Effect Of Changes In Body Composition Research Articles

Sarcopenic obesity may predict worse liver regeneration after right graft living donor liver transplantation.

Sarcopenic obesity impairs the outcome after liver transplantation. The effect of this on liver regeneration has not yet been studied. The aim of this study was to evaluate the potential effect of body composition changes on liver volume gain after living donor liver transplantation. We observed liver regeneration in 100 patients who underwent living donor liver transplantation using right lobe grafts (Segments V-VIII). Liver volumetry and body composition analysis were performed based on CT images with special software. The gain of liver volume was calculated between 2 points in time considering the absolute and percentage values: before surgery and early after surgery, with a median time of 10 days. Pearson's correlation and multivariate analysis using stepwise multiple regression were used to examine the potential correlation between body composition and liver volume gain. The liver volume increase was significantly negatively correlated with adipose tissue in the body stem ( r = -0.4, p < 0.001) and positively correlated with psoas mass ( r = 0.24, p = 0.02). These results correspond with those of the multiple regression analysis, which indicated adipose tissue (ß = -1.0, p < 0.001) and psoas mass (ß = 0.12, p < 0.001). The presence of malignancy as an indication for liver transplantation was another significant independent factor negatively affecting liver growth (ß = -13.1, p = 0.046). Sarcopenic obesity predicts an impaired liver volume increase after living donation. This could worsen the postoperative outcome. The role of alimentary interventions and exercises in improving body composition and thus postoperative outcome should be evaluated through prospective interventional studies.

Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced-stage ovarian cancer.

BackgroundSarcopenia is commonly observed in patients with advanced‐stage epithelial ovarian cancer (EOC). However, the effect of body composition changes—during primary debulking surgery (PDS) and adjuvant platinum‐based chemotherapy—on outcomes of patients with advanced‐stage EOC is unknown. This study aimed to evaluate the association between body composition changes and outcomes of patients with stage III EOC treated with PDS and adjuvant platinum‐based chemotherapy.MethodsPre‐treatment and post‐treatment computed tomography (CT) images of 139 patients with stage III EOC were analysed. All CT images were contrast‐enhanced scans and were acquired according to a standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured using CT images obtained at the L3 vertebral level. Predictors of overall survival were identified using Cox regression models.ResultsThe median follow‐up was 37.9 months. The median duration between pre‐treatment and post‐treatment CT was 182 days (interquartile range: 161–225 days). Patients experienced an average SMI loss of 1.8%/180 days (95% confidence interval: −3.1 to −0.4; P = 0.01) and SMD loss of 1.7%/180 days (95% confidence interval: −3.3 to −0.03; P = 0.046). SMI and SMD changes were weakly correlated with body mass index changes (Spearman ρ for SMI, 0.15, P = 0.07; ρ for SMD, 0.02, P = 0.82). The modified Glasgow prognostic score was associated with SMI loss (odds ratio: 2.42, 95% confidence interval: 1.03–5.69; P = 0.04). The median time to disease recurrence was significantly shorter in patients with SMI loss ≥5% after treatment than in those with SMI loss <5% or gain (5.4 vs. 11.2 months, P = 0.01). Pre‐treatment SMI (1 cm2/m2 decrease; hazard ratio: 1.08, 95% confidence interval: 1.03–1.11; P = 0.002) and SMI change (1%/180 days decrease; hazard ratio: 1.04, 95% confidence interval: 1.01–1.08; P = 0.002) were independently associated with poorer overall survival. SMD, body mass index, and total adipose tissue index at baseline and changes were not associated with overall survival.ConclusionsSkeletal muscle index decreased significantly during treatment and was independently associated with poor overall survival in patients with stage III EOC treated with PDS and adjuvant platinum‐based chemotherapy. The modified Glasgow prognostic score might be a predictor of SMI loss during treatment.

Effects of a Randomized Weight Loss Intervention Trial in Obese Adolescents on Tibia and Radius Bone Geometry and Volumetric Density.

Obese adolescents have increased fracture risk, but effects of alterations in adiposity on bone accrual and strength in obese adolescents are not understood. We evaluated 12-month changes in trabecular and cortical volumetric bone mineral density (vBMD) and cortical geometry in obese adolescents undergoing a randomized weight management program, and investigated the effect of body composition changes on bone outcomes. Peripheral quantitative computed tomography (pQCT) of the radius and tibia, and whole-body dual-energy X-ray absorptiometry (DXA) scans were obtained at baseline, 6 months, and 12 months in 91 obese adolescents randomized to standard care versus behavioral intervention for weight loss. Longitudinal models assessed effects of body composition changes on bone outcomes, adjusted for age, bone length, and African-American ancestry, and stratified by sex. Secondary analyses included adjustment for physical activity, maturation, vitamin D, and inflammatory biomarkers. Baseline body mass index (BMI) was similar between intervention groups. Twelve-month change in BMI in the standard care group was 1.0 kg/m2 versus -0.4 kg/m2 in the behavioral intervention group (p < 0.01). Intervention groups were similar in bone outcomes, so they were combined for subsequent analyses. For the tibia, BMI change was not associated with change in vBMD or structure. Greater baseline lean body mass index (LBMI) associated with higher cortical vBMD in males, trabecular vBMD in females, and polar section modulus (pZ) and periosteal circumference (Peri-C) in both sexes. In females, change in LBMI positively associated with gains in pZ and Peri-C. Baseline visceral adipose tissue (VFAT) was inversely associated with pZ in males and cortical vBMD in females. Change in VFAT did not affect bone outcomes. For the radius, BMI and LBMI changes positively associated with pZ in males. Thus, in obese adolescents, weight loss intervention with modest changes in BMI was not detrimental to radius or tibia bone strength, and changes in lean, but not adiposity, measures were beneficial to bone development. © 2017 American Society for Bone and Mineral Research.

High-Dose-Rate Intraoperative Radiotherapy Combined With Neck Dissection to Salvage Isolated Cervical Nodal Recurrences

mass index (BMI) is associated with improved recovery from CRT and survival. Emerging evidence suggests that BMI may be used in conjunction with other body composition indices, including skeletal muscle and visceral adipose loss to individualize nutritional assessment and survival prognostication. This study evaluates the effect of body composition changes on survival in a population-based cohort of patients with locally advanced HNC treated with curative intent. Materials/Methods: A retrospective review was performed on 43 patients with Stage III/IV HNC treated with radical RT chemotherapy between 2007 and 2010. Preand post-treatment CT datasets encompassing the L3 vertebral body were available in 36 cases. Visceral adipose tissue and skeletal muscle cross sectional area (cm) were contoured at the L3 level with Eclipse v.10.0, using established thresholds of Hounsfield units. Pre and post treatment weight and BMI were recorded. Body composition indices analyzed included pre-treatment BMI, changes in skeletal muscle and visceral adipose tissue. Results: Median follow-up was 23.1 months. Mean disease specific survival (DSS) was 37.6 months. The average weight loss on treatment was 5.1kg. 72% of patients had acute grade 2 dysphagia and 79% had grade 2 mucositis. The median time from end of treatment to repeat CT scan was 3.1 months. Of 36 cases with preand postCT scans, the mean skeletal muscle loss was 19.5 cm and mean visceral adipose loss was 54.0 cm. Mean DSS was 38.3 months (95% CI 32.8-43.9) in patients with pretreatment BMI 25 kg/m vs. 30.2 months (95% CI 23.4-37.0) with BMI <25 kg/m (P Z NS). Mean DSS was longer in patients with post-treatment skeletal muscle loss <20 cm and visceral adipose loss <50%, but the differences were not statistically significant (Table). Conclusion: The observation of a trend toward improved survival in HNC patients with high pre-treatment BMI is consistent with other reports. Though not statistically significant, a trend toward longer survival was also observed with lower post-treatment skeletal muscle and visceral adipose loss. These preliminary findings support the plan to expand the cohort to increase sample size, calculate lean body mass based on established regression models, and correlate body composition changes with survival.

Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease: Do They Influence Patient-Related Outcomes?

Aims: The follow-up of the ECLIPSE study, a prospective longitudinal study to identify and define parameters that predict disease progression over 3 years in chronic obstructive pulmonary disease (COPD), allows the examination of the effect of body composition changes on COPD-related outcomes. Methods: Body composition and health status were established in 2,115 COPD patients, 327 smoking and 239 nonsmoking controls at baseline and 3 years, while mortality was recorded in year 2 and 3 in the COPD patients. Associations between fat free mass index (FFMI) and fat mass index (FMI) changes to deterioration in health status and mortality were determined. Results: Change in FFMI and FMI over 3 years was small and comparable between the groups. Underweight and obese patients had the worst health status. Worsening health status was associated with FFMI decrease in underweight patients and FMI increase in overweight/obese patients. While overweight patients had the lowest mortality, FFMI or FMI decrease was associated with a higher mortality. Conclusion: Changes in body composition over 3 years were small and comparable in COPD patients and control subjects. Nevertheless, muscle mass decline in underweight and fat mass increase in overweight/obese patients is associated with worsening health status. Overweight is associated with decreased mortality, but muscle mass and fat mass decline are detrimental for mortality.

Evaluating the Prognostic Impact of Lean Body Mass on Head-and-Neck Cancer Outcomes

Chemoradiation (CRT) side effects in head and neck cancers (HNC) often result in substantial weight loss. Higher body mass index (BMI) is associated with improved recovery from CRT and survival. Emerging evidence suggests that BMI may be used in conjunction with other body composition indices, including skeletal muscle and visceral adipose loss to individualize nutritional assessment and survival prognostication. This study evaluates the effect of body composition changes on survival in a population-based cohort of patients with locally advanced HNC treated with curative intent.

Patterns of Failure in Patients Treated With Intensity Modulated Radiation Therapy (IMRT) Using Helical Tomotherapy (HT) for Head-and-Neck Squamous Cell Carcinoma (HNSCC): Results of a Prospective Trial

mass index (BMI) is associated with improved recovery from CRT and survival. Emerging evidence suggests that BMI may be used in conjunction with other body composition indices, including skeletal muscle and visceral adipose loss to individualize nutritional assessment and survival prognostication. This study evaluates the effect of body composition changes on survival in a population-based cohort of patients with locally advanced HNC treated with curative intent. Materials/Methods: A retrospective review was performed on 43 patients with Stage III/IV HNC treated with radical RT chemotherapy between 2007 and 2010. Preand post-treatment CT datasets encompassing the L3 vertebral body were available in 36 cases. Visceral adipose tissue and skeletal muscle cross sectional area (cm) were contoured at the L3 level with Eclipse v.10.0, using established thresholds of Hounsfield units. Pre and post treatment weight and BMI were recorded. Body composition indices analyzed included pre-treatment BMI, changes in skeletal muscle and visceral adipose tissue. Results: Median follow-up was 23.1 months. Mean disease specific survival (DSS) was 37.6 months. The average weight loss on treatment was 5.1kg. 72% of patients had acute grade 2 dysphagia and 79% had grade 2 mucositis. The median time from end of treatment to repeat CT scan was 3.1 months. Of 36 cases with preand postCT scans, the mean skeletal muscle loss was 19.5 cm and mean visceral adipose loss was 54.0 cm. Mean DSS was 38.3 months (95% CI 32.8-43.9) in patients with pretreatment BMI 25 kg/m vs. 30.2 months (95% CI 23.4-37.0) with BMI <25 kg/m (P Z NS). Mean DSS was longer in patients with post-treatment skeletal muscle loss <20 cm and visceral adipose loss <50%, but the differences were not statistically significant (Table). Conclusion: The observation of a trend toward improved survival in HNC patients with high pre-treatment BMI is consistent with other reports. Though not statistically significant, a trend toward longer survival was also observed with lower post-treatment skeletal muscle and visceral adipose loss. These preliminary findings support the plan to expand the cohort to increase sample size, calculate lean body mass based on established regression models, and correlate body composition changes with survival.

Premature ovarian failure and body composition changes with adjuvant chemotherapy for breast cancer

Premature ovarian failure and weight gain are both common in women receiving adjuvant chemotherapy for breast cancer. The objective of this preliminary analysis was to characterize changes in weight and body composition in premenopausal women receiving adjuvant chemotherapy for early stage breast cancer and investigate whether these changes were associated with chemotherapy-induced ovarian failure (CIOF). The body composition of 43 premenopausal women with stage I or II breast cancer was measured using dual-energy x-ray absorptiometry within 4 weeks before beginning chemotherapy and after 12 months from baseline. At 12 months, the CIOF was determined using the history of amennorhea for 3 months or more and serum follicle-stimulating hormone. Of the 43 women, 30 (70%) developed CIOF by the 12-month follow-up. Significant weight gain occurred in women with and without CIOF and consisted of fat but not lean mass in the trunk and legs. In women who developed CIOF, truncal fat increased by a median of 1.8 kg (P = 0.0004), whereas truncal lean mass decreased by 0.6 kg (P = 0.02). Women who retained ovarian function gained a median of 0.9 kg (P = 0.06) in truncal fat with no significant change in truncal lean mass. Women with CIOF tended to lose lean mass. Loss of total body lean mass was directly correlated with the decrease in bone density as measured by bone mineral density at the femoral neck (Spearman correlation coefficient, 0.4; P = 0.03). Energy intake decreased similarly in women with and without CIOF (-184 vs -290 kcal, respectively; P = 0.77). The results of this small preliminary analysis suggest that body composition changes in women receiving adjuvant chemotherapy for breast cancer include an increase in fat mass in the trunk and leg regions without an increase in fat-free mass. Future research with a larger study cohort and longer follow-up is needed to further investigate the role of CIOF in body composition changes in women with breast cancer. Further research is also needed to evaluate the potential effects of body composition changes on breast cancer outcomes.

Hormones and body composition in humans: clinical studies.

Leptin in relation to body fat and hormonal regulation of body fat distribution will be treated. Leptin circulating levels are strongly related to the percentage of body fat and in women leptin values are always twofold those observed in men. A role of androgens has been suggested to explain this gender difference. Insulin resistance may contribute to the wide variation in leptin levels. Leptin levels and insulin resistance are increased at the end of pregnancy and normalize after delivery. Furthermore, insulin resistance is associated with elevated plasma leptin levels independent of body fat mass and leptin levels are significantly related to insulin sensitivity independent of BMI. Energy restriction can strongly influence leptin levels, overcoming the effects of body composition changes. The shift from a state of triglycerides storage to a state of release could down-regulate leptin production. Triglyceride flux at the intra-abdominal level depends on the balance between insulin and corticosteroids, which have liposynthetic activity, and between sexual and growth hormones, which have lipolytic activity. Both hormonal and body composition change with ageing, primarily due to a decrease in lipolytic activity, with consequent prevalence of liposynthesis and visceral fat accumulation. Enlargement of intra-abdominal adipose cells is more gradual in men and more abrupt in women after menopause.

The Effects of Body Composition Changes to Observed Improvements in Cardiopulmonary Parameters After Exercise Training With Cardiac Rehabilitation

To discriminate the effects of body fat reduction on improvements in peak aerobic capacity made following exercise training during cardiac rehabilitation. Observational, prospective study. Outpatient cardiovascular health center at regional academic center. PATIENT INTERVENTIONS: Peak oxygen uptake (pkVO2), percent body fat, lean body mass (LBM), and other anthropometric measures were assessed before and after a 3-month program of cardiac rehabilitation and exercise training in 500 consecutive cardiac patients following a major coronary event. Baseline pkVO2 was corrected for LBM (pk/VO2 lean) and compared with posttraining values. Following exercise training, percent body fat decreased 5% from 26.2+/-8.0 to 24.8+/-7.5 (p<0.0001), and LBM increased 1% from 61.3+/-12.5 to 61.7+/-11.8 kg (p=0.02). pk/VO2 increased 16% from 16.0+/-4.1 to 18.5+/-4.8 mL/kg/min (p<0.0001), and pkVO2 lean increased 13% from 21.7+/-5.3 to 24.6+/-6.0 mL/kg/min (p<0.0001). Isolating the effects of reduction in body fat, we discern that these changes contributed to 0.3 of the 2.5 mL/kg/min increase in pkVO2 or 12% of the increase in pkVO2 observed. Changes in body composition, as a consequence of dietary and exercise modification, contribute to 12% of the "observed" improvement noted in weight-adjusted peak aerobic capacity following cardiac rehabilitation and exercise training. Changes in pkVO2 lean should be used by investigators to assess the singular effects of exercise conditioning alone.