Accuracy of subcutaneous fat measurement: comparison of skinfold calipers, ultrasound, and computed tomography

Clinical evaluation of the safety and efficacy of a 1060 nm diode laser for non-invasive fat reduction of the flanks

BACKGROUND

Laser hyperthermia-induced lipolysis is a non-invasive method of localized fat treatment. Non-invasive approaches could be an option for a growing number of patients who are risk-averse and are seeking out non-invasive alternatives to surgical procedures such as liposuction. This study evaluated the safety and efficacy of a 1060 nm diode laser for the non-invasive fat reduction of the flanks.

METHODS

A total of 30 subjects were enrolled in this prospective, single center study. Subjects received one 25-min treatment with a 1060 nm diode laser to both flanks. Follow-up visits were conducted at 6 and 12 weeks after the last treatment. Ultrasound adipose thickness, body weight, and circumference measurements were taken at baseline and at the 6- and 12-week follow-up visits. Subject satisfaction was assessed using a self-assessment of fat reduction, pain, and tolerability scales, and a subject satisfaction questionnaire. Safety was assessed via the presence or absence of any adverse events.

RESULTS

The average age of subjects was 47.3 years. A total of 27 subjects completed the treatment and returned for both follow-up visits. An adipose reduction of 7.57 ± 1.15% at 6 weeks post-treatment (p < 0.0001) was measured using ultrasound. High subject satisfaction was seen, with 74% of subjects reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert Scale. Eighty-two percent of subjects stated they would recommend the treatment to their friends. All subjects had either mild or moderate pain, with 52% of subjects rating their pain as "mild" (1-3), while 48% rated their pain as moderate (4-7) on the Wong-Baker Scale.

CONCLUSIONS

A single treatment with a 1060 nm diode laser was both safe and effective in reducing unwanted fat in the flanks without any unanticipated adverse events. Subjects described their treatment pain as mild or moderate and were highly satisfied with their treatment outcomes.

Body Composition of Male Professional Soccer Players Using Different Measurement Methods: A Systematic Review and Meta-Analysis

The performance of male soccer players (MSP) depends on multiple factors such as body composition. The physical demands of modern soccer have changed, so the ideal body composition (BC) requirements must be adapted to the present. The aim of this systematic review and meta-analysis was to describe the anthropometric, BC, and somatotype characteristics of professional MSP and to compare the values reported according to the methods and equations used. We systematically searched Embase, PubMed, SPORTDiscus, and Web of Science following the PRISMA statement. Random-effects meta-analysis, a pooled summary of means, and 95% CI (method or equation) were calculated. Random models were used with the restricted maximum likelihood (REML) method. Seventy-four articles were included in the systematic review and seventy-three in the meta-analysis. After comparing the groups according to the assessment method (kinanthropometry, bioimpedance, and densitometry), significant differences were found in height, fat mass in kilograms, fat mass percentage, and fat-free mass in kilograms (p = 0.001; p < 0.0001). Taking into account the equation used to calculate the fat mass percentage and ∑skinfolds, significant differences were observed in the data reported according to groups (p < 0.001). Despite the limitations, this study provides useful information that could help medical technical staff to properly assess the BC of professional MSP, providing a range of guidance values for the different BC.

From Esthetic Medicine to Optimizing Reconstructive Outcome: A Feasibility Trial on Secondary Refinement of Fasciocutaneous Anterolateral Thigh Flaps with Cryolipolysis

BACKGROUND

 Free adipocutaneous anterolateral thigh (ALT) flaps have evolved as workhorse flaps to reconstruct complex, multicompound defects. While coverage is safely achieved, flaps may remain bulky. As a standard of care, flaps are refined with liposuction, partial excision, or combination of both. Cryolipolysis is widely used for fat reduction in esthetic medicine. This pilot comparative study analyses whether cryolipolysis may serve as a safe alternative method to effectively reduce volume in fasciocutaneous flaps. Moreover, patients' satisfaction with the procedure is evaluated.

METHODS

 In this single-center, retrospective, interventional comparative cohort study, 10 patients with free subfascial ALT flaps for distal extremity reconstruction underwent cryolipolysis (60 minutes, -9°C). Circumference of the extremities and subcutaneous fat thickness were determined before (T1) and 12 weeks (T2) after cryolipolysis. Patient satisfaction was evaluated with a questionnaire of Likert's scale questions. Duration of hospital stay, intervention time, costs, and possible complications were analyzed and compared with surgical flap contouring (n = 12).

RESULTS

 All patients undergoing cryolipolysis were male, with a median age of 52 years without arterial disease-like state or deep vein thrombosis (DVT). At T2, a significant reduction of circumference of 1.8 ± 0.9 cm (p < 0.001) and subcutaneous fat layer of 7.7 ± 3.0 mm (p < 0.0001) was recorded. Overall, 90% of the patients were satisfied with the result. Cryolipolysis was well tolerated. One patient developed a second-degree frostbite which healed without further intervention. Cryolipolysis proofed to be as safe as surgical flap contouring. Hospital stay was significantly shorter (p < 0.01) and personal resources were spared when flap contouring was performed with cryolipolysis.

CONCLUSION

 This is a novel application of evolving body-contouring cryolipolysis from esthetic medicine into optimizing outcomes in reconstructive surgery. Cryolipolysis has been shown to be relatively safe and effective to reduce ALT's volume with high patients' satisfaction. This successful pilot study encourages further investigation with a prospective randomized control trial.

Relative Body Fat Distribution in Preadolescent Indian Children Exposed to a Natural Disaster during Early Development

Fetal life and infancy are critical periods when adverse environmental conditions, such as natural disasters, may alter a developing organism, leading to life-lasting unfavorable health outcomes, such as central body fat distribution. Therefore, the aim of this study was to assess the effect of the exposure to cyclone Aila in utero or during infancy on the relative subcutaneous adiposity distribution in preadolescent Indian children. The study included children prenatally (N = 336) or postnatally (during infancy, N = 212) exposed to Aila and a non-affected group (N = 284). Anthropometric indices involved, i.e., subscapular, suprailiac, triceps, and biceps skinfolds. The relative adiposity distribution (PC1) and socioeconomic status (SES) were assessed using principal component analysis. An analysis of covariance and Tukey’s post hoc test for unequal samples were performed to assess the effect of exposure to a natural disaster on the PC1, controlling for age, sex, Z-BMI, and SES. Prenatally and postnatally Aila-exposed children revealed a significantly more central-oriented pattern of relative subcutaneous fat distribution compared to the controls (p < 0.05). Early-life exposure to a natural disaster was related to an adverse pattern of relative adipose tissue distribution in preadolescent children.

Differences between Four Skinfold Calipers in the Assessment of Adipose Tissue in Young Adult Healthy Population

Background: The aim of this study was to analyze the validity of four different skinfold calipers, as well as to establish the differences between them in a healthy young adult population. Methods: The present study followed a cross-sectional design, including 138 participants, with 69 males (21.46 ± 2.52 years) and 69 females (22.19 ± 2.85 years). The measurement protocol included basic measurements of body mass and stretch stature and eight skinfolds with a Harpenden, Holtain, Slim Guide, and Lipowise. The ∑6 and ∑8 skinfolds and fat mass were calculated. The order in which the skinfold calipers were used was randomized. Results: No significant differences were found in either the Σ6 and Σ8 skinfolds or masses and fat percentages calculated with the skinfolds obtained with the different calipers (p > 0.05), and the inclusion of the covariates of sex, BMI, and hydration status of the participants showed no effect on the differences. The Bland−Altman test showed significant differences between the calipers (p < 0.001). Conclusion: It has been observed that the analyzed calipers have shown validity for the assessment of adiposity-related variables in a male and female sample of non-overweight, young healthy adults, but they are not interchangeable with each other when the assessment is meant to be compared over time or with other samples.

Effect of gender, muscle type and skinfold thickness on myometric parameters in young people

Background

The aim of the study was to compare the mechanical properties of three human skeletal muscles: biceps brachii (BB), rectus femoris (RF), and tibialis anterior (TA) at rest measured by myoton device in males (n = 16, mean age 21.2 ± 0.6 years) and females (n = 16; 21.2 ± 0.9 years) and to investigate the influence of skin and subcutaneous tissue thickness (skinfold thickness, SFT) and gender on myometric parameters of the three skeletal muscles.

Methods

We measured the following mechanical and viscoelastic muscle properties using MyotonPRO^®: frequency (F [Hz]), decrement (D [log]), stiffness (S [N/m]), relaxation time (R [ms]) and creepability (C [De]). The values of SFT for all selected muscles were assessed by caliper. A mixed-design analysis of variance with gender as between subject comparison was used for assessing the differences between gender and muscles in SFT and each of the myometric parameters separately (F, D, S, R and C). Pearson correlation coefficient or Spearman’s rank correlation coefficient between SFT and myometric parameters was conducted for males, females and males and females together. The level of statistical significance was set at α ≤ 0.05 with Bonferroni correction for multiple comparisons.

Results

The SFT over the RF, TA, and BB muscles in women was statistically significantly larger compared with that of males. In females and males, the SFT over the RF was larger than over the TA and BB, and the SFT over the TA was larger compared with over the BB. The values of F and S recorded for the TA muscle were the highest among the three muscles, while D, C, and R were lowest in TA but highest in the RF muscle in men and women. The values of F and S were smaller in females than in males. Gender comparison of D, C, and R values showed that only D for the RF was significantly lower in females than in males, and C for the RF and TA was significantly larger in females than in males. Some correlation between SFT and myometric parameters were different between males and females. For example, there was a significant, negative correlation between SFT and F for all muscles in females, and a significant, positive correlation between these parameters for BB and TA (not for RF) in males. For pooled data (males and females together), a negative significant correlation between SFT and F was observed for RF and TA (not significant for BB muscle).

Discussion

It is concluded that the TA compared with the BB and RF has significantly greater F and S but the smallest D and C and the shortest R. Gender and muscle differences in the SFT may affect the measurements of muscle properties using MyotonPRO^®. The relationship between SFT and myometric parameters is different in males and females in the RF, TA, and BB muscles. Therefore, the myometric data should be analyzed in males and females separately.

Predictive Ability of Body Fat Percentage and Thigh Anthropometrics on Tissue Cooling During Cold-Water Immersion

CONTEXT

Cold-water immersion (CWI) is a common aid in exercise recovery. The effectiveness of CWI depends on the magnitude of muscle and core cooling. Individual cooling responses to CWI vary and are likely influenced by the CWI dose and individual physiological characteristics.

OBJECTIVE

To evaluate body fat percentage and thigh anthropometric values as predictors of intramuscular and skin-cooling responses to CWI.

DESIGN

Descriptive laboratory study.

SETTING

Sports medicine research center.

PATIENTS OR OTHER PARTICIPANTS

Sixteen young adults (8 males, 8 females, age = 24.3 ± 1.84 years, height = 176.4 ± 12.7 cm, mass = 86.6 ± 29.4 kg).

INTERVENTION(S)

Body fat percentage was measured using a 3-site skinfold assessment. Thigh length, thigh circumference, anterior thigh adipose thickness, anterior thigh muscle thickness, and thigh volume were estimated using manual and ultrasound methods. Using sterile techniques, we placed thermocouple probes in the belly of the rectus femoris (2-cm deep to the subadipose tissue) and on the anterior midthigh surface. Participants cycled on an ergometer for 30 minutes at a target heart rate of 130 to 150 beats/min. Postexercise, participants were placed in CWI (immersion depth to the iliac crest; 10°C) until intramuscular temperature was 7°C below pre-exercise baseline temperature, with a maximum immersion duration of 30 minutes.

MAIN OUTCOME MEASURE(S)

Intramuscular rectus femoris and thigh skin temperatures measured postexercise, after 10 and 15 minutes of CWI, and post-CWI.

RESULTS

Body fat percentage significantly predicted the rectus femoris cooling magnitude and rate after 10 minutes of CWI, 15 minutes of CWI, and post-CWI (P < .001; R2 range = 0.58-0.67). Thigh anthropometric values significantly predicted the thigh skin-cooling rate post-CWI (P = .049; R2 = 0.46).

CONCLUSIONS

A simple 3-site skinfold assessment may improve the effective prescription of CWI by allowing estimation of the dose required for minimal muscle tissue cooling.

Fat mass affects nutritional status of ICU COVID-19 patients

BACKGROUND

Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU).

METHODS

Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day.

RESULTS

Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients.

CONCLUSION

This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.

Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 h and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

Serum Fibroblast Growth Factor 21 Levels in Patients with Hyperthyroidism and its Association with Body Fat Percentage

BACKGROUND

Most of the actions of thyroid hormone (TH) on body metabolisms like maintenance of basal metabolic rate (BMR) and body fat are similar to that of fibroblast growth factor 21 (FGF21). We hypothesized that in patients with hyperthyroidism, the pathological changes in the BMR, body fat are mediated by TH through FGF21.

OBJECTIVES

To study the association of serum FGF21 levels with hyperthyroidism and correlate body fat percentage with serum FGF21 levels in hyperthyroid patients.

STUDY DESIGN

Case-control prospective follow-up study.

METHODOLOGY

A total of 68 hyperthyroid patients and age, sex-matched healthy controls who fulfilled the inclusion and exclusion criteria were studied. Among them, 45 cases were followed up at 3 to 6 months after the achievement of euthyroidism. Body fat percentage was calculated from Jackson and Pollock 3 site equation and Siri equation. BMR percentage was calculated by the Gale formula.

RESULTS

The mean age in years in the cases was similar to that of controls (36.14 ± 10.01 vs. 36.57 ± 10.53, P = 0.81). The serum FGF21 levels at baseline were significantly elevated in patients with hyperthyroidism compared to controls [median 406.6 pg/ml (interquartile range, 262.9-655.6) vs. 252.3 (125.1-341) P < 0.001] and declined dramatically following treatment with anti-thyroid drugs [405 (275.5-680.4) vs. 203.6 (154.6-230.6) P < 0.001]. Serum FGF21 levels negatively correlated with body fat percentage (r = -0.268, P = 0.002). After adjusting to various confounding factors, serum FGF21 was independently associated with hyperthyroidism and was significant. (OR [95%CI] 3.78 (1.046-13.666) P = 0.043).

CONCLUSION

Serum FGF21 levels were elevated in hyperthyroid patients and decreased following treatment with anti-thyroid drugs. It was independently associated with hyperthyroidism. There may be a future therapeutic role of FGF21 inhibition in the reversal of these changes in addition to anti-thyroid drugs in patients with hyperthyroidism.

Urate and Nonanoate Mark the Relationship between Sugar-Sweetened Beverage Intake and Blood Pressure in Adolescent Girls: A Metabolomics Analysis in the ELEMENT Cohort

We sought to identify metabolites that mark the relationship of sugar-sweetened beverage (SSB) intake with adiposity and metabolic risk among boys (n = 114) and girls (n = 128) aged 8–14 years. We conducted the analysis in three steps: (1) linear regression to examine associations of SSB intake (quartiles) with adiposity, glycemia, lipids, and blood pressure (BP); (2) least absolute shrinkage and selection operator (LASSO) regression to identify SSB-associated metabolites from an untargeted dataset of 938 metabolites; and (3) linear regression to determine whether SSB-related metabolites are also associated with adiposity and metabolic risk. In girls, SSB intake was associated with marginally higher BP (Q2 vs, Q1: 1.11 [−3.90, 6.13], Q3 vs. Q1: 1.16 [−3.81, 6.13], Q4 vs. Q1: 4.65 [−0.22, 9.53] mmHg systolic blood pressure (SBP); P-trend = 0.07). In boys, SSB intake corresponded with higher C-peptide insulin resistance (Q2 vs. Q1: 0.06 [−0.06, 0.19], Q3 vs. Q1: 0.01 [−0.12, 0.14], Q4 vs. Q1: 0.17 [0.04, 0.30] ng/mL; P-trend = 0.03) and leptin (P-trend = 0.02). LASSO identified 6 annotated metabolites in girls (5-methyl-tetrohydrofolate, phenylephrine, urate, nonanoate, deoxyuridine, sn-glycero-3-phosphocholine) and 3 annotated metabolites in boys (2-piperidinone, octanoylcarnitine, catechol) associated with SSB intake. Among girls, urate and nonanoate marked the relationship of SSB intake with BP. None of the SSB-associated metabolites were related to health outcomes in boys.

Skinfold thickness for rivastigmine patch application in Alzheimer's disease

RATIONALE

Rivastigmine patches are used for patients with Alzheimer's disease (AD), but little is known about the serum concentration of rivastigmine and its metabolite or clinical adherence in relation to skinfold thickness after rivastigmine patch application.

OBJECTIVES

The aim of this study was to examine the association between rivastigmine and NAP 226-90 serum concentration and skinfold thickness and to determine the appropriate skinfold thickness for the use of rivastigmine patch in patients with AD.

METHODS

Patients with AD who continuously used rivastigmine patches (4.6 mg/24 h, 5 cm²) for more than 6 months were recruited. The serum concentrations of rivastigmine and NAP 226-90 were measured. Skinfold thickness was measured using a Lange Skinfold Caliper.

RESULTS

In total, 91 patients with AD (40 men and 51 women) participated in this study on skinfold thickness measurement. Among them, 27 patients were examined for rivastigmine and NAP 226-90 serum concentrations, with mean concentrations of 1.0 ± 0.6 ng/mL and 3.6 ± 3.6 ng/mL, respectively. The skinfold thickness in the subscapular area was significantly negatively correlated with the NAP 226-90 serum concentration (Spearman's rank correlation coefficient = - 0.47, P = .01). In addition, patients with AD and a subscapular skinfold thickness of ≥25 mm exhibited a significantly high risk of decreased Mini-Mental Status Examination score and nonadherence to a rivastigmine patch (odds ratio 3.00; 95% confidence interval = 1.076-8.366, P = .03).

CONCLUSIONS

Subscapular skinfold thickness was significantly negatively correlated with the NAP 226-90 serum concentration and may be considered an appropriate predictor of response and adherence to clinical application of a rivastigmine patch.

Nutritional Considerations of Cardiovascular Diseases and Treatments

Nutritional considerations of many chronic diseases are not fully understood or taken into consideration in everyday clinical practice. Therefore, it is not surprising that high proportion of hospitalized patients with cardiovascular diseases remains underdiagnosed with malnutrition. Malnourished patients have increased risk of poor clinical outcomes, complications rate, prolonged hospital stay, more frequent rehospitalizations, and lower quality of life. The purpose of this review is to recapitulate recent data on nutritional considerations in cardiovascular medicine.

Assessing subcutaneous adipose tissue by simple and portable field instruments: Skinfolds versus A-mode ultrasound measurements

Purpose

This study compared subcutaneous adipose tissue (SAT) measurements using a skinfold caliper and Renco Lean-Meater Series 12 A-mode portable ultrasound scanner (A-US). It aimed to assess their inter- and intra-rater reliability and measure the agreement between both methods.

Methods

Eighty-four volunteers of different fitness levels were divided into three groups by Ʃ6 skinfolds: G1 ≤ 55 mm (n = 33 males); G2 > 55 mm (n = 32 males); G3 = 98.0 ± 52.3 mm (n = 19 females). Triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, front thigh and medial calf were assessed by ultrasound and skinfolds. Two technicians for both tools performed triplicate measures. Intraclass correlation (ICC), technical error of measurement (TEM) and coefficients of variation (CVs) were applied for test-retest and inter-rater reliability. Non-Parametric statistics were used in order to establish possible statistical differences and correlation between skinfolds thickness and uncompressed subcutaneous adipose tissue thickness from ultrasound. The amount of agreement between both methods was assessed with Lin’s coefficient and a scatterplot of all site locations. A Bland-Altman plot was constructed to establish limits of agreement between groups and regression analysis was employed to assess the ability of skinfolds to explain the variance of ultrasound.

Results

Test-retest ICC for skinfolds and ultrasound were higher than 0.989 and 0.793, respectively. Inter-rater ICC for skinfolds was 0.999 with a 95% CI of 0.995 to 0.999 and for ultrasound was 0.755 with a much larger 95% CI of 0.622 to 0.841. TEMs (> 8.50%) and CVs (> 6.72%) compromised ultrasound reliability. Statistical differences were found in most of the analysed anatomical sites (p < 0.001) except in biceps G2 (Z = -1.150, p = 0.25) and G3 (Z = -1.309, p = 0.19). Good correlations (r > 0.7, p ≤ 0.05) were reported at almost all anatomical sites and groups except for biceps (G1: Rho = 0.26, p = 0.140) and abdominal (G2: Rho = -0.16, p = 0.38; G3: Rho = 0.43, p = 0.068). Lin’s concordance correlation coefficient registered low values of agreement between skinfolds and A-mode ultrasound (ranged from—0.009–0.646). The scatterplot and the estimated regression line drawn through the midst of all anatomical sites of the whole sample had a slope of 0.51 and R² adjusted = 0.62 was obtained. The combined analysis between the Bland-Altman plot and the linear regression showed that specifically in the G2 and G3 groups, as the SAT increases the differences between skinfolds and ultrasounds measurements also increases.

Conclusions

The Renco Lean-Meater ultrasound is not interchangeable with skinfold measures. Its utility is questionable, particularly for assessing SAT in active adult populations. Its poor test-retest and inter-rater reliability as well as the lack of agreement when compared to the skinfolds would exclude the free use of the A-mode ultrasound scanner in its hypothetical replacing of the classical calipers.

Dietary Patterns Exhibit Sex-Specific Associations with Adiposity and Metabolic Risk in a Cross-Sectional Study in Urban Mexican Adolescents

Background: Studies in Western nations have shown associations of certain dietary patterns with obesity and metabolic risk in youth. Little is known about these relations in newly industrialized countries where obesity prevalence is surpassing those of developed countries.Objective: We sought to characterize dietary patterns in a cross-sectional study in 224 adolescents aged 8-14 y in Mexico and to investigate associations of the dietary patterns with adiposity and metabolic risk.Methods: We used principal components analysis to derive dietary patterns from food-frequency questionnaire data. By using linear regression models that accounted for mother's marital status, education, and smoking habits and child's age and physical activity, we examined associations of the dietary patterns with adiposity [body mass index z score, waist circumference, the sum and ratio of the subscapular and triceps skinfold thicknesses, blood pressure, serum fasting glucose and a C-peptide-based measure of insulin resistance (CP-IR), lipid profile, and a metabolic syndrome risk z score (MetS z score)].Results: We identified a "prudent" dietary pattern characterized by high intakes of vegetables, fruit, fish, chicken, and legumes and a "transitioning" dietary pattern, which comprises processed meats, Mexican foods, and sweetened beverages. Each unit increase in the prudent pattern factor score corresponded with 0.33 ng/mL (95% CI: 0.09, 0.57 ng/mL) lower C-peptide, 0.08 units (95% CI: 0.02, 0.13 units) lower CP-IR, and a 0.14 unit (0.00, 0.27 unit) lower MetS z score in boys. In girls, the transitioning pattern corresponded with higher subscapular + triceps skinfold thickness (per 1-unit increase in the factor score: 2.46 mm; 95% CI: 0.10, 4.81 mm). These results did not change after accounting for pubertal status.Conclusions: A prudent dietary pattern was protective against metabolic risk in adolescent boys, whereas a transitioning dietary pattern corresponded with higher adiposity among adolescent girls. Given that adolescence is a key developmental period for long-term health, efforts to elucidate dietary determinants of metabolic risk during this life stage may have long-term benefits.

Quantifying the effect of adipose tissue in muscle oximetry by near infrared spectroscopy

Change of muscle tissue oxygen saturation (StO2), due to exercise, measured by near infrared spectroscopy (NIRS) is known to be lower for subjects with higher adipose tissue thickness. This is most likely not physiological but caused by the superficial fat and adipose tissue. In this paper we assessed, in vitro, the influence of adipose tissue thickness on muscle StO2, measured by NIRS oximeters. We measured StO2 of a liquid phantom by 3 continuous wave (CW) oximeters (Sensmart Model X-100 Universal Oximetry System, INVOS 5100C, and OxyPrem v1.3), as well as a frequency-domain oximeter, OxiplexTS, through superficial layers with 4 different thicknesses. Later, we employed the results to calibrate OxyPrem v1.3 for adipose tissue thickness in-vivo.

Effect of laser acupuncture on obesity: study protocol for a randomized controlled trial

BACKGROUND

Obesity-related diseases have a profound economic impact on health care systems. Laser acupuncture has been shown to have beneficial effects on obesity. However, to our knowledge, those trials were either non-randomized, non-blinded or included low-calorie diet control. We have, therefore, designed a patient-assessor-blinded, randomized, sham-controlled crossover trial to investigate the significance of laser acupuncture on obesity.

METHODS/DESIGN

104 subjects above 20 years of age with a body mass index (BMI) of over 25 kg/m(2) will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 3 times a week for 8 weeks. After 8 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include BMI, body fat percentage, waist-to-hip ratio (WHR), waist circumference, hip circumference, skinfold thickness, thigh circumference, body fat, blood pressure, heart rate, hunger and the 36-item Short-Form Health Survey (SF-36).

DISCUSSION

The results of this study will provide the basis for future large-scale multicenter trials investigating the effects of laser acupuncture on obesity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02167308 ; registration date: 14 June 2014.

[Anthropometric indices to identify metabolic syndrome and hypertriglyceridemic waist phenotype: a comparison between the three stages of adolescence]

OBJECTIVE:

To determine the prevalence of metabolic syndrome (MS) and the hypertriglyceridemic waist phenotype (HW) in a representative adolescent sample; as well as to establish which anthropometric indicator better identifies MS and HW, according to gender and adolescent age.

METHODS:

This cross sectional study had the participation of 800 adolescents (414 girls) from 10-19 years old. Anthropometric indicators (body mass index, waist perimeter, waist/stature ratio, waist/hip ratio, and central/peripheral skinfolds) were determined by standard protocols. For diagnosis of MS, the criteria proposed by de Ferranti et al. (2004) were used. HW was defined by the simultaneous presence of increased waist perimeter (>75th percentile for age and sex) and high triglycerides (>100 mg/dL). The ability of anthropometric indicators was evaluated by Receiver Operating Characteristic curve.

RESULTS:

The prevalence of MS was identical to HW (6.4%), without differences between genders and the adolescence phases. The waist perimeter showed higher area under the curve for the diagnosis of MS, except for boys with 17-19 years old, for whom the waist/stature ratio exhibited better performance. For diagnosing HW, waist perimeter also showed higher area under the curve, except for boys in initial and final phases, in which the waist/stature ratio obtained larger area under the curve. The central/peripheral skinfolds had the lowest area under the curve for the presence of both MS and HW phenotype.

CONCLUSIONS:

The waist perimeter and the waist/stature showed a better performance to identify MS and HW in both genders and in all three phases of adolescence.

Growth failure in children: a symptom or a disease?

One of the most important aspects of a well-child examination is an assessment of a child's growth. Children who are failing to grow are often labeled "failure to thrive." However, close examination of the pattern of growth on standardized growth charts often allows the caregiver to characterize the growth failure as failure to grow, failure to gain weight, or failure to grow and gain weight. Such refinement of the pattern of growth failure allows for a more specific differential diagnosis and helps to focus laboratory and radiographic evaluation.

Body fat does not affect venous bubble formation after air dives of moderate severity: theory and experiment

For over a century, studies on body fat (BF) in decompression sickness and venous gas embolism of divers have been inconsistent. A major problem is that age, BF, and maximal oxygen consumption (Vo2max) show high multicollinearity. Using the Bühlmann model with eight parallel compartments, preceded by a blood compartment in series, nitrogen tensions and loads were calculated with a 40 min/3.1 bar (absolute) profile. Compared with Haldanian models, the new model showed a substantial delay in N2 uptake and (especially) release. One hour after surfacing, an increase of 14-28% in BF resulted in a whole body increase of the N2 load of 51%, but in only 15% in the blood compartment. This would result in an increase in the bubble grade of only 0.01 Kisman-Masurel (KM) units at the scale near KM = I-. This outcome was tested indirectly by a dry dive simulation (air breathing) with 53 male divers with a small range in age and Vo2max to suppress multicollinearity. BF was determined with the four-skinfold method. Precordial Doppler bubble grades determined at 40, 80, 120, and 160 min after surfacing were used to calculate the Kisman Integrated Severity Score and were also transformed to the logarithm of the number of bubbles/cm(2) (logB). The highest of the four scores yielded logB = -1.78, equivalent to KM = I-. All statistical outcomes of partial correlations with BF were nonsignificant. These results support the model outcomes. Although this and our previous study suggest that BF does not influence venous gas embolism (Schellart NAM, van Rees Vellinga TP, van Dijk FH, Sterk W. Aviat Space Environ Med 83: 951-957, 2012), more studies with different profiles under various conditions are needed to establish whether BF remains (together with age and Vo2max) a basic physical characteristic or will become less important for the medical examination and for risk assessment.

Overweight and obesity alters the cumulative transverse strain in the Achilles tendon immediately following exercise

This research evaluated the effect of obesity on the acute cumulative transverse strain of the Achilles tendon in response to exercise. Twenty healthy adult males were categorized into 'low normal-weight' (BMI <23 kg m(-2)) and 'overweight' (BMI >27.5 kg m(-2)) groups based on intermediate cut-off points recommended by the World Health Organization. Longitudinal sonograms of the right Achilles tendon were acquired immediately prior and following weight-bearing ankle exercises. Achilles tendon thickness was measured 20-mm proximal to the calcaneal insertion and transverse tendon strain was calculated as the natural log of the ratio of post- to pre-exercise tendon thickness. The Achilles tendon was thicker in the overweight group both prior to (t18 = -2.91, P = 0.009) and following (t18 = -4.87, P < 0.001) exercise. The acute transverse strain response of the Achilles tendon in the overweight group (-10.7 ± 2.5%), however, was almost half that of the 'low normal-weight' (-19.5 ± 7.4%) group (t18 = -3.56, P = 0.004). These findings suggest that obesity is associated with structural changes in tendon that impairs intra-tendinous fluid movement in response to load and provides new insights into the link between tendon pathology and overweight and obesity.

Evaluation of ultrasonography for measurement of skin thickness in Shar-Peis

OBJECTIVE

To determine whether high-frequency diagnostic ultrasonography is useful for assessment of skin thickness in Shar-Peis.

ANIMALS

10 healthy Shar-Peis and 10 healthy Beagles used as controls.

PROCEDURES

Ultrasonographic examination of the skin was performed on 4 cutaneous sites by use of a 13-MHz linear-array transducer, and the mean of 3 measurements was calculated. Ultrasonography results were compared with histologic findings of skin specimens stained with H&E, Alcian blue at a pH of 2.5, and Masson trichrome stains, with histometric measurements of skin thickness made by use of a microscope, and with measurements of skin thickness made by use of a plicometer. Ultrasonograpy results were also compared via age and sex of selected animals.

RESULTS

A clear correlation was detected between ultrasonography results and results of histologic and histometric analysis in both groups. In Shar-Peis, no correlation was found between ultrasonography results and age and sex, whereas in Beagles, a weak positive correlation was found only between skin thickness in dorsal cervical and frontal (on the rostral margins of the supraorbital processes) regions and age. A positive overall correlation was found in Shar-Peis between measurements made via ultrasonography and plicometery.

CONCLUSIONS AND CLINICAL RELEVANCE

Ultrasonography was a useful tool to assess skin thickness, and in Shar-Peis, it might be considered a valid alternative to invasive methods such as histologic examination to objectively estimate the severity of hereditary cutaneous hyaluronosis.

Footprint-based estimates of arch structure are confounded by body composition in adults

Previous research employing indirect measures of arch structure, such as those derived from footprints, have indicated that obesity results in a "flatter" foot type. In the absence of radiographic measures, however, definitive conclusions regarding the osseous alignment of the foot cannot be made. We determined the effect of body mass index (BMI) on radiographic and footprint-based measures of arch structure. The research was a cross-sectional study in which radiographic and footprint-based measures of foot structure were made in 30 subjects (10 males, 20 female) in addition to standard anthropometric measures of height, weight, and BMI. Multiple (univariate) regression analysis demonstrated that both BMI (β = 0.39, t(26) = 2.12, p = 0.04) and radiographic arch alignment (β = 0.51, t(26) = 3.32, p < 0.01) were significant predictors of footprint-based measures of arch height after controlling for all variables in the model (R(2) = 0.59, F(3,26) = 12.3, p < 0.01). In contrast, radiographic arch alignment was not significantly associated with BMI (β = -0.03, t(26) = -0.13, p = 0.89) when Arch Index and age were held constant (R(2) = 0.52, F(3,26) = 9.3, p < 0.01). Adult obesity does not influence osseous alignment of the medial longitudinal arch, but selectively distorts footprint-based measures of arch structure. Footprint-based measures of arch structure should be interpreted with caution when comparing groups of varying body composition.

Determination of abdominal fat thickness using dual electrode separation in the focused impedance method (FIM)

Subcutaneous fat layer thickness in the abdomen is a risk indicator of several diseases and disorders like diabetes and heart problems and could be used as a measure of fitness. Skinfold measurement using mechanical calipers is simple but prone to error. Ultrasound scanning techniques are yet to be established as accurate methods for this purpose. magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide the answer but are expensive and not available widely. Some initiatives were made earlier to use electrical impedance to this end, but had inadequacies. In the first part of this paper, a 4-electrode focused impedance method (FIM) with different electrode separations has been studied for its possible use in the determination of abdominal fat thickness in a localized region. For this, a saline phantom was designed to provide different electrode separations and different layers of resistive materials adjacent to the electrodes. The background saline simulated the internal organs having low impedance while the resistive layers simulated the subcutaneous fat. The plot of the measured impedance with electrode separation had different 'slopes' for different thicknesses of resistive layers, which offered a method to obtain an unknown thickness of subcutaneous fat layer. In the second part, measurements were performed on seven human subjects using two electrode separations. Fat layer thickness was measured using mechanical calipers. A plot of the above 'slope' against fat thickness could be fitted using a straight line with an R(2) of 0.93. Then this could be used as a calibration curve for the determination of unknown fat thickness. Further work using more accurate CT and MRI measurements would give a better calibration curve for practical use of this non-invasive and low-cost technique in abdominal fat thickness measurement.

Prediction of skeletal muscle and fat mass in patients with advanced cancer using a metabolomic approach

Urine and plasma metabolites originate from endogenous metabolic pathways in different organs and exogenous sources (diet). Urine and plasma were obtained from advanced cancer patients and investigated to determine if variations in lean and fat mass, dietary intake, and energy metabolism relate to variation in metabolite profiles. Patients (n = 55) recorded their diets for 3 d and after an overnight fast they were evaluated by DXA and indirect calorimetry. Metabolites were measured by NMR and direct injection MS. Three algorithms were used [partial least squares discriminant-analysis, support vector machines (SVM), and least absolute shrinkage and selection operator] to relate patients' plasma/urine metabolic profile with their dietary/physiological assessments. Leave-one-out cross-validation and permutation testing were conducted to determine statistical validity. None of the algorithms, using 63 urine metabolites, could learn to predict variations in individual's resting energy expenditure, respiratory quotient, or their intake of total energy, fat, sugar, or carbohydrate. Urine metabolites predicted appendicular lean tissue (skeletal muscle) with excellent cross-validation accuracy (98% using SVM). Total lean tissue correlated highly with appendicular muscle (Pearson r = 0.98; P < 0.0001) and gave similar cross-validation accuracies. Fat mass was effectively predicted using the 63 urine metabolites or the 143 plasma metabolites, exclusively. In conclusion, in this population, lean and fat mass variation could be effectively predicted using urinary metabolites, suggesting a potential role for metabolomics in body composition research. Furthermore, variation in lean and fat mass potentially confounds metabolomic studies attempting to characterize diet or disease conditions. Future studies should account or correct for such variation.

Ethnic differences in body fat distribution among Asian pre-pubertal children: a cross-sectional multicenter study

Background

Ethnic differences in body fat distribution contribute to ethnic differences in cardiovascular morbidities and diabetes. However few data are available on differences in fat distribution in Asian children from various backgrounds. Therefore, the current study aimed to explore ethnic differences in body fat distribution among Asian children from four countries.

Methods

A total of 758 children aged 8-10 y from China, Lebanon, Malaysia and Thailand were recruited using a non-random purposive sampling approach to enrol children encompassing a wide BMI range. Height, weight, waist circumference (WC), fat mass (FM, derived from total body water [TBW] estimation using the deuterium dilution technique) and skinfold thickness (SFT) at biceps, triceps, subscapular, supraspinale and medial calf were collected.

Results

After controlling for height and weight, Chinese and Thai children had a significantly higher WC than their Lebanese and Malay counterparts. Chinese and Thais tended to have higher trunk fat deposits than Lebanese and Malays reflected in trunk SFT, trunk/upper extremity ratio or supraspinale/upper extremity ratio after adjustment for age and total body fat. The subscapular/supraspinale skinfold ratio was lower in Chinese and Thais compared with Lebanese and Malays after correcting for trunk SFT.

Conclusions

Asian pre-pubertal children from different origins vary in body fat distribution. These results indicate the importance of population-specific WC cut-off points or other fat distribution indices to identify the population at risk of obesity-related health problems.

Subcutaneous thigh fat assessment: a comparison of skinfold calipers and ultrasound imaging

CONTEXT

Skinfold calipers (SC) typically are used to determine subcutaneous fat thicknesses. Identifying the exact separation of muscle and fat can complicate measurements. Ultrasound imaging (USI) might provide a better technique for analyzing subcutaneous fat thicknesses.

OBJECTIVE

To compare measurements from SC and USI in assessing subcutaneous thigh fat thickness.

DESIGN

Descriptive laboratory study.

SETTING

Laboratory.

PATIENTS AND OTHER PARTICIPANTS

Twenty healthy adults (13 men, 7 women; age  =  26.9 ± 5.4 years, height  =  173.9 ± 7.3 cm, mass  =  77.4 ± 16.1 kg) participated.

INTERVENTION(S)

Participants were seated in 90° of knee flexion and 85° of trunk extension. A standardized template was used to identify measurement sites over the vastus medialis obliquus (VMO), distal rectus femoris (dRF), proximal rectus femoris (pRF), and vastus lateralis (VL). Three measurements at each of the 4 sites were made in random order and were averaged for each measurement tool by the same investigator.

MAIN OUTCOME MEASURE(S)

Fat thickness was measured in millimeters with SC and USI. Measurements at each site were compared using Pearson product moment correlations and Bland-Altman plots.

RESULTS

Strong correlations between measures were found at the VMO (r  =  .90, P < .001), dRF (r  =  .93, P < .001), pRF (r  =  .93, P < .001), and VL (r  =  .91, P < .001). Mean differences between measures ranged from 1.7 ± 2.4 mm (dRF) to 3.7 ± 2.6 mm (pRF), indicating that the SC resulted in larger thicknesses compared with USI. Limits of agreement, as illustrated by the Bland-Altman plots, were fairly wide at each site: from -3.38 mm to 7.74 mm at the VMO, from -3.04 mm to 6.52 mm at the dRF, from -1.53 mm to 8.87 mm at the pRF, and from -3.73 mm to 8.15 mm at the VL. All plots except for the VL demonstrated increasing overestimation via the SC as fat thicknesses increased.

CONCLUSIONS

We found strong correlations between the SC and USI; however, the large limits of agreement and increasing mean differences with larger fat thicknesses were a concern in terms of using this tool. When measuring subcutaneous fat thickness of the thigh, SC tended to overestimate thickness in individuals with higher fat values.

Fat and fat-free mass in Nepalese children: an assessment of nutritional status

The aims of the present study were to determine the body composition and to assess the nutritional status on the basis of body composition parameters in Nepalese children. Body fat percentage (BF%), fat mass (FM), and fat-free mass (FFM) of 1,988 (1,016 boys and 972 girls) Nepalese children aged 6 to 10 years were calculated from triceps and subscapular skinfolds. FM and FFM were then divided by height-squared in meter to determine the fat mass index (FMI) and fat-free mass index (FFMI), respectively. Growth curves of BF% and FFM for Nepalese children remained at a low level compared to international data. BF%, FM, and FMI of Nepalese girls were significantly (p < 0.001) higher than Nepalese boys, whereas FFM and FFMI of Nepalese boys were significantly (p < 0.001) higher than Nepalese girls of all age groups. BF%, FM, and FFM were significantly correlated with almost all anthropometric parameters in both sexes. Growth curves of BF% and FFM showed that the undernutrition prevailed in Nepalese children. BF% and FFM were good indicators for measuring nutritional status in Nepalese children. Sexual dimorphism of fat patterning was present in Nepalese children.

Using simple anthropometric measures to predict body fat in South Asians

Previously determined predictive equations for body fat mass (BFM) are primarily derived from populations of European origin, which may not be appropriate for all ethnic groups. The objective of this study was to develop an improved predictive equation for BFM specific to South Asians and derived from common anthropometric measurements that include measures of central adiposity. A total of 208 apparently healthy South Asian men and women, aged 30–65 years, were recruited. Anthropometric measurements and BFM by dual energy X-ray absorbitometry (DEXA) were obtained. Sex-specific equations predicting BFM were developed using regression models on a reference subset (68 men, 70 women) and tested on a validation group. New predictive equations (BFMNEW) were tested for agreement with Durin and Wormersley and Siri equations and with the reference method, DEXA. The best predictive sex-specific equation involved a combination of skinfolds, waist circumference, hip circumference, humerus breadth, height, mass, and age. Models significantly correlated with BFM determined by DEXA (r = 0.946 for men; r = 0.974 for women; p < 0.001). The estimates of BFM from reference and validation groups had excellent correlations and displayed excellent agreement to DEXA measures. We demonstrated new predictive equations for BFM that are specific to South Asians and incorporate measures of central adiposity. This may help resolve issues surrounding inaccurate determination of adiposity in South Asians, and consequently provide better estimations of disease risk.

A comparison of field methods to assess body composition in a diverse group of sedentary women

Accurate assessment of body composition is essential in the evaluation of obesity. While laboratory methods are commonly used to assess fat mass, field measures (e.g., skinfold thickness [SKF] and bioelectrical impedance [BIA]) may be more practical for screening large numbers of individuals in intervention studies. In this study, a correlational design was used among 46 racially and ethnically diverse, sedentary women (mean age = 25.73 years) to (a) compare the percentage of body fat as determined by SKF and the upper body BIA and (b) examine the effects of body mass index (BMI), racial/ethnic background, age, and stage of the menstrual cycle on differences in the estimated percentage of body fat obtained using the SKF and BIA. Overall, a significant correlation between SKF and BIA (r = .98, p < .001) was found, with similar findings among Black, Hispanic and White non-Hispanic women. The mean differences between BIA and SKF were not significantly correlated with BMI, age, race/ethnicity or stage of the menstrual cycle. Data from this study suggest that BIA showed similar body fat prediction values compared with SKF and may be a viable alternative to SKF among diverse groups of healthy women. Additional testing and comparison of these field methods with the laboratory methods of hydro-densitometry or dual energy X-ray absorptiometry is recommended to further determine whether BIA devices can be routinely recommended as an alternative to the SKF.

Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry

PURPOSE

Measurements in muscle tissue are often performed at a selected single location over the muscle of interest. The hypothesis is that the values obtained reflect the status within the entire muscle or muscle group. This, however, may not be the case. The study was performed to investigate whether this hypothesis is true for hemodynamics and oxygenation in the healthy human calf muscle at rest.

MATERIALS AND METHODS

Hemoglobin flow, blood flow, oxygen consumption, and venous hemoglobin oxygen saturation were mapped at 22 locations in 30 legs of 15 healthy subjects (nine women, six men aged 26-37 years) simultaneously by using frequency-domain near-infrared spectrophotometry with a specially designed probe during venous occlusion.

RESULTS

For all parameters, spatial heterogeneity was found between subjects and within individual legs. All parameters were highly significantly different when comparing proximal and distal regions. Differences were also found between medial and lateral regions. The global mean values (+/-standard deviation) over all measurements were as follows: hemoglobin flow, 1.27 micromol per 100 mL/min +/- 0.88; blood flow, 0.56 mL per 100 g/min +/- 0.38; oxygen consumption, 0.016 mL per 100 g/min +/- 0.011; and venous oxygen saturation, 77.6% +/- 5.9. The thickness of the overlying adipose tissue had an influence on the measurements and must be considered.

CONCLUSION

Highly significant spatial heterogeneity of hemodynamics and oxygenation was found in the healthy human calf muscle.

Mesenteric fat thickness as an independent determinant of fatty liver

OBJECTIVE

Mesenteric fat is drained by the portal circulation and has been suggested to be a key component in obesity-related health risk, notably the metabolic syndrome. There are increasing epidemiological and experimental data showing that fatty liver is another component of this multifaceted syndrome. Given their intimate anatomical and physiological relationships, we hypothesized that mesenteric fat thickness may be independently associated with the risk of fatty liver. To test this hypothesis, we examined the predictive role of various fat deposits including mesenteric fat thickness, and various metabolic variables on the risk of fatty liver.

SUBJECTS AND METHODS

A total of 291 Chinese subjects (134 men and 157 women with a mean BMI of 23.7 kg/m2, range: 16.5-33.4 kg/m2) underwent ultrasound examination for measurement of mesenteric, subcutaneous and preperitoneal fat thickness, and for diagnosis of fatty liver. Body mass index, waist circumference, and waist-hip ratio were recorded. Blood pressure was measured. Fasting plasma glucose, insulin resistance, high-density lipoprotein cholesterol (HDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), liver enzymes were determined by common methods.

RESULTS

The subjects with fatty liver had greater abdominal fat thickness and higher anthropometric indexes than those without fatty liver. The subjects with fatty liver also showed higher blood pressure, worse lipid and glycaemic profile compared with those without fatty liver. Using multiple logistic regression analysis, mesenteric fat thickness was a risk factor of fatty liver, independent of body mass index, age, sex, insulin resistance, fasting plasma glucose, lipid and blood pressure. The odds ratio was 1.5 (95% confidence interval: 1.27-1.77) for every 1 mm increase in the mesenteric fat thickness. Measurement of preperitoneal and subcutaneous fat deposits did not show significant associations with fatty liver.

CONCLUSION

Mesenteric fat thickness measured on ultrasound is an independent determinant of fatty liver.

Association between physical and echographic fat thickness assessments and a lipodystrophy grading scale in lipodystrophic HIV patients: practical implications

A simple diagnostic method for detecting in clinical routine HAART-associated lipodystrophy in HIV-infected patients is lacking. We studied the relationships between the scores obtained with a subjective lipodystrophy severity grading scale (LSGS) and standard anthropometric and echographic measurements of the subcutaneous and visceral fat thickness of 74 HIV-infected patients. Patients were divided into four groups according to their LSGS score (0, 1-7, 8-14, 15-21). Significant correlations between the LSGS and the anthropometric and echographic measurements of fat thickness, mainly the limb circumferences (brachial: r= -0.43, p < 0.001; thigh: r= -0.41, p < 0.001), and, especially, the echographically assessed perirenal fat diameters either adjusted (r= 0.46, p < 0.001) or nonadjusted to the body mass index (r= 0.35, p < 0.001) were observed. Significant differences in most of these anthropometric parameters between either the lowest (score 0) and the highest (score 15-21) score groups and the remaining groups were found, but not between the two intermediate groups (scores 1-7 vs. 8-14). This suggests that lipodystrophy should be clinically categorized as absent, mild, or marked, and that even minor changes in physical aspect should be considered as indicative of this disorder. The combination of these subjective and objective parameters could be helpful in the early detection of lipodystrophy in clinical practice.

Midarm computerized tomography fat, muscle and total areas correlation with nutritional assessment data

BACKGROUND AND OBJECTIVES

Correlated nutritional assessment data (anthropometric, bioimpedance and biochemical) with computerized tomography (CT) of total, muscle and fat midarm areas. Total body fat and fat-free mass were estimated using bioimpedance. Daily urinary urea and creatinine were also quantified. In all, 28 subjects (13 males, 15 females) were evaluated and, they were clinically divided in obese, malnourished and control subjects.

DESIGN

Quantification of total, fat muscle midarm areas by tomography and anthropometry and total body fat and free-fat mass by bioimpedance.

RESULTS

CT values were 29% higher for fat area and 4-5% lower for total and muscle midarm areas compared against anthropometric data. The midarm skinfold thickness highly correlated with CT fat midarm area. Total body fat and free-fat mass bioimpedance data showed significant correlation with CT midarm data. Urinary creatinine correlated with CT muscle midarm area.

CONCLUSION

Utilization of anthropometry can lead to error estimation of fat and fat-free arm areas and that bioimpedance gives fair correlation between total body and CT midarm measurements.

Sonographic measurement of mesenteric fat thickness is a good correlate with cardiovascular risk factors: comparison with subcutaneous and preperitoneal fat thickness, magnetic resonance imaging and anthropometric indexes

OBJECTIVE

Visceral fat, notably mesenteric fat, which is drained by the portal circulation, plays a critical role in the pathogenesis of metabolic syndrome through increased production of free fatty acids, cytokines and vasoactive peptides. We hypothesize that mesenteric fat thickness as measured by ultrasound scan could explain most of the obesity-related health risk. We explored the relationships between cardiovascular risk factors and abdominal fat as determined by sonographic measurements of thickness of mesenteric, preperitoneal and subcutaneous fat deposits, total abdominal and visceral fat measurement by magnetic resonance imaging (MRI) and anthropometric indexes.

DESIGN

A cross-sectional study.

SUBJECTS

Subjects included 18 healthy men and 19 women (age: 27-61 y, BMI: 19-33.4 kg/m(2)).

MEASUREMENTS

The maximum thickness of mesenteric, preperitoneal and subcutaneous fat was measured by abdominal ultrasound examination. MRI examinations of whole abdomen and pelvis were performed and the amount of total abdominal and visceral fat was quantified. The body mass index, waist circumference and waist-hip ratio were recorded. Cardiovascular risk factors were assessed by physical examination and blood taking.

RESULTS

Men had more adverse cardiovascular risk profile, higher visceral fat volume and thicker mesenteric fat deposits than women. Among all the investigated obesity indexes, the mesenteric fat thickness showed the highest correlations with total cholesterol, LDL-C, triglycerides, fasting plasma glucose, HbA(1c) and systolic blood pressure in men, and with triglycerides and HbA(1c) in women. On stepwise multiple regression analysis with different obesity indexes as independent variables, 30-65% of the variances of triglycerides, total cholesterol, LDL-C and HbA(1c) in men, and triglycerides in women were explained by the mesenteric fat thickness.

CONCLUSION

Compared with sonographic measurement of subcutaneous and preperitoneal fat thickness, MRI measurement of total abdominal and visceral fat and anthropometric indexes, sonographic measurement of mesenteric fat thickness showed better associations with some of the cardiovascular risk factors. It may potentially be a useful tool to evaluate regional distribution of obesity in the assessment of cardiovascular risk.

Cadaver-assessed validity of anthropometric indicators of adipose tissue distribution

Although the waist-to-hip ratio (WHR) has emerged as the best anthropometric indicator of the body's adipose tissue distribution, it has never been directly validated. Waist and hip girths, and triceps and subscapular skinfold thickness were measured in 12 male and 13 female cadavers aged 55-94 y. Adipose tissue from the upper limbs, lower limbs, subcutaneous trunk and intra-abdominal regions was then separated by dissection and weighed. Adipose volumes were also determined by hydrostatic weighing. The following adipose tissue mass ratios (and corresponding volume ratios) were derived: trunk to sum of lower limbs, trunk to sum of upper and lower limbs, intra-abdominal to sum of lower limbs and intra-abdominal to sum of upper and lower limbs. Centrality index (CI-subscapular-to-triceps skinfold ratio) and WHR were regressed on the tissue mass and volume ratios of the 25 cadavers. WHR was significantly related to mass and volume ratios for the 12 men (R2=36.0-57.5%, P<0.05), except for intra-abdominal to sum of upper and lower limbs (R(2)=26.3%, P=0.09), but none of these relations was significant in the women. CI was significantly related to all mass and volume ratios only for men and women combined (R(2)=16.2-21.8%, P<0.05). The WHR was better related to all mass and volume ratios than the CI. These results, especially the strong association between WHR and the ratio of intra-abdominal to lower limb adipose masses (R(2)=35.4%, P=0.002), demonstrate a clear relation between the selected anthropometric variables (hip and waist girths, and subscapular and triceps skinfolds) and adipose tissue distribution, thus validating the use of WHR as an important predictor of health risk.

Age-related muscle atrophy does not affect all muscles and can partly be compensated by physical activity: an ultrasound study

In adults, the volume of quadriceps femoris muscle decreases with age, whereas the impact of increasing age on the size of other extremity muscles was hardly studied. This study was conducted to examine whether age-related muscle atrophy is a general phenomenon, whether it is accompanied by increasing subcutaneous fat and whether physical activity can compensate age-related muscle atrophy. One hundred and two female and 101 male subjects (aged 19-86 years), with common physical activity, as well as 29 women and 38 men (aged 20-81 years) regularly performing sports at least 3 h per week for several years (mean, 10 years in women and 14 years in men, respectively), were examined. Both in athletes and control subjects, the thickness of thigh muscles significantly decreased with age (-15(-)-21% from age 20 to age 70), whereas diameter of upper arm muscles remained nearly unchanged. Diameters of the calf muscle decreased with advancing age only in the control group. In male control subjects, the tibialis anterior muscle shrunk as well. Except for the vastus lateralis muscle in women, the relative loss of muscle thickness was more evident in control subjects than in athletes. Thickness of the subcutaneous fat layers remained almost unchanged. In summary, not all extremity muscles exhibit age-related decrease in size. Regular physical activity can ease off muscle atrophy.

Randomized trial of measures of body fat versus body weight in the treatment of anorexia nervosa

OBJECTIVE

To determine whether treatment goals based on body weight or body fat assessed by anthropometrics caused a larger reduction in the Eating Disorder Examination (EDE) over 3 months during the treatment of anorexia nervosa (AN).

METHODS

Randomized trial comparing the use of body weight versus measures of body fat by anthropometrics, with the EDE as the outcome measure. Of 23 patients enrolled, 11 subjects who met diagnostic criteria for AN (DSM-IV) and received outpatient treatment from the Eating Disorders clinic of a university teaching hospital completed the study.

RESULTS

Comparison of the 2 methods by independent t-tests, verified by Mann-Whitney and Sign tests, suggests no difference (p = 0.33). Due to the small sample size, statistical significance could not be assured. A cross-sectional survey of 48 clinic users found the majority of patients preferred to be followed by skinfold measurements and felt they were more helpful than weight.

DISCUSSION

Regardless of which measurement is used, if the clinic staff firmly believe that a method is more helpful and more useful, it is likely that the patients will find it acceptable.

Body composition in children based on anthropometric data. A presentation of normal values

Knowledge of the body composition in terms of fat and fat-free mass is used in paediatrics to estimate a child's nutritional status. To obtain the fat content or protein content sophisticated techniques exist. These techniques are often difficult to apply in daily practice. An anthropometric approach is therefore relevant because of its simplicity. In this study skinfold thicknesses and mid-upperarm circumference are presented as reference values and used to derive the fat-free mass fraction of the body and the arm muscle area.

CONCLUSION

Despite the shortcomings of an anthropometric approach in estimating the fraction of fat-free mass or protein content, its simplicity makes the method of calculating these fractions on skinfold thicknesses and mid-upperarm circumference valuable to apply in daily paediatric practice.