Mass In Women Research Articles

Recurrence of Urethral Diverticula

Objectives: Periurethral masses are an uncommon but challenging diagnosis, with up to ten different etiologies. The list includes: urethral diverticulum, leiomyoma, vaginal wall cyst, Skene’s gland cyst, Skene’s gland abscess, urethral prolapse, urethral caruncle, Gartner’s duct cyst, ectopic ureterocele, and malignancies. There is limited literature addressing the widespread scope of diagnoses in periurethral masses. While urethral diverticula is the most common diagnosis, other pathology can mimic their presentation posing both a diagnostic and therapeutic challenge. Our primary objective of this study was to review the presentation, evaluation, diagnosis, surgical management and outcomes of periurethral masses in women. Materials and Methods: Retrospective chart review was performed of 59 patients over a twelve year period from urology and urogynecology departments at a single academic institution. Demographic, clinical, and surgical data were collected and presented as descriptive statistics. Results: Fifty-nine patients were evaluated for symptomatic periurethral masses with a mean age of 46 years (range = 22-73). The most common presenting symptoms include a palpable mass in 54 (92%), pain 38 (64%), urinary tract infections 27 (46%), urinary incontinence 27 (46%), and frequency 21 (36%). MRI was utilized in 48 of the 59 patients (81%). Cystoscopy was performed on all patients and urethral defects were visualized in only 28 (47%) of the cases. Final diagnosis revealed that 38 (64%) of the periurethral masses were diverticula, with 2 (5%) associated with adenocarcinoma and 4 (11%) associated with previous bulking agents. The remaining periurethral masses were: 7 (12%) Skene’s duct cysts/abscess, 3 (5%) Gartner’s duct cysts, 2 (3%) vaginal wall cysts, 2 (3%) bulking agents, 2 (3%) urethral polyps, 1 (2%) leiomyoma, 1 (2%) angiomyofibroblastoma, and remaining three including redundant vaginal mucosa, suture abscess, and encapsulated mesh remnant. Fifty-seven of the patients underwent surgical excision and 2 elected observations. One concomitant sling was performed with excision and Martius flap was used in 2 patients with circumferential diverticula identified on MRI. Of the patients surgically managed, 4 (7%) had demonstrable SUI and 7 (12%) had lower urinary tract symptoms postoperatively. Of the 38 urethral diverticulum, 6 (16%) had recurrence of a periurethral mass. Overall, 46 (78%) reported resolutions of symptoms after excision. Conclusion: While urethral diverticula most commonly present as a periurethral mass, other pathology can mimic the presentation and a thorough investigation is necessary for correct diagnosis. MRI is most effective in determining the size and location of the periurethral mass. Surgical excision provides reasonable anatomic and functional outcomes for a symptomatic patient. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:

Periurethral Masses in Women: Presentation, Evaluation, Management, and Diagnosis

Periurethral Masses in Women: Presentation, Evaluation, Management, and Diagnosis

Ageing influence in the evolution of strength and muscle mass in women with fibromyalgia: the al-Ándalus project.

Fibromyalgia is associated with physical disabilities in daily activities. Moreover, patients with fibromyalgia present similar levels of functional capacity and physical condition than elderly people. The aim of this study was to analyse the evolution of strength and muscle mass in women with fibromyalgia along ageing. A total sample of 492 fibromyalgia patients and 279 healthy control women were included in the study. Participants in each group were further divided into four age subgroups: subgroup 1: 30-39years old, subgroup 2: 40-49years old, subgroup 3: 50-59years old and subgroup 4: 60-69years old. Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand, handgrip strength and arm curl tests). Fibromyalgia patients did not show impairment on muscle mass along ageing, without values of skeletal muscle mass index below 6.76kg/m(2) in any group. However, in all variables of muscle strength, the fibromyalgia group showed less strength than the healthy group (p<0.05) for all age groups. As expected, handgrip strength test showed differences along ageing only in the fibromyalgia group (p<0.001). Age was inversely associated with skeletal muscle mass (r=-0.155, p<0.01) and handgrip strength (r=-0.230, p<0.001) in the FM group. Women with fibromyalgia showed a reduction in muscle strength along ageing process, with significantly lower scores than healthy women for each age group, representing a risk of dynapenia.

한국 성인의 혈청 잔류성 유기오염물질 농도와 연령 및 체질량지수와의 관련성

Objectives: Persistent organic pollutants (POPs) are known to be the detrimental chemicals in the body, even at low levels, and are stored in adipose tissue. Recently, POPs have been reported to be associated with chronic diseases, including cancer and cardiovascular disease, and aging and obesity are reported as common factors in chronic disease. However, there have been only a few studies on the associations of POPs with age and body mass index (BMI) in Korea. Therefore, we analyzed the associations of serum POPs levels with age and BMI in Korea. Methods: This cross-sectional study includes 444 subjects (253 men and 191 women) from the Korean Cancer Prevention Study-II (2004-2011). Serum levels of 33 polychlorinated biphenyls (PCBs) and 19 organochlorine pesticides (OCPs) were measured by a gas chromatographer (Agilent 6890) coupled to high resolution mass spectrometer (JEOL JMS-800D). Results: Concentrations of PCB 153 (men: 12.26 ng/g lipid, women: 10.50 ng/g lipid) and p,p`-DDE (men: 94.66 ng/g lipid, women: 96.66 ng/g lipid) were the highest among serum PCBs and OCPs, respectively. PCBs and OCPs were significantly positively correlated with age in both sexes. After adjustment for age, non-dioxin like PCBs were significantly negatively correlated with body mass in women. However, cis-heptachlor epoxide was significantly positively correlated with body mass index in both sexes. When analyzed by sex, stronger associations were shown between POPs and age in men and POPs and BMI in women. Conclusion: These results may provide baseline data for the study of POPs and for the health management field in Korea.

Outcomes From Ultrasound Follow-up of Small Complex Adnexal Masses in Women Over 50

Objective The discovery of a complex adnexal mass in an older woman often raises concern for cancer. We evaluate outcomes for a large population-based cohort of women older than age 50 years with a small complex adnexal mass reported on ultrasound, without elevated CA125 or other evidence of malignancy, including time to detection of malignancy and stage at diagnosis for those initially observed. Study Design Women older than age 50 years who had an ultrasound during 2007-2011 reporting a complex adnexal mass 1-6 cm in size were identified. Previous or subsequent pelvic ultrasounds were reviewed to determine when the mass was first identified and whether there was change over time. Women with concurrent elevated CA125, evidence of metastatic disease, or less than 24 months of clinical follow-up were excluded. Surgical pathology from removal and diagnoses of ovarian cancer within 24 months of follow-up were identified. Results Among 1363 complex masses identified, 18 cancers or borderline tumors (1.3%; 95% confidence interval, 0.8–2.1%) were found. Six cases were diagnosed among 204 women who had immediate surgery after initial ultrasound (15%), and 12 additional cases were found among 994 women with at least 1 repeat ultrasound (73%). Growth was apparent on ultrasound by 7 months for all borderline and epithelial ovarian cancers. Of the 12 cases diagnosed during follow-up, 10 were found to be stage 1 at surgery. Conclusion Among isolated adnexal masses reported as complex and 1-6 cm on pelvic ultrasound in women older than 50 years, the overall risk of malignancy is low. All cases of epithelial cancer and borderline tumor demonstrated growth by 7 months of observation.

Pathological profile of patients with breast diseases in Shiraz.

Around 200,000 breast disorders are annually diagnosed all over the world. Fibrocystic changes are the most common breast disorder and fibroadenoma is the most prevalent benign breast tumor. The present study aimed to determine the spectrum, type and prevalence of breast masses in women referred to Shiraz University of Medical Sciences between 2004 and 2012 . A cross-sectional study was conducted on the diagnostic reports data. A total of 640 samples were studied. Most 57.3% of masses were detected in the left breast, 65%, 28.2% and 6.1% of cases presenting with benign, malignant, and inflammatory lesions, respectively. Among all the samples the most prevalent diagnosis (37.7%) was fibroadenoma and fibrocystic lesions (17%). 174 samples (96% of the malignant cases) were invasive. 6.5% of the benign, and 37% of the malignant cases occurred in post menopause women and the differences were statistically significant. Among those with malignant tumors lymph nodes were involved in 25.6% of menopausal women and 44.2% of non-menopausal ones, and the difference was statistically significant. Regular clinical breast examination beside mammographic follow-ups, especially during menopause, should be carried out as a priority and a national organized program should be designed for screening breast disorders.

The associations of serum serotonin with bone traits are age- and gender-specific.

ContextSerotonin plays a potential role in bone metabolism, but the nature and extent of this relationship is unclear and human studies directly addressing the skeletal effect of circulating serotonin are rare.ObjectiveThe study aimed to investigate the associations between serum serotonin and bone traits at multiple skeletal sites in women and men.Subjects and MethodsSubjects were part of the CALEX-family study and comprised 235 young women, 121 premenopausal women, 124 postmenopausal women, and 168 men. Body composition was assessed using DXA, as was areal bone mineral density (aBMD) of spine, femur and whole body. In addition, pQCT was used to determine bone properties at tibial midshaft and distal radius. Fasting serum serotonin concentration was assessed using a competitive enzyme-linked immunosorbent assay.ResultsSerum serotonin declined with advancing age both in females and males (all p<0.01). Serotonin was negatively correlated with weight, BMI, lean and fat mass in women (r = −0.22 to −0.39, all p<0.001), but positively with height and lean mass in men (all p<0.01). In the premenopausal women, serotonin was negatively correlated with lumbar spine aBMD (r = −0.23, p<0.05) but the statistical significance disappeared after adjustment for weight. Conversely, in postmenopausal women, serotonin was positively correlated with whole body and femur aBMD, as well as with distal radius bone mineral content and volumetric BMD (r = 0.20 to 0.30, all p<0.05), and these associations remained significant after adjustment for weight. In men, no significant associations were found between serotonin and bone traits.ConclusionSerum serotonin is positively associated with bone traits in postmenopausal women, but not in premenopausal women or men. This partially supports the idea of circulating serotonin playing a role in the regulation of bone metabolism, but also indicates the importance of gender and age specific factors.

Outcomes of solid palpable masses assessed as BI-RADS 3 or 4A: a retrospective review.

The purpose of this study was to evaluate the outcomes and cancer rate in solid palpable masses with benign features assessed as BI-RADS 3 or 4A. This study was Institutional Review Board approved. Mammography and breast ultrasound reports in our Radiology Information System were searched for solid, palpable masses with benign features described from 1/1/2000 to 12/31/2009, and retrospectively reviewed. Those masses prospectively assessed as BI-RADS 3 or 4A, or suggestive of a fibroadenoma or other benign pathology were retrieved. Chart review was used to assess outcomes and cancer rate. Basic summary measures were summarized and compared between BI-RADS 3 and 4A groups using Wilcoxon Rank Sum test for continuous data or Fisher's exact test for categorical data. The cancer rate across age quartiles was assessed using Cochran-Armitage trend test. 573 solid palpable masses with benign features in 487 women were identified. There were 197 BI-RADS 3 and 376 BI-RADS 4A masses. The overall cancer rate was 1.6% (9/573). All cancers were BI-RADS 4A (cancer rate 2.4%-9/376). Smaller mean size and younger age at presentation in BI-RADS 3 women was found compared to BI-RADS 4A (P<0.0001). There was a significant increase in cancer rate across age quartiles (P=0.03124). The cancer rate is very low in solid palpable masses with benign features. In particular, BI-RADS 3 palpable masses in young women may undergo close surveillance without immediate biopsy, confirming what other investigators have found. All cancers were in the BI-RADS 4A group with increasing incidence with age, with over half occurring in women over 40years old. Palpable masses in women 40 and older with benign features should be considered for immediate biopsy.

Validity of the pelvic mass score in comparison with other scoring systems in preoperative evaluation of ovarian masses

To evaluate the value of the pelvic mass score (PMS) in the prediction of the nature of ovarian masses in women presenting to a large tertiary gynecological center, namely, the Ain Shams University Maternity Hospital. The study included women presenting to the outpatient clinic of Ain Shams University Maternity Hospital with a diagnosis of an ovarian mass, and planned for surgical intervention. The following scoring systems were used in the current study: risk of malignancy index (RMI), Sassone score, ovarian tumor index (OTI), and the PMS. All the women included underwent a surgical intervention in the form of laparotomy for cytoreduction, oophorectomy/adnexectomy, ovarian cystectomy, or just deroofing and biopsy. A total of 176 women with ovarian masses were included in the study. The mean age of the women included was 42.94±13.53 years (range 18–76 years). The ovarian mass was of a benign nature in 98 (55.7%) women, of a borderline nature in eight (4.5%), and of a malignant nature in 70 (39.8%). PMS was the most significant predictor among all these variables and score by having the largest area under the curve [AUC 0.919, 95% confidence interval (CI) 0.878–0.960, P<0.001], followed by RMI (AUC 0.900, 95% CI 0.850–0.951, P<0.001). PMS seems to be a significant preoperative predictor of ovarian malignancy in women with a diagnosis of an ovarian mass. It incorporates sonographic, biochemical, and Doppler parameters as well as the patient’s menopausal status in one scoring system. It, therefore, showed a slightly higher sensitivity, and a lower, yet comparable, specificity, when compared with the widely acceptable RMI.

Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50

The discovery of a complex adnexal mass in an older woman often raises concern for cancer. We evaluate outcomes for a large population-based cohort of women older than age 50 years with a small complex adnexal mass reported on ultrasound, without elevated CA125 or other evidence of malignancy, including time to detection of malignancy and stage at diagnosis for those initially observed. Women older than age 50 years who had an ultrasound during 2007-2011 reporting a complex adnexal mass 1-6 cm in size were identified. Previous or subsequent pelvic ultrasounds were reviewed to determine when the mass was first identified and whether there was change over time. Women with concurrent elevated CA125, evidence of metastatic disease, or less than 24 months of clinical follow-up were excluded. Surgical pathology from removal and diagnoses of ovarian cancer within 24 months of follow-up were identified. Among 1363 complex masses identified, 18 cancers or borderline tumors (1.3%; 95% confidence interval, 0.8-2.1%) were found. Six cases were diagnosed among 204 women who had immediate surgery after initial ultrasound (15%), and 12 additional cases were found among 994 women with at least 1 repeat ultrasound (73%). Growth was apparent on ultrasound by 7 months for all borderline and epithelial ovarian cancers. Of the 12 cases diagnosed during follow-up, 10 were found to be stage 1 at surgery. Among isolated adnexal masses reported as complex and 1-6 cm on pelvic ultrasound in women older than 50 years, the overall risk of malignancy is low. All cases of epithelial cancer and borderline tumor demonstrated growth by 7 months of observation.

Transformation of Women's Mass Sport in the Process of Urbanisation in Contemporary China

Since the 1980s, China has initiated a new era of urbanisation. Urbanisation, like a social engine, has driven a dramatic change in the way that people take part in sport. The particular focus of this article is to explore the impact of urban development on the systematic transformation of women's sport at the grass-roots level. Based on Riess's perspective of the relationship between cities and sport, and socialist feminist's points of view concerning female sport, this research applied a qualitative research paradigm using an in-depth interview method to examine the major social forces which stimulated the rise of women's mass sport in urban China. It is argued that urban development has provided Chinese women with a governmental guarantee, comparatively free individual choices and diversified opportunities to pursue their own interests and fulfilment in and through sport. Generally speaking, Chinese women's mass sport has improved. However, there are still limitations within the institutional structure, physical structure and value systems of the urban society, as well as its sport subsystem to support the sustainable development of women's mass sport. Ideas concerning women's inferiority and gender inequality still remain during this transformation.

Transvaginal sonographic features of perineal masses in the female lower urogenital tract: a retrospective study of 71 patients

To assess the transvaginal ultrasonographic features of perineal masses in the lower urogenital tract in a cohort of 71 women. Seventy-one women with perineal masses were referred consecutively for transvaginal ultrasonography. Two-dimensional (2D) ultrasound was used to scan the pelvic floor, including the urethra, vagina and rectum, and identify any possible areas of interest. A static three-dimensional (3D) sonographic reconstruction of the pelvic anatomy was created to further delineate the relation of the lesions with their neighboring structures. Ultrasound results were compared retrospectively with surgical pathology outcome when possible. Seventy-nine cystic, cystic-solid or solid masses were detected on transvaginal 2D ultrasonography in the 71 women: in 44 patients, 47 anechoic cystic masses were identified and diagnosed as vaginal wall cysts; in 19 patients, 23 hyperechoic cystic masses were diagnosed as vaginal epidermoid cysts; in each of two patients, a hypoechoic cystic-solid mass showing blood-flow signals on color Doppler imaging was diagnosed as urogenital angiomyofibroblastoma; in each of three patients, a hypoechoic cyst was diagnosed as urethral diverticulum; and in three patients with a known history of gynecological malignancy, solid heterogeneous masses with blood flow signals on color Doppler imaging were diagnosed as metastatic cancer. In all patients, 3D ultrasonography delineated the anatomical relationship of these masses to the vagina, urethra and rectum. Transvaginal 2D and 3D ultrasonography is an accurate, non-invasive, cost-effective diagnostic modality for the delineation of congenital, septic and neoplastic lower urogenital tract perineal masses in women.

Impact of age, sex, and indexation method on MR left ventricular reference values in the Framingham Heart Study offspring cohort.

To determine normative values for left ventricular (LV) volumes, mass, concentricity, and ejection fraction (EF) and investigate associations between sex, age, and body size with LV parameters in community-dwelling adults. In all, 1794 Framingham Heart Study Offspring cohort members underwent LV short-axis oriented, contiguous multislice cine steady-state free precession MR of the left ventricle; from these a healthy referent group (n = 852, 61 ± 9 years, 40% men) free of clinical cardiac disease and hypertension (SBP < 140, DBP < 90 mmHg, never used antihypertensive medication ≥30 years prior to scanning) was identified. Referent participants were stratified by sex and age group (≤55, 56-65, >65 years); LV parameters were indexed to measures of body size. Men have greater LV volumes and mass than women both before and after indexation to height, powers of height, and body surface area (P < 0.01 all), but indexation to fat-free mass yielded greater LV volume and mass in women. In both sexes, LV volumes and mass decrease with advancing age, although indexation attenuates this association. LVEF is greater in women than men (68 ± 5% vs. 66 ± 5%, P < 0.01) and increases with age in both sexes (P < 0.05). Among nonhypertensive adults free of cardiac disease, men have greater LV volumes and mass with sex differences generally persisting after indexation to body size. LV volumes and mass tend to decrease with greater age in both sexes. Female sex and advanced age were both associated with greater LVEF. J. Magn. Reson. Imaging 2015;41:1038-1045. © 2014 Wiley Periodicals, Inc.

Inverse relationship between “a body shape index” (ABSI) and fat-free mass in women and men: Insights into mechanisms of sarcopenic obesity

Sarcopenic obesity may be defined by a high fat to fat-free mass (FM/FFM) ratio. Skeletal muscle may be negatively influenced by the pro-inflammatory milieu associated with visceral fat, while the loading effect induced by a heavier body mass index (BMI) may enhance muscle anabolism. Recently, a new anthropometric measure based on waist circumference (A Body Shape Index, ABSI) was developed. In this study we have assessed the predictive power of ABSI on the FFM index (FFMI), a surrogate marker of lean mass. Standard anthropometric parameters and ABSI as well as body composition data (fat and fat-free mass determined by bioelectrical impedance analysis) were assessed in 111 female and 89 male overweight/obese subjects, with no clinically significant co-morbidities. Groups with higher- or lower-ABSI were identified according to median values of this index. In women and men, ABSI did not correlate with BMI, while multiple linear regression indicated that BMI (β-coefficients: 0.62 and 0.77, respectively) and ABSI (β-coefficients: -0.26 and -0.22, respectively) independently predicted FFMI (multiple R: 0.72 and 0.83, respectively, P < 0.001). Men and women with lower-ABSI exhibited significantly greater FFMI than the higher-ABSI groups for comparable values of BMI. In men, ABSI was correlated positively with C-reactive protein (CRP) (R = 0.30; P < 0.05) and negatively with the reciprocal of insulin (R = 0.28; P < 0.05), an index of insulin sensitivity. FM/FFM ratio significantly (P < 0.01) correlated with CRP (R = 0.31) in women only. ABSI, a recently introduced marker of abdominal adiposity, may contribute to define the risk of sarcopenia in overweight/obese individuals.

Dietary magnesium is positively associated with indices of skeletal muscle mass and may attenuate the association between C‐reactive protein and muscle mass (257.2)

Background: Chronic age‐related muscle loss is one component of sarcopenia and dietary magnesium (Mg) intake may influence low‐grade inflammation, a risk factor for muscle loss. Therefore, associations between indices of skeletal muscle mass in women, and the potential attenuation by Mg of the relationship between C‐reactive protein (CRP) and muscle were investigated.Methods: A cross‐sectional study of 2570 women aged 18‐79 years with fat free mass (FFM) measured using dual‐energy X‐ray absorptiometry, and with circulating HsCRP in 1658 participants. Dietary Mg was calculated using an FFQ and indices of FFM (FFM, as a percentage ‐ FFM% and FFM index ‐ FFMI ‐ FFM in kg/height2) calculated according to quintile of Mg using multivariate regression, and adjusted for age, physical activity, smoking, energy intake, anti‐inflammatory medication, HRT (for FFMI with BMI).Results: Significant positive associations were found between Mg and FFM% (P trend =0.004) and FFMI (P trend=0.001) with extreme quintile differences of 1.58% for FFM% and 0.5 kg/m2 for FFMI. The association between indices of muscle mass and CRP (per quintile of CRP) was ‐1.2 % P&lt;0.001 for FFM% and ‐0.07 kg/m2 for FFMI which was attenuated by Mg by 0.7 % for FFM% and 5.4% for FFMI.Conclusions: We found significant positive associations between Mg and indices of muscle mass, and dietary Mg attenuated the associations between CRP and muscle mass. Dietary intervention studies are needed to confirm this finding.

Dietary Fat and Fatty Acid Profile Are Associated with Indices of Skeletal Muscle Mass in Women Aged 18–79 Years1,2

Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m2) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18–79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were −0.6 kg for FFM and −0.28 kg/m2 for FFMI; for SFAs, MUFAs, and TFAs, these were −0.5 to −0.8 kg for FFM and −0.26 to −0.38 kg/m2 for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.

Antiosteoporotic effect of orally administered yolk-derived peptides on bone mass in women.

The main objective of this study was to verify the effect of oral intake of a yolk-derived peptide preparation (HYP) obtained by enzymatic hydrolysis of yolk water-soluble protein on bone markers and bone density in 65 perimenopausal women with an average age of 47.6 ± 5.2 years. Subjects were divided into three groups, and then enrolled in a 6-month, randomized, double-blind clinical trial. Bone formation and resorption markers were measured at 0, 3, and 6 months, while bone mineral density (BMD) in the lumbar spines was measured at 0 and 6 months. Although the bone formation marker levels showed the similarity changes among the groups, bone resorption markers in the test HYP group were significantly decreased after 3 and 6 months in comparison to other groups (P < 0.05). After 6 months, BMD in the test HYP group maintained at healthy numerical values whereas BMD values were decreased in other groups. Hence HYP would be an antiosteoporotic agent originated from natural food to maintain bone health, especially for women.

Socioeconomic position across life and body composition in early old age: findings from a British birth cohort study

BackgroundPrevious studies have reported associations between lower lifetime socioeconomic position (SEP) and higher body mass index in adulthood, but few have examined associations with direct measures of fat and lean...

WISE-2005: Countermeasures to prevent muscle deconditioning during bed rest in women

The objectives of this study were to evaluate the efficacy of two separate countermeasures, exercise and protein supplementation, to prevent muscle strength and lean tissue mass losses during 60 days of bed rest (BR) in women and whether countermeasure efficacy was influenced by pre-BR muscular fitness (strength, endurance, tissue mass). Twenty-four women were assigned to an exercise (EX, n = 8), a no-exercise control (CON, n = 8), or a no-exercise protein supplementation group (PROT, n = 8). EX performed supine treadmill exercise within lower body negative pressure 3-4 days/wk and maximal concentric and eccentric supine leg- and calf-press exercises 2-4 days/wk. PROT consumed a diet with elevated protein content compared with CON and EX (1.6 vs. 1.0 g·kg(-1)·day(-1)). Knee and calf isokinetic strength and endurance, isotonic leg-press strength, and leg lean mass were measured before and after BR. Post-BR knee extensor strength and endurance, ankle strength, and leg lean mass were significantly greater and leg-press strength tended to be higher in EX than in CON and PROT. Post-BR measures in PROT were not different than those in CON. Exercise countermeasure efficacy was less, and strength, endurance, and leg lean mass losses in CON and PROT were greater, in subjects who were more fit pre-BR. An exercise protocol combining resistive and aerobic exercise training protects against losses in strength, endurance, and leg lean mass in women during BR, while a nutritional countermeasure without exercise was not effective. Exercise countermeasures may require individualization to protect higher levels of strength and endurance.

Teriparatide Increases Bone Formation and Bone Mineral Density in Adult Women With Anorexia Nervosa

Anorexia nervosa (AN), a prevalent psychiatric disorder predominantly affecting women, is characterized by self-induced starvation and low body weight. Increased clinical fractures are common, and most women have low bone mineral density (BMD). Previously investigated treatments have led to no or modest increases in BMD in AN. Our objective was to investigate the effect of teriparatide (TPT; human PTH[1-34]), an anabolic agent, on low bone mass in women with AN. This randomized, placebo-controlled trial at a clinical research center included 21 women with AN: 10 (mean age ± SEM, 47 ± 2.7 years) treated with TPT and 11 (47.1 ± 2.3 years) treated with placebo. TPT (20 μg s.c.) or placebo was administered for 6 months. Our primary outcome measure was change in BMD of the spine and hip by dual-energy x-ray absorptiometry. Secondary outcome measures included changes in serum N-terminal propeptide of type 1 procollagen (P1NP), C-terminal collagen cross-links, sclerostin, and IGF-1 levels. At 6 months, spine BMD increased significantly more with TPT (posteroanterior spine, 6.0% ± 1.4%; lateral spine, 10.5% ± 2.5%) compared with placebo (posteroanterior spine, 0.2% ± 0.7%, P < .01; lateral spine, -0.6% ± 1.0%; P < .01). The results remained significant after controlling for baseline body mass index, P1NP, and IGF-1. Changes in femoral neck (P = .4) and total hip (P = 0.8) BMD were comparable in both groups, as were changes in weight. Serum P1NP levels increased after 3 months of TPT treatment and remained at this higher level at 6 months, whereas P1NP levels were unchanged in the placebo group (P = .02). TPT was well-tolerated by all subjects. This study demonstrates that TPT administration increases spine BMD substantially after only 6 months of therapy in women with AN.