Lower Arm Muscle Research Articles

Lower Arm Muscle Activation during Indirect-Localized Vibration: The Influence of Skill Levels When Applying Different Acceleration Loads.

We investigated the electromyographic response to synchronous indirect-localized vibration interventions in international and national table tennis players. Twenty-six male table tennis players, in a standing position, underwent firstly an upper arms maximal voluntary contraction and thereafter two different 30-s vibration interventions in random order: high acceleration load (peak acceleration = 12.8 g, frequency = 40 Hz; peak-to-peak displacement = 4.0 mm), and low acceleration load (peak acceleration = 7.2 g, frequency = 30 Hz, peak-to-peak displacement = 4.0 mm). Surface electromyography root mean square from brachioradialis, extensor digitorum, flexor carpi radialis, and flexor digitorum superficialis recorded during the two vibration interventions was normalized to the maximal voluntary contraction recording. Normalized surface electromyography root mean square was higher in international table tennis players with respect to national ones in all the interactions between muscles and vibration conditions (P < 0.05), with the exception of flexor carpi radialis (at low acceleration load, P > 0.05). The difference in normalized surface electromyography root mean square between international table tennis players and national ones increased in all the muscles with high acceleration load (P < 0.05), with the exception of flexor digitorum superficialis (P > 0.05). The muscle activation during indirect-localized vibration seems to be both skill level and muscle dependent. These results can optimize the training intervention in table tennis players when applying indirect-localized vibration to lower arm muscles. Future investigations should discriminate between middle- and long-term adaptations in response to specific vibration loads.

Body composition of preschool children and relation to birth weight.

to evaluate the relationship between body composition of preschool children suffering from excess weight and birth weight (BW). probabilistic sample, by conglomerates, with 17 daycare centers (of a total of 59) composing a final sample of 479 children. We used Z-score of Body Mass Index (zBMI) ≥ +1 and ≥ +2, respectively, to identify preschool children with risk of overweight and excess weight (overweight or obesity). The arm muscle area (AMA) and the arm fat area (AFA) were estimated from measurements of arm circumference, triceps skin fold thickness. the prevalence of risk of overweight was 22.9% (n=110) and excess weight was 9.3% (n=44). The risk of overweight and excess weight in children did not show correlation between BW and AFA, but it did with adjusted arm muscle area (AMAa) (rp= 0.21; p= 0.0107). The analysis of the group with excess weight alone also showed a positive correlation between BW and AMAa (rp= 0.42; p= 0.0047). among overweight children, lower BW is associated with a lower arm muscle area in early preschool age, regardless of the fat arm area presented by them.

The association between nutritional status and cognitive impairment in brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui study.

In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass.OBJECTIVETo investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly.METHODSParticipants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression.RESULTSCognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over).CONCLUSIONThere was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age.

An investigation into the association between nutritional status and quality of life in older people admitted to hospital

Malnutrition is prevalent in acute hospitals and malnourished patients have an increased risk of morbidity and mortality. Studies of malnutrition and quality of life (QoL) are generally limited by both the nutritional and QoL assessment methods employed. The present study aimed to evaluate the relationship between malnutrition, as assessed using a range of nutritional assessment methods, and QoL, as measured by EuroQol-5D-3L and Short-Form (SF)-36 questionnaires. The study comprised a prospective cross-sectional study of malnutrition and QoL in 149 inpatients aged 65-99years. Exclusion criteria were: terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Spearman's rank correlation coefficient was used to test the association between QoL indices and nutritional markers. QoL scores for those scoring above and below thresholds for nutritional risk were compared. Regression models were created to identify nutritional indices contributing to the variability of QoL. There were significant associations between QoL scores and the Mini Nutritional Assessment (MNA)-SF. Clear differences were evident between malnourished and well-nourished patients (on the MNA-SF), those with low and normal arm muscle circumference and those with good and poor physical function. Regression analysis showed that nutritional scores and functional status made independent contributions to the prediction of QoL. The effect on food intake, mobility and psychological stress/acute disease also had a significant influence. Malnutrition risk is linked to a poorer QoL in older people on admission to hospital. Functional status and eating-related factors are major influencers on QoL in this group. These findings reinforce the role of nutrition as a priority with respect to achieving improvements in QoL.

Nutritional vulnerability in Mbyá‐Guaraní adolescents and adults from Misiones, Argentina

The aim of this study was to evaluate the nutritional status and body composition in Mbyá-Guaraní adolescents and adults from three communities in the Province of Misiones, in northern Argentina. Anthropometric parameters were analyzed in 45 individuals (aged 14-60). Data were transformed to z-scores using NHANES I and II. Ninety-three percent of the sample showed some kind of malnutrition (undernutrition and/or excess of weight). Stunting and overweight reached the highest prevalences (85.0 and 10.0%, respectively). The most Mbyá people were found to have low arm muscle and fat areas. They also tended to have shorter than normal lower limbs. Centralized obesity was evident in both sexes and in all the age intervals. Extreme poverty, together with changes in life habits and diet composition, resulted in decrease of body size and changes in body proportions and composition. Although these changes could be considered as an adaptive response to the chronic exposure of these populations to adverse environmental conditions, they would favor the co-occurrence of malnutrition and overweight in a single scenario, and consequently increase the risk of infectious and nontransmissible diseases.

Effects of concurrent physical and mental demands for a short duration static task

The purpose of this study was to quantify the effects of concurrent physical and mental demands on the upper extremity muscle activity during static exertions. Seventeen healthy participants performed isometric upper extremity exertions at five levels of physical intensity (5%, 25%, 45%, 65%, and 85% maximum voluntary contraction (MVC)) in the presence and absence of a mental task (Stroop color word test). Muscular responses were quantified using surface electromyography (EMG) and motor performance was measured through force fluctuations. Subjective assessments were obtained through the NASA-TLX tool and the Borg CR-10 Scale. In general, a decrease in mean anterior and posterior deltoid muscle activity and co-contraction index (CCI) of the shoulder was observed in the presence of the mental task. However, these changes were more prominent at higher physical exertion levels compared to the lower levels. Furthermore, the additional mental task resulted in decreased upper and lower arm muscle activity, specifically at the 45% MVC level. Motor performance improved at the middle exertion levels, but was adversely affected by the mental task at higher exertion levels. Decreased motor performance at higher loads may have been a result of decreased muscular effort to maintain the loads in a steady posture. Both mental and physical demand adversely affected the NASA-TLX ratings, however, ratings using the Borg CR-10 Scale were only sensitive to changes in physical demand. Relevance to industry Workplace tasks, such as jobs performed by healthcare workers, assembly line workers, and computer operators, have become more multidimensional in the recent years; with workers experiencing combined physical and mental demands in their daily jobs, yet their effect on muscular responses is not clearly understood. Results from this study suggest that certain physical exertion levels are more susceptible to interference by mental demands than others.

Maternal muscle mass may influence system A activity in human placenta

During pregnancy, nutrient partitioning between the mother and fetus must balance promoting fetal survival and maintaining nutritional status of the mother for her health and future fertility. The nutritional status of the pregnant woman, reflected in her body composition, may affect placental function with consequences for fetal development. We investigated the relationship between maternal body composition and placental system A amino acid transporter activity in 103 term placentas from Southampton Women's Survey pregnancies. Placental system A activity was measured as Na +-dependent uptake of 10 μmol/L 14C-methylaminoisobutyric acid (a system A specific amino acid analogue) in placental villous fragments. Maternal body composition was measured at enrolment pre-pregnancy; in 45 infants neonatal body composition was measured using dual-energy x-ray absorptiometry. Term placental system A activity was lower in women with smaller pre-pregnancy upper arm muscle area ( r = 0.27, P = 0.007), but was not related to maternal fat mass. System A activity was lower in mothers who reported undertaking strenuous exercise (24.6 vs 29.7 pmol/mg/15 min in sedentary women, P = 0.03), but was not associated with other maternal lifestyle factors. Lower placental system A activity in women who reported strenuous exercise and had a lower arm muscle area may reflect an adaptation in placental function which protects maternal resources in those with lower nutrient reserves. This alteration may affect fetal development, altering fetal body composition, with long-term consequences.

Nutritional status, body composition, and intestinal parasitism among the Mbyá‐Guaraní communities of Misiones, Argentina

Indigenous communities in Argentina represent socially and economically neglected populations. They are living in extreme poverty and environmental degradation conditions. New information about health status and socio-environmental features is urgently needed to be applied in future sanitary policies. Present study describes the nutritional status, body composition, and intestinal parasitism among Mbyá-Guaraní children from three communities in the Misiones Province. Anthropometric parameters were analyzed for 178 individuals (aged 1-14). Data were transformed to z-scores using NHANES I and II. Stunting showed the greatest prevalence (44.9%). Children were found to have low arm circumference and low arm muscle area, although with tricipital skinfold value near to the reference. They also tend to have shorter than normal lower limbs. Fecal samples and anal brushes (for Enterobius vermicularis) were collected in 45 children (aged 1-13). Ritchie's sedimentation and Willis' flotation techniques were used to determine parasitoses. Ninety five percent of children were infected with at least one species and 81.4% were polyparasitized. The higher prevalences corresponded to Blastocystis hominis, hookworms (Ancylostoma duodenale/Necator americanus), and Entamoeba coli. Associations occurred between hookworms with B. hominis/E. coli and B. hominis with nonpathogenic amoebas. Thirty nine percent of the children with stunting presented B. hominis, Strongyloides, and hookworms. Our results indicate that this indigenous population is subjected to extreme poverty conditions and is one of the most marginalized in this country. Severe growth stunting and parasitic infection are still quite common among Mbyá children affecting about half of them along with significant changes in body composition and proportions.

TNF promoter polymorphisms associated with muscle phenotypes in humans

Tumor necrosis factor-alpha (TNF-alpha) is a potent catabolic factor to skeletal muscle. Single-nucleotide polymorphisms (SNPs) in the promoter region of the TNF-alpha coding gene, TNF, have been implicated in the interindividual variation in TNF-alpha production via transcriptional regulation. The present study investigated the association of muscle phenotypes with five TNF promoter SNPs, which potentially have biological significance. Female and male volunteers (n = 1,050) from the Baltimore Longitudinal Study of Aging were genotyped, and their regional and total body muscle mass, and arm and leg muscle strength were measured. Results indicated that putative high-expression alleles at positions -1031 and -863, individually or in combination in the haplotype 1031C-863A-857C-308G-238G, were associated with lower muscle mass in men. Specifically, carriers of -1031C, compared with noncarriers, exhibited lower arm muscle mass (6.4 +/- 0.1 vs. 6.8 +/- 0.1 kg, P = 0.01) and appendicular skeletal muscle mass (ASM) (24.3 +/- 0.4 vs. 25.4 +/- 0.2 kg, P = 0.02), with leg muscle mass and the ASM index (ASMI; kg/m(2)) also tending to be lower (P = 0.06 and 0.07). Similarly, -863A allele carriers (linked with -1031), compared with noncarriers, exhibited lower arm muscle mass (6.4 +/- 0.1 vs. 6.8 +/- 0.1 kg, P = 0.04). Carriers of the haplotype 1031C-863A-857C-308G-238G, compared with noncarriers, exhibited lower arm muscle mass (6.3 +/- 0.2 vs. 6.8 +/- 0.1 kg, P < 0.01), trunk muscle mass (25.7 +/- 0.5 vs. 26.9 +/- 0.3 kg, P < 0.05), and ASM (24.1 +/- 0.5 vs. 25.3 +/- 0.2 kg, P < 0.025), with tendencies for lower leg muscle mass and ASMI (P = 0.07 and 0.08). Results indicate that genetic variation in the TNF locus may contribute to the interindividual variation in muscle phenotypes in men.

Role of Adipose Tissue in Determining Muscle Mass in Patients With Chronic Kidney Disease

Malnutrition is a powerful predictor of mortality in chronic kidney disease (CKD). However, its etiology is unclear. We hypothesized that the adipocyte-derived proteins leptin and adiponectin, inflammation (as measured by C-reactive protein, CRP), and insulin resistance (as measured by homeostasis model assessment, HOMA), implicated in the malnutrition-inflammation complex syndrome commonly seen in maintenance dialysis patients, would be associated with the loss of muscle mass in earlier stages of CKD. Arm muscle area was used as an indicator of muscle mass. The Modification of Diet in Renal Disease Study cohort of people with CKD stages 3 and 4 was used for analysis (N = 780). Regression models were carried out to examine the relationships of leptin, adiponectin, CRP, and HOMA with arm muscle area (the main study outcome). Arm muscle area was 39 +/- 15 cm(2) (mean +/- SD), and adiponectin levels were 13 +/- 7 microg/mL. Median and interquartile range (IQR) concentrations were: 9.0 (13.6) ng/mL for leptin, 2.3 (4.9) mg/L for CRP, and 2.4 (2.0) for HOMA. Higher leptin (beta coefficient and 95% confidence interval, -6.9 [-8.7 to -5.1], P < .001) and higher CRP (beta coefficient and 95% confidence interval, -2.7 [-3.9 to -1.4], P < .001) were associated with lower arm muscle area. There was a trend toward lower arm muscle area with higher adiponectin (P = .07), but no association with HOMA (P = .80). Leptin and CRP were associated with lower muscle mass in subjects with CKD at stages 3 and 4. Further studies are needed to understand the mechanisms underlying these associations, and to develop targeted interventions for this patient population.

Anthropometric measurements of mid-upper arm as a mortality predictor for community-dwelling Japanese elderly: The Nagoya Longitudinal Study of Frail Elderly (NLS-FE)

It remains controversial whether mid-arm anthropometric measurements (MAAMs) are reflected with physical impairment or useful predictors of mortality in the frail elderly. We examined the following hypotheses: (1) MAAMs in frail community-dwelling elderly are lower than those of independent elderly, (2) the lower MAAMs are associated with physical function impairment, and (3) are independent predictors of 2-year mortality. This study was composed of cross-sectional and prospective cohort analyses of 957 community-dwelling elderly. Data included the clients' demographic characteristics, comorbidity, activities of daily living (ADL), and MAAMs at baseline. The mean scores of MAAMs of participants were compared with Japanese Anthropometric Reference Data. Survival analysis of 2-year mortality was conducted using multivariate Cox proportional hazards models. Significantly lower arm muscle area (AMA) and higher triceps skinfold (TSF) levels were observed in most of the age groups of the study participants than those of the standard Japanese population. ADL function was correlated with AMA but not with TSF, both of which were independent risk factors for 2-year mortality in the participants (highest tertile versus lowest, AMA, HR:2.03, 95%CI:1.36-3.02; TSF, HR:1.89, 95%CI:1.30-2.75). AMA and TSF were independent risk factors for 2-year mortality in the community-dwelling frail elderly.

The German hospital malnutrition study

Malnutrition is frequently observed in chronic and severe diseases and associated with impaired outcome. In Germany general data on prevalence and impact of hospital malnutrition are missing. Nutritional state was assessed by subjective global assessment (SGA) and by anthropometric measurements in 1,886 consecutively admitted patients in 13 hospitals (n=1,073, university hospitals; n=813, community or teaching hospitals). Risk factors for malnutrition and the impact of nutritional status on length of hospital stay were analyzed. Malnutrition was diagnosed in 27.4% of patients according to SGA. A low arm muscle area and arm fat area were observed in 11.3% and 17.1%, respectively. Forty-three % of patients 70 years old were malnourished compared to only 7.8% of patients <30 years. The highest prevalence of malnutrition was observed in geriatric (56.2%), oncology (37.6%), and gastroenterology (32.6%) departments. Multivariate analysis revealed three independent risk factors: higher age, polypharmacy, and malignant disease (all P<0.01). Malnutrition was associated with an 43% increase of hospital stay (P<0.001). In German hospitals every fourth patient is malnourished. Malnutrition is associated with increased length of hospital stay. Higher age, malignant disease and major comorbidity were found to be the main contributors to malnutrition. Adequate nutritional support should be initiated in order to optimize the clinical outcome of these patients.

Body composition in children with sickle cell disease , ,

Impaired growth, poor nutritional status, and delayed skeletal and sexual maturation are common in children with sickle cell disease (SCD), yet the nature of associated body-composition deficits has not been fully described. The objective was to assess growth, nutritional status, and body composition in 36 African American children with type SS SCD (20 females and 16 males) and 30 healthy control children (15 females and 15 males) of similar age (5-18 y) and ethnicity. Height, weight, bone age, pubertal status, skinfold thickness, and arm circumference were assessed. Height and weight were converted to z scores by comparison with national reference data and skinfold-thickness measurements were converted to z scores by comparison with African American- specific reference data. Fat-free mass (FFM) and fat mass (FM) were estimated by using 4 methods. Prepubertal children, pubertal males, and pubertal females were analyzed separately. Relative to the control subjects and to a national sample, children with SCD had significantly lower z scores for weight, height, arm circumference, and upper arm fat and muscle areas. Relative skeletal maturation was significantly delayed. After adjustment for age, children with SCD had significantly lower FM (prepubertal children and pubertal males only) and FFM (all 3 groups). Children with SCD have impaired growth, delayed puberty, and poor nutritional status. Low z scores for upper arm fat area indicate deficits in fat (energy) stores, and low FFM coupled with low upper arm muscle area indicate muscle wasting and low protein stores. These body-composition abnormalities suggest that the nutritional needs of the African American children with SCD were not being met.

Nutrition and handgrip strength of older adults in rural Malawi.

To examine the relationship between the nutritional status and handgrip strength of older people in rural Malawi. Cross-sectional study. : Lilongwe rural, Malawi, situated approximately 35-50 km from the city. Ninety seven males and 199 females participated in this study. Selected anthropometric measurements were taken and nutrition indices were computed using standard equations. Handgrip strength was measured using an electronic grip strength dynamometer. The mean handgrip strength (in kg) for men was significantly higher than for women vs. In addition, there was a significant decline in handgrip strength with age in both sexes. Furthermore, handgrip strength was positively correlated to the following nutritional status indicators: BMI in males and in females), mid-upper arm circumference (MUAC) in males and in females) and arm-muscle area (AMA) in males and in females). After controlling for potential confounders, namely sex, height and age, the correlations between handgrip strength and the nutrition indices were still significant. The results of this study support the hypothesis that poor nutritional status is associated with poor handgrip strength. Malawian males had both lower handgrip strength and lower arm muscle area than their counterparts from industrialised countries. However, Malawian females had similar handgrip strength despite lower arm muscle area, in comparison with women from industrialised countries, reflecting perhaps their higher level of physical activity. Further studies are required to determine whether by alleviating nutritional problems a concomitant improvement in handgrip strength can be obtained.

Nutritional State and Functional Capacity among Elderly Swedish People with Acute Hip Fracture

The objective of this study was to describe characteristics in a group of elderly men and women with hip fracture, regarding presumed risk factors, such as nutritional state and functional capacity. A total of 142 men and women aged 75 years or more were consecutively included on admittance to the hospital. Anthropometry and body composition were measured 4-6 days after the fracture. Data on functional status, activities of daily living and living arrangements at the time of the fracture were collected. The women and men had a body mass index (BMI) of 22.3 +/- 3.7 kg/m2 and 21.7 +/- 2.1 kg/m2, respectively. Of the whole group, 71% had a BMI < 24 kg/m2 and 25% a BMI < 20.0 kg/m2. Forty-five percent of the patients needed daily home help, and a majority of them were mentally impaired (p < 0.0001). Women with a trochanteric hip fracture were shorter, had lower body weight, lower lean body mass and lower arm muscle circumference (AMC) than the cervical fracture group (p < 0.05). Fewer women with a trochanteric fracture and fewer women with mental impairment took walks outside before the fracture, (p = 0.023 and p = 0.002, respectively). Characteristics found in the group were low BMI, low muscle mass as indicated by low lean body mass and mental impairment. It seems important to evaluate such factors when developing post-operative care plans aimed at avoiding further deterioration. Extra frail sub-groups of patients, such as people who are mentally impaired, women with trochanteric fracture and women with high dependency concerning ADL functions were identified.

Excess Fruit Juice Consumption as a Contributing Factor in Nonorganic Failure to Thrive

To determine whether excessive consumption of fruit juice is a contributing factor in nonorganic failure to thrive in early childhood. Eight patients, aged 14 to 27 months, referred for failure to thrive were evaluated by medical history, physical examination, and biochemical assessment. Growth patterns were reviewed and anthropometric measurements including skinfold thickness and midarm circumference were obtained. Diet history included 3-day food records and 24-hour diet recalls. An open-ended interview explored factors associated with fruit juice consumption. Breath hydrogen testing of fructose, sorbitol, or fruit juice was performed in three children who had a history of diarrhea or gastrointestinal complaints. Nutritional intervention focused on reducing fruit juice consumption and increasing the energy and nutrient density of the children's diets. In each case, deterioration of weight and linear growth progression coincided with excessive juice consumption. All children exhibited weights < 5th percentile and five also had lengths < -5th percentile. Weight-for-length deficits ranged from 11% to 25%. Two patients demonstrated low arm muscle mass and five children had diminished fat stores. Organic disease was ruled out in all cases. Three children had iron deficiency. The children's diets were hypocaloric, providing 78% to 92% of recommended energy intake for age and weight. Dietary intake included considerable juice consumption (12 to 30 oz/d). Fruit juice, primarily apple juice, contributed 25% to 60% of daily energy intake. As a result, food consumption was reduced; lowering dietary protein, fat, and micronutrient intakes. Excessive juice was consumed for various reasons including children's preferences, parental health beliefs, behavioral feeding difficulties, and financial considerations. Breath hydrogen testing revealed malabsorption of fructose and/or sorbitol. After nutritional intervention, dietary intake increased to 96% to 116% of recommended intakes. Weight gain increased significantly in the first month and persisted for follow-up of 5 to 18 months. These findings indicate that large intakes of fruit juices may displace more calorie- and nutrient-dense foods. Additionally, fructose and sorbitol malabsorption may occur. Excess fruit juice consumption may present a contributing factor in nonorganic failure to thrive.

Is low blood pressure in elderly people just a consequence of heart disease and frailty?

Low blood pressure has been associated with increased mortality in older people, but it is unclear whether the hypotension is a risk in its own right or just a marker of disease. In this study we investigated the extent to which those in the lowest decile of systolic and diastolic pressures could be predicted by measures of cardiovascular disease and frailty. We studied 782 people 70 years and over drawn from the only group of general practices in a rural township. Hypotension was defined separately for systolic and diastolic blood pressures as a pressure less than the tenth percentile for the sample as a whole. This was a systolic pressure of < or = 122 mmHg and a diastolic pressure of < or = 68 mmHg. There was a significant relationship between low systolic blood pressure and male sex, history of myocardial infarction by questionnaire and low body mass index (BMI), and between low diastolic pressure and male sex, history of angina and myocardial infarction, use of one or more hypotensive drugs, low BMI, low corrected arm muscle area, low self-maintenance score and the use of two or more home services. There was no association with ECG abnormalities. In the multivariate analysis only 4.2% of those with low diastolic pressure and none of those with low systolic pressure could be correctly classified. Hypotension in old age is only partially explained by established cardiovascular disease and frailty.

Sarcopenia: A critical review of its measurements and health-related significance in the middle-aged and elderly.

A summary of the work performed by Stanley Garn relating to muscle mass while he worked at the Fels Research Institute is followed by a critical review of the measurement of sarcopenia, which is a deficiency of muscle mass, and its implications for health. The only satisfactory data for total muscle mass come from one cadaver study of a small selected sample. Analyses in relation to health (mortality rates) are limited to indices of muscle mass of which the body mass index (BMI) and arm muscle area or circumference are the most important because large amounts of serial data are available for analysis. The association between low BMI values and increased mortality rates is well established. Multiple studies, some of large samples, indicate that the increased mortality in those with low BMI values at entry is not fully explained by smoking behavior or disease at entry. There are, however, contrary findings from one major study. Associations between arm muscle circumference or area with mortality rates have also been reported. Independent effects of low BMI and low arm muscle values on mortality rates could be due to effects of low fat-free mass, particularly low muscle mass, on host defense mechanisms and risk factors for disease but few relevant data have been reported. © 1994 Wiley-Liss, Inc.

Anthropometric measures in relation to Schistosomiasis mansoni and socioeconomic variables.

A cross-sectional study of anthropometric measures and their association with socioeconomic variables, infection by Schistosoma mansoni, intensity of infection and splenomegaly was carried out in an endemic area for schistosomiasis in Brazil (Comercinho), using multiple logistic regression methods. Eighty-seven per cent of all 1.5-14.4 year-old children in the area participated in the study. Children below the 5th percentile (USA Ten State Survey) for height-for-age, weight-for-age and arm muscle area-for-age were compared to those greater than the 5th percentile. There was no association between low anthropometric measures and schistosomiasis or socioeconomic variables in children under five years of age. For the 4.4-14.4 year-old children, poor condition of the heads of family and poorer housing were independently associated with low height and arm muscle area. Heavy excretion of S. mansoni eggs (greater than or equal to 500 epg) was related to low height, and splenomegaly was the variable which showed the strongest association with low height, weight and arm muscle area (odds ratios adjusted for socioeconomic variables were 6.4, 3.5 and 3.7 respectively). This indicates that there is a biological component for low anthropometric measures in the severe form of schistosomiasis and this reinforces the need for public health measures to prevent the development of splenomegalies in endemic areas.

Protein-energy intake and malnutrition in Crohn’s disease

A detailed nutrient assessment was made of 23 male and 24 female patients with Crohn's disease who entered sequentially into an outpatient clinic. Assessment included 48-hour dietary recall, anthropometric measurements, and biochemical and hematological tests appropriate to characterize protein-energy malnutrition. Approximately 40% of patients had energy intakes equal to only two-thirds of the Recommended Dietary Allowance (RDA). Three men and five women had relative body weights less than 85% of standard, but body weight was not correlated with energy intake. Relative body weight was correlated with arm muscle circumference in both male and female patients and with triceps skinfold and total lymphocyte count in women. Although the mean protein intake was greater than 150% of the RDA, evidence of protein malnutrition included low arm muscle circumference in 14% of the men and 15% of the women, low serum albumin concentration in 13% of the women, and low total lymphocyte count in one-half of the patients. The Crohn's disease activity index was correlated significantly with serum albumin, energy intake, and duration of disease in men and with serum ferritin and hemoglobin concentration in women. Thus, a reduced relative body weight or reduced serum albumin was not uncommon in patients with Crohn's disease but did not necessarily occur in those with reduced intakes of protein and energy. However, a low relative body weight may indicate need for further nutritional assessment.