Appendicular Fat Mass Research Articles

Sarcopenia As a Significant Prognostic Factor in Acute Myeloid Leukemia: Validation of a Novel Scoring System

Background: Acute myeloid leukemia (AML) is a malignant hematologic disease mainly occurs in the elderly. Sarcopenia is a muscle disease (muscle failure) common among adults of older age but can also occur earlier in life. This study indicates to investigate the prognostic value of sarcopenia in AML patients. Methods: From January 2014 to April 2019, a total of 100 patients diagnosed with de novo AML according to the WHO classification were included in this study. Clinical data and biological characteristics were collected. Giemsa R-banding method was used to detect the karyotype of metaphase bone marrow cells. Targeted gene sequencing was taken to test a total of 23 gene mutations including DNMT3A, IDH1, IDH2, ASXL1, RUNX1, NPM1, CEBPA, FLT3, KIT, and TP53, etc. Bioelectrical impedance analysis (BIA) of human body before treatment was used to calculate the Body Mass Index (BMI), Appendicular Skeletal Muscle Mass (ASM), SMI (ASM/height2), Fat Mass (FM), Fat-free Mass (FFM), and FFMI (FFM/height2), etc. The diagnosis of sarcopenia was based on the consensus report of the Asian Working Group for Sarcopenia. Results: Sixteen AML patients were diagnosed as sarcopenia. Patients with sarcopenia had significantly lower weight (P=0.049), BMI (P=0.039), ASM (P=0.002), SMI (P<0.001) and FFMI (P=0.005) than non-sarcopenia ones (Figure 1A~E). With a median follow-up time of 25 months, the overall survival (OS) of patients with sarcopenia was shorter than non-sarcopenia patients (median 7 vs. 28 months, P=0.054, Figure 2A). When stratified by age (≥60 yrs vs. <60 yrs), elderly patients with sarcopenia showed a significantly inferior OS to normal elder ones (median 3 vs. 12 months, P=0.008, Figure 2B). Receiver operator characteristic curves suggested that sarcopenia as one additional point to the 2017 European Leukemia Net risk stratification by genetics obtained superior area under the curve (AUC) in predicting AML OS than the latter alone (AUC 0.67 vs. 0.649, P=0.3305, Kaplan-Meier plotting see Figure 2C~D). Conclusion: Sarcopenia is common in AML patients, and BIA offers a useful objective tool for identifying these patients. We illustrated a marked clinical impact of sarcopenia on patients with AML, and presented a novel prognostic scoring system. In elderly patients, the presence of sarcopenia before treatment may offer a useful factor for avoiding intensive therapeutic strategies for AML. Disclosures No relevant conflicts of interest to declare.

Interactions between Sedentary and Physical Activity Patterns, Lean Mass, and Bone Density in Arab Men.

The study examined the associations between physical activity and appendicular lean mass (ALM), fat mass, and bone mineral density (BMD) and examined the role of physical activity on these variables. The participants included 497 men (age: 32.2 ± 10.4 years and body mass index: 28.2 ± 5.4 kg/m2). The study was cross-sectional, and measurements included body composition measured on dual-energy X-ray absorptiometry and self-reported physical activity assessed using the International Physical Activity Questionnaire. Physical activity, including light physical activity, was associated with increased ALM (P ≤ 0.05). Fat indicators, including waist circumference, were positively associated with ALM (P ≤ 0.05), but not with BMD. Physical activity, including moderate-to-vigorous physical activity, was not associated with BMD, whereas ALM and handgrip strength were significantly associated with BMD (P ≤ 0.05). Physical activity independent of exercise intensity was directly associated with ALM and indirectly associated with BMD through increased muscle mass and strength.

Nutritional condition analysis of the older adult patients with femoral neck fracture

Many factors can contribute to the fracture of femoral neck, nutritional condition appears play a key role. The objective of this study was to investigate the relationship between nutritional condition and femoral neck fracture in an elderly population. A cross-sectional study was carried out among patients aged 55 years old or older, with or without femoral neck fracture. The study sample included 82 newly femoral neck fractured hospitalized patients as experimental group and 106 non-fracture out-patients as control group. Prealbumin, albumin and hemoglobin were evaluated in both femoral neck fracture group and control group. Bioelectrical Impedance Analyzer (BIA) were used to analyze the body composition. Appendicular Lean Mass (aLM) and Fat Mass (FM) were analyzed in different age grade, Percentage of Body Fat (PBF) was analyzed according to Body Mass Index (BMI) level. Eight-two (male 29, female 53) patients older than 55 years old with femoral neck fracture and 106 (male 43, female 63) orthopaedic out-patients were included in this study. Albumin, prealbumin and hemoglobin in the femoral neck fracture group are significantly lower than the control group. According to the criteria for the Asia Working Group for Sarcopenia (AWGS), the prevalence of sarcopenia in femoral neck fracture group is much higher than in the control group. As for the FM analysis, although the fat mass index in the control group is higher than that in femoral neck fracture group, we did not find any differences in terms of PBF analysis. Malnutrition contributes to the development of femoral neck fracture, according to the BIA analysis, aLM, rather than FM is a protection factor for the older people to get rid of femoral neck fracture.

SAT-LB018 Different Definitions of Sarcopenia and Its Correlations with Anthropometric Measurements, Body Composition, Handgrip Strength, Metabolic Profile and Bone Mineral Density in Obese Women

BACKGROUND: The concept of sarcopenic obesity hasn’t been fully elucidated, due to the different muscle mass indexes (MMIs) as a dilemma in its definition. There are few trials about MMIs related to the clinical outcomes in young adults with severe obesity. OBJECTIVE: To correlate 3 MMIs, used in the diagnosis of sarcopenia, with age, anthropometric measures, body composition, handgrip strength (HS), metabolic profile and bone mineral density (BMD) in obese women preceding bariatric surgery (BS). METHODS: A cross-sectional study involving 62 obese women of a public hospital in Brazil. Body composition was given by bio-impedance (inbody-370), multifrequency (5, 50, 250Hz) with 12 hours fasting, and BMD by Lunar Densitometer Prodigy Advance. The following MMIs were studied: height2-adjusted appendicular skeletal muscle mass (ASMM): ASMM/ht2 (Kg/m2); weight-adjusted ASMM: ASMM/weight x100 (%) and BMI-adjusted ASMM: ASMM/BMI (m2). The HS (dominant) was evaluated by Jamar Dynamometer (3 measurements; 30 sec interval). Metabolic profile included: Fasting glucose, HbA1c, HOMA-IR, insulin, lipid profile and hs-CRP. RESULTS: Patients were 39±8,99 years old; weight 108.6±13.8 Kg; BMI 42.6±4.6 kg/m2; ASMM/wt 19.76±1.87%; ASMM/BMI 0.505±0.080 m2; ASMM/ht2 8.46±1.00 Kg/m2 and body fat percentage (BFP) 51.8±3.32%. None of the MMIs were associated with age. Concerning anthropometric measures, only the ASMM/ht2 was correlated with wt (r=0.701 p<0.001), otherwise all MMIs were associated with ht (had p<0.05). ASMM/wt x100 and ASMM/BMI had negative and significant association with BMI, while ASMM-ht was positively associated with BMI (r=0.597 p<0.001). Regarding body composition, ASMM/wt and ASMM/BMI had negative correlation with BFP (r=-0.769 p<0.001; r=-0.669 p<0.001), respectively. All MMIs correlated positively and significantly with skeletal muscle mass. ASMM/ht2 was correlated with appendicular fat mass (p<0.001) and ASMM/wt x100 obtained negative and significant association with fat mass of upper limbs. All MMIs were positively and significantly associated with HS. Concerning metabolic profile, ASMM/ht2 was the only MMI to correlate with HOMA-IR (r=0.381 p=0.003). Regarding BMD, only the ASMM/wt x100 correlated positively and significantly with all sites (L1-L4, CF and FT) of BMD evaluated. There was only correlation between ASMM/wt x100 and ASMM/BMI (r=0.933 p=0.001). CONCLUSION: The ASMM/wt x100 and the ASMM/BMI seem to be more accurate to evaluate the sarcopenia in obese women than ASMM/ht2, because they have correlated negatively with adiposity (BMI and BFP). Besides that, both ASMM/wt x100 and ASMM/BMI have correlated with HS, which is an important parameter of disability and mortality. However, only ASMM/wt x100 had correlated positively with all BMD sites evaluated proving to be useful in the evaluation of sarcopenia in obese women preceding BS. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Prognostic value of muscle mass assessed by DEXA in elderly hospitalized patients

To analyze the prognostic value of lean mass measured by DEXA and to compare it with lean muscle mass assessed by anthropometrics, calf circumference, subjective assessment and with physical muscle function tests in elderly hospitalized patients. We study 187 hospitalized patients aged ≥65 years. We assessed nutrition by anthropometrics, mid arm muscle area, triceps skinfold and calf circumference, by subjective nutritional assessment and by DEXA, lean and fat mass and bone mineral density (BMD); muscle function by handgrip strength, gait speed, standing balance and stand-up test; disability and activities of daily living and the clinical frailty score; and comorbidity by Charlson index. Outcomes were assessed by mortality at 100 days and long-term follow up. Male sex showed higher comorbidity and mortality although females were older, with decreased muscle mass and function, disabled and frailer. Long term mortality was also related to decreased lean mass evaluated by subjective assessment, midarm anthropometry, calf circumference and DEXA (appendicular lean and fat mass and BMD); muscle function impairment assessed by gait speed, standing balance and stand-up test; frailty; disability and comorbidity. Variables with long term independent predictive value were comorbidity, inability to perform any of the muscle function tests: gait speed, standing balance and stand-up; subjective nutritional score, appendicular lean mass under the 10th percentile and male sex. Females are older and frailer but with lower comorbidity; they showed a better survival. The best predictive mortality factor was comorbidity, but DEXA appendicular lean mass under the 10th percentile showed an independent and high predictive value on mortality.

Relationships between muscle mass, strength and regional bone mineral density in young men.

PurposeAlthough the relationship between body composition and bone mineral density (BMD) is well established, the relative contribution of appendicular lean mass (ALM) and fat mass (FM) to BMD has been rarely evaluated in young men.MethodsWe assessed 100 young men (age: 24.4±2.8 years, BMI: 23.4±2.81 kg/m2). Appendicular lean mass index (ALM/H2) (ALMI), fat mass index (FM/ H2) (FMI), percentage of body fat, BMD at lumbar spine (LS), total hip (TH), femoral neck (FN) and whole body (WB) were measured using DXA. Muscle strength was evaluated by handgrip strength. Pearson’s correlations and interactions between all variables were assessed using stepwise regression analyses.ResultsALM index (ALMI) was positively correlated with BMD at all sites (r = 0.62 for WB p<0.05, r = 0.54 for FN p<0.05, r = 0.64 for TH p<0.05, r = 0.56 for LS p<0.05) whereas FMI was not correlated to BMD values. Stepwise regression analyses showed that ALMI produced a significant and positive influence on BMD (β = 0.07 for WB p<0.001, β = 0.04 for FN p<0.001, β = 0.06 for TH p<0.001). Conversely, FMI was negatively associated with BMD at all sites (β = -0.02 for WB p<0.001, β = - 0.03 for FN p<0.001, β = - 0.03 for TH p<0.001, β = - 0.07 for LS p<0.001). Handgrip strength and BMDs were significantly and positively associated at all sites.ConclusionsOur data suggest that BMD was positively associated with ALMI while negatively with FMI. We confirm that ALMI is the strongest factor associated with BMD in a population of young men.

Relative sarcopenia and mortality and the modifying effects of chronic kidney disease and adiposity.

BackgroundConventional definitions of sarcopenia based on lean mass may fail to capture low lean mass relative to higher fat mass, that is, relative sarcopenia. The objective of this study is to determine the associations of sarcopenia and relative sarcopenia with mortality independent of co‐morbidities, and whether chronic kidney disease (CKD) and adiposity alter these associations.MethodsDual energy X‐ray absorptiometry‐derived appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI, kg/m2) were assessed in 14 850 National Health and Nutrition Examination Survey participants from 1999 to 2006 and were linked to death certificate data in the National Death Index with follow‐up through 2011. Sarcopenia was defined using sex‐specific and race/ethnicity‐specific standard deviation scores compared with young adults (T‐scores) as an ALMI T‐score < −2 and relative sarcopenia as fat‐adjusted ALMI (ALMIFMI) T‐score < −2. Glomerular filtration rate (GFR) was estimated using creatinine‐based (eGFRCr) and cystatin C‐based (eGFRCys) regression equations.ResultsThree (3.0) per cent of National Health and Nutrition Examination Survey participants met criteria for sarcopenia and 8.7% met criteria for relative sarcopenia. Sarcopenia and relative sarcopenia were independently associated with mortality (HR sarcopenia 2.20, 95% CI 1.69 to 2.86; HR relative sarcopenia 1.60, 95% CI 1.31 to 1.96). The corresponding population attributable risks were 5.2% (95% CI 3.4% to 6.4%) and 8.4% (95% CI 4.8% to 11.2%), respectively. Relative sarcopenia remained significantly associated with mortality (HR 1.32, 95% CI 1.08 to 1.61) when limited to the subset who did not meet the criteria for sarcopenia. The risk of mortality associated with relative sarcopenia was attenuated among persons with higher FMI (P for interaction <0.01) and was not affected by CKD status for either sarcopenia or relative sarcopenia.ConclusionsSarcopenia and relative sarcopenia are significantly associated with mortality regardless of CKD status. Relative sarcopenia is nearly three‐fold more prevalent amplifying its associated mortality risk at the population level. The association between relative sarcopenia and mortality is attenuated in persons with higher FMI.

Longitudinal Changes of Body Composition Phenotypes and Their Association with Incident Type 2 Diabetes Mellitus during a 5-Year Follow-up in Koreans.

BackgroundTo elucidate longitudinal changes of complex body composition phenotypes and their association with incident type 2 diabetes mellitus.MethodsA total of 17,280 (mean age, 48.1±8.2 years) Korean adults who underwent medical check-ups were included. The mean follow-up duration was 5.5±0.5 years. Body compositions were assessed using a bioelectrical impedance analysis. Four body composition phenotypes were defined using the median of appendicular skeletal muscle mass (ASM) index and fat mass index: low muscle/low fat (LM/LF); high muscle (HM)/LF; LM/high fat (HF); and HM/HF groups.ResultsOf the individuals in the LM/LF or HM/HF groups, over 60% remained in the same group, and over 30% were moved to the LM/HF group. Most of the LM/HF group remained in this group. In the baseline HM/LF group, approximately 30% stayed in the group, and the remaining individuals transitioned to the three other groups in similar proportions. Incident diabetes was significantly lower in participants who remained in the HM/LF group than those who transitioned to the LM/LF or LM/HF group from the baseline HM/LF group in men. ASM index was significantly associated with a decreased risk for incident diabetes in men regardless of obesity status (adjusted odds ratio [OR], 0.71 per kg/m2; 95% confidence interval [CI], 0.52 to 0.97 in non-obese) (adjusted OR, 0.87; 95% CI, 0.77 to 0.98 in obese) after adjusting for other strong risk factors (e.g., baseline glycosylated hemoglobin and homeostasis model assessment of insulin resistance).ConclusionMaintenance of ASM may be protective against the development of type 2 diabetes mellitus in men, regardless of obesity status.

Relationships Among Limb Circumferences and Appendicular Muscle and Fat Masses Using Bioelectrical Impedance Analysis

Background: Sarcopenia, the loss of muscle mass due to aging, results in falls, fractures, and the onset of frailty. Calf circumference is positively associated with appendicular muscle mass and lower muscle mass is useful for determining the existence and extent of sarcopenia. Circumference is easily and quickly determined with a tape measure, although it has been reported that the length of circumference is affected by subcutaneous fat. Till date, not many studies have studied the effect of limb circumference on appendicular muscle and fat mass using bioelectrical impedance analysis. This study aimed to clarify the relationship between circumference of upper arm, forearm, thigh, and calf and appendicular muscle and fat mass using bioelectrical impedance analysis. Methods: We recruited seventy-four healthy young men and women [age: 20–22 years (mean; 21.2 ± 0.6)]. Circumference of the right and left upper arm, forearm, thigh, and calf were measured using a tape measure. Appendicular muscle and fat mass were estimated using segmental multifrequency bioelectrical impedance analysis. Correlation and regression analysis were used for estimating the association of appendicular muscle and fat mass with limb circumference. Results: Limb circumference and appendicular muscle mass in men were significantly higher than those in women (P 0.05). Circumference of right and left upper arm, forearm, thigh and calf were significantly related to appendicular muscle mass and the independent explanators of appendicular muscle mass in multiple regression analysis adjusted for sex (P < 0.001). Right and left upper arm, forearm, thigh and calf circumferences were also significantly associated with appendicular fat mass (P < 0.001). Right and left forearm circumferences had the lowest correlation with appendicular fat mass (P

Cross-Sectional and Longitudinal Association between Glycemic Status and Body Composition in Men: A Population-Based Study.

This study sought to evaluate the associations between changes in glycemic status and changes in total body (TB), trunk, and appendicular fat (FM) and lean mass (LM) in men. A population-based study of men aged 20–66 years at baseline were included in cross-sectional (n = 430) and three-year longitudinal (n = 411) analyses. Prediabetes was defined as fasting glucose 100–125 mg/dL. Type 2 diabetes (T2D) was determined by: self-reported diabetes, current anti-diabetic drug use (insulin/oral hypoglycemic agents), fasting glucose (≥126 mg/dL), or non-fasting glucose (≥200 mg/dL). Body composition was evaluated by dual-energy X-ray absorptiometry. Longitudinal analyses showed that changes in TB FM and LM, and appendicular LM differed among glycemic groups. Normoglycemic men who converted to prediabetes lost more TB and appendicular LM than men who remained normoglycemic (all, p < 0.05). Normoglycemic or prediabetic men who developed T2D had a greater loss of TB and appendicular LM than men who remained normoglycemic (both, p < 0.05). T2D men had greater gains in TB FM and greater losses in TB and appendicular LM than men who remained normoglycemic (all, p < 0.05). Dysglycemia is associated with adverse changes in TB and appendicular LM.

Association between 25-Hydroxyvitamin D Status and Components of Body Composition and Glucose Metabolism in Older Men and Women.

Obesity and sarcopenia are major causes of morbidity and mortality among seniors. Vitamin D deficiency is very common especially among seniors and has been associated with both muscle health and obesity. This study investigated if 25-hydroxyvitamin D (25(OH)D) status is associated with body composition and insulin resistance using baseline data of a completed RCT among relatively healthy community-dwelling seniors (271 seniors age 60+ years undergoing elective surgery for unilateral total knee replacement due to osteoarthritis). Cross-sectional analysis compared appendicular lean mass index (ALMI: lean mass kg/height m2) and fat mass index (FMI: fat mass kg/height m2) assessed by DXA and insulin resistance between quartiles of serum 25(OH)D concentration using multivariable linear regression adjusted for age, sex, smoking status, physical activity, and body mass index (BMI). Participants in the lowest serum 25(OH)D quartile (4.7–17.5 ng/mL) had a higher fat mass (9.3 kg/m2) compared with participants in the third (8.40 kg/m2; Q3 = 26.1–34.8 ng/mL) and highest (8.37 kg/m2; Q4 = 34.9–62.5 ng/mL) quartile (poverall = 0.03). Higher serum 25(OH)D quartile status was associated with higher insulin sensitivity (poverall = 0.03) and better beta cell function (p = 0.004). Prevalence of insulin resistance tended to be higher in the second compared with the highest serum 25(OH)D quartile (14.6% vs. 4.8%, p = 0.06). Our findings suggest that lower serum 25(OH)D status may be associated with greater fat mass and impaired glucose metabolism, independent of BMI and other risk factors for diabetes.

Knee extension rate of velocity development affects walking performance differently in men and women.

Acceleration capacity affects physical function, but whether it differentially affects men versus women or weak versus strong individuals is less known. We investigated whether knee extension rate of velocity development (RVD, a measure of acceleration) is associated with walking performance independent of peak torque and whether the relationships differ in men versus women and in weak versus strong individuals. Relationships of RVD with walking performance were assessed in 326 women and 365 men aged 26-96 years enrolled in the Baltimore Longitudinal Study of Aging. Tests included knee extension peak torque and RVD assessed during a 180°·s-1 isokinetic strength test and four walking performance measures (usual-paced and fast-paced 6 m walks and 2.5 min usual-paced and 400 m fast-paced walks). Sex-stratified linear regression models were adjusted for age, race, height, appendicular lean mass, fat mass, peak torque, knee pain, and RVD*peak torque interaction. In men, RVD was not independently associated with any walking performance measure (p > 0.05), and, for the 6 m-usual walk only, there was a significant RVD*peak torque interaction (p < 0.0001). In women, RVD was independently associated with usual-paced walks (p < 0.05) and there were significant RVD ∗ peak torque interactions for all measures. Strength-specific analyses indicated that RVD was most associated with performance among weaker individuals. RVD is associated with walking performance in women, but less in men, and is most related to performance when strength is low. Strategies to accomplish motor tasks may be sex-specific. Future studies are needed to understand the mechanisms underlying such sex differences.

The impact of DXA-derived fat-free adipose tissue on the prevalence of low muscle mass in older adults.

To investigate the impact of eliminating fat-free adipose tissue (aFFAT) on the prevalence of low muscle mass in older adults. Three hundred and forty-three (153 men and 190 women) well-functioning Japanese older adults (aged 65-79) had their appendicular lean mass (aLM) and appendicular fat mass (aFM) measured using dual-energy X-ray absorptiometry (DXA). aFFAT was then estimated from DXA-derived aFM (aFM = (FM/0.15)*0.85). Both traditional cutoffs and those corrected for aFFAT were used for diagnosing low muscle mass. With traditional cutoff values, the prevalence of low muscle mass using the unadjusted aLM index was 20.1%. After adjusting the aLM index for aFFAT, the prevalence increased to 49.0% (p < 0.001). However, when the cutoff values were also adjusted for aFFAT, the prevalence of low muscle mass only increased to 23.0% (p < 0.001). Further, ~5% of the participants (7 men and 8 women) were newly classified as having low muscle mass after correction for aFFAT. However, several women (n = 5) were not classified as having low muscle mass using the corrected cutoff value, although they would have been when using the non-corrected cutoff. Adjusting for the effect of aFFAT on DXA-derived aLM significantly increases the prevalence of low muscle mass in older adults. For clinical research and practice, the influence of aFFAT on DXA-derived aLM may need to be taken into consideration when diagnosing low muscle mass.

Nutritional intervention in patients with juvenile systemic lupus erythematosus: protective effect against the increase in fat mass.

Patients with juvenile systemic lupus erythematosus (JSLE) usually have an increase in fat mass and decrease in lean body mass. The purpose of this study was to assess the effect of a nutritional intervention on changes in body composition and food consumption of adolescents with JSLE compared with a control group and its variation over time and to assess the association of total fat mass with clinical parameters. This randomized controlled study evaluated 31 girls. Body composition and food intake were evaluated at baseline. The patients were randomly allocated into a nutritional intervention group and a control group. The intervention group received monthly nutritional guidelines for 9months. After this period, evaluations were repeated. The carbohydrates intake decreased in the intervention group compared with the control group (p = 0.031) at the end of the study period. Additionally, a significant decrease was observed in the intake of energy (p = 0.023), carbohydrates (p = 0.031), protein (p = 0.024), total fat (p = 0.027), saturated fat (p = 0.012), and trans fat (p = 0.029) in the intervention group between baseline and the end of the study. There was an average increase of 3.7kg (95% CI 0.8-6.5) in the total fat mass (p = 0.013) and 0.36kg/m2 (95% CI 0.10-0.62) in the appendicular fat mass (p = 0.007) in the control group during the study period; this finding was not observed in the intervention group. A 9-month nutritional intervention in JSLE patients improved their eating habits and protected against the excessive gain of weight and body fat.

The Adiponectin Paradox in the Elderly: Associations With Body Composition, Physical Functioning, and Mortality.

To determine if adiponectin levels are associated with weight loss, low muscle mass, and physical functioning among the elderly and to determine independent associations with incident disability and death. Included were 3,044 participants from the Health, Aging and Body Composition Study, who had whole-body dual energy absorptiometry performed to evaluate appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI, kg/m2), computed tomography measures of thigh muscle density, weight histories, estimates of physical functioning, and adiponectin levels at enrollment. Associations between adiponectin levels and body composition, weight loss, and physical functioning were assessed in multivariable linear regression models. Associations between adiponectin and incident disability and mortality were assessed in mediation analyses, adjusting for other factors. Greater adiponectin at baseline was independently associated with low FMI Z-score, lower waist circumference, low ALMI Z-score, low muscle density, a history of weight loss, and poor physical functioning (all p < .05). Greater adiponectin levels (per SD) were associated with incident disability [HR: 1.14 (1.08, 1.20), p < .001] and greater mortality [HR: 1.17 (1.10, 1.25), p < .001] in models adjusting for demographic factors, adiposity, and comorbid conditions. The association was completely attenuated and no longer significant (all p > 0.05) when adjusting for body composition, muscle density, weight loss, and physical functioning at baseline. Greater serum adiponectin levels are associated with historical weight loss, low skeletal muscle mass, low muscle density, and poor physical functioning. High adiponectin is associated with a greater risk of incident disability and death, but not independently of these factors.

Within-day protein distribution does not influence body composition responses during weight loss in resistance-training adults who are overweight

Background: Emerging research suggests that redistributing total protein intake from 1 high-protein meal/d to multiple moderately high-protein meals improves 24-h muscle protein synthesis. Over time, this may promote positive changes in body composition.Objective: We sought to assess the effects of within-day protein intake distribution on changes in body composition during dietary energy restriction and resistance training.Design: In a randomized parallel-design study, 41 men and women [mean ± SEM age: 35 ± 2 y; body mass index (in kg/m2): 31.5 ± 0.5] consumed an energy-restricted diet (750 kcal/d below the requirement) for 16 wk while performing resistance training 3 d/wk. Subjects consumed 90 g protein/d (1.0 ± 0.03 g · kg-1 · d-1, 125% of the Recommended Dietary Allowance, at intervention week 1) in either a skewed (10 g at breakfast, 20 g at lunch, and 60 g at dinner; n = 20) or even (30 g each at breakfast, lunch, and dinner; n = 21) distribution pattern. Body composition was measured pre- and postintervention.Results: Over time, whole-body mass (least-squares mean ± SE: -7.9 ± 0.6 kg), whole-body lean mass (-1.0 ± 0.2 kg), whole-body fat mass (-6.9 ± 0.5 kg), appendicular lean mass (-0.7 ± 0.1 kg), and appendicular fat mass (-2.6 ± 0.2 kg) each decreased. The midthigh muscle area (0 ± 1 cm2) did not change over time, whereas the midcalf muscle area decreased (-3 ± 1 cm2). Within-day protein distribution did not differentially affect these body-composition responses.Conclusion: The effectiveness of dietary energy restriction combined with resistance training to improve body composition is not influenced by the within-day distribution of protein when adequate total protein is consumed. This trial was registered at clinicaltrials.gov as NCT02066948.

Muscle Deficits in Rheumatoid Arthritis Contribute to Inferior Cortical Bone Structure and Trabecular Bone Mineral Density.

Rheumatoid arthritis (RA) is associated with muscle loss, osteoporosis, and fracture. We examined associations between skeletal muscle mass, strength, and quality and trabecular and cortical bone deficits in patients with RA and healthy controls. Participants, ages 18-75 years, completed whole-body dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT) of the tibia to quantify appendicular lean mass and fat mass indices (ALMI, FMI), muscle density at the lower leg, trabecular bone density, and cortical bone thickness. Age-, sex-, and race-specific Z scores were calculated based on distributions in controls. Associations between body composition and pQCT bone outcomes were assessed in patients with RA and controls. Linear regression analyses assessed differences in bone outcomes after considering differences in body mass index (BMI) and body composition. The sample consisted of 112 patients with RA (55 men) and 412 controls (194 men). Compared to controls, patients with RA had greater BMI Z score (p < 0.001), lower ALMI Z score after adjustment for FMI (p = 0.02), lower muscle strength Z score (p = 0.01), and lower muscle density Z score (p < 0.001). Among RA, ALMI Z scores were positively associated with trabecular density [β: 0.29 (0.062-0.52); p = 0.01] and cortical thickness [β: 0.33 (0.13-0.53; p = 0.002]. Associations were similar in controls. Bone outcomes were inferior in patients with RA after adjusting for BMI, but similar to controls when adjusting for body composition. Radiographic damage and higher adiponectin levels were independently associated with inferior bone outcomes. Patients with RA exhibit deficits in cortical bone structure and trabecular density at the tibia and a preserved functional muscle-bone unit. A loss of mechanical loading may contribute to bone deficits.

Prediction and Validation of DXA-Derived Appendicular Fat-Free Adipose Tissue by a Single Ultrasound Image of the Forearm in Japanese Older Adults.

To develop regression-based equations for estimating dual-energy x-ray absorptiometry (DXA) derived appendicular fat-free adipose tissue (FFAT) using a single ultrasound image in the forearm, and to investigate the validity of those equations to calculate FFAT-free appendicular lean mass (aLM-minus-FFATappendicular ) in 311 Japanese adults aged 60 to 79 years. Subjects were randomly separated into two groups: 215 in the model-development group (91 men and 124 women) and 96 in the cross-validation group (42 men and 54 women). Appendicular fat mass and aLM were measured by the DXA, and subcutaneous adipose tissue (AT-forearm) and muscle (MT-ulna) thicknesses were measured by ultrasound. Appendicular FFAT was calculated based on the results of a previous study (appendicular FFAT = appendicular fat mass/0.85 x 0.15). The aLM was estimated from MT-ulna using a previously published equation (aLM = 4.89 x MT-ulna x body height - 9.15). Stepwise linear regression analysis was used to determine predictive models for DXA-derived appendicular FFAT from AT-forearm, sex, age, and anthropometrical variables. The best ultrasound prediction equation for estimation of appendicular FFAT was developed and then cross-validated in a subsample of older adults. There was no significant difference between the DXA-derived and ultrasound-predicted aLM-minus-FFATappendicular . A strong correlation was observed between the DXA-derived and ultrasound-predicted aLM-minus-FFATappendicular (r = 0.935, P < .001). Bland-Altman analysis did not indicate a bias in the prediction of the aLM-minus-FFATappendicular for the validation group. Our results indicated that a single ultrasound forearm measurement can be used to accurately estimate DXA-derived aLM-minus-FFATappendicular in Japanese older adults, which may be advantageous for community-based physical examinations.

Estimation of Skeletal Muscle Mass Relative to Adiposity Improves Prediction of Physical Performance and Incident Disability.

We assessed the discrimination of lean mass estimates that have been adjusted for adiposity for physical functioning deficits and prediction of incident disability. Included were 2,846 participants from the Health, Aging and Body Composition Study with available whole-body dual energy absorptiometry measures of appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI, kg/m2). Age-, sex-, and race-specific Z-Scores and T-Scores were determined by comparison to published reference ranges. ALMI values were adjusted for FMI (ALMIFMI) using a novel published method. Sex-stratified analyses assessed associations between lean mass estimates and the physical performance score, ability to complete a 400-meter walk, grip strength, and incident disability. Dichotomized definitions of low lean for age and sarcopenia were examined and their performance compared to the ALM-to-BMI ratio. Compared to ALMI T-Scores and Z-Scores, the ALMIFMI scores demonstrated stronger associations with physical functioning, and were similarly associated with grip strength. Greater FMI Z-Scores and T-Scores were associated with poor physical functioning and incident disability. Definitions of low lean for age and sarcopenia using ALMIFMI (compared to ALMI) better discriminated those with poor physical functioning and a greater risk of incident disability. The ALM-to-BMI ratio was modestly associated with grip strength and physical performance, but was not associated with completion of the 400-meter walk or incident disability, independent of adiposity and height. Estimation of skeletal muscle mass relative to adiposity improves correlations with physical performance and prediction of incident disability suggesting it is an informative outcome for clinical studies.

The Combyn™ ECG: Adding haemodynamic and fluid leads for the ECG. Part II: Prediction of total body water (TBW), extracellular fluid (ECF), ECF overload, fat mass (FM) and “dry” appendicular muscle mass (AppMM)

Simultaneous with a 12 channel ECG, body composition was analysed by segmental multi-frequency impedance analysis in 101 healthy subjects and in 118 patients with chronic heart failure (CHF, n= 40), chronic renal failure with haemodialysis (HD, n= 20), and miscellaneous internal diseases (n= 58). Whole body DXA and sodium bromide dilution were used as reference methods for total body water (TBW), extracellular fluid (ECF), appendicular muscle mass (AppMM) and fat mass (FM). Empirical prediction equations were developed in a randomized evaluation sample and then evaluated in unknowns. TBW, ECF, AppMM and FM could be predicted with regression coefficients of 0.96, 0.90, 0.95 and 0.93, respectively, all with p< 0.001. Only segmental impedances and height, but not age, sex, weight and BMI contributed to the prediction of water compartments. About half the patients with CHF and half of those on HD showed increased ECF/ICF ratio in relation to % FM at the legs but not at the thorax. The predicted AppMM was additionally corrected for increased ECF to determine “dry AppMM”, which is markedly lower than the misleading reference DXA.This methodology shows promise as a combination of routine ECG with measurement of body composition, assessment of sarcopenia and detection of overhydration.