Arm Fat Research Articles

Full Breastfeeding Modifies Anthropometric and Body Composition Indicators in Nursing Mothers.

Background: It has been observed that breastfeeding mobilizes the deposits of fat that accumulate during pregnancy and promotes weight loss through energy expenditure. The purpose of this study was to demonstrate that full breastfeeding (FBF) reduces anthropometric and body composition indicators in women between the 8th and the 16th week postpartum. Methods: In a nonrandom cohort study, 170 mothers at the Hospital Civil de Guadalajara, Guadalajara, México, were enrolled: FBF 74, partial breastfeeding (PBF) 57, and human milk substitutes (HMS) 39. Anthropometric indicators and body composition were measured at the 8th and 16th week postpartum. We performed analysis of variance to compare body composition according to the type of feeding and paired Student's t-test to compare the changes from the 8th to 16th week postpartum. Results: We found that FBF mothers had a trend to lower arm fat area and triceps skinfold than PBF and HMS mothers at 8 and 16 weeks postpartum. We observed a decrease in weight (p = 0.004), weight/age index (p = 0.003), body mass index (p = 0.003), hip circumference (p = 0.037), and lean mass (p = 0.003) from 8 to 16 weeks postpartum in mothers who offered FBF. The mid-upper arm circumference, the arm total area, and their z-score increased in the three feeding groups. Conclusions: Our results show that FBF mothers had some lower adiposity from 8 to 16 weeks postpartum compared with the result observed among PBF mothers and those who utilized HMS.

Increased myocardial fat supply improves cardiac energetics and function in heart failure

Abstract Introduction The failing heart is starved of energy, in part accounting for its contractile dysfunction. Reduced uptake of fat and sugar required for energy production has frequently been demonstrated in heart failure, therefore altering metabolism of glucose and/or fat is therefore attractive as a therapy. We hypothesized increasing glucose supply would be beneficial over increasing fat supply so measured ATP usage (via PCr/ATP ratio and flux through creatine kinase) and cardiac function during fat emulsion infusion or euglycaemic hyperinsulinaemic clamp. Methods 11 patients with a diagnosis of heart failure and nonischaemic cardiomyopathy were recruited, mean age 66 (range 49–80), mean BMI 27.7 (range 21.3–37.5), F:M 3:8, 3 diabetic and 8 non-diabetic. On the first visit they had a baseline cardiac magnetic resonance (CMR), collecting cardiac volumes and function, then were randomised to receive either fat infusion or euglycaemic clamp. Following an hour of infusion, CMR was repeated followed by 31P cardiac magnetic resonance spectroscopy, then a dobutamine stress sequence at 65% maximum heart rate. They received the alternate infusion at the next visit. Results Data was normally distributed. Baseline ejection fraction was 37±9%. PCr/ATP ratio was greater with the fat infusion compared to euglycaemic clamp (1.82±0.26 vs 1.68±0.24, p=0.04). Fat emulsion infusion also brought about a greater ejection fraction increase over the baseline, compared to the euglycaemic clamp in which there was little difference (+5.3±5.3% vs −0.6±3.1%, p=0.004). Calculated cardiac work was greater in the fat infusion group than the Insulin/glucose group (682±156 L.mmHg/min vs 581±85 L.mmHg/min, p=0.009). There was no significant difference in creatine kinase first order rate constant (fat infusion 0.2±0.09/s vs euglycaemic clamp 0.16±0.07/s, p=0.32) nor creatine kinase flux (fat infusion 1.85±0.92 μmol/g/s vs euglycaemic clamp 1.46±0.58 μmol/g/s, p=0.22). The increment in cardiac output on stress over baseline was not significantly different between arms (fat infusion +3.39±3.07 L/min vs euglycaemic clamp +3.08±2.57 L/min, p=0.42). The PCr/ATP ratio showed positive correlation with the stress ejection fraction (R2=0.656, p=0.001), but not with resting ejection fraction. Conclusions Increased supply of fat to the myocardium brought about improved contractility and cardiac energetics compared to an increased glucose supply. The increase in PCr/ATP ratio would imply (given ATP concentrations are kept constant in the myocardium) there is a greater availability of phosphocreatine, suggesting increased mitochondrial ATP synthesis. These results were unexpected as it has traditionally been thought that increased glucose metabolism would yield greater cardiac function in the failing heart. These data suggest targeting myocardial fat metabolism may provide novel treatments for cardiac dysfunction. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

HIV-Exposed, Uninfected Infants in Uganda Experience Poorer Growth and Body Composition Trajectories than HIV-Unexposed Infants.

HIV-uninfected infants of HIV-positive women may experience worse growth and health outcomes than infants of HIV-negative women, but this has not been thoroughly investigated under the World Health Organization's most recent recommendations to reduce vertical transmission. To determine whether HIV-exposed and -uninfected (HEU) infants whose mothers received Option B+ have higher odds of experiencing suboptimal growth trajectories than HIV-unexposed, -uninfected infants, and if this relationship is affected by food insecurity. Repeated anthropometric measures were taken on 238 infants (HEU = 86) at 1 week and 1, 3, 6, 9, and 12 months after delivery in Gulu, Uganda. Latent class growth mixture modeling was used to develop trajectories for length-for-age z-scores, weight-for-length z-scores, mid-upper arm circumference, sum of skinfolds, and arm fat area. Multinomial logistic models were also built to predict odds of trajectory class membership, controlling for socioeconomic factors. HEU infants had greater odds of being in the shortest 2 length-for-age z-scores trajectory classes [odds ratio (OR) = 3.80 (1.22-11.82), OR = 8.72 (1.80-42.09)] and higher odds of being in smallest sum of skinfolds trajectory class [OR = 3.85 (1.39-10.59)] vs. unexposed infants. Among HEU infants, increasing food insecurity was associated with lower odds of being in the lowest sum of skinfolds class [OR = 0.86 (0.76-0.98)]. There continues to be differences in growth patterns by HIV-exposure under the new set of World Health Organization guidelines for the prevention of mother-to-child transmission of HIV and the feeding of HEU infants in low-resource settings that are not readily identified through traditional mixed-effects modeling. Food insecurity was not associated with class membership, but differentially affected adiposity by HIV-exposure status.

CORRELATION OF HANDGRIP STRENGTH WITH ARM ANTHROPOMETRIC VARIABLES IN CRICKETERS

OBJECTIVES: To estimate correlation of handgrip strength with arm anthropometric variables of dominant side. METHODS: This cross-sectional study was conducted on 241 male cricketers from July 2017 to August 2018 in Lahore using convenient sampling. Arm anthropometric variables and handgrip strength of dominant side were measured by standard anthropometric techniques & formulas. Pearson correlation coefficient & linear regression analysis were applied to find out extent of relationship. RESULTS: Mean age of 241 players is 25.19±3.493 years. Out of 241 players, 74 (30%) players were batsmen, 69 (29%) were bowlers, 14 (6%) were wicket keepers and 84 (35%) were all-rounder players. Mean handgrip strength of study participants was 65.783±3.365 kg. Mean values for various anthropometric variables included triceps skinfold thickness (13.807±0.815 mm), subscapular skinfold thickness (16.552±0.763 mm), mid arm circumference (33.398±1.274 cm), arm muscle area (67.381±5.149 cm2), arm muscle girth (29.070±1.116 cm), arm area (88.986±6.643 cm2), arm fat area (21.605±1.836 cm2), and arm fat index (24.281±1.055). Handgrip showed positive correlation with triceps skinfold (r=0.608, p=<0.001), mid-arm circumference (r=0.738, p=<0.001), upper arm muscle area (r=0.694, p=<0.001), upper arm muscle girth (r=0.695, p=<0.001), total arm area (r=0.740, p=<0.001), upper arm fat area (r=0.728, p=<0.001), subscapular skinfold (r=0.215, p=0.001), and arm fat index (r=0.158, p=0.013). CONCLUSION: All the anthropometric variables had a positive significant correlation with handgrip strength. Handgrip strength is standard indicator to achieve target of excellent performance as well as can be made a valuable criterion of selection for cricket & multiple games involving grip.

A Simplified Prediction Model for Lower Extremity Long Bone Stress Injuries in Male Endurance Running Athletes.

Develop a prediction model for lower extremity long bone injuries (LBIs) in male endurance running athletes using dual-energy x-ray absorptiometry (DEXA). Retrospective. Sports medicine department in a university athletic setting. National Collegiate Athletic Association (NCAA) Division 1 white male endurance athletes (n = 27). Backward stepwise elimination was used to achieve a model that predicts LBI, by removing noncontributory variables (P > 0.10), using binary logistic regression. Independent prediction variables analyzed for model were as follows: (1) height (cm), body mass index (BMI) (kg/m), and total mass (kg); and (2) regional and total lean mass, fat mass, and bone density assessed using DEXA. Dichotomous dependent variable was LBI. Final constructed model predicted 96.3% of athletes with and without LBI. Prediction model were as follows: predict lower extremity long bone stress injury = 23.465 - 0.896 BMI + 1.043 (total upper-body mass) TUB - 34.536 leg bone mineral density (BMD). Predict lower extremity long bone stress injury is the LBI prediction, and TUB (kg) is total fat, muscle, and bone weight in trunk and arms. These preliminary data suggest that Division 1 white male endurance running athletes are at risk of LBI with higher relative TUB and lower BMI in combination with a lower leg BMD.

The Physical Characteristics of Elite Female Rugby Union Players

This study explored the anthropometric and body composition characteristics of elite female rugby union players, comparing between and within different playing positions. Thirty elite female rugby union players (25.6 ± 4.3 y, 171.3 ± 7.7 cm, 83.5 ± 13.9 kg) from New Zealand participated in this study. Physical characteristics were assessed using anthropometric (height, body mass, skinfolds) and body composition (dual-energy X-ray absorptiometry) measures. Forwards were significantly taller (p < 0.01; d = 1.34), heavier (p < 0.01; d = 2.19), and possessed greater skinfolds (p < 0.01; d = 1.02) than backs. Forwards also possessed significantly greater total (p < 0.01; d = 1.83–2.25) and regional (p < 0.01; d = 1.50–2.50) body composition measures compared to backs. Healthy bone mineral density values were observed in both forwards and backs, with significantly greater values observed at the arm (p < 0.01; d = 0.92) and femoral neck (p = 0.04; d = 0.77) sites for forwards. Tight-five players were significantly heavier (p = 0.02; d = 1.41) and possessed significantly greater skinfolds (p < 0.01; d = 0.97) than loose-forwards. Tight-five also possessed significantly greater total body composition measures (p < 0.05; d = 0.97–1.77) and significantly greater trunk lean mass (p = 0.04; d = 1.14), trunk fat mass (p < 0.01; d = 1.84), and arm fat mass (p = 0.02; d = 1.35) compared to loose-forwards. Specific programming and monitoring for forwards and backs, particularly within forward positional groups, appear important due to such physical characteristic differences.

Switch to Efavirenz Attenuates Lipoatrophy in Girls With Perinatal HIV.

Children with HIV (CHIV) have lifetime exposure to antiretrovirals (ART); therefore, optimizing their regimens to have the least impact on fat redistribution is a priority. This is a cross-sectional study of 219 perinatally infected CHIV and 219 HIV-uninfected controls from similar socioeconomic backgrounds in Johannesburg, South Africa. We compared total body and regional fat distribution in CHIV on suppressive ART regimens with controls and, among CHIV, between ritonavir-boosted lopinavir (LPV/r)-based and efavirenz (EFV)-based regimens. The mean age of the 219 uninfected children (45% girls) and the 219 CHIV (48% girls) was 7.0 and 6.4 years, respectively. CHIV had lower adjusted total body fat (P = 0.005) and lower percentage fat at the trunk (P = 0.020), arms (P = 0.001), and legs (P < 0.001) than uninfected children. CHIV on LPV/r had similar body composition as those on EFV, except for arm fat mass (P = 0.030). When stratified by sex, girls with HIV on LPV/r had lower adjusted total (P = 0.007), trunk (P = 0.002), arms (P = 0.008), legs (P = 0.048) fat mass; trunk-to-total body fat (P = 0.044); and higher legs-to-total body fat (P = 0.011) than those on EFV. South African CHIV receiving ART had lower global and partial fat mass and percentage fat than healthy controls. In girls with HIV with sustained virologic suppression on ART, switching from LPV/r to EFV could attenuate fat mass loss, indicating that EFV-based regimen may be a better option in this group of individuals.

Predictive Value of Markers of Adiposity in Carpal Tunnel Syndrome: A Clinical and Electrophysiological Evaluation.

To determine the association of total and segmental body composition adiposity indices with electrophysiological indicators of CTS. Observational cross-sectional study. Departments of Medicine and Clinical Physiology at King Saud University Medical City, King Saud University, Riyadh from August 2018 to December 2019. Total and segmental body composition analyses were performed by a bio-impedance body composition analyser. All the patients were grouped according to body mass index [BMI], total body fat % [TBF%], total fat mass [TFM], arm fat % [AF%], arm fat mass [AFM], and visceral fat rating [VFR] scores. Nerve conduction studies (NCS) were performed according to the standard protocols. CTS clinical severity score and CTS by NCS correlated significantly with BMI, TBF%, TFM, VFR, AF% and AFM. In ROC analysis, it was revealed that adiposity indices including BMI, TFM, VFR and AFM were significant predictors of abnormal NCS with area under the curve (AUC) of 0.824, 0.795, 0.795, and 0.803, respectively. VFR was a significant independent predictor of CTS severity (β coefficient=0.613, p<0.001) and delayed median nerve latency (β coefficient=0.317, p=0.017). Total and segmental body composition adiposity indicators are significantly associated with clinical severity of CTS and electrophysiological markers; especially, visceral adiposity. Large scale studies are required to explore the true predictive value of body composition in CTS. Key Words: Body mass index, Body composition, Adipose tissue, Body fat distribution, Carpal tunnel syndrome, Nerveconduction, Mediannerveentrapment, Visceralfat, Bioelectricalimpedance, ROCanalysis.

Body Composition of National Collegiate Athletic Association (NCAA) Division I Female Soccer Athletes through Competitive Seasons.

The purpose of this study was to examine body composition of National Collegiate Athletic Association Division I female soccer players by position and season. One hundred seventy-five female athletes were categorized by positions of forward (n=47), midfielder (n=51), defender (n=57), and goalkeeper (n=20). A dual X-ray absorptiometry scan assessed percent body fat, total lean mass, total fat mass, arm and leg lean mass and fat mass, and visceral adipose tissue. Goalkeepers had significantly higher total, arm, and leg lean mass and fat mass compared to all other positions (p<0.05). For seasonal changes, body fat percentage was significantly higher in winter off-season (26.7%) compared to summer off-season (25.7%) and pre-season (25.8%; p<0.01) for all positions. Total and leg lean mass was significantly lower in winter off-season compared to all other seasons, and total lean mass was significantly higher in summer off-season than pre-season (p<0.01). Overall, goalkeepers were significantly different than all other positions. Body fat percentage increased and lean mass decreased in winter off-season indicating potential undesired changes in training and/or nutrition over the break whereas lean mass was the highest in summer off-season potentially reflecting the emphasis on resistance training and increased volume of training.

Sarcopenic Obesity Among Adults With Facioscapulohumeral Muscular Dystrophy

BACKGROUND: Sarcopenic obesity has been observed in people with neuromuscular impairment and is linked to adverse health outcomes; it is unclear, however, if adults with facioscapulohumeral muscular dystrophy (FSHD) develop this condition. PURPOSE: Determine if adults with FSHD meet criteria for sarcopenic obesity (appendicular lean mass index (ALMI) scores of <7.26 kg/m2 or 5.45 kg/m2; % body fat of ≥27% or 38% in men/women). METHODS: Ten FSHD patients (50±11.4 years, 2 females) and ten age/sex-matched controls (47±13.6 years, 2 females) completed one visit, which included a full-body DXA scan. Regional and whole body total mass (g), fat mass (FM, (g, %)), and lean mass (LM, (g, %)) were collected; body mass index (BMI, kg/m2) and sarcopenia measures (appendicular lean mass (sum of arm/leg lean mass, ALM (kg)) and ALM index (ALMI, kg/m2)) were computed. RESULTS: Whole body total mass was similar between cohorts (FSHD: 84.5±12.9 vs. control: 81.8±13.5 kg; p=0.65). A decrease in ALM volume was found in the FSHD group (FSHD: 20.5±4.4 vs. control: 26.5±5.9 kg; p=0.02); similarly, ALMI scores were different between FSHD and controls (FSHD: 6.3±1.2 vs. control: 8.6±1.4 kg/m2; p=0.001). An increase in the proportion of whole body FM to whole body total mass (% body fat) in the FSHD group was observed (FSHD: 40.8±7.0 vs. control: 27.9±7.5%; p=0.001). While mean alterations in ALMI (6.3 ±1.3 kg/m2) and % body fat (40.0 ± 6.4%) among men with FSHD met diagnostic criteria for sarcopenic obesity, this finding was not mirrored among female FSHD counterparts (ALMI: 6.2 ±1.0 kg/m2, % body fat: 44.1 ±11.4%). Whole body LM was 15% lower in FSHD (p=0.05), furthermore, the FSHD group had a reduced proportion of whole body LM to whole body total mass vs. controls (p=0.001), along with lower total arm (p<0.01) and total leg lean mass (p=0.03). Study participants with FSHD did exhibit an increase in total body FM (p<0.01), along with greater total leg fat mass (p<0.001) but not total arm fat mass (p=0.09). CONCLUSIONS: A loss in ALM and increase in FM may lead to sarcopenic obesity in men with FSHD, resulting in a reduced quality of life and longevity.

Evaluation of upper arm muscle and fat area of children and adolescents from Ankara, Turkey

Arm anthropometry is a commonly used method for determining the nutritional status of children and adolescents. The purpose of the study is to evaluate the arm anthropometry of 1484 children and adolescents (760 boys and 724 girls) aged between 6–17 years. The sample groups are selected who are living in Ankara to establish local reference values. In order to determine upper Arm Muscle Area (AMA) and upper Arm Fat Area (AFA), height, weight, upper arm circumference and triceps skinfold thickness measurements were taken in accordance with International Biological Program (IBP) protocols. Smoothed percentiles of AMA and AFA were obtained. Body mass index was calculated with weight and height measurements (kg/m2). Fat mass (FM) and fat free mass (FFM) were measured using bio-impedance analyzer. According to the obtained results, arm muscle area values were higher in boys and arm fat area was higher in girls. In addition, sex difference in these variables increased with age. There was a high positive correlation between body mass index (BMI) and AMA, AFA. It has been found that there is a difference in AMA and AFA values for Ankara children compared to previous studies in Turkey.

Handgrip Strength in Young Adults: Association with Anthropometric Variables and Laterality.

The measurement of handgrip strength (HGS) is an indicator of an individual’s overall strength and can serve as a predictor of morbidity and mortality. This study aims to investigate whether HGS is associated with handedness in young adults and if it is influenced by anthropometric characteristics, body composition, and sport-related parameters. We conducted a cross-sectional study on a sample of 544 young Italian adults aged 18–30 years. We measured HGS using a dynamometer and collected data on handedness and physical activity, along with anthropometric measurements. In both sexes, the HGS of the dominant side was significantly greater than that of the non-dominant side. Furthermore, in ambidextrous individuals, the right hand was stronger than the left. A comparison between the lowest and the highest tercile of HGS highlighted its significant association with anthropometric and body composition parameters in both sexes. Moreover, sex, dominant upper arm muscle area, arm fat index, fat mass, and fat-free mass were found to be significant predictors of HGS by multiple regression analysis. Our findings suggest that HGS is especially influenced by body composition parameters and handedness category. Therefore, HGS can be used as a proxy for unhealthy conditions with impairment of muscle mass, provided that the dominance in the laterality of the subject under examination is taken into account.

HIV-Exposed, Uninfected Infants in Uganda Experience Poorer Growth and Body Composition Trajectories than HIV-Unexposed Infants

Abstract Objectives To determine if HIV-exposed and -uninfected (HEU) infants whose mothers received Option B + have higher odds of experiencing suboptimal growth trajectories than HIV-unexposed uninfected (HUU) infants. Methods Anthropometric measures were taken on 238 infants (HEU = 86) at 1 week and 1,3,6,9, and 12 months. Latent class growth mixture modeling was used to develop trajectories for length-for-age z-scores, weight-for-length z-scores, MUAC, sum of skinfolds, and arm fat area. Multinomial logistic models were built to predict odds of class membership by HIV and food security status, controlling for socioeconomic factors. Results HEU infants had greater odds of being in the shortest two classes (OR = 4.30, P = 0.01 and OR = 10.70, P &amp;lt; 0.01) and lower odds of being in smallest arm fat area class (OR = 0.26, P = 0.01) relative to HUU infants. Food insecurity was associated with a smaller increase in the odds that HEU infants were in the second shortest class (OR interaction = 0.83, P = 0.03). Only among HEU, food insecurity increased odds of being in the lowest sum of skinfolds class (OR interaction = 3.80, P = 0.01). Conclusions HEU experience suboptimal growth patterns compared to unexposed infants. HEU infants are differentially affected by food insecurity. The mechanisms which drive these differences and successful strategies for counteracting any potential harm need further investigation. Funding Sources CL was supported by the Royster Society of Fellows. Data collection was supported by the Feed the Future Innovation Laboratory for Nutrition, which is funded by the United States Agency for International Development (USAID) and based at Tufts University (USAID OAA-L-10- 00006), and by a seed grant for collaborations between Cornell University– Ithaca and Weill Cornell Medical College faculty. EMW was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K99/R00 HD086304), the National Institute of Diabetes and Digestive and Kidney Diseases (T32DK091227 and T32DK007559), and PepsiCo Global R + D (unrestricted grant to support research in maternal and child health). SLY was supported by the National Institute of Mental Health (K01MH098902). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Prevalence and factors associated with motoric cognitive risk syndrome in community-dwelling older Chinese: a cross-sectional study.

A recently proposed pre-dementia syndrome, motoric cognitive risk (MCR) syndrome, is characterized by cognitive complaints and slow gait, and increases the risk of dementia and mortality. The aim of the present study was to explore the prevalence of and factors associated with MCR syndrome in elderly community-dwelling Chinese subjects. The Ningbo Community Study on Aging recruited 953 Chinese community-dwelling participants aged≥65years from November 2016 to March 2017. Handgrip, Five-Times-Sit-to-Stand (FTSS) test time and body composition, as well as comprehensive geriatric evaluation, were measured as potentially independent factors associated with MCR syndrome. The prevalence of MCR syndrome was 12.8% in men and 12.6% in women, and high prevalence of MCR syndrome was not associated with age or sex. Multiple logistic regression analysis by sex showed that a 1-SD increase in FTSS test time in males and females was associated with 45% (95% confidence intervals, 19-76; P<0.01) and 20% (95% confidence intervals, 9-33; P<0.01) higher risk of having MCR syndrome, respectively, whereas handgrip strength was inversely correlated with MCR syndrome in males [odds ratio (OR), 0.91; P=0.02] but not females (P=0.06). Moreover, the relationship of arm fat mass and MCR syndrome was statistically significant in both sexes (OR, 1.69-1.77), but leg fat mass was only associated with MCR syndrome (OR, 1.56; P=0.02) in men. Handgrip, FTSS test time and body composition were associated in a sex-specific manner with MCR syndrome in elderly community-dwelling Chinese subjects. Our results on MCR syndrome are novel and should be considered as important information in future studies.

Nutrition and Neurodisability Edited by Peter BSullivan, Guro LAndersen, and Morag JAndrewLondon: Mac Keith Press,2020£55.00 (Softback), pp 208. ISBN: 9781911612254

This practical, evidence-based handbook is for all health professionals who care for children with feeding, nutritional, and gastrointestinal problems that derive from neurological disability, particularly cerebral palsy. This is a new revision of two previous books on this topic by the same editor (published in 1996 and 2009), and arises from the growing interest and research in this field during the last decade. The authors are some of the world’s leading experts in the field from Europe, Australia, and North America. They have contributed their extensive knowledge and expertise, and have reviewed all the recent studies and guidelines in order to address the most important aspects of this challenging topic. These include oral sensorimotor dysfunction, gastrointestinal problems, nutritional status definition, and nutritional impairment, as well as feeding and nutritional management strategies. The perspective of the handbook is practical, useful for both clinicians new in the field and those more experienced. Many of the chapters have included the description of clinical cases to enhance the key messages. Thanks to nutritionists and gastrointestinal pediatrician pioneers in this field (with a special mention to Prof Sullivan) and the progressive support of the multidisciplinary community in the field of childhood-onset neurodisability, nutrition is now part of the preventive program for any child with neurological disability. Early intervention and ongoing support are necessary to prevent undernutrition, defined by one or more of the so-called ‘nutritional red flags’, such as weight-for-age z-score <–2; triceps skinfold thickness <10th centile for age and sex; mid-upper arm fat or muscle area <10th centile; faltering weight and/or failure to thrive; and physical signs of undernutrition.1, 2 A skilled multidisciplinary clinical team is fundamental in assessing and managing children with neurological impairment and feeding difficulties. This includes the prescription and administration of interventions, as well as ongoing monitoring and adjustment of treatments as required. The main tools of interventions are detailed in the book, including oral nutrition support and/or enteral tube feeding. Oral nutrition support strategies include managing the child’s mealtime environment and positioning, offering modified food or fluid textures, and using adaptive equipment, caregiver behavioral techniques, and sensorimotor therapy. Despite modest evidence, the book also mentions emerging treatment options, such as robotic assistive feeding devices, intraoral appliances, and neuromuscular electrical stimulation.3 Whether and when to insert a gastrostomy feeding tube is one of the most important decisions in managing a child with neurodisability. It should take into account the interplay between outcomes of safety, efficiency, skill development, and mealtime stress, considered in the socio-cultural context in which the child lives.1, 2 Moreover, as increasing numbers of children with neurological impairment are undergoing gastrostomy placement and are now surviving beyond childhood into adulthood, the question arises as to whether long-term benefit could be achieved by starting enteral tube feeding earlier in life. Children and their families need to be at the centre of the team’s efforts. Families will require support and collaboration, working to reduce the impact on their lives of their child’s eating and drinking difficulties, including use of tube feeding.4 All members of the multidisciplinary team should be well informed about the indications for and advantages and disadvantages of tube feeding, so that a consistent message is conveyed to parents. Working in partnership with families of children with neurodisability has been shown to lead to improved outcomes.5 Understanding parents’ perceptions will help health professionals to develop effective, family-centered, patient-appropriate intervention and adherence strategies for tube-fed children with neurodisability. All these topical questions are dealt with in an instructive and persuasive way in this excellent handbook.

MRI Assessment of Arm and Calf Muscle Toning With High-Intensity Focused Electromagnetic Technology: Case Study

Arms and calves have long been a subject of interest in aesthetic medicine. Current surgical and non-invasive procedures focus on sagging skin and fat deposits without targeting the muscles. The aim of this study is to investigate the feasibility of high-intensity focused electromagnetic (HIFEM) technology for arm and calf toning through simultaneous fat reduction and muscle strengthening. In this case study, two subjects received four 20-minute HIFEM treatments of biceps, triceps, and calves, with the outcomes assessed by MRI. The analysis of MRI images showed an average increase in all three muscle groups, biceps muscle mass 17.1%, triceps muscle mass 10.2%, and gastrocnemius muscle mass increased by 14.6%. In addition, the arm fat thickness was decreased by 12.8% on average and the calf fat thickness decreased by 9.9%. The results suggest that HIFEM technology is a feasible modality for both arm and calf toning. However, it will be necessary to continue to validate this outcome in a larger sample size study. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4546.

Age and sex specific variations in body composition in Indian urban Bengali Hindu children, adolescents and young adults aged 7–21 years

Childhood and adolescent obesity is a public health concern worldwide. However, little attention has been paid on status of overweight and body composition of Indian Bengali urban middle and high SES population. The objective was to determine the prevalence of overweight and body composition status by age and sex in children, adolescents and young adults. This cross-sectional study was carried out among 4194 unmarried school and college students (1999 males and 2195 females) aged 7–21 years belonging to the Bengali Hindu Population in Kolkata, India. The survey period was from 1999 to 2011. Anthropometry of participants were measured. Age and sex specific ≥85 percentile of body mass index (BMI) for children (&lt;18 years of age) and BMI ≥23 kg/m2 (≥18 years of age) for adults were used to define overweight. Fat percent, upper arm fat area (UAFA) and upper arm muscle area (UAMA) were estimated. Simple linear regression was performed to check trend of changes with age. The overall prevalence of overweight was 14.8% in both sexes. Mean fat percent was higher in females than males (23.5% vs 13.5% respectively; p&lt;0.001) and it increased by 0.18% (0.02) in males and 0.56% (0.02) in females per year (both p&lt;0.001). UAMA gradually increased with age in both sexes and increasing rate per year was by 2.07 (0.04) cm2 in males and 1.19 (0.04) cm2 in females (both p&lt;0.001). However, UAFA increased by 0.41 (0.03) cm2 and 0.90 (0.03) cm2 every year in males and females respectively (both p&lt;0.001). Sum of biceps, triceps, subscapular and suprailliac skinfolds increased by 1.66 (0.06) mm and 0.5 (0.07) mm per year in females and males respectively (both p&lt;0.001). Overall prevalence of overweight was the same in both sexes but adipose tissue was higher and muscularly was lower in females than males.

Body Composition Using Air Displacement Plethysmography in Children With Inflammatory Bowel Disease.

The aim of the study was to assess the body composition of children with inflammatory bowel disease (IBD) and to study the accuracy of clinically available tools in predicting excess body fatness. We aimed at also exploring the influence of adiposity on pharmacokinetics during early Infliximab exposure. Prospective cohort study in 5- to 17-year-old children with IBD initiating Infliximab therapy. Patient demographic, phenotypic, and laboratory data at the time of Infliximab initiation were recorded. Body composition was assessed using air displacement plethysmography (ADP). fat mass index (FMI = fat mass [kg]/(height [m])) was calculated to determine excess adiposity (defined as FMI ≥75th centile). Anthropometrics (weight, height, mid upper arm circumference [MUAC] and triceps skin fold thickness [TSF]) were obtained and MUAC and TSF measurements were used to calculate arm fat area (AFA) and arm muscle area z-scores. Statistical analysis was applied as appropriate. Fifty-three (68% male; 55% Crohn disease [CD], 45% ulcerative colitis [UC], median [IQR] age 15 [13-16] years) children with IBD were included. Twenty-four percentage of children with IBD (21% CD, 29% UC) had excess adiposity. Four children (31%) with FMI ≥75th centile were not identified by body mass index (BMI) alone (kappa of 0.60), and 2 children (15%) were not identified by AFA z-score alone. The intra- and interobserver reliability of MUAC and TSFT measurements was excellent. There was no difference in Infliximab trough levels at the end of induction between those with FMI less than or ≥75th centile. Excess adiposity affects approximately 1 in 4 young patients with IBD and can be missed by routine obesity screening. Our exploratory study did not raise concerns of underexposure to infliximab in those children with excess adiposity during early drug exposure.

Time trends in mid-upper-arm anthropometry from 1982 to 2011 in male children and adolescents from Kolkata, India.

The aim of this study was to investigate inter-generational changes in selected mid-upper-arm measurements of boys from Kolkata, India. The analysis was based on the anthropometric measurements of two cohorts of Bengali boys aged 7-16 from middle-class families, in 1982-83 and 2005-11. The two cohorts were compared in terms of their mid-upper-arm circumference (MUAC) and mid-upper-arm area (MUAA), mid-upper-arm muscle area (MUAMA), mid-upper-arm fat area (MUAFA) and Arm Fat Index (AFI). The significances of the differences were determined using two-way ANOVA. All features differed significantly between the examined cohorts and all showed a general positive secular trend. In most cases, the biggest differences were noted for 14- and 16-year olds and the smallest for the youngest boys. The contemporary boys seemed to have more favourable overall developmental conditions, probably related to socioeconomic progress in India over recent decades.

Examining Bone, Muscle and Fat in Middle-Aged Long-Term Endurance Runners: A Cross-Sectional Study.

Aerobic exercise training has many known cardiovascular benefits that may promote healthy aging. It is not known if long-term aerobic exercise training is also associated with structural benefits (e.g., lower fat mass, higher areal bone mineral density (BMD) and greater muscle mass). We evaluated these parameters in middle-aged long-term endurance runners compared to sex-, age-, height-, and weight-matched non-running controls. Total and regional lean and fat mass and areal BMD were assessed by dual-energy X-ray absorptiometry. Sagittal magnetic resonance images captured the cross-sectional area and thickness of the lumbar multifidus. Runners (n = 10; all male) had a mean (standard deviation; SD) age of 49 (4) years, height of 178.9 (4.9) cm, weight of 67.8 (5.8) kg, body mass index (BMI) of 21.4 (1.4) kg/m2 and had been running 82.6 (27.9) km/week for 23 (13) years. Controls (n = 9) had a mean (SD) age of 51 (5) years, height of 176.0 (5.1) cm, weight of 72.8 (7.1) kg, and BMI of 23.7 (2.1) kg/m2. BMI was greater in controls (p = 0.010). When compared to controls on average, runners had a 10 percentage-point greater total body lean mass than controls (p = 0.001) and 14% greater trunk lean mass (p = 0.010), as well as less total body (8.6 kg; p < 0.001), arm (58%; p = 0.002), leg (52%; p < 0.001), trunk (73%; p < 0.001), android (91%; p < 0.001), and gynoid fat mass (64%; p < 0.001). No differences were observed between groups for BMD outcomes or multifidus size. These results underscore the benefits of endurance running to body composition that carry over to middle-age.