a significantly reduced likelihood of the number of phenotypes of adverse body composition (P for trend < 0.05). Those in the highest tertile group of serum vitamin D levels, compared with those in the lowest tertile, were less likely to have adverse body composition, numbering one (odds ratio [OR] = 0.67, 95% confidence interval [CI]: 0.49, 0.92), two (OR = 0.49, 95% CI: 0.33, 0.73), and three (osteosarcopenic obesity; OR = 0.42, 95% CI: 0.26, 0.67). In women, those in the highest tertile group of serum vitamin D levels, compared with those in the lowest tertile, were less likely to have osteosarcopenic obesity (OR = 0.55, 95% CI: 0.33, 0.93). Vitamin D deficiency (<20 ng/mL) in men was significantly associated with an increased likelihood of a higher number of adverse body composition, especially for osteosarcopenic obesity (OR = 2.08, 95% CI: 1.42, 3.03). Vitamin D deficient women, compared with those having normal levels of serum vitamin D, were also more likely to demonstrate osteosarcopenic obesity (OR = 1.99, 95% CI: 1.30, 3.05).ConclusionsA high serum vitamin D level in mid‐ and late‐life was associated with reduced odds of multiple adverse body composition, especially osteosarcopenic obesity, suggesting potential health benefits of maintaining adequate levels of vitamin D.