Lean Body Mass Values Research Articles

Efect of ALD518, a humanized anti-IL-6 antibody, on lean body mass loss and symptoms in patients with advanced non-small cell lung cancer (NSCLC): Results of a phase II randomized, double-blind safety and efficacy trial.

7622 Background: ALD518 is a humanized anti-IL-6 antibody being developed for the treatment of anemia, cachexia, and fatigue. The primary objective of the study was to determine the efficacy and safety of ALD518. Methods: 124 patients (pts) with advanced NSCLC, ECOG 0-3, weight loss in the preceding 3 months of >5% body weight, hemoglobin >7g/dl and C-reactive protein (CRP) > 10 mg/L were dosed. Pts were randomized to 1 of 4 treatment groups (∼30/group). Placebo or ALD518 80 mg, 160 mg, or 320 mg was administered i.v. every 8 weeks. Pts were followed up for 24 weeks. Data included FACIT-F, FACT-L, body composition (DEXA), lab safety tests (LSTs) and adverse events (AEs). Results: 29 pts completed the study, 52 died of progressive disease, 5 withdrew because of AEs, and 38 failed to complete every visit. There were no DLTs or infusion reactions. 84 pts had serious AEs of which 1 was deemed possibly related to administration of ALD518 (rectal hemorrhage). Enough patients remained in the study up to week 12 to make a statistical comparison valid. The mean (±SD) values for lean body mass (LBM), FACT-L lung symptom subscale (LCS) and FACIT-F fatigue subscale (FS) are shown in the Table. Conclusions: ALD518 given to pts with NSCLC was safe and well tolerated. ALD518 improved the lung symptom score, reversed fatigue, and there was less loss of LBM (-0.19 kg on ALD518 vs. -1.50 kg on placebo). There were no major safety signals or infusion reactions related to the administration of ALD518. Visit n LBM (kg) n FACT-LLCS n FACIT-FFS ALD518 Pre-dose 93 41.90 (±9.35) 93 13.3 (±4.3) 93 20.5 (±9.6) (pooled) Week 2 - - 79 15.1 (±3.8)* 79 22.9 (±10.5)** Week 12 35 41.71 (±10.29) 39 15.6 (±5.2) 39 23.8 (±10.9) Placebo Pre-dose 31 41.58 (±10.74) 31 13.7 (±3.4) 31 21.9 (±9.6) Week 2 - - 29 14.1 (±4.2) 29 21.3 (±11.1) Week 12 20 40.08 (±11.00) 21 15.2 (±3.9) 21 22.1 (±13.2) * p ≤ 0.0006. ** p = 0.025 (paired t-test compared to baseline). Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Alder Biopharmaceuticals Inc. Alder Biopharmaceuticals Inc. Alder Biopharmaceuticals Inc.

Walking With Obesity: Differences In Muscle Function

Obese individuals display different gait kinematics and kinetics than non-obese individuals. Although this may be due to body weight, joint alignment, anthropometry, etc., it may also be attributed to differences in the capacity to exert lower extremity muscle forces. Studies on maximal voluntarily-exerted force, specifically in the knee extensors, have found lower values relative to body weight in obese groups. Decreased relative maximal strength has been used to explain why less knee flexion is present during walking in this group. However, walking requires sub-maximal forces and the contributions of individual muscle forces has not been measured in an obese population PURPOSE: To quantify differences between the muscle forces of obese and non-obese women during walking. METHODS: Ten Obese (25.3 yrs; 33.1±4.2 kg·m-2) and Ten Control (25.2 yrs; 22.7±0.9 kg·m-2) women walked at a preferred speed across a force platform while kinetic and kinematic measures were recorded. Three-dimensional hip, knee and ankle joint angles and moments were calculated for use in a static optimization approach with a cost function of minimization of muscle stress cubed. The physiological cross-sectional areas of select knee flexors and knee extensors were scaled to lean body mass values obtained from DEXA scans. Peak muscle forces were compared using ANOVA. RESULTS: No significant differences were found between groups in the knee extensor muscles. However, obese women used significantly greater (p=0.048) muscle force in the medial gastrocnemius. CONCLUSIONS: At a preferred walking speed, obese and non-obese women use similar levels of knee extensor force, but require more force from certain knee flexors. This is the first study to quantify the contributions of individual muscle forces to the measured kinetics and kinematics in an obese population. These results give insight into potential mechanisms obese women use to accomplish level walking.

Migrating passerines can lose more body mass reversibly than previously thought

Knowing the amount of body mass that migrants can lose is essential for the estimation of potential flight ranges, assessing the importance of stopover sites or modelling migration strategies. ‘Lean’ body mass, (the mass without fat stores) is often used to describe the limit of body‐mass loss but birds also use protein as fuel for flight. The mean body mass of 621 passerines mist‐netted in Mauritania between 2001 and 2004 with a fat score of 0 (no visible subcutaneous fat stores) and a muscle score of 0 (emaciated flight muscle) was much lower compared to the lean body mass values found in the literature. Recaptures showed that these birds were able to refuel again. The mean body mass of 122 Garden Warbler Sylvia borin with both a fat score and a muscle score of 0 was 12.8 g. The mean potential flight range of four Garden Warblers captured in the desert was 35% higher when 12.8 g was used for the estimation compared to the 15.0 g often used in previous studies. This has implications for future studies of the migration strategies of passerines, and suggests that, in the past, the fuel load of migrating passerines has been underestimated.

Correlations of lean body mass with nutritional indicators and mortality in patients on peritoneal dialysis

Detection of malnutrition in dialysis patients is important since this is a predictor of morbidity and mortality. Lean body mass (LBM) reflects the somatic protein store and this was measured by creatinine kinetics, anthropometry, and biometric impedance in 210 incident Chinese patients on continuous ambulatory peritoneal dialysis. The study was started in the third month of dialysis and the patients were followed for an average of 29 months. We devised three models of survival by combining the three different LBM measures with several nutritional markers and recognized outcome predictors. Follow-up was censored for transplantation or transfer to hemodialysis with an end point of death while on peritoneal dialysis. Statistical correlations were observed among the LBM values determined by all the three methods and these correlated significantly with both left and right hand grip strength but not with nutritional markers. LBM by creatinine kinetics, mean arterial pressure, and the calcium-phosphorus product were significant, independent predictors of death in one survival model. Anthropometry and bioelectric impedance were not significant predictors of death in the other two models. Our study suggests that LBM measured by creatinine kinetics, anthropometry, and bioelectrical impedance correlates well with the somatic protein store but not with the general nutritional status.

The Evaluation Of Body Composition Of Residential And Nonresidential Students

This study was done to put forward the sex and age difference according to school kind by determining the body composition of 12-14 years old residential and nonresidential students. A total of 410 students, 184 residential (75 girls, 109 boys) and 226 nonresidential (111girls, 115 boys) living in districts of Erzincan voluntarily participated in this study. One Way ANOVA was used to determine the differences among age groups. The differences between sex and school kind was determined by t- test. From the viewpoint of sex it was established that there were significant differences in body fat percentage, fat mass and lean body mass of students in both school (p<0.01). When the comparison were done between overall residential and nonresidential students, it was determined that there were significant difference in height, body fat persentage and fat mass values (p<0.01, p<0.05). It was established that there were significant difference in body weight and lean body mass values of all age group students in both school. From the viewpoint of fat mass value only between 12-14 age group residential students, but for height variable except 12-13 age group residential students, in all age groups of both school it was determined significant differences (p<0.01, p<0.05). When residential and nonresidential students were compared to age groups, in body weight and lean body mass values only at 13 age, but in height variable at 12 and 13 age significant differences were found (p<0.01). Consequently both to age group and to overall, it was determined that body composition values of students were higher than residential students.

Physical fitness indices and anthropometrics profiles in schoolchildren with sickle cell trait/disease

The current studies aimed at determining physical fitness indices and anthropometrics profiles of school children with sickle cell trait (SCT) and sickle cell disease (SCD). Male school children (150) comprising 3 Groups participated in the studies. Group 1 has 50 normal healthy controls, while Groups 2 and 3 each has 50 children who were suffering from SCT and SCD, respectively. Anthropometrics measurement and parameters of physical fitness were assessed in all subjects. All children were also subjected to a 5-min running exercise test on a flat motorized treadmill at speed corresponding to 5 km/hr. Throughout the test, heart rate was monitored and recorded during exercise and for 10-min during recovery. Blood lactate was measured before and 5 min following the completion of test. The mean values of lean body mass and height were lower in the SCD children (P < 0.05) compared with the healthy subjects and SCT individuals. Children with SCD exhibited a higher mean value (P < 0.05) for percent body fat and fat mass than the normal healthy subjects and SCT individuals. Although all groups tolerated well the treadmill exercise protocol, the SCD group exhibited higher (P < 0.05) mean values of heart rate during exercise than those observed in the SCT and normal control children. In addition, SCD children showed higher serum lactate values before and after treadmill exercise compared to the other groups. Children with SCD exhibit high level of adiposity; low level of fitness and their exercise performance appears to be physiologically more stressful as indicated by heart rate and blood lactate concentration responses.

Maximal Accumulated Oxygen Deficit in Patients with Chronic Heart Failure

To evaluate feasibility and repeatability of maximal accumulated oxygen deficit (MAOD) measurement in patients with chronic heart failure (CHF) and asymptomatic left ventricular dysfunction (ALVD), and to identify MAOD predictors employable in the clinical setting. We studied 10 CHF and 5 ALVD patients. Five normals (N) were used as controls. All subjects underwent a ramp incremental cardiopulmonary exercise test (CPX), three moderate-intensity constant-power exercise tests (CPET) at 30, 60, and 90% of ventilatory anaerobic threshold (VAT) power, and three severe-intensity CPET (1-2, 2-3, and >3 min in duration). MAOD was calculated as the difference between accumulated O2 demand and uptake during severe-intensity CPET. Postexercise lactate (PEL) was measured at 2, 4, 6, and 8 min of recovery after CPX and severe-intensity CPET. MAOD did not vary with increasing severe-intensity CPET duration in any study subgroup. MeanMAOD (mean of the three severe-intensity CPET) was lower in the CHF than ALVD or N subgroups (12.2 +/- 4.9 vs 23.7 +/- 11.8 and 24.8 +/- 8.2 mL x kg(-1), P < 0.05), with comparable lean body mass values. In the total study population, meanMAOD was significantly but not highly correlated with peak VO2 and PEL from CPX, PEL from severe-intensity CPET, and O2 deficit and steady-state VO2 from moderate-intensity CPET. Intraclass correlation coefficient of MAOD measurement in CHF and ALVD was 0.98. MAOD is repeatedly measurable in patients with CHF by a single severe-intensity CPET. MAOD of CHF patients is lower than that of age-matched ALVD patients and N, and this finding is muscle mass-independent. Finally, ergospirometric parameters and PEL from CPX, PEL from severe-intensity CPET, and VO2 on-kinetic descriptors from moderate-intensity CPET seem useless to reliably predict MAOD in CHF patients.

Antioxidants Did Not Prevent Muscle Damage in Response to an Ultramarathon Run

This study was conducted to determine if 6 wk of supplementation with vitamins E and C could alleviate exercise-induced muscle damage. We studied 22 runners during a 50-km ultramarathon. Subjects were randomly assigned to one of two groups: (a) placebos (PL) or (b) antioxidants (AO) (1000 mg vitamin C and 300 mg RRR-alpha-tocopheryl acetate). Blood samples were obtained before supplementation (baseline), 24 h pre-, 12 h pre-, and 1 h prerace; midrace, postrace, 2 h postrace, and for 6 d postrace. Plasma alpha-tocopherol (alpha-TOH), ascorbic acid (AA), and muscle damage markers (creatine kinase (CK) and lactate dehydrogenase (LDH)), as well as maximal voluntary contraction (MVC) of the hamstring and quadriceps were assessed. With supplementation, plasma alpha-TOH and AA increased in the AO but not the PL group. LDH and CK increased in response to the race; LDH peaked at postrace and CK reached maximal values 2 h and 1 d postrace; neither was affected by treatment. Adjusting for between-subject differences in baseline CK values revealed that men had higher levels of CK than did women throughout the study. Correcting CK values for lean body mass (kg) eliminated sex differences, but not changes over time. CK was significantly correlated (R = 0.52, P < 0.0001) with C-reactive protein, an acute phase response marker. MVC decreased 14-26% in all groups in response to the run. Eccentric hamstring (EH) torque and concentric quadriceps (CQ) power exhibited the largest deficits, 26 and 24%, respectively, with no effect of treatment. CQ recovered at a faster rate in women than in men. Antioxidants appeared to have no effect on exercise-induced increases in muscle damage or recovery, but important sex differences were observed.

Pediatric in vivo cross-calibration between the GE Lunar Prodigy and DPX-L bone densitometers

Dual energy x-ray absorptiometry (DXA) machine cross-calibration is an important consideration when upgrading from old to new technology. In a recent cross-calibration study using adult subjects, close agreement between GE Lunar DPX-L and GE Lunar Prodigy scanners was reported. The aim of this work was to cross-calibrate the two machines for bone and body composition parameters for pediatrics from age 5 years onwards. One-hundred ten healthy volunteers aged 5-20 years had total body and lumbar spine densitometry performed on DPX-L and Prodigy densitometers. Cross-calibration was achieved using linear regression and Bland-Altman analysis. There was close agreement between the machines, with r2 ranging from 0.85 to 0.99 for bone and body composition parameters. Paired t-tests demonstrated significant differences between machines that were dependent on scan acquisition mode, with the greatest differences reported for the smallest children. At the lumbar spine, Prodigy bone mineral density (BMD) values were on average 1.6% higher compared with DPX-L. For the total body, there were no significant differences in BMD; however, there were significant differences in bone mineral content (BMC) and bone area. For small children, the Prodigy measured lower BMC (9.4%) and bone area (5.8%), whereas for larger children the Prodigy measured both higher BMC (3.1%) and bone area (3.0%). A similar contrasting pattern was also observed for the body composition parameters. Prodigy values for lean body mass were higher (3.0%) for small children and lower (0.5%) for larger children, while fat body mass was lower (16.4%) for small children and higher (2.0%) for large children. Cross-calibration coefficients ranged from 0.84 to 1.12 and were significantly different from 1 (p<0.0001) for BMC and bone area. Bland-Altman plots showed that within the same scan acquisition modes, the magnitude of the difference increased with body weight. The results from this study suggest that the differences between machines are mainly due to differences in bone detection algorithms and that they vary with body weight and scan mode. In general, for population studies the differences are not clinically significant. However, for individual children being measured longitudinally, cross-over scanning may be required.

Reference Values for the Indicators of Skeletal and Muscular Status of Healthy Polish Children

Dual-energy X-ray absorptiometry (DXA) results are affected by the growth- and maturation-based anthropometric variances during childhood and adolescence. To address this issue, anthropometric variables were implemented to normative DXA values for the total body (TB) and lumbar spine (S) data obtained from a cross-sectional sample of 562 healthy Caucasian children (278 females) aged 5 to 18 yr who were measured using a pencil-beam DXA device (DPX-L; GE Lunar). Across age or body height (BH) groups, female and male values for TB bone mineral content (TBBMC) (g), TB bone mineral density (TTBMD) (g/cm(2)), SBMC (g), SBMD (g/cm(2)), lean body mass (LBM) (g), TBBMD/LBM (g/g), and SBMC/LBM [(g/g) x 100)] were assessed and compared using ANOVA and t-tests. There was no gender difference in TBBMC until age 16 and in TBBMD until age 17; thereafter, male values were significantly higher. At 12 to 13 yr of age, female SBMD values were significantly higher than male. The BH matching revealed lack of major gender-related differences in TBBMC or TBBMD values across whole height range, whereas at heights of 150 to 175 cm, females had generally higher values of SBMC and SBMD than male counterparts. Further, the LBM values and calculated TBBMC/LBM and SBMC/LBM ratios were considered as the muscle and muscle-bone indicators, respectively. The muscle-bone relationship analysis using LBM and TBBMC/LBM and SBMC/LBM values revealed age- and BH-related differences between genders. At LBM values of 32 kg and above and ages 14 yr and above for the whole skeleton as well as 12 yr and above for spine segment, females accrued significantly more BMC for the LBM unit than males. In order to properly assess children who might be at risk for low bone mass, we provide reference values for BMC and BMD of usually studied sites, expanded by muscle-bone relationship indicators owing to reduced diagnostic errors and distinguished bone disorders.

Body Composition in Diabetic Subjects with Chronic Kidney Disease: Interest of Bio-Impedance Analysis, and Anthropometry

Background/Aims: Lean body mass (LBM) is reduced in uremia, but this has not been reported in diabetic nephropathy. Subjects and Methods: We compared predicted % LBM to DEXA measurements in 10 non-diabetic uremic, 10 non-uremic diabetic and 10 uremic diabetic subjects matched for age, gender and BMI. We also measured % LBM by anthropometry, bio-impedance analysis (BIA) and compared them with DEXA in 49 diabetic subjects with a wide range of renal failure. The results were compared and a Bland & Altman procedure was performed. Associations between glomerular filtration rate (GFR) and % LBM were tested. Results: In matched groups, predicted % LBM values were overestimated in non-diabetic uremic subjects, and underestimated in non-uremic diabetic subjects. In uremic diabetic subjects, the error was intermediary. As compared to DEXA (% LBM: 69.0 ± 7.1%), measurement of % LBM by anthropometry (71.4 ± 8.0%, p < 0.05) and BIA (67.2 ± 7.6%, p < 0.05) were biased in the 49 diabetic subjects. The mean of anthropometric and BIA (Ant+BIA) were similar to DEXA results (69.3 ± 6.8%, p = 0.64), with best correlation coefficients and Bland & Altman plots. GFR was correlated to % LBM assessed by DEXA, BIA and Ant+BIA. Conclusion: In diabetic subjects with chronic kidney disease, LBM should be measured, rather than predicted. A good evaluation is possible, even without DEXA.

Physiological and sport-specific skill response of olympic youth soccer athletes.

Although many studies have been focused on soccer athletes, no comprehensive studies have been conducted on adolescent soccer athletes in the United States. Therefore, the purpose of this study was to quantify the physiological and sport-specific skill characteristics of Olympic Developmental Program (ODP) soccer athletes by age group and game experience. Following written, informed consent, 59 male athletes (age = 14.6 +/- 2.0 years; wt = 60.5 +/- 1.4 kg; ht = 172.4 +/- 1.2 cm) completed a battery of tests to determine aerobic power (VO(2)max), heart rate (HR(max)), ventilation (VE(max)), respiratory exchange ratio (RER), anaerobic threshold (AT), blood pressure (BP(rest/max)), anaerobic power/capacity [peak power (PP), mean power (MP), total work output (TWO), fatigue index (FI)], leg power [vertical squat jump (VJS), countermovement jump (VJC)], body composition [percent body fat (%BF), lean body mass (LBM)], joint range of motion (trunk, back, hip, knee, and ankle), and agility/sport-specific skills (T-test, line drill test, juggling test, Johnson wall volley, and modified-Zelenka circuit). Factor analyses with subsequent multivariate analyses of variance (MANOVAs) indicated significant main effects across age (p = 0.0001) but not by game experience (p = 0.82). Older athletes exhibited greater height, weight, LBM, VE(max), Time(max), PP, TWO, and VSJ values than younger athletes. Although not significant, there were differences with increasing age in the agility tests (T-test, wall volley, and juggling test). In conclusion, improvements in anaerobic power, agility, and sport-specific skill should be addressed at this developmental level of competition.

Association between Gastric Emptying Rate and Nutritional Status in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

To estimate gastric emptying rate in continuous ambulatory peritoneal dialysis (CAPD) patients, with or without indwelling dialysate, and to evaluate if there is an association between gastric motility and nutritional status. Single-center cross-sectional study. Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Krakow, Poland. 20 end-stage renal disease patients [11 F, 9 M; mean age 50.1 +/- 11 years; treated with CAPD for median 13.5 (2-61) months] were studied. All patients were nondiabetic and had no comorbidity that might influence gastric motility; nor were they receiving any prokinetic drugs. Gastric emptying rate was estimated with dynamic abdominal scintigraphy, started immediately after complete ingestion of a standard 200-kcal solid meal injected with 99mTc-labeled colloid, activity 40 MBq. Scintigraphy was performed at the rate of 23 images in 4-minute intervals for 92 minutes. Two consecutive procedures--with and without PD fluid--were performed at weekly intervals. As nutritional parameters, protein catabolic rate (PCR) and lean body mass (LBM) (based on urea and creatinine kinetics, respectively), body mass Index (BMI), and serum albumin were measured. All analyzed gastric emptying parameters, measured with or without dialysis fluid, were markedly prolonged in patients compared to values accepted as normal in the local scintigraphy unit. Gastric emptying half-time (T(1/2)) and percent of initial activity in minute 46 and in minute 92 were 60.5 +/- 25.0 minutes, 57.19% +/- 17.5%, and 33.8% +/- 20.9% with a full peritoneal cavity, and 63.9 +/- 28.2 minutes, 59.1% +/- 23.9%, and 33.9% +/- 24.3% with an empty peritoneal cavity. The T(1/2) and percent of initial activity after 46 and 92 minutes for healthy subjects were 39 +/- 9 minutes, 45% +/- 11%, and 15% +/- 6%, respectively. T(1/2) without dialysis fluid revealed a negative correlation with LBM and BMI values (r = -0.5, p < 0.05, and r = -0.56, p < 0.01; respectively). Patients with dialysate-free T(1/2) > 40 minutes were characterized by significantly lower serum albumin level compared to subjects with T(1/2) < 40 minutes (39.2 +/- 2.9 vs 42.9 +/- 3.6 g/L, p < 0.05). The values of all gastric emptying parameters measured for an empty abdomen were prolonged in subjects with BMI < 25 kg/m2. No difference was found between patients with and without PD fluid. Gastric emptying is markedly impaired in CAPD patients compared to healthy subjects. However, the presence of dialysate does not influence it significantly. Gastric emptying rate was negatively associated with the nutritional status of treated subjects. This association can be demonstrated when gastric motility is measured with an empty peritoneal cavity.

Changes in lean body mass in obese children and adolescents treated with protein sparing modified fast

The aim of this study was to evaluate the lean body mass variation in obese children and adolescents under Protein Sparing Modified Fast (PSMF) treatment through two indirect, not invasive, methods: The Slaughter-Lohman formal as an anthropometric method, and the urinary excretion of 3-Methylhistidine (3MHIS) as a biochemical method. Materials and methods. Thirty-five subjects, divided in two groups, participated in this study: Group A, 12 children (4 girls, 8 boys, age 9.5±1.9, OW% 73.8±20.1); Group B, 19 adolescents (14 girls, 5 boys, age 14.6±2.3, OW% 61.7±19.7). Diet: PSMF: Protein g 1.8±0.08 kg. IBW. day, total Kcalories 10.64±0.63 kg. IBW.day, prescribed for 9 weeks ± 1. Results. The 3MHIS final values were not significantly increased compared to the initial ones in both groups. In both groups the final value of lean body mass was significantly higher than the initial ones (p<0.03) in terms of percentage and Kg, while the fat mass was significantly reduced. Conclusion. With all the limitations using indirect methods to measure body composition, it seems that a PSMF, prescribed for 9 weeks ± 1, does not cause a significant lean body mass loss in obese children and adolescents.

Differential growth of fetal tissues during the second half of pregnancy

OBJECTIVE: Our purpose was to examine the pattern of growth of both fetal lean body mass incorporating bone, brain, and muscle and subcutaneous fat mass during the course of normal pregnancy. We hypothesized that there are detectable differences in the accretion of fat versus lean body mass. STUDY DESIGN: To establish our method we correlated standardized cross-sectional ultrasonographic images of the fetal extremities with anthropometric assessment of neonatal body composition in 25 subjects. Subsequently 36 nonsmoking women with normal prepregnancy body mass index, normal glucose screening results, and no medical or obstetric complications were recruited. We performed 135 ultrasonographic examinations between 19 and 40 weeks' gestation (mean 3.8 scans per fetus, range 2 to 6) at 4-week intervals. Lean body mass measures included biparietal diameter, head circumference, and femur length. Fetal subcutaneous fat and lean body mass were examined both in the mid upper arm and midthigh by standardized cross-sectional images. All neonates were born between 37 and 42 weeks' gestation and had normal birth weight distribution. Stepwise regression analysis established best-fit equations for fetal measurements obtained ultrasonographically. Independent variables included gestational age, maternal age, weight gain in pregnancy, parity, fetal gender, and maternal prepregnancy weight. RESULTS: Fetal bone growth was best described by a second-order quadratic equation demonstrating deceleration with advancing gestational age (p < 0.0001, R2 0.92 to 0.96). A quadratic equation that accelerates with advancing gestation best described lean body mass accretion in the extremities (p < 0.0001, R2 = 0.85 to 0.86). Fetal fat deposition in the extremities was characterized by an accelerating quadratic equation when plotted against gestational age with maternal age and prepregnancy weight contributing significantly (p < 0.0001, R2 = 0.80 to 0.81). CONCLUSION: Consistent with our hypothesis, fetal fat and lean body mass demonstrate unique growth profiles. We speculate that, as a result of an accelerated rate of growth in late gestation, the measurement of fetal fat will provide a more sensitive and specific marker of abnormal fetal growth when compared with index values of lean body mass. (Am J Obstet Gynecol 1997;176:28-32.)

Lean body mass estimation by creatinine kinetics, bioimpedance, and dual energy x-ray absorptiometry in patients on continuous ambulatory peritoneal dialysis.

Lean body mass (LBM), which is fat free body mass, can be used as an index of nutritional status. We evaluated three techniques for LBM estimation, including dual energy x-ray absorptiometry (DEXA), creatinine kinetics (CrKin), and bioimpedance (BI) in 10 patients on continuous ambulatory peritoneal dialysis (CAPD). Two different formulae were applied for BI LBM estimation, Segal (S) and Deurenberg (D). Mean values (+/- SEM) of LBM estimated were 48.2 +/- 3.6, 46.12 +/- 2.87, 43.32 +/- 3.87, and 41.27 +/- 4.26 by DEXA, BI-S, BI-D, and CrKin, respectively. LBM by CrKin was significantly lower than that by DEXA and BI-S values. There was no statistically significant difference between DEXA and BI-S values. Statistically significant correlations were found between LBM values by all methods. Particularly strong correlations were found between DEXA versus BI-S (r = 0.976) and BI-S versus BI-D (r = 0.98). Because clinical assessment of hydration status is inaccurate, and both BI and DEXA measure excess extracellular water in LBM, falling muscle mass may be missed by these techniques. The CrKin technique for estimating LBM at normal body fluid volumes (dry weight) may be a better index of nutritional status in patients on CAPD because this may truly reflect the dry LBM and changes in muscle mass. Both DEXA and BI include excess body water in LBM and may mask malnutrition in the presence of subclinical or clinical overhydration, which is common in patients on peritoneal dialysis.

30 GROWTH FAILURE AND BODY COMPOSITION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE

Malnutrition and growth failure are complications of inflammatory bowel disease (IBD) in children. Contributing factors to these effects are malabsorption, inadequate food intake, enhanced loss of nutrients, and corticosteroid treatment. Increased resting energy expenditure (REE) may also contribute to the growth retardation. Twenty children with endoscopicaly and histologically proven ulcerative colitis (n=13) or Crohns disease (n = 7) and twenty age and sex matched controls were studied. REE was measured using a metabolic cart with principle of indirect calorimetry (Deltatrac, Datex, Finland), lean body mass (LBM) with bioelectrical impedance analysis (BIA). With Dual energy X-ray absorptiometry (DEXA) (Lunar Rad. Corp., USA) an analysis of bone mineral density (BMD) and of LBM was done. The median age of IBD children was 13,5 years (range 6-18), of controls 14 years (range 6-18). The mean REE in children was increased: 33 ± 1,7 versus 28,9 ± 1,5 Kcal/kg bodyweight (p<0.01). The LBM was significantly increased in children with IBD versus controls: 81,5 ± 1,7 versus 74,7 ± 1,6% of bodyweight. REE in Kcal/kg LBM was not different in children with IBD versus controls: 41,7 ± 2,1 versus 38,8 ± 2,1 Kcal/kg. No difference in REE was found between patients with low (n=14) and high disease activity (n = 6). In five patients (25%) a decreased BMD (>2 SD below mean value) of lumbar spine was found. An inverse relation between 8MD and cumulative prednison dose was found. The LBM values measured with BIA and with DEXA technique correlated very well (R =0.95).

Lean body mass estimation by creatinine kinetics.

A new technique for estimating lean body mass (LBM) from creatinine kinetics has been developed. It is based on the principle that creatinine production is proportional to LBM and that, in the steady state, creatinine production is equal to the sum of creatinine excretion (urinary and dialytic) and metabolic degradation. This technique was applied to 17 normal subjects, 26 stable, chronic hemodialysis (HD) patients, and 71 stable, chronic peritoneal dialysis (PD) patients. In the HD group, LBM was also determined by bioimpedance in 11 patients and calculated from total body water, measured as the volume of urea distribution of a sterile urea infusion, in 15 patients. In normal subjects and in the PD group, LBM was assessed by creatinine kinetics as well as by bioimpedance, near infrared, and anthropometric techniques. In the HD patients, LBM by creatinine kinetics correlated significantly with LBM from total body water and the bioimpedance technique. There was no statistical difference between the total body water and creatinine kinetics techniques, but the bioimpedance values were systematically higher than those obtained by the kinetic technique. In the PD group and in normal volunteers, LBM values by creatinine kinetics correlated significantly with the other methods but were lower. Forty-seven percent of the HD patients and 66% of the PD patients had significantly lower LBM by creatinine kinetics than expected for their sex and age. Estimation of LBM by creatinine kinetics is proposed as a simple and convenient technique for the routine nutritional assessment of dialysis patients.

Creatinine height index and lean body mass in adult patients with insulin-dependent diabetes mellitus followed for 7 years from onset.

The 24-hour urinary creatinine excretion value can be used as an index of protein nutrition; the creatinine height index and lean body mass can be estimated from this value. On the basis of longitudinally measured 24-hour urinary creatinine excretions during the initial 7 years of type 1 diabetes in an incidence cohort of 147 adult patients, we studied creatinine height index and lean body mass and possible relationships to sequential measurements of glycated hemoglobin (HbA1c). The patients were divided into four groups according to their glycemic control during these 7 years: I, HbA1c < 7.4% (n = 37); II, HbA1c 7.4% to 8.2% (n = 37); III, HbA1c 8.3% to 8.9% (n = 38); IV, HbA1c > 8.9% (n = 35). One year after the onset of diabetes, height indices were as follows (% of normal values, median and quartiles): I, 104% (90 to 116); II, 101% (78 to 105); III, 121% (92 to 128); IV, 87% (78 to 109) ([IV] < [I to III]; p < .05). During the following 6 years no significant differences in height index were observed among the four groups of patients at any point in time. Slightly higher calculated lean body mass values were found in the most well-controlled patients, but otherwise no differences were found in lean body mass. It is concluded that, apart from the first year, indices of protein nutrition remain normal during the initial 7 years of type 1 diabetes, even in patients with poor glycemic control.

The use of bioelectrical impedance analysis for monitoring body composition changes during nutritional support.

Body composition was measured with bioelectric impedance analysis (BIA) in 30 patients with protein malnutrition following biliopancreatic diversion. Determinations were carried out prior to, during, and at the completion of intravenous nutritional support when the nutritional parameters had completely reverted to normal. Before treatment, body weight (BW), lean body mass (LBM), and body fat (BF) values were similar to those of controls, whereas the total body sodium/total body potassium (TBNa/TBK) and extracellular mass/body cell mass (ECM/BCM) ratios were considerably higher. During the support, no changes in BW, LBM, and BF were demonstrated, although a sharp decrease of TBNa/TBK and ECM/BCM was observed, thus demonstrating improved LBM composition. At the end of parenteral feeding, the BW, LBM, and BF values were similar to those observed before the support, while a further decrease in TBNa/TBK and ECM/BCM demonstrated a recovery towards normal of body composition. The full correspondence between clinical and BIA findings therefore suggests that this method may be valuable for monitoring body composition changes during nutritional support.