Duel-energy X-ray Absorptiometry Research Articles

Applications of Body Imaging Techniques in Clinical Practice and Biomedical Research: An Overview

Background: Applications of imaging technology modalities have accumulated evidence that individual components of body composition (BC) have significant influences on chronic disease onset, disease progression, treatment responses and health outcomes. Objective: To analyse the currently available body imaging techniques and their applications in clinical practice and medical research. Methods: To review the various body imaging techniques and their applications in clinical practice and medical research, Medline, PubMed, Google scholar, ResearchGate and other databases were searched. Furthermore, references of selected studies and documents available in different libraries were also searched. Findings: Imaging modalities have provided a systematic method for differentiating phenotypes of BC that diverge from normal, i.e. having low bone mass (osteopenia/osteoporosis), low muscle mass (sarcopenia), high fat mass (obesity), or high fat with low muscle mass (sarcopenic obesity). Tremendous advances were made over the past decades in the sensitivity and quality of imaging techniques such as Duel-Energy X-Ray Absorptiometry (DXA), Computed Axial Tomography (CT), Ultrasound (US), Magnetic Resonance Imaging (MRI), Magnetic Resonance Spectroscopy (MRS), Positron Emission Tomography (PET), Bioelectrical Impedance Analysis (BIA) etc. These imaging techniques have been useful to differentiate layers or depots within tissues and cells enhancing our understanding of distinct mechanistic, metabolic and functional roles of BC within human phenotypes. Conclusion: In the present overview, we focused on DXA, CT and US for the use in clinical practice and biomedical research relevant to future investigation of human BC and how they may be applied to remedy the pandemic of obesity, diabetes and metabolic syndrome. Bangladesh Med Res Counc Bull 2021; 47(2): 103-109

Acute Effects Of A Single Bout Of Exercise On Intrahepatic And Intramyocellular Triglyceride In Obese Individuals With Nafld

High amounts of intrahepatic triglyceride (IHTG) and intramyocellular triglyceride (IMTG) are common metabolic complications associated in obese individuals with Non-alcoholic fatty liver disease (NAFLD). Caloric restriction is often prescribed to treat NAFLD, however, the effects of aerobic exercise in reducing IHTG and IMTG is unknown. PURPOSE: The aim of this study was to evaluate the effect of a single bout of the aerobic exercise on IHTG and IMTG content obese individuals with NAFLD. METHODS: Ten obese people (Means ± SD, Age 45.2 ± 5.2 years, BMI = 38.1 ± 4.6 kg/m2) with NAFLD performed a single bout of aerobic exercise (60 minutes at 50% of V02max) on a motor driven treadmill. Magnetic resonance spectroscopy was used to evaluate IHTG and IMTG content before and immediately after the exercise bout. IMTG was evaluated from the soleus muscle. Duel Energy X-ray Absorptiometry (DXA) was used to measure body weight and percent body fat. RESULTS: A single bout of aerobic exercise resulted in a significant (p < 0.05) decrease in IHTG from before (15.0 ± 1.8%) to after (12.2 ± 1.2%) the exercise bout. IMTG significantly (p < 0.05) decreased from before (3.2 ± 0.7%) to after (1.5 ± 0.8%) the single exercise bout. As expected there was no significant change in body weight (104.1 ± 3.2 kg and 103.9 ± 3.3 kg) or percent body fat (30.0 ± 2.0% and 30.2 ± 2.1%) before and after the exercise bout. CONCLUSION: Performing even a single bout of aerobic exercise reduces IHTG and IMTG obese persons with NAFLD.

Early migration of stemless and stemmed humeral components after total shoulder arthroplasty for osteoarthritis\u2014study protocol for a randomized controlled trial

BackgroundGlenohumeral osteoarthritis can, in the most severe cases, require surgery with insertion of a shoulder arthroplasty. A design with a stem in the humeral bone canal is currently regarded as the standard treatment option in patients who have an intact rotator cuff function, but complications related to the stem including humeral fractures can have devastating consequences. By using a stemless humeral component, stem-related complications can be reduced. The aim of this study is to compare the Comprehensive Nano stemless total shoulder arthroplasty (intervention group) with the Comprehensive stemmed total shoulder arthroplasty (control group).Materials and methodsThis is a randomized controlled trial comparing the stemless and the stemmed total shoulder arthroplasty. All Danish citizens with glenohumeral osteoarthritis indicating a total shoulder arthroplasty referred to the orthopedic department at Copenhagen University Hospital in Herlev/Gentofte will be offered participation. The following exclude from participation: below 18 years of age, cognitive or linguistic impairment, insufficient function of the rotator cuff, poor bone quality, and ASA groups 4–5. A total of 122 patients will be included of which 56 will be part of a radiostereometric analysis (RSA) study of humeral component migration. The primary outcomes are magnitude of migration of the humeral component assessed by RSA and patient-reported outcome by Western Ontario Osteoarthritis of the Shoulder index (WOOS). The secondary outcomes are additional patient-reported outcomes, functional outcome, readmission, complications, revisions, and changes in bone mineral density (BMD) of the proximal humerus assessed by duel energy x-ray absorptiometry (DXA) and economy (cost-utility analysis). The patients are examined before the operation and 3, 6, 12, and 24 months postoperative.DiscussionTo our knowledge, RSA has never been used to access migration of a stemmed or a stemless humeral component nor has the stemmed and the stemless humeral component been compared with regard to pain relief and shoulder function in a randomized clinical trial. Today, the two designs are considered equal in the treatment of osteoarthritis. The study will provide surgeons and patients with information about shoulder arthroplasty for osteoarthritis and assist them in decision-making.Trial registrationClinicalTrials.gov NCT04105478. Registered on 25 September 2019

Bone Densitometry in a Cohort of Egyptian Children with Steroid Sensitive Nephrotic Syndrome.

Introduction Nephrotic syndrome is one of the most frequent glomerular diseases among children. Steroid therapy is still the standard treatment of this disease. Aim of the Study This study aims to assess bone density in children with steroid sensitive nephrotic syndrome (SSNS) and to correlate the degree of bone density affection to steroid dose and duration. Methods Fifty children with SSNS [25 steroid dependent/ frequent relapsing (SDNS/FRNS) and 25 infrequently relapsing (IFRNS) patients] were assessed clinically and laboratory. Bone mineral density (BMD) was measured to all included patients by Duel energy X-ray absorptiometry. Results BMD abnormality is significantly increased in SDNS/FRNS group than IFRNS group (p = 0.0001). BMD Z score negatively correlated with relapse frequency-/year [p = 0.001 and correlation coefficient (CC) = -0.586]. Bone ache was the only significant complaint in patients with abnormal BMD (p = 0.004). Significant negative correlation was found between BMD Z score and each of serum alkaline phosphatase (ALP) level and Levamisol therapy duration (p 8329.4 mg/m2 with sensitivity of 85% and specificity of 96.67% and area under curve (AUC) of 0.92. Conclusion Impaired BMD in SSNS children significantly correlates with frequency of relapses, serum alkaline phosphatase level, Levamisol therapy duration, steroid doses and duration. At a cumulative steroid dose > 8329.4 mg/m2, BMD impairment is predicted with sensitivity 85% and specificity 97%.

Changes in total body surface area and the distribution of skin surfaces in relation to body mass index.

A correct estimation of total burn surface area is important since it is used for determining fluid resuscitation volumes, nutritional estimates and hospital admission criteria. Wallace's rule of nines is the most commonly used methods for this purpose. However, fat distribution is non-uniform and the total body surface area changes with obesity. The aim of this study was to determine if the rule of nines applies to all body mass index groups. A total of 217 individuals were included in the study. The patients were divided into 4 groups according to their BMI (18.5-25kg/m2 (60 persons)), 25-29.9kg/m2 (61 individuals)), 30-34.9kg/m2 (55 persons)), >35kg/m2 (41 persons)). Each patient underwent a complete duel-energy X-ray absorptiometry body scan to determine the surface area (cm2) of the various regions of the body. We found no statistically significant variations between the Wallace body percentage distributions and our results in the men for all BMI ranges (head p=0.331, arms p=0.861, legs p=0.282, trunk p=0.696). In contrast, among women we found a statistically significant change in body surface area percentage distribution between the BMI groups and specific body regions (head p=0.000, legs p=0.000 and trunk p=0.001). The Wallace rule of nines is a quick and acceptable method for estimating the total burn surface area percentage in men of all BMI ranges. However, for women, a more accurate method of burn area estimation is required as proposed by our BMI adjusted charts.

Assessment of Bone Mineral Density in Nonalcoholic Steatohepatitis Cirrhosis

Background: Cirrhosis is characterized by diffused hepatic fibrosis and nodule formation that can occur at any age. It has significant morbidity and mortality. Worldwide common causes of cirrhosis are viral hepatitis (hepatitis B virus and hepatitis C virus), prolonged excessive alcohol intake and nonalcoholic fatty liver disease (NAFLD). Progression of chronic liver disease (CLD) and deterioration of liver function are associated with various hepatic complications. Hepatic osteodystrophy is an important extrahepatic manifestation of advanced liver disease with features of classical osteoporosis and an increased risk for fractures. The objective of the study to assess the bone mineral density (BMD) by duel energy x-ray absorptiometry (DEXA) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis of liver.&#x0D; Patients and Methods: A cross sectional observational study was carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, Dhaka, from July, 2016 to June, 2017. This study included the diagnosed cases of NASH cirrhosis patients presented at outpatient or inpatient department of Hepatology of BSMMU. For measurement of the BMD dual energy x-ray absorptiometry (DEXA) scan was performed by DMS Strator DR Bone densitometer at NINMAS. BMD were measured at lumbar vertebrae L1-L4 and both the femoral neck. Analysis of data from DEXA was computerized and completely automated (software 3DXA, Medix DR.) &#x0D; Results: A total of 54 participants was included and among them 27 were cirrhotic patients (cirrhotic group) &amp; 27 were non-cirrhotic patients with healthy liver (non-cirrhotic group). The age range of the patients was 40-70 years in both groups. Male to female ratio was 1:1.45. The mean age was 56.3 ± 6.7 years in cirrhotic group and 55.0 ± 6.3 years in non cirrhotic group. In cirrhotic group, 22 (66.7%) patients had low BMD and five (23.8%) patients had normal BMD. In non-cirrhotic group, 11 (33.3%) patients had low BMD and 16 (76.2%) patients had normal BMD. The difference was statistically significant (p &lt; 0.05) between two groups. Multivariate logistic regression analysis was done to see the effect of multiple independent variables (age, menopause and cirrhosis) on dependent variable (low BMD). In cirrhotic patients odds ratio (OR) was 1.961 (95% CI 0.110 to 25.893) which implies cirrhotic patients had 1.961 times greater chance to develop low BMD than non cirrhotic patients keeping all other factors in fixed level.&#x0D; Conclusion: Hepatic osteodystrophy is an important extrahepatic complication of cirrhosis. NASH cirrhosis is found among elderly people and female. Osteoporosis is common in aged people and menopausal female. But in this study it was observed that a NASH cirrhosis patient is highly significant risk factor for low BMD (osteopenia and osteoporosis) other than aged persons and menopausal females. So, special measures and monitoring should be taken regarding osteoporosis in NASH cirrhotic patient to reduce subsequent morbidity.&#x0D; Bangladesh J. Nuclear Med. 21(1): 16-20, January 2018

Aging, lifestyle factors, hormones and bone health in Singaporean men

PurposeThe present study examined how age, bodyweight, body fat, regular exercise and some endocrine factors are associated with osteoporosis, spine bone mineral density (Sbmd) and femoral neck bone mineral density (Fnbmd) in Singaporean men. MethodsBody composition and bone scans of lumbar spine at L2-L4 and hip were carried out with duel-energy X-ray absorptiometry (DXA). Anthropometric parameters were measured and demographic data, medical history and exercise schedule were collected via a questionnaire. ResultsOsteoporosis prevalence was higher and Sbmd and Fnbmd were lower in men with high percent body fat (PBF) and conversely osteoporosis prevalence was lower and Sbmd and Fnbmd were higher in men with higher body mass index (BMI). Age was negatively associated with Fnbmd but not Sbmd. On the other hand, PBF and insulin levels were negatively associated with both Sbmd and Fnbmd. Body mass index and exercise intensity were positively associated with both Sbmd and Fnbmd. Sex hormones were significantly associated with only Sbmd but not Fnbmd. Both estradiol and DHEAS were positively, while testosterone was negatively associated with Sbmd. ConclusionThe study shows that the prevalence of osteoporosis and some of the determinants of bone mineral density (BMD) in Singaporean men was site-specific. Further, BMI and PBF are opposing predictors of BMD. Therefore, any strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass. The bone health of Singaporean men is comparable to non-Hispanic whites and better than some other Asian men.

Single Bout Of Aerobic Exercise Reduces Intrahepatic And Intramyocellular Triglyceride In Obese Individuals With Nafld

High amounts of intrahepatic triglyceride (IHTG) and intramyocellular triglyceride (IMTG) are common metabolic complications associated in obese individuals with Non-alcoholic fatty liver disease (NAFLD). Caloric restriction is often prescribed to treat NAFLD, however, the effects of aerobic exercise in reducing IHTG and IMTG is unknown. PURPOSE: The aim of this study was to evaluate the effect of a single bout of the American College of Sports Medicine physical activity guidelines for adults on IHTG and IMTG content obese individuals with NAFLD. METHODS: Ten obese people (Mean ± SD, Age 45.2±5.2 years, BMI=38.1±4.6 kg/m2) with NAFLD performed a single bout of aerobic exercise (30 minutes at 50% of V02max) on a motor driven treadmill. Magnetic resonance spectroscopy was used to evaluate IHTG and IMTG content before and immediately after the exercise bout. IMTG was evaluated from the soleus muscle. Duel Energy X-ray Absorptiometry (DXA) was used to measure body weight and percent body fat. RESULTS: A single bout of aerobic exercise resulted in a significant (p<0.05) decrease in IHTG from before (16.0 ± 2.8%) to after (14.2 ± 2.2%) the exercise bout. IMTG significantly (p<0.05) decreased from before (2.2 ± 0.9%) to after (1.3 ± 0.7%) the single exercise bout. As expected there was no significant change in body weight (103.1±4.2 kg and 102.9±4.2 kg) or percent body fat (38.9±2.1% and 39.2±2.1%) before and after the exercise bout. CONCLUSION: Performing even a single bout of physical activity as recommended by the ACSM reduces IHTG and IMTG obese persons with NAFLD.

Evaluation of isometric force in lower limbs and body composition in preterm infants

Abstract Introduction Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and to evaluate the relationship between prematurity, strength and muscle mass. Material and methods Case–control study. Participants were premature 7-to-11-year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X -ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth weight ≤1500 g, 29 prematures with birth weight 1500–2000 g, and 30 controls. Results Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth weight. Conclusions Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

Effects of matching diet type to obesity-related genotype on body composition changes in women during a six-month resistance-exercise training and walking program

Methods Fifty sedentary, obese women (41.6 ± 12 yrs, 35.4 ± 8 kg/ m) were assigned to diet groups based on five obesityrelated genetic variants from four genes prominently associated with obesity (FABP2, PPARG, ADRB2, ADRB3). Participants were either truly matched (T) to their diet group based on genotype (n = 28) or falsely matched (F) based on genotype (n = 22). Prescribed diets consisted of 1,500 kcal/d and included carbohydrate:fat: protein percentages of 30:25:45 (H) or 20:35:45 (L). Participants performed a supervised circuit-style resistanceexercise program four days/week and a walking program consisting of 10,000 steps/day, three days/week. Body weight and duel energy X-ray absorptiometry (DXA) body composition measures were obtained at baseline, 4, 8, 12, 16, 20, and 24 weeks. Data were analyzed by MANOVA, with baseline body weight and body composition values used as covariates to normalize baseline differences between groups. Data are presented as changes from baseline at each time point, respectively. Results MANOVA revealed an overall Wilks’ Lamda time effect (p < 0.001) with no significant time by diet (p = 0.51), time × gene type (0.84), or time × diet × gene type (0.81) effects observed. Univariate analysis revealed that the exercise and diet interventions promoted significant reductions in weight (-5.36 ± 5.0 kg, p < 0.001), fat mass (-4.53 ± 3.6 kg, p < 0.001), and body fat (-2.88 ± 2.7 %, p < 0.001) with a trend toward a reduction in fat free mass (-0.65 ± 2.3 kg, p < 0.071). When baseline body weight and DXA body composition variables were used as covariates, Wilks’ Lambda time × diet (p = 0.098) tended to differ, a time × gene type interaction was observed (p = 0.011), while no differences were seen in time × diet × gene type (p = 0.18). Univariate analyses revealed some trends in time × diet changes in weight (H -2.03 ± 1.7, -3.13 ± 2.6, -4.17 ± 3.3, -4.62 ± 4.0, -4.75 ± 4.6, -4.41 ± 5.1; L -2.47 ± 1.8, -3.66 ± 2.4, -4.56 ± 3.1, -5.49 ± 3.9, -5.89 ± 4.5, -6.17 ± 4.8 kg, pq = 0.02), fat mass (H -1.53 ± 1.4, -2.67 ± 2.3, -3.63 ± 2.5, -3.73 ± 2.8, -4.14 ± 3.6, -3.95 ± 3.6; L -1.31 ± 1.6, -2.66 ± 2.2, -3.22 ± 2.5, -4.32 ± 2.9, -4.60 ± 3.0, -5.03 ± 3.7 kg, pq = 0.10), FFM (H -0.49 ± 1.2, -0.58 ± 1.5, -0.52 ± 1.8, -0.68 ± 2.4, -0.51 ± 2.2, -0.31 ± 2.3; L -0.95 ± 1.5, -0.73 ± 1.9, -1.20 ± 1.9, -0.86 ± 2.0, -1.03 ± 2.6, -0.94 ± 2.4 kg, p = 0.14), or body fat (H -0.50 ± 1.9, -1.51 ± 1.8, -2.32 ± 2.2, -2.22 ± 2.0, -2.68 ± 2.5, -2.65 ± 2.3; L -0.46 ± 1.5, -1.55 ± 2.1, -1.67 ± 2.4, -2.56 ± 2.5, -2.78 ± 2.7, -3.08 ± 3.0 %, pq = 0.13) generally in favor of the more carbohydrate restricted diet. Some trends were also seen in time × gene type changes in weight (T -2.06 ± 1.8, -2.91 ± 2.6, -3.99 ± 3.3, -4.83 ± 4.0, -5.07 ± 4.6, -5.15 ± 5.1; F -2.54 ± 1.7, -4.05 ± 2.2, -4.88 ± 2.9, -5.43 ± 3.8, -5.73 ± 4.6, -5.62 ± 5.0 kg, p = 0.20), Exercise & Sport Nutrition Lab, Texas A&M University, College Station, TX, USA Full list of author information is available at the end of the article Coletta et al. Journal of the International Society of Sports Nutrition 2015, 12(Suppl 1):P16 http://www.jissn.com/content/12/S1/P16

Valoración de fuerza isométrica en extremidades inferiores y composición corporal en prematuros

IntroductionStrength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass. Material and methodsCase-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls. ResultsWeight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight. ConclusionsBetween 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

Short Duration of Sleep Is Associated with Hyperleptinemia in Taiwanese Adults

Higher plasma levels of leptin have been associated with increased cardiometabolic risk. The aim of this study was to investigate the association between short duration of sleep and hyperleptinemia in Taiwanese adults. We examined the association between duration of sleep and hyperleptinemia in 254 men and women recruited from the physical examination center at a regional hospital in southern Taiwan. Hyperleptinemia was defined as a plasma leptin level of 8.13 ng/mL and above. Short sleep duration was defined as < 6.5 h/day. Multiple logistic regression analysis was used to assess the association between short duration of sleep and hyperleptinemia. In females, short duration of sleep (< 6.5 h/day; OR = 2.15, 95% CI = 0.99-4.78), greater hip circumference (OR = 3.00, CI = 1.13-8.78), higher percent body fat (OR = 1.75, CI = 1.07-2.95), and higher white blood cell counts (OR = 1.67, CI = 1.26-2.28) were associated with an increased risk of hyperleptinemia. In males, greater body weight was significantly associated with an increased risk of hyperleptinemia (OR = 3.55, 95% CI = 1.46-10.23). There was also a trend of association (p = 0.096) between short duration of sleep and an increased risk of hyperleptinemia (OR = 4.98, 95% CI = 0.80-42.40). In this study of healthy Taiwanese adults, short duration of sleep was significantly associated with hyperleptinemia in women, and the association was independent of adiposity.

Abdominal myosteatosis is independently associated with hyperinsulinemia and insulin resistance among older men without diabetes

Design and MethodsSkeletal muscle adipose tissue (AT) infiltration (myosteatosis) increases with aging and may contribute to the development of type 2 diabetes mellitus (T2DM). It remains unclear if myosteatosis is associated to glucose and insulin homeostasis independent of total and central adiposity. We evaluated the association between intermuscular AT (IMAT) in the abdominal skeletal muscles (total, paraspinal and psoas) and fasting serum glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in 393 non-diabetic Caucasian men aged 65+. Abdominal IMAT, visceral (VAT) and subcutaneous (SAT) AT (cm3) were measured by quantitative computed tomography at the L4-L5 intervertebral space.ResultsIn age, study site, height and muscle volume adjusted regression analyses, total abdominal and psoas (but not paraspinal) IMAT were positively associated with glucose, insulin and HOMA-IR (all P < 0.003). The associations between total abdominal and psoas IMAT and insulin and HOMA-IR remained significant after further adjusting for lifestyle factors, as well as DXA total body fat, VAT or SAT in separate models (all P <0.009).ConclusionsOur study indicates a previously unreported, independent association between abdominal myosteatosis and hyperinsulinemia and insulin resistance among older Caucasian men. These associations may be specific for particular abdominal muscle depots, illustrating the potential importance of separately studying specific muscle groups.

Su1241 Short- and Long-Term Efficacy of Tacrolimus in Patients With Refractory Ulcerative Colitis

disease (CD) or ulcerative colitis (UC)], had a measured low vit D 25 OH level ( ,30 ng/ mL), and were treated with high-dose vit D received high-dose vit D treatment (ergocalciferol 50,000 units once a week for eight weeks). Outcomes included duel-energy x-ray absorptiometry (DEXA) scan measures and repeat vit D 25 -OH level if obtained before and after high dose vit D treatment. Statistical analysis included Wilcoxon signed-rank test. Results: 52 pts with IBD (39 CD, 13 UC), low vit D 25 OH levels, and treatment with high dose vit D were identified. 34 were male (66%), and the median age was 57 (range 22, 83 yrs). 14 (27%) had one or more IBD-related surgeries. 11 were smokers (22%). 7 (13%) pts were on corticosteroids, 8 (15%) pts were on budesonide, 20 (38%) were on immunomodulator therapy, and 20 (38%) were on anti-TNF medications. 19 (37%) pts had a previous diagnosis of osteopenia, and 12 (23%) had osteoporosis. 19 (37%) were taking a bisphosphonate. 24 (46%) had documented daily non-prescription vit D supplementation. 29 pts had a DEXA scan before and after high dose vit D treatment after a median of 2.1 yrs (range 1, 6.5 yrs). Spine bone mineral density (BMD) scores improved significantly (1.05 ± 0.17 to 1.10 ± 0.20, p , 0.05). There was no significant change in BMD of the hip (0.79 ± .15 to 0.75 ± .31), and hip and spine T scores and Z scores did not change significantly. 36 pts had repeat vit D 25 OH levels checked after a median of 120 days (range 47, 964 days). Vit D 25 OH increased significantly (15.5 ± 8.4 to 29.4 ± 19.0, p , 0.05). However, 14 (36%) pts remained vit D deficient (vit D 25 OH levels , 20 ng/mL), and 8 (22%) pts remained vit D insufficient (vit D 25 OH levels 20-30 ng/mL). Persistent vit D insufficiency was not dependent on gender, surgical history, medication type, or disease type. Conclusion: In this study, the majority patients with IBD who are vit D insufficient failed to achieve normal serum vit D levels after treatment with high dose vit D, but bone health based on DEXA scan did not worsen significantly. Further research into appropriate calcium and vit D dosing in this patient population is warranted.

Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin.

BackgroundObesity is a serious disease that is associated with an increased risk of diabetes, hypertension, heart disease, stroke, and cancer, among other diseases. The United States Centers for Disease Control and Prevention (CDC) estimates a 20% obesity rate in the 50 states, with 12 states having rates of over 30%. Currently, the body mass index (BMI) is most commonly used to determine adiposity. However, BMI presents as an inaccurate obesity classification method that underestimates the epidemic and contributes to failed treatment. In this study, we examine the effectiveness of precise biomarkers and duel-energy x-ray absorptiometry (DXA) to help diagnose and treat obesity.Methodology/Principal FindingsA cross-sectional study of adults with BMI, DXA, fasting leptin and insulin results were measured from 1998–2009. Of the participants, 63% were females, 37% were males, 75% white, with a mean age = 51.4 (SD = 14.2). Mean BMI was 27.3 (SD = 5.9) and mean percent body fat was 31.3% (SD = 9.3). BMI characterized 26% of the subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by BMI, but were found to be obese by DXA. BMI misclassified 25% men and 48% women. Meanwhile, a strong relationship was demonstrated between increased leptin and increased body fat.Conclusions/SignificanceOur results demonstrate the prevalence of false-negative BMIs, increased misclassifications in women of advancing age, and the reliability of gender-specific revised BMI cutoffs. BMI underestimates obesity prevalence, especially in women with high leptin levels (>30 ng/mL). Clinicians can use leptin-revised levels to enhance the accuracy of BMI estimates of percentage body fat when DXA is unavailable.

Hypertriglyceridemia and Waist Circumference Predict Cardiovascular Risk among HIV Patients: A Cross-Sectional Study

BackgroundAlthough half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC) combined with triglyceride (TG) levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women.Methods1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT) and abdominal subcutaneous AT (SAT) were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast.ResultsThe high TG/high WC men had the most VAT (208.0±94.4 cm2), as well as the highest prevalence of metabolic syndrome (42.2%) and type-2 diabetes (16.2%), and the highest Framingham risk score (10.3±6.5) in comparison to other groups (p<0.05 for all). High TG/high WC women also had elevated VAT (150.0±97.9 cm2) and a higher prevalence of metabolic syndrome (53.3%), hypertension (30.5%) and type-2 diabetes (12.0%), and Framingham risk score(2.9±2.8) by comparison to low TG/low WC women (p<0.05 for all).ConclusionsA simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients.

Training and Detraining Effects of Low Intensity Resistance on Functional Fitness in Postmenopausal Women

PURPOSE: To investigate the changes in the body composition and functional fitness after one year of low intensity resistance training, and 24 weeks of detraining in postmenopausal women. METHODS: Sixteen healthy volunteers matched for strength were assigned to a control (n=7, age: 55.26±3.09 yrs, BMI: 23.89±5.02 kg/m2) or exercise group (n=9, age: 55.67±4.74 yrs, BMI: 23.51±5.79 kg/m2). The exercise group was instructed to a supervised progressive high repetition/ low resistance training 1 hour, 2 days per week for one year by using the elastic bands or body weight for resistance. Duel-energy X-ray absorptiometry (DXA) was used to measure subjects' body composition. The body fat, lean body mass, and senior functional fitness including flexibility, muscle strength, muscle endurance, aerobic endurance, and body agility/dynamic balance were assessed at baseline, after training and detraining. The Mann-Whitney U test was used for data analysis. RESULTS: After one year training, the exercise group demonstrated significant improvements in aerobic endurance (69%; 2-minute stepping), muscle endurance (112%; 60-second abdominal crunch), and agility/dynamic balance (11%; 8-foot up-and-go). The fat mass of trunk and the percentage of total body were significantly greater in exercise group than the control groups (p<.05). In addition, the aerobic endurance of the functional fitness, and fat mass of the leg in the exercise group were still greater than the baseline after 24 weeks of detraining, but muscle endurance, agility/dynamic balance, and flexibility declined significantly after detraining in the exercise group. CONCLUSIONS: Low intensity resistance training using elastic band can reduce body fat and improves functional physical fitness in postmenopausal women. However, the interrupting exercise has negative effects on several physical parameters of functional fitness and body composition.

The Effects Of Different Mode Of Low-intensity Exercise Training On Bone Mineral Density And Bone Metabolism In Postmenopausal Woman

PURPOSE: To investigate the effects of 12-month low-intensity resistance training using the elastic band and brisk walking on bone mineral density, body composition, and bone formation marker in postmenopausal woman. METHODS:Thirty-two postmenopausal women (49-63 yr) were assigned to resistance training group (RTG) (n=11; 55.9 ± 4.28 yrs), brisk walking group (BWG) (n=10; 53.2 ± 4.24 yrs) and control group (CG) (n=11; 54.4 ± 3.42 yrs). The training program consisted of resistance exercises using elastic bands and brisk walking for 2 sessions and one hour for each session per week. Total bone mineral density (TBMD), total bone mineral content (TBMC), lumbar spine (LS), femoral neck (FN), body fat, and lean body mass were measured at baseline and after one year training. Duel-energy X-ray absorptiometry (DXA) was used to measure subjects' body composition, regional and total bone mineral density. Serum intact N-terminal propeptide of type I collagen (PINP) and carboxyterminal telopeptide of type I collagen (ICTP) were determined as indices of bone metabolism. The statistical comparisons for the changes of different variables among the three groups were performed by applying one-way ANOVA. RESULTS: The three groups had similar BMD and BC characteristics at baseline. After the training period, there was a tendency of decline in BMD with age, and group differences change were not significant (p > 0.05) except for the spine of BWG. The BWG increased significantly in TBMC (1.4%), lumbar spine (1.3%), and PINP (12%) among groups (p<.05). In body composition, RTG showed significant decrease in body fat in the arm, leg, and total body than the other two groups (p<0.05). Leg lean mass in the walking group increased significantly than both the RTG and CG (p<0.05). CONCLUSIONS: These findings suggest that brisk walking is a medium-impact and weight-bearing exercise which is beneficial on bone mass in postmenopausal woman. Therefore, the impact of exercise training on bone metabolism may depend on the type of exercise during the early phase of training. However, the different mode of low-resistance exercises training on body composition have the different effects which is relatively site specific to the working muscle, thus, brisk walking is more beneficial on the leg and resistance training benefits more towards the whole body.

Relationship between Health Behavior Factors and Bone Mineral Density among College Students in a Health-Related Department

Purpose: The study investigated the relationship of health behavior with bone mineral density (BMD) for college students. Methods: A descriptive study was done using a convenient sampling of college students (n=116) enrolled in a health-related department. Height, weight, body mass index (BMI), health behaviors recognition of subjective health, smoking, drinking, exercise, food habits, intake of calcium, and family history of fracture were measured. BMD was measured at the right forearm using Hologic lunar duel-energy X-ray absorptiometry. Data were analyzed using descriptive analysis, t-test, ANOVA and multiple linear regression. Results: The prevalence of osteopenia and osteoporosis was 41.4% and 22.4%, respectively. Significant relationships were observed between BMD of right forearm and gender, BMI, subjective health recognition, drinking, and exercise (p

Bone mineral density in children with steroid-sensitive nephrotic syndrome

To observe the influence of prednisolone treatment on bone mineral density (BMD) in children with idiopathic nephrotic syndrome. Duel-energy X-ray absorptiometry of lumbar spine (L1-L4) was performed on 40 patients (18 first episode and 22 relapsers) of steroid sensitive idiopathic nephrotic syndrome. Patients of first episode and relapsers had comparable values of mean age, weight, height, body mass index, serum calcium, phosphate, spine area, bone mineral content (BMC) and BMD. Relapsing nephrotic syndrome patients received significantly higher mean total cumulative dose of prednisolone in comparison to first episode (p<0.001). The BMD Z-scores were normal in 39 of 40 (97.5%) patients. On regression analysis, it was found that both BMC and BMD did not correlate with cumulative dose of prednisolone, when other co-variants such as age, weight, height and spine area were adjusted. Bone mineral density in steroid sensitive nephrotic syndrome is unaffected by cumulative dose of prednisolone therapy both in first episode as well as relapser group of patients.