Higher FMI Research Articles

Differential impacts of fat and muscle mass on cardiovascular and non-cardiovascular mortality in individuals with type 2 diabetes.

The distribution of fat and muscle mass in different regions of the body can reflect different pathways to mortality in individuals with diabetes. Therefore, we investigated the associations between whole-body and regional body fat and muscle mass with cardiovascular disease (CVD) and non-CVD mortality in type 2 diabetes (T2D). Within the National Health and Nutrition Examination Survey 1999-2006, 1417 adults aged ≥50years with T2D were selected. Dual-energy X-ray absorptiometry was used to derive whole-body, trunk, arm, and leg fat mass and muscle mass indices (FMI and MMI). Mortality data until 31 December 2019 were retrieved from the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. A total of 1417 participants were included in this study (weighted mean age [standard error]: 63.7 [0.3] years; 50.5% female). Over a median follow-up of 13.6years, 797 deaths were recorded (371 CVD-related and 426 non-CVD deaths). Higher FMI in the arm was associated with increased risk of non-CVD mortality (fourth quartile [Q4] vs. first quartile [Q1]: HR 1.82 [95% CI 1.13-2.94]), whereas higher FMI in the trunk or leg was not significantly associated with CVD or non-CVD mortality. Conversely, higher arm MMI was associated with a lower risk of both CVD (Q4 vs. Q1: HR 0.51 [95% CI 0.33-0.81]) and non-CVD (Q4 vs. Q1: HR 0.56 [95% CI 0.33-0.94]) mortality. There was a significant interaction between smoking status and arm FMI on non-CVD mortality (P for interaction=0.007). Higher arm FMI was associated with a higher risk of non-CVD mortality among current or former smokers (Q4 vs. Q1: HR 2.67 [95% CI 1.46-4.88]) but not non-smokers (Q4 vs. Q1: HR 0.85 [95% CI 0.49-1.47]). Fat mass and muscle mass, especially in the arm, are differently associated with CVD and non-CVD mortality in people with T2D. Our findings underscore the predictive value of body compositions in the arm in forecasting mortality among older adults with T2D.

Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis.

A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis. Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011‒2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis. Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [ORQ5vs1]=1.787, 95% confidence interval: 1.209-2.640) or %BF (ORQ5vs1=2.221, 1.509-3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR=1.528, 1.037-2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men. The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.

Gestational age, intrauterine growth and body composition at 11 years of age.

To assess the association of gestational age (GA) and intrauterine growth with body composition at 11 years of age. Analysis of data from the 2004 Pelotas birth cohort, whose outcomes were fat mass (FM, kg), fat mass index (FMI, kg/m2), fat-free mass (FFM, kg), fat-free mass index (FFMI, kg/m2) - measured by air displacement plethysmography - and body mass index for age (BMI/age, Z-score). The exposures of interest were the gestational index (GA) of infants born at less than 33 weeks, from 34 to 36 and from 37 to 41, and intrauterine growth categorized as small (SGA), adequate (AGA) and large (LGA) for gestational age. Analysis of variance was used to compare means and linear regression was used to assess the strength of association. The analyses were adjusted according to variables collected at birth, such as monthly family income, maternal characteristics - education, age, pre-gestational body mass index (BMI), weight gain during pregnancy, smoking during pregnancy, type of delivery, and parity - and adolescent characteristics - skin color and birth weight. For analysis, FM and FMI underwent logarithmic transformation due to data asymmetry. A total of 3,401 adolescents were analyzed, including boys and girls born at less than 33 weeks, with lower FM and FFM means than those born at term. However, in the adjusted analyses, there was no association between GA and any of the outcomes in either sex. LGA boys had a 10.5% higher FMI (p = 0.026) and +0.3 BMI/age Z-score (p = 0.019) as compared to AGA boys, and LGA girls had +0.3 kg/m 2 of FFMI (p = 0.039) than AGA girls. GA was not associated with body composition at 11 years of age. However, LGA boys had higher BMI and BMI/age Z-score, and LGA girls had higher FFMI than AGA girls.

Non-melancholic depressive symptoms are associated with above average fat mass index in the Helsinki birth cohort study

There is an existing link between two of the most common diseases, obesity and depression. These are both of great public health concern, but little is known about the relationships between the subtypes of these conditions. We hypothesized that non-melancholic depressive symptoms have a stronger relationship with both body composition (lean mass and fat mass) and dysfunctional glucose metabolism than melancholic depression. For this cross-sectional study 1510 participants from the Helsinki Birth Cohort Study had their body composition evaluated as lean mass and fat mass (Lean Mass Index [LMI, kg/m2] + Fat Mass Index [FMI kg/m2] = Body Mass Index). Participants were evaluated for depressive symptoms utilizing the Beck depression inventory, and had laboratory assessments including an oral glucose tolerance test. Higher than average FMI was associated with a higher percentage (mean [%], 95% CI) of participants scoring in the depressive range of the Beck depression inventory (20.2, 17.2–23.2) compared to those with low FMI (16.3, 13.8–18.9; p = 0.048) when adjusted for age, sex, education, and fasting plasma glucose concentration. Higher FMI was associated with a higher likelihood of having depressive symptoms (OR per 1-SD FMI = 1.37, 95% CI 1.13–1.65), whereas higher LMI was associated with a lower likelihood of having depressive symptoms (OR per 1-SD LMI = 0.76, 95% CI 0.64–0.91). Participants with an above average FMI more frequently (mean [%], 95% CI) had non-melancholic depressive symptoms (14.7, 11.8–17.7) as compared to those with low FMI (9.7, 7.6–11.9; p = 0.008) regardless of LMI levels. There was no difference between the body composition groups in the likelihood of having melancholic depressive symptoms. The non-melancholic group had higher (mean [kg/m2], SD) FMI (9.6, 4.1) than either of the other groups (BDI < 10: 7.7, 3.1; melancholic: 7.9, 3.6; p < 0.001), and a higher (mean [mmol/l], SD) 2-h glucose concentration (7.21, 1.65) than the non-depressed group (6.71, 1.70; p = 0.005). As hypothesized, non-melancholic depressive symptoms are most closely related to high fat mass index and dysfunctional glucose metabolism.

Abstract P1-04-10: Breast cancer survivors exhibit an accumulation of CD4+ central memory T cells, a fall in CD8+ naïve T cells and higher activation of CD4+/CD8+ memory T cells in blood, which is positively correlated with age and fat mass index

Abstract Introduction: T cells are important for tumour control and surveillance, but it is not well known how breast cancer treatment impacts their characteristics in blood. Methods: Healthy women (n=38, age 45 ± 11 y), breast cancer survivors (n=27, age 56 ± 6 y) and breast cancer patients (n=5, age 44 ± 9 y) took part. Survivors comprised women who had received any form of treatment for breast cancer within 1-2 years and were considered free from disease by their oncologist. Patients were recently diagnosed women scheduled to undergo neoadjuvant chemotherapy within 2 weeks. Using flow cytometry, CD4+ and CD8+ T cell subsets, including Naïve (NA), Central memory (CM) and Effector cells (EM and EMRA) were identified using CD27/CD45RA. Activation was measured by HLA-DR expression. Age, Cytomegalovirus (CMV) serostatus, cardiorespiratory fitness and body composition were assessed. Statistical analyses were conducted between healthy women and survivors. Data for patients enabled a qualitative interpretation of immune profiles at the time of diagnosis. Results: Lymphocyte, monocyte and neutrophil counts were not different between groups. However, compared to healthy women, CD4+ CM T cells were +Δ21% higher among survivors (cells/l: 417 ± 110 vs 346 ± 161, p=0.028) and CD8+ NA T cells were −Δ25% lower (cells/l: 106 ± 46 vs 142 ± 83, p=0.034). The proportion of activated (HLA-DR+) CD4+ and CD8+ T cell subsets was +Δ31% higher among survivors compared to healthy women: CD4+ CM (+Δ25%: 35 ± 16 % vs 28 ± 6 %), CD4+ EM (+Δ32%: 54 ± 17 % vs 41 ± 9 %) and CD4+ EMRA (+Δ43%: 53 ± 21 % vs 37 ± 11 %), total CD8+ (+Δ30%: 43 ± 18 % vs 33 ± 9 %), CD8+ EM (+Δ30%: 57 ± 18 % vs 44 ± 13 %) and CD8+ EMRA T cells (+Δ25%: 55 ± 21 % vs 44 ± 12 %) (p&amp;lt;0.046). Compared to healthy women, survivors were older (56 ± 6 y vs 45 ± 11 y), had lower cardiorespiratory fitness (VO2max mL•kg-1•min-1: 29.0 ± 5.1 vs 36.2 ± 8.5), had lower lean mass (42.3 ± 5.1 kg vs 48.4 ± 15.8 kg), had higher body fat (36.2 ± 5.4 % vs 32.7 ± 6.4 %) and higher fat mass index (FMI kg/m2: 9.5 ± 2.3 vs 8.1 ± 2.7) (all p&amp;lt;0.034). Among all participants, age positively correlated with activation levels of CD4+ EMRA and CD8+ EMRA T cells and FMI positively correlated with the proportion of activated CD4+ EMRA and CD8+ EM and EMRA T cells (Pearson r&amp;gt;0.277 p&amp;lt;0.036). CMV serostatus was not different between groups and did not influence results. Compared to healthy women and survivors, patients were younger (44 ± 9 y), had lower cardiorespiratory fitness (VO2max 27.3 ± 2.2 mL•kg-1•min-1), higher body fat (40 ± 5.8%) and higher FMI (11.2 ± 3.8 kg/m2). Lean mass (44.3 ± 4.4 kg) was higher than survivors but lower than healthy women. Patterns exhibited by survivors (compared to healthy women) tended to be present among patients (e.g. an accumulation of memory T cells and a decline in NA T cells). T cell activation was closer to the levels exhibited by healthy women. Conclusion: Breast cancer survivors exhibited signs of immunosenescence, including a decline in naïve T cells and accumulations of memory T cells, which exhibited higher activation levels. Among all participants, T cell activation was positively correlated with age and fat mass index, potentially contributing to systemic inflammation and a decline in immune competency. Citation Format: Ainhoa Arana Echarri, Lauren Struszczak, Mark Beresford, John P Campbell, Robert H Jones, Rachel Butler, Dylan Thompson, James E Turner. Breast cancer survivors exhibit an accumulation of CD4+ central memory T cells, a fall in CD8+ naïve T cells and higher activation of CD4+/CD8+ memory T cells in blood, which is positively correlated with age and fat mass index [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-04-10.

Correlation between body composition and blepharoptosis in adults.

The present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis. The study evaluated 12,168 Korean adults aged 40 years or older using data from the Korea National Health and Nutrition Examination Survey (2008-2011). FM index (FMI, kg/m2) and LBM index (LBMI, kg/m2) were used to correct for the effects of body size. Multivariable logistic regression analysis was performed to investigate the association between blepharoptosis and body composition indices such as FMI, LBMI, and fat percentage of whole body or head. Stratified analyses were also performed by levator function. Higher FMI and head fat percentage were significantly associated with blepharoptosis (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; and aOR = 1.32, 95% CI = 1.03-1.69 in the highest tertile compared with the lowest, respectively). In the subgroup with good levator function (≥8 mm), higher FMI, head fat percentage, and head lean mass were significantly associated with blepharoptosis (aOR for the right eye [aORr] = 1.42 and aOR for the left eye [aORl] = 1.36; aORr = 1.41 and aORl = 1.37; and aORr = 1.50 and aORl = 1.49 in the highest tertile compared with the lowest, respectively; all p < 0.05). Body compositions with high adiposity indices, such as high FMI and head fat percentage, were positively associated with blepharoptosis. Awareness of the potential correlation between obesity-associated fat deposition and blepharoptosis could improve management of the condition and contribute to understanding the pathogenesis of blepharoptosis.

P124: Body composition and chemotherapy toxicity in women with early breast cancer: The cando-3 study

Introduction: The extent to which variations in body Fat Mass (FM) and Fat Free Mass (FFM) influence the risks of treatment related complication including chemotherapy toxicity is poorly characterised. Bioelectrical Impedance Analysis (BIA) can be used to estimate body composition and obtain impedance values at routine clinic appointments during neo/adjuvant chemotherapy for Early Breast Cancer (EBC). Differences in impedance measures of resistance, reactance and phase angle, and/or derived estimates of elevated FM index and low FFM index can be individually and/or jointly predictive of chemotherapy toxicity. Primary objective to determine if higher FMi is associated with increased grade 3 chemotherapy toxicity in women receiving neo/adjuvant chemotherapy for EBC.

Reference values for skeletal muscle mass and fat mass measured by bioelectrical impedance in 390565 UK adults.

BackgroundLoss of skeletal muscle mass (SMM) increases the risk of frailty and, together with excess fat mass (FM), is a risk factor for cardio‐metabolic disease. However, use of body composition measurements in nutritional surveillance and routine clinical practice is limited by the lack of reference data. Our aim was to produce age‐specific and sex‐specific reference values for SMM and FM in the White ethnic adult population in the UK. Secondary objectives were to examine the tracking over time using a subsample of the population with repeated measures of body composition and to assess the validity of these reference values in different ethnic subgroups.MethodsWe used data from segmental bioelectrical impedance analysis (BIA) in 390 565 participants, aged 40–69 years, in the UK Biobank, and data from dual‐energy X‐ray absorptiometry from n = 905 participants to validate the BIA measurements. SMM was calculated as the sum of the predicted muscle mass from the limbs. The LMS method was used to produce percentile curves for the SMM index (SMMI = SMM/height2) and the FM index (FMI = FM/height2). We investigated the validity of the White ethnic reference values by plotting z‐scores (99.7% confidence interval) from Black and Asian groups to check if their confidence interval included zero. Longitudinal trajectories were predicted based on the baseline z‐scores and the correlation between repeated measurements at follow‐up.ResultsThe percentile curves show that SMMI declines in men from the age of 40, whereas in women, SMMI is more stable and decreases only slightly among women in the higher percentiles. FMI increases with age in both men and women. Women have higher FMI and lower SMMI than men in all age groups. The validity of the White‐based reference values for non‐White ethnic groups is poor. Longitudinal trajectories in body composition in the subsample of participants with a follow‐up assessment show regression towards the mean in both men and women, with some evidence of declining SMMI only among men. The predicted 90% limits for the expected 5 year trajectories of SMMI and FMI can be used to identify people with unusual trajectories and in clinical practice to identify and track individuals at risk of excessive loss of SMM.ConclusionsThese body composition reference values developed from BIA in a middle/older‐aged healthy White ethnic population in the UK could be used as a simple assessment tool for nutritional surveillance and to identify individuals with low SMMI or high FMI who may be at increased risk of disease and/or frailty.

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

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

Adolescent body composition and associations with body size and growth from birth to late adolescence. The Tromsø study: Fit Futures-A Norwegian longitudinal cohort study.

Fat and fat-free masses and fat distribution are related to cardiometabolic risk. to explore how birth weight, childhood body mass index (BMI) and BMI gain were related to adolescent body composition and central obesity. In a population-based longitudinal study, body composition was measured by dual-energy X-ray absorptiometry in 907 Norwegian adolescents (48% girls). Associations between birth weight, BMI categories, and BMI gain were evaluated by fitting linear mixed models and conditional growth models with fat mass index (FMI, kg/m2 ), fat-free mass index (FFMI, kg/m2 ) standard deviation scores (SDS), and central obesity at 15 to 20years, as well as change in FMI SDS and FFMI SDS between ages 15 to 17 and 18 to 20 as outcomes. Birth weight was associated with FFMI in adolescence. Greater BMI gain in childhood, conditioned on prior body size, was associated with higher FMI, FFMI, and central overweight/obesity with the strongest associations seen at age 6 to 16.5years: FMI SDS: β=0.67, 95% CI (0.63-0.71), FFMI SDS: 0.46 (0.39, 0.52), in girls, FMI SDS: 0.80 (0.75, 0.86), FFMI SDS: 0.49 (0.43, 0.55), in boys. Compared with birth and early childhood, high BMI and greater BMI gain at later ages are strong predictors of higher fat mass and central overweight/obesity at 15 to 20years of age.

Body Composition, Strength, and Dietary Intake of Patients with Hip or Knee Osteoarthritis.

To describe body composition (fat mass (FM) and fat-free mass (FFM)), strength, and nutritional characteristics of patients with hip or knee osteoarthritis undergoing total joint arthroplasty. In this prospective pilot study, osteoarthritic patients underwent body composition assessment using bioelectrical impedance analysis, grip strength measurement, and completed a 24-h dietary recall during their pre-operative assessment. Fifty-five patients were included (∼66% females, age 43-89 years). Mean ± SD body mass index (BMI) was 32.79 ± 6.48 kg/m(2) and 62% were obese. Compared with hip osteoarthritis patients, knee osteoarthritis patients had a higher BMI (P = 0.018) and males with knee osteoarthritis had a lower grip strength (P = 0.028). There was a wide range in FM and FFM values across the BMI spectrum. Patients with a higher FM index (FMI, FM/height in m(2)) had higher levels of pain (P = 0.036) and females with higher FMI had a lower grip strength (P = 0.048). Dietary under-reporting was common and many patients did not meet recommendations for protein, vitamins C and E, or omega-3 fatty acids. Those who consumed less protein than the recommended dietary allowance were older (P = 0.018). A wide variability of body composition and dietary intake was observed which may impact strength and ultimately affect physical function. As such, patients with osteoarthritis may benefit from targeted nutrition and physical activity interventions before and after surgery.

Environmental correlates of adiposity in 9–10 year old children: Considering home and school neighbourhoods and routes to school

The rapid speed of the recent rise in obesity rates suggest environmental causes. There is therefore a need to determine which components of the environment may be contributing to this increase. In this cross-sectional study, we examined the associations between adiposity and the characteristics of areas around homes, schools and routes to school among 1995 9–10 year old boys and girls in Norfolk, UK. The relationships between Fat Mass Index (FMI, calculated as fat mass (kg)/height (m) 2) and objectively computed environmental indicators describing access to food outlets and physical activity facilities, the safety and connectivity of the road network, and the mix of land uses present were investigated. Multivariable hierarchical regression models were fitted with log-transformed FMI as the outcome, and stratification by gender and mode of travel to school. Among girls, better access to healthy food outlets (supermarkets and greengrocers) in the home environment was associated with lower FMI while better access to unhealthy outlets (takeaways and convenience stores) around homes and schools was associated with higher FMI. Also in girls, a higher proportion of accessible open land and a lower mix of land uses around the school were associated with higher FMI. Among boys the presence of major roads in the home neighbourhood was associated with higher FMI among non-active travellers, while major roads in the school neighbourhood were associated with lower FMI among active travellers. No significant associations were seen between FMI and any of the route characteristics. While the relative paucity of associations provides few indicators for the design of effective interventions, there was some evidence that environmental characteristics may be more important among active travellers than non-active travellers, and among girls than boys, suggesting that future interventions should be sensitive to such differences.

School level correlates with adiposity in 9–10 year old children

We examined the associations between the physical, social, and policy environments of schools and adiposity in 9–10 year old children in Norfolk, UK. The relationships between 56 school-level variables and Fat Mass Index (FMI; fat mass (kg)/height (m 2)) were investigated among 1724 well characterised children from 92 schools in this cross-sectional study. After stepwise removal of variables from multilevel linear regression models stratified by gender, only three variables were significantly associated with FMI. Among girls, attending a school with more pupils in the year group was associated with lower FMI, and attending a school with better cycle provision was associated with higher FMI. In boys being allowed to eat any food at break-time was associated with higher FMI. There was some evidence of moderation of the relationship between cycle provision and FMI by urban–rural location. These data suggest that few school factors are associated with FMI, and provide limited pointers to inform potential future school-based interventions to reduce obesity.

Do Physical Activity and Aerobic Fitness Moderate the Association Between Birth Weight and Metabolic Risk in Youth?

OBJECTIVELower birth weight has been associated with a greater risk of metabolic diseases. The aim of this study was examine whether physical activity and aerobic fitness may modify associations between birth weigh and metabolic risk.RESEARCH DESIGN AND METHODSThe European Youth Heart Study is a population-based study of 9 and 15 year olds (n = 1,254). Birth weight was maternally reported. Skin fold measures were used to calculate body fat and fat mass index (FMI = fat mass [kilograms]/height2). Insulin was measured using fasting blood samples. Physical activity was measured using a hip-worn accelerometer (MTI Actigraph) for >600 min/day for ≥3 days and is expressed as “average activity” (counts per minute) and time spent in above moderate intensity activity (>2000 cpm). Aerobic fitness was assessed using a maximal cycle ergometry test (watts per kilogram fat-free mass).RESULTSHigher birth weight was associated with higher FMI (β = 0.49 [95% CI 0.21–0.80]; P = 0.001) and greater waist circumference (0.90 [0.32–1.47]; P < 0.001), adjusted for sex, age-group, sexual maturity, height, and socioeconomic status. Lower birth weight was associated with higher fasting insulin only after further adjustment for adolescent waist circumference and height (−0.059 [−0.107 to −0.011]; P = 0.016). There was no evidence for any modification of the associations after adjustment for physical activity or aerobic fitness.CONCLUSIONSThe present study did not find any evidence that physical activity or aerobic fitness can moderate the associations among higher birth weight and increased fat mass and greater waist circumference or between lower birth weight and insulin resistance in healthy children and adolescents.

Body composition in Swedish old people aged 65–99 years, living in residential care facilities

It is important to evaluate body composition changes in subjects with an existing multi-system reduction in capacity, as a small decrease in fat-free mass (FFM) can cause serious impairments. The aim of the study was to describe body composition in old people living in institutions. Body composition data were collected within a study of 173 subjects with functional and cognitive impairment, aged 65–99 years, and living in residential care facilities. A bioelectrical impedance spectrometer (BIS) (Xitron Hydra 4200; 5–1000 kHz) was used to assess the amount of both FFM and fat mass (FM) which where adjusted for height. The Harpenden caliper and a tape measure were used to assess body fat, arm-muscle and arm-fat area (mm 2). A large proportion of the old and functionally impaired population was at risk of malnutrition or already malnourished (63.4% vs. 17.4%) according to Mini-Nutritional Assessment (MNA). Women had significantly lower fat-free mass index (FFMI) and higher FMI, inversely related to age, than men. Bioelectrical impedance spectroscopy and anthropometrical measurements correlated but on different levels. In addition the FM% differed between the two methods (46.3% vs. 33.4%).

Indices of fatness and relationships with age, ethnicity and lipids in New Zealand European, Māori and Pacific children

To investigate the relationships between body mass index (BMI), body fatness, ethnicity, age and blood lipids. In a subsample (N=643) of the 2002 New Zealand Child Nutrition Survey (N=3275, age 5-14 years) consisting Māori (89 boys, 69 girls), Pacific (154 boys, 194 girls) and European (71 boys, 66 girls) ethnic groups, fat-free mass (FFM) was determined by bioimpedance analysis. FFM index (FFMI, FFM/height(2)), fat mass index (FMI, fat mass/height(2)) and percentage body fat (%BF) were derived. Plasma total cholesterol and high-density lipoprotein (HDL) cholesterol were measured in 515 (80%) of these children. For the same BMI, %BF was lower in Pacific Island (P<0.0001) and Māori (P<0.0001) girls compared with European but for boys there were no ethnic differences. Cross-sectional analysis across ages using Hattori charts clearly showed sexual dimorphism with girls having a higher FMI, FFMI and BMI than boys by the age of 13 year. Both Pacific girls and boys showed upward trends in FFMI and FMI with age that were significantly higher than those of the other ethnicities. Adjusting for age, sex and ethnicity, %BF was a better predictor (R(2)=0.090, P=0.0002) of total cholesterol than BMI (R(2)=0.061, P=0.049) or waist (R(2)=0.075, P=0.013) while FFMI was the best predictor of HDL cholesterol (R(2)=0.15, P<0.0001) and waist was the best predictor of the total cholesterol/HDL cholesterol ratio (R(2)=0.17, P<0.0001). Measurements of body fat and indices of body fatness additional to BMI in multiethnic paediatric populations allow changes in fat mass and FFM to be tracked and improve the ability to predict dyslipidaemia.

Body fat mass and lean mass as predictors of survival in hemodialysis patients

A higher body mass index (BMI) is a predictor of better survival in hemodialysis patients, although the relative importance of body fat and lean mass has not been examined in the dialysis population. We performed an observational cohort study in 808 patients with end-stage renal disease on maintenance hemodialysis. At baseline, fat mass was measured by dual-energy X-ray absorptiometry and expressed as fat mass index (FMI; kg/m2). Lean mass index (LMI) was defined as BMI minus FMI. During the mean follow-up period of 53 months, 147 deaths, including 62 cardiovascular (CV) and 85 non-CV fatal events, were recorded. In univariate analysis, LMI was not significantly associated with CV or non-CV death, whereas a higher FMI was predictive of lower risk for non-CV death. Analyses with multivariate Cox models, which took other confounding variables as covariates, indicated the independent associations between a higher LMI and a lower risk of CV death, as well as between a higher FMI and a lower risk of non-CV death. These results indicate that increased fat mass and lean mass were both conditions associated with better outcomes in the dialysis population.

Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study

Reduced lean tissue as well as high fat mass may be independent nutritional risk factors resulting in increased length of hospital stay (LOS). This controlled population study (1707 patients, 1707 volunteers) aimed to evaluate the association between LOS in Geneva and Berlin patients at hospital admission and high fat mass index (FMI, kg/m2) and low fat-free mass index (FFMI, kg/m2), and the respective value of body mass index (BMI) and of FFMI and FMI for nutritional assessment. Patients (891 men, 816 women) were prospectively recruited at hospital admission and compared to gender-, age- and height-matched healthy volunteers. Fat-free mass and fat mass, determined at admission by 50 kHz-bioelectrical impedance analysis, were expressed as indices (FFMI and FMI-kg/m2) to normalize for height. Patients were classified in four groups: normal, low FFMI, high FMI, or low FFMI and high FMI. Logistic regressions were used to determine the association between body composition and LOS. Higher FMI and lower FFMI were found in patients at hospital admission than in sex- and age-matched healthy volunteers. Low FFMI, high FMI, and low FFMI/high FMI combined, adjusted for age, were all significantly associated with longer LOS (high FFMI: 1-5 days OR 2.4, CI 2.0-2.9; 6-10 days OR 2.3, CI 1.8-3.0; 11 days OR 2.8, CI 2.2-3.5); low FMI: 1-5 days OR 1.9, CI 1.6-2.2; 6-10 days OR 2.7, CI 2.0-3.5, 11 days OR 2.1, CI 1.7-2.7; low FFMI/high FMI: 1-5 days OR 7.8, CI 5.3-11.4; 6-10 days OR 13.6, CI 7.8-23.5, 11 days OR 11.8, CI 7.0-19.8). Increased LOS is associated with adiposity (high FMI) and low muscle mass (low FFMI). The current study shows that both depletion of lean tissue and excess of fat mass negatively affect the LOS. Finally, we found that excess fat mass reduces the sensitivity of BMI to detect nutritional depletion.