Arm Lean Mass Research Articles

Association of adiponectin with peripheral muscle status in elderly patients with heart failure

BackgroundReduced peripheral muscle mass was demonstrated in patients with chronic heart failure (HF). Adipokines may have potent metabolic effects on skeletal muscle. The associations between adipokines, peripheral muscle mass, and muscle function have been poorly investigated in patients with HF. MethodsWe measured markers of fat and bone metabolism (adiponectin, leptin, 25-hydroxy vitamin D, parathyroid hormone, osteoprotegerin, RANKL), N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in 73 non-cachectic, non-diabetic, male patients with chronic HF (age: 68±7years, New York Heart Association class II/III: 76/26%, left ventricular ejection fraction 29±8%) and 20 healthy controls of similar age. Lean mass as a measure of skeletal muscle mass was measured by dual energy X-ray absorptiometry (DEXA), while muscle strength was assessed by hand grip strength measured by Jamar dynamometer. ResultsSerum levels of adiponectin, parathyroid hormone, osteoprotegerin, RANKL, and NT-pro-BNP were elevated in patients with chronic HF compared to healthy controls (all p<0.0001), while no difference in serum levels of leptin, testosterone or SHBG was noted. Levels of 25-hydroxy vitamin D were reduced (p=0.002) in HF group. Peripheral lean mass and hand grip strength were reduced in patients with HF compared to healthy subjects (p=0.006 and p<0.0001, respectively). Using backward selection multivariable regression, serum levels of increased adiponectin remained significantly associated with reduced arm lean mass and muscle strength. ConclusionsOur findings may indicate a cross-sectional metabolic association of increased serum adiponectin with reduced peripheral muscle mass and muscle strength in non-cachectic, non-diabetic, elderly HF patients.

Significant positive relationship between serum magnesium and muscle quality in maintenance hemodialysis patients

Serum magnesium (Mg) levels have been associated with muscle performance in the general population. We hypothesized that serum Mg would be associated with muscle quality in hemodialysis patients. A total of 310 patients were examined (age: 58 ± 12 years, hemodialysis duration: 6.4 ± 6.0 years, 60.6% men, and 36.1% diabetics). Arm lean mass was measured by dual energy X-ray absorptiometry (DXA) on the dominant side. Arm muscle quality was defined as the ratio of the handgrip strength to the arm lean mass of the same side (kg/kg). Serum Mg was 1.15 ± 0.16 mmol/L (2.8 ± 0.4 mg/dL), being higher than the reference range of normal subjects. There was a significant negative correlation between muscle quality and age (r = -0.326, p<0.0001) and duration of hemodialysis (r = -0.253, p<0.0001). The muscle quality of the diabetics was significantly lower than that of the non-diabetics (p<0.001). There was a significant, positive correlation between muscle quality and serum Mg (r = 0.118, p<0.05), but not serum calcium or phosphate. In multiple regression analysis, age, gender, hemodialysis duration, diabetes, and serum Mg (β = 0.129, p<0.05) were significantly and independently associated with muscle quality (R(2) = 0.298, p<0.0001). These results demonstrated that a lower serum Mg concentration was significantly associated with poor muscle quality in hemodialysis patients. Further studies are needed to explore the mechanism by which lower serum Mg affects muscle quality.

Sarcopenia in women with vertebral fragility fractures

We performed a pilot study with the purpose to evaluate the prevalence of sarcopenia in osteoporotic women with vertebral fractures. Dual-energy X-ray absorptiometry (DXA) was used to measure the whole and regional body composition. Appendicular lean mass (aLM) was calculated as the sum of lean mass in arms and legs. We calculated the skeletal muscle mass index (aLM/h(2)), and we measured bone mineral density and T scores by DXA scan at total-body and at femoral neck. Participants were divided according to the number of vertebral fractures (single or multiple fractures). A total of 67 women were included. Thirty-five women (52.23%) had a vertebral fracture, of them 8 (22.85%) were sarcopenic and 32 women (47.76%) had multiple vertebral fractures, of them 14 (43.75%) were sarcopenic. Our results suggest that sarcopenia is common among osteoporotic women increasing along with the number of vertebral fragility fractures.

The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia

Patients with transfusion-dependent thalassemia have abnormal growth, hormonal deficits, and increased bone loss. We investigated the relationship between skeletal muscle mass, fat mass, and bone mineral density in adult subjects with transfusion-dependent thalassemia based on their gonadal status. Our findings show that hypogonadism attenuates the strength of the muscle-bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. Transfusion-dependent thalassemia is associated with a high prevalence of fractures. Multiple hormonal complications, in particular hypogonadism, can lead to changes in body composition and bone mineral density (BMD). We investigated for the first time the relationship between skeletal muscle mass (SMM), fat mass, and BMD in adult subjects with transfusion-dependent thalassemia based on their gonadal status. A retrospective cohort study of 186 adults with transfusion-dependent thalassemia was analyzed. Body composition and BMD were measured using dual energy X-ray absorptiometry. The association between skeletal muscle, fat, and BMD was investigated through uni-, multi-, and stepwise regression analyses after adjusting for multicollinearity. SMM was derived using the formula, SMM = 1.19 × ALST-1.65, where ALST is equivalent to the sum of both arm and leg lean tissue mass. There were 186 subjects, males (43.5 %) and females (56.5 %), with a median age of 36.5. Hypogonadism was reported in 44.4 % of males and 44.7 % of females. SMM and BMD were positively correlated and strongest in eugonadal males (0.36 ≤ R (2) ≤ 0.59), but the association was attenuated in hypogonadal males. SMM (0.27 ≤ R (2) ≤ 0.69) and total fat mass (0.26 ≤ R (2) ≤ 0.55) were positively correlated with BMD in hypogonadal females, but the correlation was less pronounced in eugonadal females. Leg lean tissue mass and arm lean tissue mass in males and females, respectively, were most highly correlated to BMD in the stepwise regression analysis. Hypogonadism attenuates the strength of the muscle-bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. This study supports the notion that exercise is important for maintaining BMD and the need to optimize treatment of hypogonadism in patients with transfusion-dependent thalassemia.

Oral nutritional supplement fortified with beta-alanine improves physical working capacity in older adults: A randomized, placebo-controlled study

This study examined the effects of an oral nutritional supplement fortified with two different doses of beta-alanine on body composition, muscle function and physical capacity in older adults. Using a double-blind placebo controlled design, 60 men and women (age±SD=70.7±6.2yrs) were randomly assigned to one of three treatment groups: 1) oral nutritional supplement (ONS; n=20) (8oz; 230kcal; 12g PRO; 31g CHO; 6g FAT), 2) ONS plus 800mg beta-alanine (ONS800; n=19), and 3) ONS plus 1200mg beta-alanine (ONS1200; n=21). Treatments were consumed twice per day for 12 weeks. At pre- and post-supplementation period, participants performed a discontinuous, submaximal cycle ergometry test to determine physical working capacity at fatigue threshold (PWCFT). Fat mass, total body and arm lean soft tissue mass (ALSTM) were measured with DEXA while muscle strength was assessed with handgrip dynamometry (GRIP) and 30-s sit-to-stand (STS) was used to measure lower body functionality. Muscle quality (MQ) was calculated with GRIPmax and DEXA derived ALSTM [GRIP (kg)·ALSTM (kg)−1]. Two-way analysis of variance was used to compare pre- to post-supplementation measures and group differences. There were 16 dropouts over the duration of the study. Final group sizes were ONS=16 (m=11, w=5), ONS800=15 (m=5, w=10), and ONS1200=13 (m=6, w=7). No significant changes were observed for body composition or GRIP values pre to post. Significant increases in PWCFT were seen in ONS1200 (13.6%) and ONS800 (17.8%) pre- to post-supplementation (p<0.05). These changes were significantly greater (p<0.05) than the changes in ONS (−6.3%). ONS1200 and ONS had significant increases in STS (22.2 and 10.7%, respectively). While ONS significantly increased in STS, no differences (p>0.05) in change scores were found between ONS and ONS800. ONS fortified with beta-alanine may improve physical working capacity, muscle quality and function in older men and women. These findings could have importance in the perception of frailty, and the maintenance of health and independent living in older adults.

Six‐year longitudinal changes in body composition of middle‐aged and elderly Japanese: Age and sex differences in appendicular skeletal muscle mass

Little is known about longitudinal changes of body composition measured by dual-energy X-ray absorptiometry (DXA) in middle-aged and elderly individuals. We evaluated longitudinal changes of body composition, and age and sex differences in appendicular skeletal muscle mass. Participants were 1454 community-dwelling Japanese men and women aged 40-79 years. Body composition at baseline and 6-year follow up was measured by DXA. Fat increased significantly in men of all ages, and in women aged in their 40s and 50s. Among men, arm lean tissue mass (LTM) changed by 0.9%, -0.5%, -1.4% and -3.7%, respectively, for the 40s to the 70s, and decreased significantly in the 60s and 70s. Leg LTM in men changed by -0.4%, -1.3%, -1.7% and -3.9%, respectively, and decreased significantly from the 50s to the 70s. Compared with the preceding age groups, significant differences were observed between the 60s and 70s in arm and leg LTM change in men. Among women, arm LTM changed by 0.7%, 0.2%, 1.6% and -1.5%, respectively, which was significant in the 60s and 70s. Leg LTM decreased significantly in all age groups of women by -2.0%, -2.8%, -2.4% and -3.9%, respectively. With respect to sex differences, leg LTM loss rates were significantly higher in women than men at the 40s and 50s. Longitudinal data suggest that arm and leg LTM decreased markedly in men in their 70s, and leg LTM had already decreased in women in their 40s.

Determining the Precision of Dual Energy X-Ray Absorptiometry and Bioelectric Impedance Spectroscopy in the Assessment of Breast Cancer-Related Lymphedema

The composition of breast cancer-related lymphedema (BCRL) has been shown to evolve from the initial accumulation of fluid to the development of fibrotic lesions and abnormal fat deposition. Therefore, precise and reliable assessments of BCRL are required to develop accurate staging and management. Although dual energy x-ray absorptiometry (DXA) and bioelectric impedance spectroscopy (BIS) have been used to assess BCRL, no study has evaluated the precision of these two modalities in the same cohort. We determined the precision of DXA and BIS in lymphedematous (LE) and nonaffected (NA) arms of 24 women with Stage II unilateral BCRL. Precision was calculated from the results of paired bilateral arm measurements obtained from DXA scans measuring fat, lean, and bone mineral masses, BIS measuring extracellular fluid (ECF) and total fluid volume, and circumferential tape measurements (CM) of the arms to calculate the anatomic volume. Precision error was expressed as the root mean square (RMS) of the coefficients of variation (%CV) and standard deviations (SD). The precisions of DXA and BIS varied from 1.16% (DXA measurements of LE arm total volume) to 1.86% (BIS LE arm total fluid volume) and from 0.95% (DXA lean mass of NA arm) to 1.72% (DXA BMC of NA arm). Precision of CM measures of arm volume were 1.71% CV for LE arm and 2.51% CV for NA arm. The fat and lean masses of the LE arm exceeded the NA arm by about 15% (p<0.0001). ECF and total fluid volume of LE arm was 22.6% and 19% greater than the NA arm (p<0.0001), respectively. For BCRL, these findings suggest that DXA and BIS are two measurement instruments that provide acceptable levels of precision for the measurement of arm lean mass, fat mass and ECF volume, respectively.

Fall risk and fracture. Diagnosing sarcopenia and sarcopenic leg to prevent fall and fracture: its difficulty and pit falls

Diagnosis of sarcopenia is based on the combination of physical-performance assessment and muscle-mass measurement. Physical performance was estimated by gait speed and grip strength. Common measuring procedures for skeletal muscle mass were dual energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) . Skeletal muscle mass index (SMI) was calculated from following formula ; [SMI (kg/m(2)) = (arm lean mass + leg lean mass) /height(2)] . Sarcopenia and sarcopenic leg are associated with poor body balance, falls, and subsequent fracture. Treatment of sarcopenia may result in successful prevention of fall and fracture for frail elderly.

Bone density and neuromuscular function in older competitive athletes depend on running distance

Individuals who are involved in explosive sport types, such as 100-m sprints and long jump, have greater bone density, leg muscle size, jumping height and grip strength than individuals involved in long-distance running. The purpose of this study is to examine the relationship between different types of physical activity with bone, lean mass and neuromuscular performance in older individuals. We examined short- (n = 50), middle- (n = 19) and long-distance (n = 109) athletes at the 15th European Masters Championships in Poznań, Poland. Dual X-ray absorptiometry was used to measure areal bone mineral density (aBMD) and lean tissue mass. Maximal countermovement jump, multiple one-leg hopping and maximal grip force tests were performed. Short-distance athletes showed significantly higher aBMD at the legs, hip, lumbar spine and trunk compared to long-distance athletes (p ≤ 0.0012). Countermovement jump performance, hop force, grip force, leg lean mass and arm lean mass were greater in short-distance athletes (p ≤ 0.027). A similar pattern was seen in middle-distance athletes who typically showed higher aBMD and better neuromuscular performance than long-distance athletes, but lower in magnitude than short-distance athletes. In all athletes, aBMD was the same or higher than the expected age-adjusted population mean at the lumbar spine, hip and whole body. This effect was greater in the short- and middle-distance athletes. The stepwise relation between short-, middle- and long-distance athletes on bone suggests that the higher-impact loading protocols in short-distance disciplines are more effective in promoting aBMD. The regional effect on bone, with the differences between the groups being most marked at load-bearing regions (legs, hip, spine and trunk) rather than non-load-bearing regions, is further evidence in support of the idea that bone adaptation to exercise is dependent upon the local loading environment, rather than as part of a systemic effect.

Bivariate genome-wide association study suggests that the DARC gene influences lean body mass and age at menarche

Lean body mass (LBM) and age at menarche (AAM) are two important complex traits for human health. The aim of this study was to identify pleiotropic genes for both traits using a powerful bivariate genome-wide association study (GWAS). Two studies, a discovery study and a replication study, were performed. In the discovery study, 909622 single nucleotide polymorphisms (SNPs) were genotyped in 801 unrelated female Han Chinese subjects using the Affymetrix human genome-wide SNP array 6.0 platform. Then, a bivariate GWAS was performed to identify the SNPs that may be important for LBM and AAM. In the replication study, significant findings from the discovery study were validated in 1692 unrelated Caucasian female subjects. One SNP rs3027009 that was bivariately associated with left arm lean mass and AAM in the discovery samples (P=7.26×10(-6)) and in the replication samples (P=0.005) was identified. The SNP is located at the upstream of DARC (Duffy antigen receptor for chemokines) gene, suggesting that DARC may play an important role in regulating the metabolisms of both LBM and AAM.

Patterns and correlates of grip strength change with age in Afro-Caribbean men

muscle strength is essential for physical functions and an indicator of morbidity and mortality in older adults. Among the factors associated with muscle strength loss with age, ethnicity has been shown to play an important role. to examine the patterns and correlates of muscle strength change with age in a population-based cohort of middle-aged and older Afro-Caribbean men. handgrip strength and body composition were measured in 1,710 Afro-Caribbean men. Data were also collected for demographic variables, medical history and lifestyle behaviours. the age range of the study population was 29-89 years. Grip strength increased below age 50 years, and decreased after age 50 years over 4.5-year follow-up. The average loss in grip strength was 2.2% (0.49% per year) for ages 50 years or older and 3.8% (0.64% per year) for ages 65 years or older. The significant independent predictors of grip strength loss included older age, a greater body mass index, lower initial arm lean mass and greater loss of arm lean mass. Afro-Caribbean men experience a significant decline in muscle strength with advanced age. The major independent factors associated with strength loss were similar to other ethnic groups, including age, body weight and lean mass.

Upper-Body Resistance Training and Self-Efficacy Enhancement in COPD.

PurposeLoss of skeletal muscle strength is commonly seen with chronic obstructive pulmonary disease (COPD). The study aim was to determine the effects of comprehensive upper-body resistance training (8 different lifts) and a self-efficacy enhancing intervention in COPD with respect to muscle strength, symptoms, functional status and exercise adherence.MethodsThis randomized trial had 3 groups: upper-body resistance training with an intervention to enhance self-efficacy (UBR + SE), upper-body resistance training and health education (UBR + HE), gentle chair exercises and health education (CE + HE). Subjects performed 16 weeks of supervised training, then 12 months of long-term maintenance at home. Outcomes were: muscle strength, dyspnea, functional status, self-efficacy, and adherence.ResultsSixty-four subjects completed 16 wks of training: age 71 ± 8 yr, fat-free mass index 19 ± 3 kg/m2, forced expiratory volume in one second 58 ± 18 percent predicted. The UBR + SE intervention produced a 46% increase in strength compared to a 36% increase in the UBR + HE group (P = 0.054). The combined UBR + SE and UBR + HE groups produced a 41% increase in strength compared to an 11% increase in the CE+HE (P < 0.001). The combined UBR groups also demonstrated increases in lean arm mass (P = 0.003) and a trend toward decreased dyspnea (P = 0.053). There were no group differences in attrition, attendance and training progression. Fifty subjects completed long-term maintenance and the UBR + SE and UBR + HE groups retained some gains in muscle strength, 24% and 21% respectively, and the CE + HE group lost 3% of muscle strength from baseline.ConclusionThe study provides strong evidence that comprehensive resistance training increased strength and lean arm mass and that strength can be partially maintained through a simple home program using hand weights. It provides limited evidence that upper-body resistance training improved dyspnea and that the exercise-specific self-efficacy enhancing intervention was beneficial.

Poor muscle quality as a predictor of high mortality independent of diabetes in hemodialysis patients

BackgroundPoor muscle quality provides a clinically relevant measure for mortality in general population, particularly in the elderly people. Our previous reports indicating poorer muscle quality in diabetes mellitus (DM) hemodialysis patients than in non-DM counterparts prompted us to examine the association between two parameters in hemodialysis patients, independent of DM prevalence. MethodsThe study was performed from 1997 to 2005. Grip dynamometry and dual-energy X-ray absorptiometry (DXA) were used to measure handgrip strength (HGS) and arm lean mass (ALM), respectively, with the muscle quality defined as the ratio of HGS to ALM. ResultsDuring the mean follow-up period of 77 months, 90 out of 272 patients died. The patients were divided into higher and lower groups based on the values of muscle quality. In Kaplan-Meier analysis, the higher group revealed lower mortality than the lower group. Cox regression hazards analysis identified higher muscle quality as a significant independent predictor for better survival in hemodialysis patients (HR; 0.889, 95% CI 0.814–0.971; P<0.05), after adjustment for age, sex and the prevalence of DM. Since DM prevalence is a major factor for poorer muscle quality, another analysis was performed after restriction of the subjects to non-DM patients. The result also indicated that muscle quality provides a relevant measure independent of the presence of DM to predict the mortality in hemodialysis patients (HR; 0.849, 95% CI 0.759–0.950; P<0.05). ConclusionThe study suggested that muscle quality provides a good marker for survival in hemodialysis patients, independently of the presence DM, age and serum albumin.

Prognostic value of changes in lean and fat mass in alcoholics

The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes. From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25-53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment). Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ² = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ² = 4.68; p = 0.03) and right leg lean mass (χ² = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan-Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality. Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass.

Long-term effect of exercise on bone mineral density and body composition in post-menopausal ex-elite athletes: a retrospective study

The aim of this retrospective study was to determine the long-term effect of exercise on bone mineral density (BMD), bone mineral content (BMC) and body composition (BC) in post-menopausal women who were elite athletes during their youth compared with sedentary controls. It is a retrospective study and carried out in an outpatient clinic. A total of 48 post-menopausal women (54-73 years of age) were enrolled. Ex-elite athletes with long-term (>20 years) histories of significant training and performance were divided into two groups: weight-bearing sports (runners, n=12) and non-weight-bearing sports (swimmers, n=12). The athletes were age matched with sedentary controls (n=24). BMD, BMC and BC were measured using dual-energy X-ray absorptiometry. Healthcare and sport activity histories were evaluated using a questionnaire. No significant differences were found with regard to body weight, height, body mass index and hours of activity between the two groups of athletes. There were no significant differences in activity levels between athletes and controls at the time of this study. BMD and BMC were not significantly different between athletes; they were significantly higher in athletes than in controls (P<0.001). Although the ex-athletes did not significantly differ in BC, left and right lean arm mass and arm BMD were significantly higher in swimmers than in runners (P<0.0001). The high level of physical activity observed in female athletes is associated with improved muscle mass, BMD and BMC, and physical activity during youth seems to have a beneficial effect on bone mass and helps to prevent bone loss due to aging.

Non-elite gymnastics participation is associated with greater bone strength, muscle size, and function in pre- and early pubertal girls

Recent reports indicate an increase in forearm fractures in children. Bone geometric properties are an important determinant of bone strength and therefore fracture risk. Participation in non-elite gymnastics appears to contribute to improving young girls' musculoskeletal health, more specifically in the upper body. The primary aim of this study was to determine the association between non-elite gymnastics participation and upper limb bone mass, geometry, and strength in addition to muscle size and function in young girls. Eighty-eight pre- and early pubertal girls (30 high-training gymnasts [HGYM, 6-16 hr/ wk], 29 low-training gymnasts [LGYM, 1-5 h r/wk] and 29 non-gymnasts [NONGYM]), aged 6-11 years were recruited. Upper limb lean mass, BMD and BMC were derived from a whole body DXA scan. Forearm volumetric BMD, bone geometry, estimated strength, and muscle CSA were determined using peripheral QCT. Upper body muscle function was investigated with muscle strength, explosive power, and muscle endurance tasks. HGYM showed greater forearm bone strength compared with NGYM, as well as greater arm lean mass, BMC, and muscle function (+5% to +103%, p < 0.05). LGYM displayed greater arm lean mass, BMC, muscle power, and endurance than NGYM (+4% to +46%, p < 0.05); however, the difference in bone strength did not reach significance. Estimated fracture risk at the distal radius, which accounted for body weight, was lower in both groups of gymnasts. Compared with NONGYM, HGYM tended to show larger skeletal differences than LGYM; yet, the two groups of gymnasts only differed for arm lean mass and muscle CSA. Non-elite gymnastics participation was associated with musculoskeletal benefits in upper limb bone geometry, strength and muscle function. Differences between the two gymnastic groups emerged for arm lean mass and muscle CSA, but not for bone strength.

Fat Tissue Distribution Changes in HIV-Infected Patients Treated with Lopinavir/Ritonavir. Results of the MONARK Trial

Given the decline in mortality among HIV-infected patients, it has become increasingly important to consider delayed disease-related and/or anti-HIV therapy-related adverse effects, such as lipodystrophy, when choosing initial therapy. Data from the MONARK trial allowed for comparison of the potential lipodystrophic effects of lopinavir/ritonavir (LPV/r) monotherapy with those of triple therapy with LPV/r plus zidovudine (ZDV) and lamivudine (3TC). This was a randomized, open-label, multinational study that included 136 antiretroviral-naive HIV-infected patients. A portion of study patients underwent evaluations of limb and trunk fat tissue by dual-energy x-ray absorptiometry at baseline and after 48 weeks of treatment (and 96 weeks in some patients). Sixty-three patients had paired absorptiometry data at baseline and week 48 (13 patients at week 96). At week 48, median change in limb fat was -63 g on LPV/r monotherapy versus -703 g on LPV/r + ZDV/3TC triple therapy (p=0.014). The proportion of patients with fat loss (>20% loss in limb fat) was significantly lower with LPV/r monotherapy (4.9% versus 27.3%; p=0.018). Changes in trunk fat did not differ significantly between treatments. Nonetheless, limb fat and trunk fat varied in the same direction with both treatments. The decrease in arm lean mass was also significantly less in patients receiving LPV/r monotherapy. Only treatment type emerged as a significant predictor of fat loss (odds ratio, 7.06; 95% CI, 1.11-78.69). These results suggest that LPV/r, and possibly other protease inhibitors, may not be the main contributor to lipoatrophy in HIV-infected patients receiving triple therapy.

Changes in body composition after 2 years with rheumatoid arthritis

Objectives: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD). Possible predictors for CVD are early changes in body composition. We therefore evaluated changes in lean body mass (LBM), lean mass of arms and legs (LMAL), total body fat mass (BFM), and truncal fat distribution (FD) after 2 years with RA and possible predictors.Methods: We registered 63 (45 women) RA patients with disease duration of ≤ 12 months at baseline and after 2 years. Disease Activity Score using 28 joint counts (DAS28), Health Assessment Questionnaire (HAQ) score, body mass index (BMI), comorbidities, smoking, and medications were recorded. Total and regional lean mass and fat mass were measured with dual energy X-ray absorptiometry (DXA). The data were compared with 63 age- and gender-matched controls.Results: LBM and LMAL at baseline in RA patients were significantly lower in men (p = 0.020 and 0.002, respectively) compared to matched controls. Truncal FD was non-significantly increased in RA patients (women p = 0.133, men p = 0.119). The age-related deterioration with decreased LBM after 2 years (p = 0.002 in women and men) and increased BFM (p < 0.001) and truncal FD (p = 0.020) in women were all significantly less pronounced in RA patients than in matched controls.Conclusions: In patients with early RA and after initiation of therapy, the age-related deterioration with decreasing LBM and increasing truncal FD was lower than in control subjects in this observational study. These potentially harmful alterations seem to be modifiable factors in patients with early RA.

Lean mass predicts asthma better than fat mass among females

The obesity phenotype associated with asthma is not known. Our objective was to define the relative contribution of various distributions of fat and lean mass to asthma prevalence. Data were obtained from 2,525 participants (including 1,422 females) who underwent dual-energy X-ray absorptiometry (DEXA) at the year 20 examination in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Total, truncal, arm and leg distributions of fat and lean mass were adjusted to the person's height. Self-reported asthma was the outcome. Asthma among females was associated with greater total fat mass, arm fat mass, total lean mass, truncal lean mass and arm lean mass. Among males, none of these mass measures were significantly associated with asthma. Among females, the association with asthma was stronger for total lean mass than for total fat mass. Further, among various regional distributions of lean and fat mass in females, truncal lean mass was the strongest predictor. Total lean mass is more strongly associated with asthma than total fat mass among females. These findings are contrary to the popular perception that excess physiological fat drives the obesity-asthma association. Rather, we hypothesise that ectopic fat within the "lean" tissues drives this association among females.

Asian and Caucasian UK women With low vitamin D status exhibit poorer indices of musculoskeletal health: results of the D-FINES study

More data is urgently required examining the link between poor vitamin D status on bone health and muscle function in different UK ethnic groups. The D-FINES study examined a total of 373 Surrey-dwelling Caucasian (C) and Asian (A) women in four seasons of the year for diet, sunlight exposure, 25-hydroxyvitamin D (25(OH)D) and grip strength (GS). In the autumn season, lumbar spine bone mineral density (LSBMD) was also measured. The specific aim of this work was to examine differences in LSBMD and GS in A and C pre and postmenopausal women according to 25(OH)D. When women were grouped by 25(OH)D ( 75nmol/l. For GS, controlling for lean arm mass, a statistically significant difference between the four ethnic/menopausal groups (F=24.851, p 0.05). In summary, LS BMD was found to be significantly higher in individuals with 25(OH)D >75nmol/l compared to those with <39nmol/l. These key findings show that poor 25(OH)D is associated with a detrimental effect on bone health. If maintained, these findings could potentially translate into increased fracture risk long-term. Furthermore, 25(OH)D was positively correlated with GS in all women in all seasons, indicating low 25(OH)D may decrease GS, most likely via poorer muscle function. These findings are a cause for public health concern. This work was funded by the UK Foods Standards Agency (NO5064). The views expressed are those of the authors alone.