Lost Fat Mass Research Articles

Impacts of time-restricted feeding on middle-aged and old mice with obesity.

Time-restricted feeding is known to ameliorate obesity in young mice. However, evaluation of its effect in old age is still lacking. The current work aims to investigate the effects of time-restricted feeding on treating pre-existing obesity in old animals. The study utilized middle-aged and old high fat diet-induced obese mice and subjected them to 8h daily time-restricted feeding. Aged obese mice did not lose fat mass but lost lean mass after 8 weeks of treatment. In addition, time-restricted feeding reduced adiposity in brown adipose tissue, reversed excessive hepatic lipid accumulation, and improved glucose homeostasis in middle-aged and old obese mice. Mechanistic studies show that these metabolic benefits were mediated by transcriptional downregulation of essential genes responsible for hepatic adipogenesis and adipose tissue chronic inflammation. These results demonstrate that time-restricted feeding improves metabolic health and has beneficial effects in combating diet-induced obesity in aged obese mice. KEY POINTS: Contrary to in young obese mice, in old obese mice time-restricted feeding did not significantly reduce body fat but decreased lean mass. Time-restricted feeding reduced adipose tissue inflammation, reversed fatty liver, and improved glucose homeostasis in aged mice with diet-induced obesity. Time-restricted feeding is effective in improving metabolic homeostasis in aged mice, but less effective in terms of reducing obesity. Future studies should investigate the underlying mechanism of how ageing impaired intermittent fasting induced fat loss.

Hypothalamic-pituitary-ovarian axis suppression is common among women during US Army Basic Combat Training

ObjectiveLess than half of servicewomen report loss of menses during initial military training. However, self-reported menstrual status may not accurately reflect hypothalamic-pituitary-ovarian (HPO) axis suppression and may underestimate reproductive health...

Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis

BackgroundCirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care.MethodsA retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing’s bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed.Results73.3% (11/15) patients were male with a median age of 63 (52–68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031).ConclusionsThis proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.

32 Exercise versus feed restriction: What is the most efficient weight loss option for your fat horse?

In first world countries, 45–75% of domesticated horses are considered overweight. Accumulation of excessive fat mass puts horses at risk for co-morbidities such as systemic inflammation and osteoarthritis. The objective was to characterize weight loss in overweight horses during 10 weeks of feed restriction, exercise, or both. Thirty-two horses, 4 geldings and 28 mares, mean age of 14 ± 4, with a body condition score (BCS) of at least 7/9, were fed controlled, individualized hay feedings 3 times a day with a concentrate meal. Diets were based on horse's body weight (BW) (kg) and calculated using FeedXL. Horses were randomly allocated into one of 4 treatment groups, Daily Exercise (E), Feed Restriction (FR), Feed Restriction & Daily Exercise (FRE), or unrestricted sedentary Control (C). The C and E horses were fed 100% of their Digestible Energy (DE) requirements, while FR and FRE horses were fed 85%. The E and FRE groups underwent submaximal unridden exercise, with a consistent working heart rate of 150 bpm, for 20 min, 5 times a week, with a walking warm-up and cooldown, with the approximate DE loss of 15% based on the NRC. In wk 1, 5 and 10, morphometric measurements were recorded, including BW (kg, via weight tape), cresty neck score (CN) (/5), whole body BCS (/9) and individual BCS (/9) for 8 different anatomical locations. Original mean BCS for all treatment groups was 7 ±0.2. Original BW (kg) for each of the treatment groups are as follows: C 486 ± 11, E 501 ± 11, FR 485 ± 12, and FRE 469 ± 11. Statistical analysis was performed using SAS Studio. Data were analyzed using 1-Way RM ANOVA for individual treatments and 2-Way RM ANOVA to determine significant (P ≤ 0.05) effects of and interactions between time and treatment. There was a reduction in BW across time for all groups (P < 0.0001). The mean weight loss (kg) for each treatment group are as follows: C 28kg, E 31kg, FR 27kg, FRE 36kg. The CN score was reduced in E and FRE horses (P = 0.01; P = 0.02). Whole body BCS was reduced in E (P < 0.0001), FR (P = 0.001) and FRE (P < 0.0001). Treatment group affected anatomical BCS of the tailhead and shoulder (P = 0.05 and P = 0.01), with FRE having the greatest reduction (P = 0.0005 and P = 0.001,). Anatomical BCS loss at the withers was found to have an interaction between time and treatment (P = 0.02). In conclusion, although all horses lost BW, there were differences in how the treatment groups lost fat mass, with exercise programs having a significant effect on the change in CN, tailhead and shoulder fat mass. Therefore, the most efficient weight loss program, is that of combining both daily exercise and feed restriction.

Instability Functional Training: Evidence-Based Recommendations for Coaches

Instability Functional Training (IFT) has been a popular form of program design in personal training certifications, and thus, widely accepted among trainers and coaches when creating programs for their clients. Training philosophies around this exercise style have been plotted in various directions, ranging from mainstream advocacy to vehement opposition. It is common practice for personal trainers to utilize unstable training and blanket all clients into this methodology in specific and non-specific exercise programs. The research does support its viability in clinical rehabilitation settings; however, it may not benefit a healthier population and may even undermine their goals. We ask trainers and coaches to consider their current position on the validity of IFT and to examine the evidence when programming it for the general public whose primary goal is to improve how they look (e.g., lose fat mass and increase lean body mass). Therefore, this article aims to help identify the merit of instability functional training, objectively review the current literature and recommend a practical approach for trainers and coaches when designing general exercise programs for clients with aesthetic goals.

PHOSPHORYLATION OF ULK1 AT S555 IS REQUIRED FOR METABOLIC ADAPTATIONS TO CALORIC RESTRICTION

Abstract Unc-51 Like Autophagy Activating Kinase 1 (Ulk1) is responsible for initiating selective degradation of damaged/dysfunctional mitochondria (mitophagy) once phosphorylated at S555 in response to energetic stress. Mitophagy is integral for mitochondrial health and Ulk1 has been implicated to be important for metabolic adaptation to exercise. Caloric restriction (CR), which extends lifespan and healthspan, has profound metabolic benefits, including improved mitochondrial health. However, the contribution of Ulk1 in adaptation to CR is unknown. To decipher a functional role of Ulk1(S555) in adaptations to CR we used CRISPR-Cas9 generated, loss-of-function Ulk1(S555A) mice, in which Ulk1 cannot be phosphorylated at S555. 6-month-old, male and female homozygous Ulk1(S555A) mice and C57BL6/J (wild type, WT) mice were placed on a 40% CR diet for 8 weeks. Body mass in both male and female Ulk1(S555A) and WT mice was reduced with CR (p &amp;lt; 0.001), however female Ulk1(S555A) were heavier than their WT counterparts (p=0.02). Via nuclear magnetic resonance (NMR), male and female Ulk1(S555A) mice did not lose fat mass during CR. In addition, periovarian (female) and epididymal (male) fat mass was greater in Ulk1(S555A) compared to WT mice post-CR (p &amp;lt; 0.001). Furthermore, fasting blood glucose increased in male and female Ulk1(S555A) post-CR (p &amp;lt; 0.0001), suggesting altered substrate metabolism. In support of this notion, glucose oxidation in both quadriceps muscle and liver of male mice increased in WT following CR but not in Ulk1(S555A) mice (interaction effect p&amp;lt; 0.002). In sum, these data suggest that phosphorylation of Ulk1 at S555 is required for metabolic adaptations to CR.

FDA-Approved Pharmacotherapy for Weight Loss Over the Last Decade.

Obesity is a recently defined illness whose diagnosis and treatment continue to be stigmatized. Currently, due to lifestyle changes brought on by technological advancements and the wide availability and affordability of high-calorie foods, millions of people around the world suffer from obesity and/or its sequelae. Finding adequate prevention and treatment options would therefore lead to massive improvements in the duration and quality of life of affected individuals. In this review, we searched the PubMed database for studies exploring the safety and efficacy of the five medications currently approved by the FDA for the treatment of obesity. We included only studies pertaining to adult patients that have been published between 2012 and 2022. We found evidence that all the drugs analyzed such as orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semaglutide appear to be effective in inducing weight loss, with the suggestion that semaglutide may have superior efficacy. However, a massive obstacle in developing treatment guidelines remains the lack of prolonged studies monitoring the long-term safety and efficacy of obesity medications. Nevertheless, in patients at risk of complications from obesity, the benefits of losing fat mass may outweigh the potential side effects associated with these medications and clinicians should prescribe whichever of the FDA-approved pharmacotherapy they deem most appropriate for the patient’s specific set of circumstances.

Is an Exercise Intervention the only way to Reduce Visceral Fat without Reducing Fat-free Mass in Children and Adolescents?

Objectives: To maintain proper development, it is recommended that children/adolescents focus more on increasing physical activity than dietary restriction when treating obesity. In other words, adults are better able to tolerate the reductions in fat-free body mass that often occur when trying to lose fat mass. In contrast, children and adolescents should avoid losses in fat-free mass in order to ensure proper development. Therefore, when trying to reduce visceral fat in children via a negative energy balance (i.e., exercise with or without calorie restriction), it is necessary to set desirable conditions in order to minimize the loss of fat-free mass. To determine whether this is possible, we reviewed literature discussing the relationship between changes in visceral fat obtained by abdominal imaging and changes in total body fat and fat-free mass after exercise training with and without calorie restriction in children and adolescents.Methods: Literature review.Results and Conclusions: Previous work found no reduction in fat-free mass in the exercise interventions in which there was no dietary-induced calorie restriction. This supports the idea that reducing visceral fat by increasing physical activity is the preferred strategy over dietary restriction in children and adolescents. Although factors such as the type (e.g. aerobic and/or resistance) of exercise and the amount (i.e. energy expenditure) of exercise will likely have an effect on the magnitude of change in intra-abdominal visceral fat, the quantity of each that is needed without reducing fat-free mass is currently unknown.

Physiologic Effects of Levothyroxine and Liothyronine in the in Older Individuals With Persistent Subclinical Hypothyroidism: A Randomized, Double-Blind, Cross-Over Study

Background: Subclinical hypothyroidism is common in older individuals, but the physiologic responses to treatment with levothyroxine (LT4) and liothyronine (LT3) are not well defined in this age group. Methods: We conducted a randomized, double-blind, cross-over study of LT4 and LT3 treatment in men and women aged 70 years and over without anti-thyroid peroxidase antibodies with persistent subclinical hypothyroidism, defined as having a TSH level between 4.5 and 19.9 µIU/mL with a normal free thyroxine (FT4) level at two consecutive time points. Physiologic outcome measures assessed after achieving a TSH level of 0.5-1.5 µIU/mL with each therapy included vital signs, weight and body composition, bone mineral content and bone density, lipids, resting energy expenditure (REE), cognitive function, quality of life, and thyroid symptoms. Results: Thirteen participants [mean (SD) age 77 (5) years], 4 women and 9 men, completed the study. Baseline mean TSH was 4.84 (1.29) µIU/mL. The mean LT4 dose was 105 (36) µg/day [1.4 (0.5) µg/kg/day] and LT4 dose was 34 (9) µg/day [0.4 (0.1) µg/kg/day]. Mean time on LT4 was 200 days and on LT3 was 231 days, with a 28 day washout period. Compared with baseline, participants had an average weight loss of 1.1 kg on LT4 (p<0.02) and 2.5 kg on LT3 (p<0.001), which was significantly different between the two treatments (p=0.01). Fat mass decreased by an average of 0.7 kg on LT4 (p=0.03 vs. baseline) and 1.5 kg on LT3 (p<0.01 vs. baseline) and differed between treatments (p=0.01). There was a significant difference in total cholesterol of 13.3 mg/dL (p<0.001) and in low-density lipoprotein cholesterol (LDL) of 10.8 mg/dL (p<0.001) between LT4 and LT3 treatment arms; for both, the levels were lower on LT3 than LT4. No differences were seen in the other assessed outcomes. Conclusions: In a cross-over study of treatment of LT4 or LT3 in persistent subclinical hypothyroidism, participants lost fat mass and weight after each treatment, with a greater decrease after treatment with LT3. These findings support different physiologic responses to LT4 compared with LT3.

Effects of 30\u2009days of ketogenic diet on body composition, muscle strength, muscle area, metabolism, and performance in semi-professional soccer players

BackgroundA ketogenic diet (KD) is a nutritional approach, usually adopted for weight loss, that restricts daily carbohydrates under 30 g/day. KD showed contradictory results on sport performance, whilst no data are available on team sports. We sought to investigate the influence of a KD on different parameters in semi-professional soccer players.MethodsSubjects were randomly assigned to a iso-protein (1.8 g/Kg body weight/day) ketogenic diet (KD) or western diet (WD) for 30 days. Body weight and body composition, resting energy expenditure (REE), respiratory exchange ratio (RER), cross sectional area (CSA) and isometric muscle strength of quadriceps, counter movement jump (CMJ) and yoyo intermittent recovery test time were measured.ResultsThere was a significantly higher decrease of body fat (p = 0.0359), visceral adipose tissue (VAT) (p = 0.0018), waist circumference (p = 0.0185) and extra-cellular water (p = 0.0060) in KD compared to WD group. Lean soft tissue, quadriceps muscle area, maximal strength and REE showed no changes in both groups. RER decreased significantly in KD (p = 0.0008). Yo-yo intermittent test improved significantly (p < 0.0001) in both groups without significant differences between groups. CMJ significantly improved (p = 0.0021) only in KD.ConclusionsThis is the first study investigating the effects of a KD on semi-professional soccer players. In our study KD athletes lost fat mass without any detrimental effects on strength, power and muscle mass. When the goal is a rapid weight reduction in such athletes, the use of a KD should be taken into account.Trial registrationregistered retrospectively on Clinical Trial registration number NCT04078971.

Effects of a Low Carb Diet and Whey Proteins on Anthropometric, Hematochemical, and Cardiovascular Parameters in Subjects with Obesity.

BackgroundThe best way to lose body weight, without using drugs and/or suffering hunger and stress, has not yet been defined. The present study tested a low carbohydrate diet, enriched with proteins, in subjects with overweight and obesity.MethodsThe study enrolled 22 uncomplicated overweight and obese subjects. Several parameters were examined before and after 6 weeks of a low-carbohydrate diet, enriched with 18 g of whey proteins. Anthropometric (body mass index, waist circumference) variables, fasting hormones (insulin, TSH, FT3, FT4), and metabolic (glucose, prealbumin, and lipid levels) parameters were measured. 25-OH-vitamin D (25 (OH) D), parathyroid hormone (PTH) and osteocalcin, were also quantified. Body composition parameters (fat mass, fat-free mass, body cell mass, total body water) were measured by electrical bioimpedance analysis. As cardiovascular parameters, blood pressure, endothelium flow-mediated dilation (FMD), and common carotid artery intima-media thickness were also measured.ResultsThe low-carbohydrate diet integrated with proteins induced a significant decrease in body weight (P < 0.001), waist circumference (P < 0.001), fat mass (P < 0.001), diastolic blood pressure (P < 0.01), triglycerides (P < 0.001), total cholesterol (P < 0.001), pre-albumin (P < 0.001), insulin (P < 0.001), HOMAIR (P < 0.001), FT3 (P < 0.05), and c-IMT (P < 0.001), and a significant increase in FMD (P < 0.001) and 25 (OH) D (P < 0.001) was also observed.ConclusionAll these results suggest that a short-term non-prescriptive low carbohydrate diet, enriched with whey proteins, may be a good way to start losing fat mass and increase health.

Body Composition Changes in an Outdoor Behavioral Healthcare Program

Abstract This study examined the body composition changes of adolescents participating in an outdoor behavioral healthcare program. The sample was grouped by body mass index (BMI) categories of underweight, normal weight, overweight, and obese to discern the physiological changes across these categories as a result of participation. In addition, this study tested for gender differences and differences based on season of enrollment (summer vs. winter). Paired samples t tests revealed that, on average, adolescent participants moved toward healthier body compositions from intake to discharge. Specifically, underweight participants gained a significant amount of weight, predominantly composed of lean mass. Normal-weight participants stayed at approximately the same weight but gained lean mass and lost fat mass. Overweight and obese participants lost significant amounts of weight. Two-way ANOVA analyses revealed gender differences in terms of weight loss within BMI categories, yet no differences by season or b...

Mediterranean Personalized Diet Combined with Physical Activity Therapy for the Prevention of Cardiovascular Diseases in Italian Women.

Cardiovascular diseases (CVDs) and inflammatory risk indexes are used to calculate the exposure to morbidity. Most of them are suggested by the American College of Cardiology/American Heart Association to predict the risk of CVDs diagnosis in primary prevention, instead of treating the ongoing pathology. Prevention starts from habit changes with the prescription of diet and physical activity (PA). The aim of the study is to investigate the effectiveness of a personalized Mediterranean Diet (MD) and a PA intervention, on the risk indexes Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP) and Fatty Liver Index (FLI) in a population of women at risk of CVDs with different pathological conditions. After treatment, patients achieved the best results in body composition (BC) and laboratory tests. The BC analysis showed a significant reduction of total body Fat Mass (FM). CVDs risk indexes significantly decreased, except for Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (PLR). The reduction of the CVDs indexes associated with lipid profile was linked to both weight and FM decrease. AIP and LAP were significantly reduced when losing fat mass and body weight, respectively. A personalized MD therapy plus a PA program led to body weight loss, BC remodelling and risk indexes reduction.

Losing Weight after Menopause with Minimal Aerobic Training and Mediterranean Diet.

Objective: It is a common belief that menopausal women have greater difficulty losing weight. The aim of this study was to assess the efficacy of a Mediterranean diet (MD) to promote weight loss in postmenopausal women. All participants were prescribed a hypocaloric traditional MD, tailored to the individual. Subjects were asked not to begin any kind of physical activity. Body composition was measured at the beginning and after 8 weeks of treatment. In total, 89 women (age 52.8 ± 4.5 years, BMI 30.0 ± 5.2 kg/m2, fat mass 31.6 ± 10.5 kg) were divided into two groups: the first group consisted of fertile women over 45 years of age, the second group consisted of those diagnosed as menopausal. All women had an improvement in body composition (fat mass −2.3 ± 2.1 kg, p < 0.001; protein −0.1 ± 0.7 kg, p = 0.190) and blood pressure values. No differences were found between the two groups except for a higher reduction of low-density lipoprotein in the menopausal group (p = 0.035). A positive significant correlation between plant to animal protein ratio and fat-free mass variation was found in the menopausal group. These data suggest that a high adherence to a traditional MD would enable menopausal women to lose fat mass and maintain muscle mass with no significant difference to younger women. Fat mass reduction provides menopausal women with improved cardiovascular and metabolic risk factors.

Diet high in protein-rich foods with structured sport activity may be useless to lose fat mass and maintain fat-free mass.

The aim of this study was to demonstrate that a normal protein diet along with minimal sports activity can be enough to lose fat mass and maintain muscle mass. All participants were prescribed a hypocaloric nutritionally balanced Mediterranean-style diet tailored to the individual for 8 weeks. Body composition and energy expenditure were measured. Sedentary patients (G1) were only recommended to perform minimal aerobic training, while sport subjects (G2) were prescribed structured physical activity and higher calorie and protein contents in the diet. There were no significant differences between the two groups for any of the measured parameters. The models of lifestyle changes that are currently circulating were for the most part ineffective. It does not appear to be necessary to increase the protein content of the diet above that recommended by guidelines in order to lose weight. Even prescribing specific physical activity is not necessary to maintain muscle mass.

PD26-11 DIFFERENTIAL EFFECTS OF TESTOSTERONE TREATMENT ON BONE DENSITY AND BODY COMPOSITION IN MEN WITH CLASSICAL VS FUNCTIONAL HYPOGONADISM

INTRODUCTION AND OBJECTIVE: There are limited data on Testosterone (T) therapy in men with functional hypogonadism (FH) compared to those with classical forms (primary/secondary hypogonadism, PH/SH) regarding bone density and body composition METHODS: Registry data of 2-5 years comprising 189 patients including 67 men with PH (mean age 32.0±10.1 years), 49 with SH (mean age 30.4±9.4 years) and 73 with FH (mean age 44.8±11.6 years) all receiving uniform treatment using intramuscular T undecanoate (1000 mg). All patients received annual assessments of bone density and body composition using dual-energy X-ray absorptiometry RESULTS: Serum T concentrations increased from 6.8±2.7 nmol/L to 18.1±2.9 nmol/L in men with PH/SH and from 7.9±2.5 nmol/L to 17.3±3.2 nmol/L in men with FH. There was an initial difference in bone density between patient groups (T-Score lumbar spine, PH: -1.8±0.3, SH: -2.3±0.4, FH: -1.2±0.3, all p<0.001 vs each other) and (T-Score hip, PH: -1.4±0.3, SH: -1.7±0.4, FH: -1.1±0.3, all p<0.001 vs each other). Body fat content was higher (p<0.001) in FH (38%±10) than in PH (28%±6) and SH (30%±5). Lean body mass was lower in FH compared to PH/SH (p<0.001), respectively. Changes over time using Kaplan-Meier models revealed fundamental differences in inter-individual effects: men with FH were more likely to lose body fat and gain lean mass compared to men with PH/SH (hazard ratio 1.4 [1.2-1.6], p=0.006 and hazard ratio 1.3 [1.1-1.6], p=0.009). A significant increase in bone density was observed for all patient groups (lumbar spine and hip, both p<0.001), albeit the effect was least pronounced in FH and strongest in SH (lumbar spine: p=0.008 and hip: p=0.01, post-hoc tests). Stepwise multiple Cox regression models could attribute these differences to the different baseline characteristics between groups including age and delta T levels. There was no difference between groups for the overall increase in hematocrit. Changes in PSA levels were more likely to occur in FH (hazard ratio 1.4 [1.2-1.6], p=0.004) CONCLUSIONS: This study provides major new findings regarding effects T therapy in different groups of hypogonadal men. Patients with FH experience greater benefits in losing fat mass and gaining lean mass than men with classical forms of hypogonadism, while these have a more pronounced increase in bone density than patients with FH Source of Funding: none

Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review.

BACKGROUNDTransgender individuals receiving masculinising or feminising gender-affirming hormone therapy with testosterone or estradiol respectively, are at increased risk of adverse cardiovascular outcomes, including myocardial infarction and stroke. This may be related to the effects of testosterone or estradiol therapy on body composition, fat distribution, and insulin resistance but the effect of gender-affirming hormone therapy on these cardiovascular risk factors has not been extensively examined.AIMTo evaluate the impact of gender-affirming hormone therapy on body composition and insulin resistance in transgender individuals, to guide clinicians in minimising cardiovascular risk.METHODSWe performed a review of the literature based on PRISMA guidelines. MEDLINE, Embase and PsycINFO databases were searched for studies examining body composition, insulin resistance or body fat distribution in transgender individuals aged over 18 years on established gender-affirming hormone therapy. Studies were selected for full-text analysis if they investigated transgender individuals on any type of gender-affirming hormone therapy and reported effects on lean mass, fat mass or insulin resistance.RESULTSThe search strategy identified 221 studies. After exclusion of studies that did not meet inclusion criteria, 26 were included (2 cross-sectional, 21 prospective-uncontrolled and 3 prospective-controlled). Evidence in transgender men suggests that testosterone therapy increases lean mass, decreases fat mass and has no impact on insulin resistance. Evidence in transgender women suggests that feminising hormone therapy (estradiol, with or without anti-androgen agents) decreases lean mass, increases fat mass, and may worsen insulin resistance. Changes to body composition were consistent across almost all studies: Transgender men on testosterone gained lean mass and lost fat mass, and transgender women on oestrogen experienced the reverse. No study directly contradicted these trends, though several small studies of short duration reported no changes. Results for insulin resistance are less consistent and uncertain. There is a paucity of prospective controlled research, and existing prospective evidence is limited by small sample sizes, short follow up periods, and young cohorts of participants.CONCLUSIONFurther research is required to further characterise the impact of gender-affirming hormone therapy on body composition and insulin resistance in the medium-long term. Until further evidence is available, clinicians should aim to minimise risk by monitoring cardiovascular risk markers regularly in their patients and encouraging healthy lifestyle modifications.

Feasibility and Effects on Muscle Function of an Exercise Program for Older Adults.

Study objective was to determine feasibility and compliance with a 3-month exercise intervention in older adults, and if peripheral quantitative computed tomography muscle measures and jumping mechanography could detect changes in muscle mass and function. A parallel group, nonblinded, pilot trial with individuals 70 yr or older randomized to control group of walking-only (WALK) or an intervention group of walking combined with exercises to improve balance and strength (W + EX). Both groups attended similar weekly nutrition education sessions. Body composition, muscle density, intramuscular adipose tissue area, and muscle function were assessed before and after the intervention using dual-energy x-ray, peripheral quantitative computed tomography, functional tests, and mechanography. Eighty-five (90%) of 94 individuals enrolled completed (41WALK, 44W + EX). Eighty-six percent of participants attended seven or more nutrition sessions, and log sheets, used to assess exercise compliance, were returned by 66% of participants, and of those, 88% logged activity on 50%+ days. Sixty-seven percent of participants stated that they increased activity levels, and 82% stated that they felt better overall. Both groups increased lean and lost fat mass, resulting in decreases in fat percentage (all, P < 0.05). Intramuscular adipose tissue area decreased and muscle density increased among WALK (P < 0.05 and P = 0.056, respectively) but were not different between groups. Improvement in force efficiency and chair-rise power were greater among W + EX group than WALK (5.9% ± 1.8% vs -1.2% ± 2.0% [P = 0.01] and 0.25 ± 0.19 W·kg and -0.37 ± 0.23 W·kg [P = 0.04], respectively). Differences in mechanography results became greater in a per-protocol analysis. A larger trial is feasible, and the program was well accepted. Both groups showed improvements, the program that included strength and balance lead to greater jump force efficiency and power than walking only. Whether these differences lead to differences in fall rates need to be determined in a larger trial.

Seasonal changes in wildland firefighter fitness and body composition

Hiking with a pack is the highest-intensity task that wildland firefighters (WLFFs) perform during sustained activities related to wildland fire suppression. Firefighters perform this and other tasks together as a crew; this provides a unique model to evaluate select physical and physiological changes in members of working crews over a fire season during extended operations. The objective of this study was to evaluate changes in peak aerobic fitness (VO2peak), sustainable aerobic fitness at the ventilatory threshold (VO2vt) and body composition over a 5-month wildland fire season. WLFFs from four crews (55 males, 10 females) participated in a maximal graded exercise treadmill test and body composition evaluation pre- and post season. VO2peak values and variance did not change across the fire season (pre=3.96±0.65, post=3.96±0.69Lmin−1, not significant). VO2vt average decreased slightly while variance decreased greatly within each crew (pre=37.5±7.0, post=35.4±2.3mLkg−1 min−1, P&amp;lt;0.05). There was an improvement in VO2vt in initially less-fit WLFFs and a VO2vt decrease in initially more-fit WLFFs. WLFFs lost fat mass (−1.56±−1.06kg, P&amp;lt;0.01) and fat-free mass (−0.38±−1.24kg, P&amp;lt;0.05). Post-season VO2vt values were the same as the higher range of the documented metabolic cost of uphill load carriage and reveal a unique group adaptation to extended physical demands.

Community-based football in men with prostate cancer: 1-year follow-up on a pragmatic, multicentre randomised controlled trial.

BackgroundPhysical exercise has been shown to be effective in relation to fatigue, aerobic fitness, and lower body strength in men with prostate cancer. However, research into the clinically relevant effects of interventions conducted in heterogeneous patient populations and in real-life clinical practice settings is warranted.Methods and findingsWe conducted a pragmatic, multicentre, parallel randomised controlled trial in 5 Danish urological departments. Recruitment began in May 2015, the first participant was randomised in June 2015, and the last participant was included in February 2017. In total, 214 men with prostate cancer were randomly assigned to either 6 months of free-of-charge football training twice weekly at a local club (football group [FG]) (n = 109) or usual care (usual care group [UG]) (n = 105), including brief information on physical activity recommendations at randomisation. Participants were on average 68.4 (SD 6.2) years old, 157 (73%) were retired, 87 (41%) were on castration-based treatment, 19 (9%) had received chemotherapy, and 41 (19%) had skeletal metastases at baseline. In this 1-year follow-up study, we evaluated the effects of community-based football training on the following outcomes: primary outcome, quality of life; secondary outcomes: continuation of football after 6 months, hip and lumbar spine bone mineral density (BMD), mental health score, fat and lean body mass, and safety outcomes, i.e., fractures, falls, and hospital admissions. Intention to treat (ITT) and per protocol (PP) analyses were conducted. No statistically significant between-group difference was observed in change in prostate-cancer-specific quality of life (ITT: 1.9 points [95% CI −1.9 to 5.8], p = 0.325; PP: 3.6 points [95% CI −0.9 to 8.2], p = 0.119). A statistically significant between-group difference was observed in change in total hip BMD, in favour of FG (0.007 g/cm2 [95% CI 0.004 to 0.013], p = 0.037). No differences were observed in change in lumbar spine BMD or lean body mass. Among patients allocated to football, 59% chose to continue playing football after the end of the 6-month intervention period. At 1-year follow-up in the PP population, FG participants had more improvement on the Mental Component Summary (2.9 [95% CI 0.0 to 5.7], p = 0.048 points higher) than UG participants, as well as a greater loss of fat mass (−0.9 kg [95% CI −1.7 to −0.1], p = 0.029). There were no differences between groups in relation to fractures or falls. Hospital admissions were more frequent in UG compared to FG (33 versus 20; the odds ratio based on PP analysis was 0.34 for FG compared to UG). There were 3 deaths in FG and 4 in UG. Main limitations of the study were the physically active control group and assessment of physical activity by means of self-report.ConclusionsIn this trial, participants allocated to football appeared to have improved hip BMD and fewer hospital admissions. Men who played football more than once a week for 1 year lost fat mass and reported improved mental health. Community-based football proved to be acceptable, even when club membership was not subsidised.Trial registrationClinicalTrials.gov NCT02430792.