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Bongiolo AM, Machado MJ, Lazarotto BA, Rupp MLC, Dal-Pizzol F, Pires MMDS. PHASE ANGLE AS A PREDICTOR OF MUSCLE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23095. [PMID: 38451661 DOI: 10.1590/s0004-2803.246102023-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. OBJECTIVE This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. METHODS Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. RESULTS The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. CONCLUSION The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition. BACKGROUND • This study aims to assess whether the phase angle is a parameter for predicting reduced muscle mass in patients with inflammatory bowel disease. BACKGROUND • There was a correlation of the phase angle with skeletal muscle mass and the associations remained in disease activity. BACKGROUND • The ROC curve analysis indicated that the cut-off point of the PhA ≤5.042° for women and PhA ≤6,079° for men can be used to predict muscle mass reduction. BACKGROUND • The phase angle can be considered a predictor of muscle mass reduction in inflammatory bowel disease.
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Affiliation(s)
- Angela Martinha Bongiolo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brasil
| | - Marcos José Machado
- Universidade Federal de Santa Catarina, Departamento de Análises Clínicas, Florianópolis, SC, Brasil
| | - Bruno Ayala Lazarotto
- Universidade Federal de Santa Catarina, Faculdade de Medicina, Florianópolis, SC, Brasil
| | | | - Felipe Dal-Pizzol
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Fisiopatologia Experimental, Unidade de Ciências da Saúde, Criciúma, SC, Brasil
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Quist JR, Rud CL, Brantlov S, Ward LC, Dahl Baunwall SM, Hvas CL. Bioelectrical impedance analysis as a clinical marker of health status in adult patients with benign gastrointestinal disease: A systematic review. Clin Nutr ESPEN 2024; 59:387-397. [PMID: 38220401 DOI: 10.1016/j.clnesp.2023.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Body composition reflects nutritional status, disease status and progression, and treatment responses. Mounting evidence supports the use of bioelectrical impedance analysis (BIA) as a non-invasive tool to assess body composition. Patients with benign gastrointestinal (GI) disease experience disease-related alterations in their body composition, and bioimpedance outcomes in patients with benign GI diseases have not previously been summarized. We aimed to evaluate BIA as a clinical body composition marker for benign GI diseases and describe its association with physical health status. METHODS We systematically searched PubMed, Scopus, Web of Science, Embase, and CINAHL from inception to October 2023 (PROSPERO registration: CRD42021265866). Of 971 screened studies, 26 studies were included in the final analysis, comprising a total of 2398 adult patients with benign GI disease. The main outcome was raw impedance data. RESULTS The most frequently reported BIA outcome was phase angle (PhA) (reported in 18 of 26 studies), followed by fat-free-mass (FFM) (reported in 13 of 26 studies). The consensus view of the included studies illustrates that BIA can be a useful tool for evaluating body composition in patients with benign GI diseases, and low PhA and FFM were associated with increased nutritional risk, abnormal physical characteristics, and increased mortality risk. CONCLUSION To fully utilize BIA as a clinical marker of health in patients with benign GI disease, standardized protocols specific to this population are needed and prospective studies testing cut-offs and ranges, accuracy, and other raw BIA parameters for classifying disease status.
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Affiliation(s)
| | - Charlotte Lock Rud
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Steven Brantlov
- Department of Procurement & Clinical Engineering, Central Denmark Region, Denmark
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Zhang Y, Zhang L, Gao X, Dai C, Huang Y, Wu Y, Zhou W, Cao Q, Jing X, Jiang H, Zhong Y, Zhu W, Wang X. Impact of malnutrition and sarcopenia on quality of life in patients with inflammatory bowel disease: A multicentre study. J Cachexia Sarcopenia Muscle 2023; 14:2663-2675. [PMID: 37779327 PMCID: PMC10751433 DOI: 10.1002/jcsm.13341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/03/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Malnutrition and subsequent alterations in body composition (BC), particularly sarcopenia, are common but not yet elucidated in patients with inflammatory bowel disease (IBD); we aimed to detail the changes in BC and the characteristics of co-occurrence of malnutrition and sarcopenia in IBD patients and to investigate its effect on quality of life. METHODS This study was a multicentre, prospective, observational study involving four tertiary referral hospitals in China. The following data were collected from consecutive IBD inpatients: demographic information, medical history, recent weight change, handgrip strength (HGS) and BC parameters by bioelectrical impedance analysis (BIA). Nutritional assessments were performed through stepwise screening (Nutritional Risk Screening 2002) and diagnosis (World Health Organization-related body mass index [BMI], subjective global assessment, European Society for Clinical Nutrition and Metabolism 2015 and Global Leadership Initiative on Malnutrition [GLIM] criteria). The quality of life was assessed by the Inflammatory Bowel Disease Questionnaire. IBD patients were compared with 1:1 sex-, age- and BMI-matched healthy controls (MHC). RESULTS A total of 238 IBD patients (177 Crohn's disease [CD] and 61 ulcerative colitis [UC]), 68.5% male, with a mean age of 38.5 ± 14.0 years and a mean BMI of 19.8 ± 3.5 kg/m2 , were recruited. Compared with MHC (n = 122), IBD patients showed significant deterioration in BC and physical function, characterized by muscle depletion (appendicular skeletal muscle mass index [ASMI], 8.0 ± 1.3 vs. 6.7 ± 1.2 kg/m2 , Δ% -15.0% [-22.0%, -10.0%], P < 0.001) and fat accumulation (visceral fat area, 32.9 ± 22.6 vs. 66.5 ± 35.8, Δ% 110.0% [35.0%, 201.0%], P < 0.001). The prevalence of GLIM-defined malnutrition and sarcopenia in IBD patients was 60.1% and 25.2%, respectively. The nutritional status of patients with CD was worse than that of patients with UC. The activity phase of IBD significantly and negatively affected BC, while the lesion location did not. The co-occurrence of sarcopenia and malnutrition was not optimistic; 16.4-21.8% of patients suffer from sarcopenia and malnutrition based on different criteria at the same time, which was accompanied by a reduction in quality of life. HGS was correlated with various BC parameters (body cell mass, r = 0.76; ASMI, r = 0.70; fat-free mass, r = 0.73, all P < 0.001). CONCLUSIONS GLIM-defined malnutrition and sarcopenia were prevalent in IBD patients and kept a high rate of co-occurrence, which was accompanied with impaired quality of life. The alteration of BC in IBD patients was characterized by muscle depletion and fat accumulation. The strong correlation between HGS and BIA-derived BC suggested its hopeful evaluation in nutritional status and sarcopenia in IBD patients.
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Affiliation(s)
- Yupeng Zhang
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xuejin Gao
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Cong Dai
- Department of Gastroenterology, First Affiliated HospitalChina Medical UniversityShenyangChina
| | - Yuhong Huang
- Department of Gastroenterology, First Affiliated HospitalChina Medical UniversityShenyangChina
| | - Yan Wu
- Department of Pharmacy, Sir Run Run Shaw Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Qian Cao
- Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Xue Jing
- Department of GastroenterologyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Haitao Jiang
- Department of Gastrointestinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yong Zhong
- Department of Health Medicine, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
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Jiao X, Wu WY, Zhan SF, Liu JB, Zhang XJ. A bidirectional Mendelian randomization study of sarcopenia-related traits and inflammatory bowel diseases. Front Immunol 2023; 14:1240811. [PMID: 38022582 PMCID: PMC10666781 DOI: 10.3389/fimmu.2023.1240811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background There is increasing evidence pointing to a close relationship between sarcopenia and inflammatory bowel disease. However, it remains unclear whether or in which direction causal relationships exist, because these associations could be confounded. Methods We conducted a two-sample bidirectional mendelian randomization analysis using data from European genome-wide association studies of the appendicular lean mass(n = 450,243), walking pace(n = 459,915), grip strength (left hand, n = 461,026; right hand, n = 461,089), inflammatory bowel disease (25,042 patients and 34,915 controls), ulcerative colitis (12,366 patients and 33,609 controls), and Crohn's disease (12,194 patients and 28,072 controls) to investigate the causal relationship between sarcopenia-related traits and inflammatory bowel disease and its subtypes on each other. The inverse-variance weighted method was used as the primary analysis method to assess the causality, and a comprehensive sensitivity test was conducted. Results Genetically predicted appendicular lean mass was significantly associated with inflammatory bowel disease (OR = 0.916, 95%CI: 0.853-0.984, P = 0.017), ulcerative colitis (OR =0.888, 95%CI: 0.813-0.971, P = 0.009), and Crohn's disease (OR = 0.905, 95%CI: 0.820-0.999, P = 0.049). Similar results also revealed that the usual walking pace was causally associated with Crohn's disease (OR = 0.467, 95%CI: 0.239-0.914, P = 0.026). Reverse mendelian randomization analysis results found that genetic susceptibility to inflammatory bowel disease, and Crohn's disease were associated with lower appendicular lean mass. A series of sensitivity analyses ensured the reliability of the present research results. Conclusion The mendelian randomization study supports a bidirectional causality between inflammatory bowel disease, Crohn's disease and appendicular lean mass, but no such bidirectional causal relationship was found in ulcerative colitis. In addition, genetically predicted usual walking pace may reduce the risk of Crohn's disease. These findings have clinical implications for sarcopenia and inflammatory bowel disease management.
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Affiliation(s)
- Xin Jiao
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-yu Wu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shao-feng Zhan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-bo Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xian-jin Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Demers K, Bak MTJ, Bongers BC, de Vries AC, Jonkers DMAE, Pierik MJ, Stassen LPS. Scoping review on health-related physical fitness in patients with inflammatory bowel disease: Assessment, interventions, and future directions. World J Gastroenterol 2023; 29:5406-5427. [PMID: 37900583 PMCID: PMC10600796 DOI: 10.3748/wjg.v29.i38.5406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Reaching the Selecting Therapeutic Targets in Inflammatory Bowel Disease-II (STRIDE-II) therapeutic targets for inflammatory bowel disease (IBD) requires an interdisciplinary approach. Lifestyle interventions focusing on enhancing and preserving health-related physical fitness (HRPF) may aid in improving subjective health, decreasing disability, or even controlling inflammation. However, ambiguity remains about the status and impact of HRPF (i.e. body composition, cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility) in IBD patients, hindering the development of physical activity and physical exercise training guidelines. AIM To review HRPF components in IBD patients and the impact of physical activity and physical exercise training interventions on HRPF. METHODS A systematic search in multiple databases was conducted for original studies that included patients with IBD, assessed one or more HRPF components, and/or evaluated physical activity or physical exercise training interventions. RESULTS Sixty-eight articles were included. No study examined the complete concept of HRPF, and considerable heterogeneity existed in assessment methods, with frequent use of non-validated tests. According to studies that used gold standard tests, cardiorespiratory fitness seemed to be reduced, but findings on muscular strength and endurance were inconsistent. A limited number of studies that evaluated physical activity or physical exercise training interventions reported effects on HRPF, overall showing a positive impact. CONCLUSION We performed a scoping review using a systematic and iterative approach to identify and synthesize an emerging body of literature on health-related physical fitness in patients with IBD, highlighting several research gaps and opportunities for future research. Findings of this review revealed a gap in the literature regarding the accurate assessment of HRPF in patients with IBD and highlighted important methodological limitations of studies that evaluated physical activity or physical exercise training interventions. This scoping review is a step towards performing studies and systematic reviews in the future, which was not possible at present given the heterogeneity in endpoints and designs of the available studies on this topic. Future well-designed studies are required to determine the optimal training paradigm for improving HRPF in patients with IBD before guidelines can be developed and integrated into the therapeutic strategy.
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Affiliation(s)
- Karlijn Demers
- Department of Surgery, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Michiel T J Bak
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
| | - Bart C Bongers
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
| | - Daisy M A E Jonkers
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Marieke J Pierik
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
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Cioffi I, Di Vincenzo O, Imperatore N, Fisco M, Testa A, Scialò F, Castiglione F, Ruoppolo M, Pasanisi F, Santarpia L. Amino acid profiles, disease activity, and protein intake in adult patients with Crohn's disease. Front Nutr 2023; 10:1245574. [PMID: 37854352 PMCID: PMC10579601 DOI: 10.3389/fnut.2023.1245574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Crohn's disease (CD) is an immune-mediated inflammatory disorder of the gastrointestinal tract with a relapsing-remitting course. Amino acids (AAs) may play critical roles in the intestinal manifestations of disease, due to their involvement in many metabolic and immune functions. The present study aimed to explore serum AA concentrations in adult patients with CD, looking into their variations due to disease activity, surgery and protein content of diet. Eventually, the link between AAs and inflammatory markers was also assessed. Methods Consecutive adult patients aged 18-65 years with diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record to assess protein intake. Disease activity was clinically defined using the Crohn's Disease Activity Index (CDAI), while blood samples were taken to analyze serum AA profile and inflammatory markers. Results A total of 103 patients with CD (61 men and 42 women; age:39.9 ± 13.9 years, BMI: 23.4 ± 3.51 kg/m2) were included. Tryptophan levels were found to be remarkably decreased in most subjects, unrelated to disease activity. On the contrary, concentration of lysine, leucine, valine and glutamine decreased in active versus quiescent CD patients, while aspartic acid, glutamate and glycine increased. The latter AAs were also directly correlated with CDAI and serum interleukin (IL)- 1β concentration. Considering the total protein intake, expressed as g/kg/body weight, we observed a reduction in some essential AAs in patients with unmet protein requirements compared to patients who met the recommendation. Discussion In conclusion, specific AAs varied according to disease activity and protein intake, adjusted to body weight and disease status. Glu and Asp concentrations raised with increasing IL-1β. However, extensive research is needed to understand the mechanisms underpinning the link between variation in serum AAs, disease activity and protein intake in patients with CD.
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Affiliation(s)
- Iolanda Cioffi
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences - DEFENS, Università degli Studi di Milano, Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Mariagrazia Fisco
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Filippo Scialò
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Margherita Ruoppolo
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Su Q, Jin C, Yang Y, Wang J, Wang J, Zeng H, Chen Y, Zhou J, Wang Y. Association Between Autoimmune Diseases and Sarcopenia: A Two-Sample Mendelian Randomization Study. Clin Epidemiol 2023; 15:901-910. [PMID: 37650009 PMCID: PMC10464831 DOI: 10.2147/clep.s416778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
Purpose Observational studies have reported that autoimmune diseases are closely related to sarcopenia, but the causalities of autoimmune diseases with sarcopenia have not been established. We conducted this Mendelian randomization (MR) study to reveal the causal associations of overall autoimmune disease and five common autoimmune diseases with sarcopenia-related traits. Methods The publicly available summary-level data of autoimmune diseases and three sarcopenia-related traits were used for analysis. The causal effects of autoimmune diseases on sarcopenia-related traits were first identified in discovery samples using the inverse-variance-weighted method as the primary method, and the robustness of results was examined by additional sensitivity analyses. Replication MR analyses were then conducted using replication samples of five autoimmune diseases. Finally, the possibility of reverse causation was assessed by reverse MR analyses. Results In both the discovery and replication samples, we identified potential causal effects of rheumatoid arthritis (RA) on appendicular lean mass (ALM) and low grip strength (OR = 0.979, 95% CI: 0.964-0.995 for ALM; OR = 1.042, 95% CI: 1.013-1.072 for low grip strength), but not on walking pace. We also found that inflammatory bowel disease (IBD) and type 1 diabetes (T1D) were only causally negatively associated with ALM in the discovery stage (OR = 0.986, 95% CI: 0.974-0.999 for IBD; OR = 0.987, 95% CI: 0.975-0.999 for T1D), whereas systemic lupus erythematosus, multiple sclerosis, and overall autoimmune disease were not associated with any of the three sarcopenia-related traits. Additionally, reverse MR analysis only found an association between walking pace and overall autoimmune disease, but this association did not remain in the weighted-median method. Conclusion This study demonstrates that RA is causally associated with low grip strength and reduced ALM, and that IBD and T1D may be causally negatively related to ALM.
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Affiliation(s)
- Qing Su
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Chen Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Jingxian Wang
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Juejin Wang
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Hao Zeng
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yaqing Chen
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Junxi Zhou
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People’s Republic of China
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Martins PC, Alves Junior CAS, Silva AM, Silva DAS. Phase angle and body composition: A scoping review. Clin Nutr ESPEN 2023; 56:237-250. [PMID: 37344079 DOI: 10.1016/j.clnesp.2023.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023]
Abstract
The aim of the study was to map evidence on the association between phase angle (PhA) and body composition in populations healthy and clinical populations). A systematic search for information regarding the topic was conducted in nine electronic databases (CINAHL, LILACS, PubMed, SciELO, Scopus, SPORTDiscus, Science Direct, MEDLINE and Web of Science) between October and November 2021. Studies with different designs, which allowed extracting information about the relationship between PhA and body composition (body cell mass [BCM], muscle tissue, bone mineral content, lean mass, total fat mass, visceral fat, and lean soft tissue mass [LSTM]) were included. Of the total of 11,913 initially identified studies, 59 were included after reading titles, abstracts, full texts and references. Most studies (40.67%; n = 24) presented data from Brazilian samples. With regard to the design of studies, 15 (25.42%) had longitudinal design. The age group of studies was wide, with studies involved 3-year-old children and 88-year-old adults. Body fat mass was evaluated by 31 studies (52.54%) in which 11 observed inverse relationships, nine studies showed direct relationships and 11 observed no relationship. Regarding lean mass, muscle mass, and fat-free mass components, most studies observed direct relationship with PhA (n = 37; 86.04%). It could be concluded that the phase angle was directly associated with lean mass and muscle mass in different age groups (children, adolescents, adults and older adults) and in people with different health diagnoses (HIV, cancer, hemodialysis, sarcopenia and without the diagnosis of diseases). Regarding body fat and the other investigated components, there is not enough evidence to establish the direction of associations.
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Affiliation(s)
- Priscila Custódio Martins
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, SC, 88040900, Brazil.
| | - Carlos Alencar Souza Alves Junior
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, SC, 88040900, Brazil.
| | - Analiza Mónica Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal.
| | - Diego Augusto Santos Silva
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, SC, 88040900, Brazil.
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Fatani H, Olaru A, Stevenson R, Alharazi W, Jafer A, Atherton P, Brook M, Moran G. Systematic review of sarcopenia in inflammatory bowel disease. Clin Nutr 2023; 42:1276-1291. [PMID: 37352818 DOI: 10.1016/j.clnu.2023.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/10/2023] [Accepted: 05/02/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION There is growing evidence of increased muscle atrophy in IBD patients, likely resulting in a higher sarcopenia prevalence in IBD. The aims of this systematic review are A1; to estimate sarcopenia prevalence in IBD patients, A2; to investigate its impact on IBD patients, and A3; the effectiveness of nutritional interventions on muscle mass and/or strength in IBD patients. METHODS On 28 July 2021, three electronic databases were used to identify eligible studies, including peer-reviewed studies (randomised controlled trials [RCTs], non-RCTs, observation studies) in adult (⩾ 18 years) IBD patients. For A1 and A2 only, studies defined low muscle mass and/or strength cut-off points. For A2, studies assessed association between sarcopenia and IBD complication. For A3, studies assessed the nutrition effect among IBD patients. RESULTS 35 studies were included, 34 for A1, 20 for A2, and three for A3. 42% of adult IBD patients have myopenia, 34% have pre-sarcopenia, and 17% sarcopenia. Myopenic IBD was significantly associated with therapy failure including IBD-related surgery risk in six studies, risk of medical therapy failure in four studies, risk of hospitalisation in one study. A significant association existed with postoperative complications risk in IBD patients in four studies, reduction in BMD in two studies, and increased incidence of non-alcoholic fatty liver disease (NAFLD) in one study. Sarcopenia in IBD was significantly associated with a reduction in BMD in one study. Two studies found a personalised nutrition plan (high protein) in IBD patients significantly improved muscle mass. One study found a significant positive association between muscle mass and dietary intake including high protein intake. CONCLUSION Over one third of adult IBD patients have myopenia and pre-sarcopenia, and nearly a fifth have sarcopenia. Myopeninc IBD is significantly associated with increased risk of IBD therapy failure, postoperative complications, and low BMD, with possible association with increased NAFLD risk. Nutritional therapy may play a role in reversing low muscle mass though yet unclear if this is through disease activity reversal. Further studies on adult IBD patients focusing on sarcopenia/myopenia are needed with recommended study designs of 1) standardised population-based definitions with recommended standard methods used to measure skeletal muscle mass, 2) prospective studies with IBD patients stratified by Montreal classification, disease activity, disease duration and concomitant medication to observe muscle changes, 3) mechanistic studies on sarcopenia aetiology, specifically focusing on protein handling atrophy and absorption, 4) properly designed RCT to assess nutrition intervention in sarcopenic IBD patients.
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Affiliation(s)
- Hala Fatani
- The Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK; MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK.
| | - Adina Olaru
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Waad Alharazi
- School of Biosciences, University of Nottingham, Nottingham, UK
| | - Ayman Jafer
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Philip Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Centre Of Metabolism, Ageing & Physiology (COMAP), School of Medicine, University of Nottingham, Derby, UK
| | - Matthew Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Centre of Metabolism, Ageing & Physiology (COMAP), School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon Moran
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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10
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Zheng Y, Li JH, Liao SY, Fu YM, Zhang YJ, Lin JL, Chen XB, Sha WH, Dai SX, Ma WJ. Joint Detection of Serum Vitamin D, Body Mass Index, and Tumor Necrosis Factor Alpha for the Diagnosis of Crohn's Disease. Curr Med Sci 2023:10.1007/s11596-023-2741-6. [PMID: 37249734 DOI: 10.1007/s11596-023-2741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Vitamin D (VD) deficiency was reported to contribute to the progression of Crohn's disease (CD) and affect the prognosis of CD patients. This study investigated the role of serum VD, body mass index (BMI), and tumor necrosis factor alpha (TNF-α) in the diagnosis of Crohn's disease. METHODS CD patients (n=76) and healthy subjects (n=76) were enrolled between May 2019 and December 2020. The serum 25-hydroxyvitamin D [25(OH)D] levels, BMI, and TNF-α levels, together with other biochemical parameters, were assessed before treatment. The diagnostic efficacy of the single and joint detection of serum 25(OH)D, BMI, and TNF-α was determined using receiver operating characteristic (ROC) curves. RESULTS The levels of 25(OH) D, BMI, and nutritional indicators, including hemoglobin, total protein, albumin, and high-density lipoprotein cholesterol, were much lower, and the TNF-α levels were much higher in the CD patients than in the healthy subjects (P<0.05 for all). The areas under the ROC curve for the single detection of 25(OH)D, BMI, and TNF-α were 0.887, 0.896, and 0.838, respectively, with the optimal cutoff values being 20.64 ng/mL, 19.77 kg/m2, and 6.85 fmol/mL, respectively. The diagnostic efficacy of the joint detection of 25(OH)D, BMI, and TNF-α was the highest, with an area under the ROC curve of 0.988 (95%CI: 0.968-1.000). CONCLUSION The joint detection of 25(OH)D, TNF-α, and BMI showed high sensitivity, specificity, and accuracy in CD diagnosis; thus, it would be effective for the diagnosis of CD in clinical practice.
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Affiliation(s)
- Ying Zheng
- Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jing-Hong Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, China
| | - Shan-Ying Liao
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Yi-Ming Fu
- The First School of Clinical Medicine & Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China
| | - Yan-Jun Zhang
- Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jun-Long Lin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, China
| | - Xin-Bin Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, China
| | - Wei-Hong Sha
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Shi-Xue Dai
- Department of Gastroenterology, Guangdong Provincial Geriatrics Institute, National Key Clinical Specialty, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Wen-Jun Ma
- Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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11
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Tang W, Xie G, Wang D, Li T, Ren Y, Li J, Deng J, Li K. Imaging-based assessment of body composition in patients with Crohn's disease: a systematic review. Int J Colorectal Dis 2023; 38:126. [PMID: 37171498 DOI: 10.1007/s00384-023-04413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND AIMS Body composition changes in patients with Crohn's disease (CD) have received increasing attention in recent years. This review aims to describe the changes in body composition in patients with CD on imaging and to analyze and summarize the prognostic value of body composition. METHODS We systematically searched Web of Science, PubMed, Embase, Cochrane Library, and Medline via OVID for literature published before November 2022, and two researchers independently evaluated the quality of the retrieved literature. RESULTS A total of 39 publications (32 cohort studies and 7 cross-sectional studies) involving 4219 patients with CD were retrieved. Imaging methods for body composition assessment, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT) and magnetic resonance imaging (MRI), were included in this review. The study found that patients with CD typically have more visceral adipose tissue and less skeletal muscle mass, and the prevalence of sarcopenia and visceral obesity was significantly different in different studies (sarcopenia: 16-100%; visceral obesity: 5.3-30.5%). Available studies suggest that changes in the body composition of CD patients are significantly related to inflammatory status, disease behavior, poor outcomes, and drug efficacy. CONCLUSION Altered body composition can be a significant predictor of poor outcomes for CD patients. Therefore, the body composition of CD patients may serve as a potential therapeutic target to help optimize disease management strategies in clinical practice.
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Affiliation(s)
- Wuli Tang
- Chongqing Medical University, Chongqing, China
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China
- Chongqing School, University of Chinese Academy of Science, Chongqing, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Gang Xie
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Danni Wang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Ting Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Yitao Ren
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Junlin Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiaxing Deng
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Kang Li
- Chongqing Medical University, Chongqing, China.
- Department of Radiology, Chongqing General Hospital, Chongqing, China.
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12
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Cioffi I, Scialò F, Di Vincenzo O, Gelzo M, Marra M, Testa A, Castiglione F, Vitale M, Pasanisi F, Santarpia L. Serum Interleukin 6, Controlling Nutritional Status (CONUT) Score and Phase Angle in Patients with Crohn's Disease. Nutrients 2023; 15:nu15081953. [PMID: 37111172 PMCID: PMC10146872 DOI: 10.3390/nu15081953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory disorder that may occur in any segment of the gastrointestinal tract. Asymptomatic or untreated inflammation along with malnutrition can often coexist in patients with CD, impairing clinical outcomes, therefore the aim of this study was to assess the relationship between inflammation, malnutrition risk and nutritional status in CD patients. Consecutive adult CD outpatients aged 18-65 years were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI), whilst anthropometry and phase angle (PhA) were measured. The Controlling Nutritional Status (CONUT) score was retrospectively calculated for screening malnutrition risk and blood samples were taken. A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and an average weight of 64.9 ± 12.0 kg were included. Serum interleukin (IL)-6 concentration was increased in active-CD patients, unrelated to medical treatment, which was associated with CDAI and PhA. Based on the CONUT score, the prevalence of patients with moderate/severe malnutrition risk (score ≥ 5) was 10%, showing lower age, body mass index and fat mass, but higher IL-6 and IL-1β levels than subjects classified as not at risk (score 0-1). Finally, increased IL-6 levels and reduced PhA values were identified as independent predictors of moderate/severe malnutrition risk (p < 0.05). In conclusion, IL-6 increased in active-CD patients, which was inversely correlated with PhA. Although the CONUT score might be helpful for identifying CD patients at moderate/severe risk of malnutrition, larger studies are needed to verify these results in different settings.
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Affiliation(s)
- Iolanda Cioffi
- Department of Food, Environmental and Nutritional Sciences-DEFENS, Division of Human Nutrition, Università degli Studi di Milano, Celoria 2, 20133 Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Maurizio Marra
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Maria Vitale
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
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13
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Di Vincenzo O, Marra M, Antognozzi V, Sammarco R, Ballarin G, Cioffi I, Scalfi L, Pasanisi F. Comparison of bioelectrical impedance analysis-derived phase angle in individuals with different weight status. Nutrition 2023; 108:111960. [PMID: 36669366 DOI: 10.1016/j.nut.2022.111960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/08/2022] [Accepted: 12/25/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obesity is characterized not only by an increase of fat mass but also by alterations in skeletal muscle. Bioimpedance analysis (BIA)-derived phase angle (PhA) may provide specific information on the inherent characteristics of fat-free mass, and is widely used as an index of poor nutritional status. The aim of this study was to describe whether and to what extent PhA varies depending on age, sex, and body mass index (BMI) in individuals with different weight status. METHODS We selected 1877 participants for this retrospective study (two weight status groups): 983 individuals with obesity (age 40 ± 13.9 y; BMI 39.5 ± 7.2 kg/m²) and 894 controls (age 40 ± 13.3 y; BMI 24.6 ± 2.7 kg/m²). Anthropometry and PhA at 50 kHz for the whole body were performed in all participants. RESULTS PhA was greater in men than in women, although a decline of PhA was observed with age, which was linear in women and occurred in men after 40 y of age. On the other hand, no significant differences were observed with increasing BMI in either sex; lower values might be observed when BMI >50 kg/m². CONCLUSIONS A more detailed appraisal of BIA-derived PhA in obesity is reported in the present study, providing basic data that might be taken into consideration in prevention and clinical nutrition. Further studies are needed to explore differences of PhA in individuals with different weight status.
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Affiliation(s)
- Olivia Di Vincenzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Department of Public Health, Federico II University, Naples, Italy.
| | - Maurizio Marra
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Rosa Sammarco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giada Ballarin
- Department of Movement Sciences and Wellbeing, Parthenope University, Naples, Italy
| | - Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University, Naples, Italy; Casa di Cura Santa Maria del Pozzo, Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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14
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Wei H, Yuan Z, Ren K, Jin Y, Ren L, Cao B, Zhou Y, Chen L. Body Composition in Inflammatory Bowel Disease. ARCHIVES OF IRANIAN MEDICINE 2023; 26:172-175. [PMID: 37543940 PMCID: PMC10685726 DOI: 10.34172/aim.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 08/08/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with body composition changes, which are associated with clinical prognosis, response to therapy, and quality of life in IBD patients. Therefore, it is critical to review the body composition distribution in IBD, summarize the potential factors affecting body composition distribution, and take steps to improve the body composition distribution of IBD patients as early as possible. In the current review, we searched PubMed via keywords 'inflammatory bowel disease', or 'IBD', or 'Crohn's disease', or 'CD', or 'ulcerative colitis', or 'UC', and 'body composition'. Malnutrition and sarcopenia are common in IBD patients and are associated with the clinical course, prognosis, and need for surgery. Disease activity, reduced nutrition intake, vitamin D deficiency, and intestinal dysbiosis are factors contributing to changed body composition. Early use of biological agents to induce remission is critical to improving body composition distribution in IBD patients, supplementation of vitamin D is also important, and moderate physical activity is recommended in IBD patients with clinical remission.
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Affiliation(s)
- Hongyun Wei
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Ziying Yuan
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Keyu Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yanchun Jin
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Linlin Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Bin Cao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yuanyuan Zhou
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Linlin Chen
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
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Casirati A, Crotti S, Raffaele A, Caccialanza R, Cereda E. The use of phase angle in patients with digestive and liver diseases. Rev Endocr Metab Disord 2023; 24:503-524. [PMID: 36745355 DOI: 10.1007/s11154-023-09785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/07/2023]
Abstract
Diseases of the liver and the digestive system can lead to malnutrition through an action of reduced food intake or nutrient use, inflammation and impaired metabolism, which result in substantial changes in body composition. Frequently, malnutrition manifests itself with weight loss and reduced muscle mass. However, weight loss and body mass index lack sensitivity to detect the loss of muscle mass and are not informative in distinguishing body water compartments and in characterizing their distribution. This issue is particularly relevant to these two disease models, which are frequently associated with fluid volume imbalances. Phase angle is a useful indicator for cell membrane integrity, water distribution between the intracellular and extracellular spaces and prediction of body cell mass as it is described by measured components of electrical impedance. Malnutrition, inflammation and oxidative stress impair electric tissue properties leading to lower values of PhA. In patients with inflammatory bowel and liver diseases, PhA was consistently found to be related to nutritional status and body composition, particularly the depletion of lean body mass and sarcopenia. It has been associated with prognosis, disease stage and severity and found to be helpful in monitoring fluid shifts and response to interventions.
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Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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Wall CL, Wilson B, Lomer MCE. Development and validation of an inflammatory bowel disease nutrition self-screening tool (IBD-NST) for digital use. Front Nutr 2023; 10:1065592. [PMID: 36819688 PMCID: PMC9935609 DOI: 10.3389/fnut.2023.1065592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aim The identification of, and timely intervention for, patients with impaired nutritional status may reduce inflammatory bowel disease (IBD) complications. This study aimed to develop and validate an IBD-specific nutrition self-screening tool (IBD-NST) that identifies patients at nutrition risk. Methods An expert IBD panel was consulted to support development of an IBD-NST. The tool was assessed in different cohorts of patients attending IBD outpatient clinics for face, content and convergent validity and repeat reliability. The tool was compared with (i) the malnutrition universal screening tool to assess face validity and (ii) subjective global assessment (SGA), hand-grip strength (HGS) and mid-arm muscle circumference to assess convergent validity. Tool content was informed by agreement between assessment tools, sensitivity analysis and chi-squared tests. The IBD-NST was completed electronically twice, 1 week apart to assess repeat reliability using observed agreement and kappa statistic. Statistical significance assumed at p < 0.05. Results In total, 282 IBD patients (175 with Crohn's disease) were recruited to validate the IBD-NST. The final validated IBD-NST includes body mass index (BMI), weight loss and IBD-specific nutrition-focussed questions which were acceptable to patients. It identified patients at risk of malnutrition, moderately or severely malnourished patients and patients at nutritional risk. The IBD-NST identified 54/179 (30%) patients at moderate or high nutrition risk and had excellent repeat reliability in 85 patients [r = 0.77 (95% CI 0.669 to 0.746)]. Conclusion The IBD-NST is a self-screening tool, validated for use as either a paper or e-health version, that identifies patients at nutrition risk who are likely to benefit from dietetic assessment and intervention. Furthermore, patients with IBD symptoms who are concerned about their dietary intake can potentially access dietetic care more easily therefore encouraging greater self-management of IBD-related symptoms. The routine use of the IBD-NST as a self-screening tool would enable patient-led care in the outpatient setting and may facilitate timely access to dietetic care.
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Affiliation(s)
- Catherine L. Wall
- Department of Nutritional Sciences, King’s College London, London, United Kingdom,Department of Medicine, University of Otago, Christchurch, New Zealand,*Correspondence: Catherine L. Wall,
| | - Bridgette Wilson
- Department of Nutritional Sciences, King’s College London, London, United Kingdom,Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Miranda C. E. Lomer
- Department of Nutritional Sciences, King’s College London, London, United Kingdom,Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Polak-Szczybyło E, Stępień AE, Zielińska M, Dąbrowski M. Hashimoto Thyroiditis, but Not Hypothyroidism Due to Other Causes, Is Associated with Lower Phase Angle Score in Adult Women: A Pilot Cross-Sectional Study. J Clin Med 2022; 12:jcm12010056. [PMID: 36614854 PMCID: PMC9821760 DOI: 10.3390/jcm12010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In recent years, Hashimoto's thyroiditis (HT) has become one of the commonest autoimmune diseases. Its clinical symptoms include systemic manifestations related mainly, but not solely, to thyroid hormone deficiency. The bioimpedance phase angle (PhA) is a reliable indicator of nutritional as well as cellular health status. PhA is decreased not only in malnutrition, but also in many inflammatory diseases. The aim of this study was to assess the relationship between HT and PhA score. METHODS In this cross-sectional study, we compared the anthropometric, laboratory and body composition parameters of 49 women with HT and 98 propensity-score-matched women without thyroid disease. RESULTS Females with HT had significantly lower PhA scores (5.78 ± 0.43) compared to women without a thyroid disorder (5.98 ± 0.49, p = 0.017). Regarding TSH levels, although they were within the normal range in all study participants, in women with HT, they were slightly but significantly higher. Women with HT treated with L-thyroxin had significantly higher PhA compared to their non-treated counterparts. No differences between women with non-HT hypothyroidism and the control group were found. CONCLUSIONS Decreased PhA scores in patients with HT may indicate that the inflammatory process in this autoimmune disease has an influence on cellular health and on the function of the entire body. Such an association was not found in women with non-HT hypothyroidism.
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Affiliation(s)
- Ewelina Polak-Szczybyło
- Department of Dietetics, Institute of Health Sciences, University of Rzeszow, College of Medical Sciences, 35-959 Rzeszów, Poland
| | - Agnieszka Ewa Stępień
- Department of Dietetics, Institute of Health Sciences, University of Rzeszow, College of Medical Sciences, 35-959 Rzeszów, Poland
- Correspondence:
| | - Magdalena Zielińska
- Department of Dietetics, Institute of Health Sciences, University of Rzeszow, College of Medical Sciences, 35-959 Rzeszów, Poland
| | - Mariusz Dąbrowski
- Institute of Medical Sciences, University of Rzeszow, College of Medical Sciences, 35-959 Rzeszów, Poland
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Decrease phase angle one year after Roux-en-Y bypass and sleeve gastrectomy is related to risks to protein nutritional status. Clin Nutr ESPEN 2022; 52:138-143. [PMID: 36513446 DOI: 10.1016/j.clnesp.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Phase angle (PhA) has been used as an indicator of nutritional status. However, the significance of PhA reduction after bariatric surgery is less known. This study evaluated PhA and its relation with biochemical parameters and prognostic inflammatory and nutritional indices at a one-year follow-up of patients subjected to Roux-en-Y bypass (RYGB) or sleeve gastrectomy (SG). METHODS Our final sample consisted of 25 patients subjected to RYGB and 11 to SG. Body mass index, fat-free mass, fat mass, PhA, serum transthyretin (TTR), albumin, C-reactive protein, alpha-1-acid glycoprotein, and prognostic inflammatory and nutritional indices were evaluated at four time points: before and approximately two, six, and 12 months after RYGB or SG. One-way repeated measures ANOVA or the Friedman test with Tukey's post hoc test was used depending on data distribution. The correlation between PhA and biochemical parameters and indices were evaluated using Spearman's or Pearson's correlation coefficients. RESULTS Except for serum albumin, all parameters significantly decreased over time (p < 0.001). Only the RYGB group showed transthyretinTR values below reference ones. Prognostic indices significantly decreased in both groups (p < 0.001). We found a significant positive correlation of PhA with TTR in both RYGB (r = 0.475; p < 0.001) and SG (r = 0.457; p < 0.001). CONCLUSIONS Data suggest that at a one-year follow-up after bariatric surgery, lower PhA values might indicate a concomitant loss of visceral protein and a worsening of protein nutritional status.
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Zhang X. Emotional Intervention and Education System Construction for Rural Children Based on Semantic Analysis. Occup Ther Int 2022; 2022:1073717. [PMID: 35874601 PMCID: PMC9273381 DOI: 10.1155/2022/1073717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Under the background of the policy of caring for the healthy growth of left-behind children, the purpose of selecting the topic is to study some common negative emotional problems of left-behind children in rural areas, focusing on the guidance of negative emotions of left-behind children in rural areas. In emotional problems, we analyze and find out the reasons for these negative emotions through observation and research. Method In this paper, a platform for acquiring emotional semantic data of scene images in an open behavioral experimental environment is designed, which breaks the limitations of time and place, and thus acquires a large amount of emotional semantic data of scene images and then uses principal component analysis to evaluate the validity of the data analysis. Psychological testing was used to measure parent-child affinity, adversity beliefs, and positive/negative emotion scales, respectively, to examine children whose parents went out, children whose fathers went out, and non-left-behind children. The characteristics of parent-child affinity, adversity beliefs, and positive/negative emotions in three types of children were examined, and the direct predictive effects of parent-child affinity and adversity beliefs on the positive/negative emotions of the three types of children were examined. Results/Discussion. Adversity beliefs played a partial mediating role between children's parent-child bonding and positive emotions. The predictive effect of adversity beliefs on children's emotional adaptation differs by emotional type. The main effects of the left-behind category were significant for both positive and negative emotions. The gender main effect of negative emotion was significant, and the negative emotion level of girls was significantly higher than that of boys. The main effect of the left-behind category of adversity beliefs was significant, and the adversity belief levels of children whose parents went out to rural areas were significantly lower than those of children whose fathers went out and non-left-behind children. The negative emotions generated by left-behind children in rural areas are channeled, and to a certain extent, they are improved and alleviated. Through the emotional counseling and improvement of the rural left-behind children in the research site in the article, the service objects can have better emotions, promote mental health, make them happy and grow up healthily, and also provide a certain theory for the establishment of the local left-behind children care system.
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Affiliation(s)
- Xiaobo Zhang
- School of Education Science, Xinyang Normal University, Xinyang, Henan 464000, China
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20
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Peng Z, Xu D, Li Y, Peng Y, Liu X. Phase Angle as a Comprehensive Tool for Nutritional Monitoring and Management in Patients with Crohn's Disease. Nutrients 2022; 14:nu14112260. [PMID: 35684060 PMCID: PMC9182801 DOI: 10.3390/nu14112260] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Aims: Crohn’s disease (CD) is usually accompanied by malnutrition. CD-related malnutrition can increase morbidity, disability, mortality, and hospitalization costs. The purpose of this study was to find a reliable indicator for evaluating CD patients’ nutritional status. Methods: All data were retrospectively collected from Xiangya Hospital, Central South University between May 2021 and February 2022. All patients were evaluated for nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body composition, resistance, and reactance were recorded by a body analyser, and the phase angle (PhA) was calculated simultaneously. The Mann−Whitney U test, chi-square test, Fisher’s exact test, and univariate and multivariate logistic regression analyses were used. A receiver operating characteristic (ROC) curve was built to evaluate the predictive value of differential variables for diagnosing malnutrition based on the GLIM criteria. Results: A total of 169 CD patients were enrolled, of which 74 (58.3%) males and 32 (76.2%) females were diagnosed with malnutrition; 34 (45.9%) males and 22 (68.8%) females were severely malnourished. Univariate analysis identified that as nutritional status deteriorated, body mass index, PhA, and levels of haemoglobin and albumin decreased, while platelet count, erythrocyte sedimentation rate, and levels of C-reactive protein and fibrinogen increased (p < 0.05). Logistic regression analysis revealed that the PhA was significantly independently associated with malnutrition (p < 0.05). The ROC curve analysis indicated that the optimal PhA cut-off levels of 6.11° and 5.55° could be used to predict malnutrition according to the GLIM criteria in males and females, respectively, with a PhA < 5.53° and < 5.12° indicating severe malnutrition in males and females, respectively. Conclusion: The PhA is a sensitive, noninvasive, portable, inexpensive tool that can be used to monitor and manage the nutritional status of CD patients.
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Affiliation(s)
- Ziheng Peng
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha 410008, China; (Z.P.); (D.X.); (Y.L.)
| | - Duo Xu
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha 410008, China; (Z.P.); (D.X.); (Y.L.)
| | - Yong Li
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha 410008, China; (Z.P.); (D.X.); (Y.L.)
| | - Yu Peng
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha 410008, China; (Z.P.); (D.X.); (Y.L.)
- Correspondence: (Y.P.); (X.L.)
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha 410008, China; (Z.P.); (D.X.); (Y.L.)
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Correspondence: (Y.P.); (X.L.)
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21
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Monfort-Ferré D, Caro A, Menacho M, Martí M, Espina B, Boronat-Toscano A, Nuñez-Roa C, Seco J, Bautista M, Espín E, Megía A, Vendrell J, Fernández-Veledo S, Serena C. The Gut Microbiota Metabolite Succinate Promotes Adipose Tissue Browning in Crohn's Disease. J Crohns Colitis 2022; 16:1571-1583. [PMID: 35554517 PMCID: PMC9624294 DOI: 10.1093/ecco-jcc/jjac069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/17/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] is associated with complex microbe-host interactions, involving changes in microbial communities, and gut barrier defects, leading to the translocation of microorganisms to surrounding adipose tissue [AT]. We evaluated the presence of beige AT depots in CD and questioned whether succinate and/or bacterial translocation promotes white-to-beige transition in adipocytes. METHODS Visceral [VAT] and subcutaneous [SAT] AT biopsies, serum and plasma were obtained from patients with active [n = 21] or inactive [n = 12] CD, and from healthy controls [n = 15]. Adipose-derived stem cells [ASCs] and AT macrophages [ATMs] were isolated from VAT biopsies. RESULTS Plasma succinate levels were significantly higher in patients with active CD than in controls and were intermediate in those with inactive disease. Plasma succinate correlated with the inflammatory marker high-sensitivity C-reactive protein. Expression of the succinate receptor SUCNR1 was higher in VAT, ASCs and ATMs from the active CD group than from the inactive or control groups. Succinate treatment of ASCs elevated the expression of several beige AT markers from controls and from patients with inactive disease, including uncoupling protein-1 [UCP1]. Notably, beige AT markers were prominent in ASCs from patients with active CD. Secretome profiling revealed that ASCs from patients with active disease secrete beige AT-related proteins, and co-culture assays showed that bacteria also trigger the white-to-beige switch of ASCs from patients with CD. Finally, AT depots from patients with CD exhibited a conversion from white to beige AT together with high UCP1 expression, which was corroborated by in situ thermal imaging analysis. CONCLUSIONS Succinate and bacteria trigger white-to-beige AT transition in CD. Understanding the role of beige AT in CD might aid in the development of therapeutic or diagnostic interventions.
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Affiliation(s)
- Diandra Monfort-Ferré
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Aleidis Caro
- Colorectal Surgery Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Marc Martí
- Colorectal Surgery Unit, General Surgery Service, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Beatriz Espina
- Colorectal Surgery Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Albert Boronat-Toscano
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Cati Nuñez-Roa
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Seco
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Michelle Bautista
- Digestive Unit, Hospital Universitari Joan XXIII, 43007, Tarragona, Spain
| | - Eloy Espín
- Colorectal Surgery Unit, General Surgery Service, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ana Megía
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain,Universitat Rovira i Virgili, Tarragona, Spain
| | - Sonia Fernández-Veledo
- Corresponding authors: Sonia Fernández-Veledo, PhD, Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain. ;
| | - Carolina Serena
- Carolina Serena, PhD, Hospital Universitari de Tarragona Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain. ;
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22
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Morlino D, Marra M, Cioffi I, Santarpia L, De Placido P, Giuliano M, De Angelis C, Carrano S, Verrazzo A, Buono G, Naccarato M, Di Vincenzo O, Speranza E, De Placido S, Arpino G, Pasanisi F. Prevalence of Sarcopenia in Women with Breast Cancer. Nutrients 2022; 14:nu14091839. [PMID: 35565806 PMCID: PMC9099516 DOI: 10.3390/nu14091839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 12/18/2022] Open
Abstract
Sarcopenia is a common finding in patients with cancer and potentially influences the patient’s outcome. The aim of this study was to evaluate the prevalence of sarcopenia, according to the European Working Group on Sarcopenia in Older People, in a sample of women with breast cancer (BC) and a BMI lower than 30 kg/m2. This cross-sectional study was conducted in patients with BC, stage 0-III, and receiving therapy for BC; the women were recruited at the Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. A control group with similar age and BMI was selected from the internal database. Anthropometry, bioimpedance analysis (BIA) and hand grip strength (HGS) were measured to detect sarcopenia. A total of 122 patients (mean age 49.3 ± 11.0 years, BMI 24.6 ± 3.0 kg/m2) and 80 healthy controls were analyzed. Sarcopenia was found in 13.9% patients with BC, while none of the subjects in the control group was sarcopenic. By comparing BC patients with and without sarcopenia and the control group, the fat-free mass of sarcopenic BC patients were significantly lower than those of both non-sarcopenic BC patients and the control (p < 0.05). The phase angle was also significantly lower in sarcopenic patients (−0.5 degrees, p = 0.048) than in the control group. Considering the prevalence of sarcopenia in patients with BC, our findings suggest the usefulness of body composition and HGS evaluation for early screening of sarcopenia to reduce the risk of associated complications.
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Affiliation(s)
- Delia Morlino
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Maurizio Marra
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
- Correspondence: ; Tel.: +39-081-746-2333; Fax: +39-081-746-2376
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Pietro De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Mario Giuliano
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Carmine De Angelis
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Simone Carrano
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Annarita Verrazzo
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Giuseppe Buono
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Marianna Naccarato
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Olivia Di Vincenzo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Enza Speranza
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
| | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Grazia Arpino
- Oncology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (P.D.P.); (M.G.); (C.D.A.); (S.C.); (A.V.); (G.B.); (S.D.P.); (G.A.)
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (D.M.); (I.C.); (L.S.); (M.N.); (O.D.V.); (E.S.); (F.P.)
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23
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Morlino D, Cioffi I, Marra M, Di Vincenzo O, Scalfi L, Pasanisi F. Bioelectrical Phase Angle in Patients with Breast Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14082002. [PMID: 35454908 PMCID: PMC9025027 DOI: 10.3390/cancers14082002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Breast cancer (BC) patients suffer from loss of muscle tissue and fluid alterations during the whole trajectory of the disease. Such alterations might be reflected by phase angle (PhA) measures, but its use in the oncologic setting is still limited. Therefore, the aim of this systematic review was to assess PhA in BC patients, since it has been proven to be a reliable index for predicting nutritional status and survival. Findings reveal that PhA decreases after chemotherapy in BC patients, with high results in women with a better nutritional status, and these changes may persist even after five years. However, PhA remains stable, or can increase in some cases, when patients are supported by targeted lifestyle interventions. Thus, PhA can be useful to identify and monitor changes in body compartments and the nutritional status of BC patients over time. Abstract Breast cancer (BC) is the most common cancer diagnosed among women worldwide. Phase angle (PhA), a proxy measure of membrane integrity and function, has gained relevance in clinical practice and it has been suggested to be a prognostic and nutritional indicator. This systematic review aimed to explore PhA and its relationship with nutritional status and survival in BC patients. Four databases (PubMed, EMBASE, Web of Science, and CINAHL) were systematically searched until September 2021 for studies evaluating PhA in BC patients. A total of 16 studies met the inclusion criteria, where 11 were observational studies and 5 were interventional studies. Baseline PhA-value varied from 4.9 to 6.30 degrees, showing a great variability and heterogeneity across the selected studies. Available data suggested that PhA decreased by 5–15% after completing chemotherapy, and those effects might persist in the long term. However, the use of tailored nutritional and/or exercise programs during and after therapy could prevent PhA reduction and body derangement. High PhA values were found in women displaying a better nutritional status, while inconsistent data were found on survival. Therefore, further studies are needed to focus on the clinical relevance of PhA in BC patients, evaluating its association with disease outcomes and survival.
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Affiliation(s)
- Delia Morlino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
| | - Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
- Correspondence: ; Tel.: +39-0817462333
| | - Maurizio Marra
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (O.D.V.); (L.S.)
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (O.D.V.); (L.S.)
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
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24
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Zhang Y, Zhang L, Gao X, Dai C, Huang Y, Wu Y, Zhou W, Cao Q, Jing X, Jiang H, Zhu W, Wang X. Validation of the GLIM criteria for diagnosis of malnutrition and quality of life in patients with inflammatory bowel disease: A multicenter, prospective, observational study. Clin Nutr 2022; 41:1297-1306. [DOI: 10.1016/j.clnu.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
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25
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Luglio G, Pellegrini L, Rispo A, Tropeano FP, Imperatore N, Pagano G, Amendola A, Testa A, De Palma GD, Castiglione F. Post-operative morbidity in Crohn's disease: what is the impact of patient-, disease- and surgery-related factors? Int J Colorectal Dis 2022; 37:411-419. [PMID: 35013822 DOI: 10.1007/s00384-021-04076-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Over 50% of patients suffering from Crohn's disease (CD) require surgery in their lifetime. Predictors/risk factors of post-operative morbidity and mortality in CD are poorly investigated. We aimed to assess the risk factors of post-operative morbidity/mortality in CD. METHODS We performed a retrospective cohort study in which all CD patients operated and followed up at our tertiary Inflammatory Bowel Disease Centre from 2014 to 2019 were enrolled. For each patient, we evaluated patient-dependent, disease-dependent and surgery-dependent variables. All patients underwent small bowel and/or colic resections. RESULTS Of the 165 operated patients, forty-two (25.5%) developed post-operative complications (major complication rate = 9.8%) including wound infection (12.1%), respiratory complications (4.8%), prolonged ileum (4.2%), anastomotic leak (3.6%), urinary infections (3%), abdominal abscess (2.4%), anastomotic bleeding (3.6%), abdominal bleeding (1.2%) and obstruction (0.6%). Two subjects (1.2%) required re-operation within 30 days, and one died. A surgery duration < 141 min was predictive of a better post-operative outcome (sensitivity 80.9%, specificity 43.1%, PPV 32.7%, NPV 86.9%). The multivariable analysis showed stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6-6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4-9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.41-0.83, p = 0.01) and surgery duration < 141 min (OR 0.2, 95% CI 0.08-0.7, p = 0.03) as the only risk factors associated with post-operative morbidities. CONCLUSIONS About 25% of CD patients develop post-operative complications. Several patient-related, disease-related and surgery-related factors should be considered risk factors for post-operative morbidity. The recognition of these factors, as well as a multidisciplinary approach to the pre-operative management of CD, could reduce post-operative complications.
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Affiliation(s)
- G Luglio
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - L Pellegrini
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - A Rispo
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - F P Tropeano
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - N Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - G Pagano
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Amendola
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Testa
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - G D De Palma
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - F Castiglione
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
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26
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Ward LC, Koelmeyer LA, Moloney E. Staging Breast Cancer-Related Lymphedema with Bioimpedance Spectroscopy. Lymphat Res Biol 2021; 20:398-408. [PMID: 34756114 DOI: 10.1089/lrb.2021.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: A number of different classification schemes, with generally similar but not identical criteria, exist to describe the different stages of lymphedema. Criteria may include both subjective and objective assessments. The present study investigated whether bioelectrical impedance parameters had utility in staging breast cancer-related lymphedema. Methods and Results: Hierarchical agglomerative cluster analysis was used to assign women (n = 221) at risk of or with clinically ascribed lymphedema to clusters sharing similar impedance characteristics. Five clusters could be identified with each cluster containing proportions of participants that closely aligned with staging allocation, according to International Society of Lymphology criteria, at initial presentation. The use of cluster analysis for tracking of lymphedema progression or response to treatment is demonstrated. Conclusions: No single assessment provides definitive assignment of a patient to lymphedema stage. Staging is usually achieved by identifying and allocating a patient to a lymphedema stage shared by a group of patients with similar clinical signs. Cluster analysis of impedance data provides similar groupings of patients and could provide a useful adjunct objective assessment for staging lymphedema.
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Affiliation(s)
- Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Louise A Koelmeyer
- Australian Lymphoedema Education, Research & Treatment Program, Department of Clinical Medicine, Macquarie University, Sydney, Australia
| | - Emma Moloney
- Australian Lymphoedema Education, Research & Treatment Program, Department of Clinical Medicine, Macquarie University, Sydney, Australia
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Analysis of Risk Factors and Nursing Intervention Measures Affecting Nutritional Status of Children with Crohn's Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5416487. [PMID: 34671406 PMCID: PMC8523233 DOI: 10.1155/2021/5416487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
In recent years, the incidence of Crohn's disease (CD) in the Asia-Pacific region is gradually increasing, and the onset age is decreased at the same time. The relapse of illness and long course of disease easily lead to malnutrition, which will affect the treatment effect of the disease and even worsen the disease. Therefore, it is very important to find the risk factors affecting the nutritional status of children with CD and to carry out effective nursing intervention accordingly. In our study, a total of 180 children with CD who were admitted to our hospital from April 2017 to April 2020 were analyzed retrospectively. The multivariate analysis showed that Pediatric Crohn's Disease Activity Index (PCDAI), platelet (PLT), hemoglobin (HB), hematocrit (HCT), and albumin (ALB) were independent risk factors affecting the nutritional status of children with CD. The results of AUC showed that combined monitoring of the PCDAI score and the expression of PLT, HB, HCT, and ALB indexes was of great value to evaluate the nutritional status of children with CD. Finally, a series of nursing intervention measures were proposed based on these results. It provides a theoretical basis for improving the nutritional status of children with CD and promoting the clinical outcome.
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Custódio Martins P, de Lima TR, Silva AM, Santos Silva DA. Association of phase angle with muscle strength and aerobic fitness in different populations: A systematic review. Nutrition 2021; 93:111489. [PMID: 34688022 DOI: 10.1016/j.nut.2021.111489] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to summarize the evidence on the association of phase angle (PhA) with muscle strength and aerobic fitness in different populations. METHODS A systematic search on this topic was performed in nine electronic databases (CINAHL, LILACS, PubMed, SciELO, Scopus, SPORTDiscus, ScienceDirect, MEDLINE, and Web of Science) in January 2021. Studies with different designs that permitted extraction of information about the relationships between PhA and muscle strength and between PhA and aerobic fitness were included. A total of 4446 studies were initially identified; 34 were included after reading of the title, abstract, full text, and references. Four of the studies included had a longitudinal design, with samples consisting of participants ages 6 to 92 years. Thirty-two of the 34 studies evaluated the relationship between PhA and muscle strength, two cross-sectional studies investigated only PhA and aerobic fitness, and three cross-sectional studies evaluated both components (muscle strength and aerobic fitness). RESULTS PhA was directly associated with muscle strength in 30 cross-sectional studies and two longitudinal studies; the two studies that did not find a direct relationship had a cross-sectional design. For aerobic fitness, the five studies identified reported a direct relationship with PhA. CONCLUSIONS PhA is directly associated with muscle strength and aerobic fitness in different age groups (children, adolescents, adults, and older adults) and in people with different health conditions (human immunodeficiency virus, Crohn's disease, chronic obstructive pulmonary disease, bariatric surgery, kidney transplant, cancer, hemodialysis, and sarcopenia).
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Affiliation(s)
- Priscila Custódio Martins
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - Tiago Rodrigues de Lima
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - Analiza Mónica Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal.
| | - Diego Augusto Santos Silva
- Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil.
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Fernandes SA, Rossoni C, Koch VW, Imbrizi M, Evangelista-Poderoso R, Pinto LP, Magro DO. Phase angle through electrical bioimpedance as a predictor of cellularity in inflammatory bowel disease. Artif Intell Gastroenterol 2021; 2:111-123. [DOI: 10.35712/aig.v2.i4.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
It is estimated in Western industrialized countries that inflammatory bowel disease (IBD) has a prevalence of 1 for every 200 inhabitants. In the past, the fat mass disproportionate increase in relation to the fat-free mass was considered uncommon in patients with IBD, due to the observation of the disease being more common with weight loss and malnutrition. However, more in-depth investigations demonstrate that the fat/lean mass disproportion stands out both in prevalence in patients with new diagnoses of ulcerative colitis or Crohn's disease as well as a factor of poor prognosis to the natural evolution of the disease or to the therapeutic response. Another important aspect associated with obesity in IBD is the increased risk of drug clearance [including anti-tumor necrosis factor (TNF) and anti-integrin agents], resulting in short half-life and low trough drug concentrations, since the levels of TNF secreted by adipocytes sequester anti-TNF agents, which could result in suboptimal response to biologics. In view of these characteristic aspects of the inflammatory process of IBD, the identification of cellular functioning is necessary, which can be associated with the staging of the underlying disease, biochemical parameters, and body composition, helping as an indicator for a more accurate clinical and nutritional conduct.
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Affiliation(s)
- Sabrina A Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Carina Rossoni
- Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon 1649-028, Portugal
| | - Vivian W Koch
- Gastroenterology Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Gastroenterology Department, Grupo Hospitalar Conceição, Porto Alegre 91350-250, Brazil
| | - Marcello Imbrizi
- Coloproctology Department, State University of Campinas (UNICAMP-SP), São Paulo 13056-405, Brazil
| | | | - Letícia Pereira Pinto
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Daniéla Oliveira Magro
- Department of Surgery, State University of Campinas (UNICAMP-SP) and Faculty of Medical Sciences (FCM), São Paulo 13056-405, Brazil
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Performance of functionality measures and phase angle in women exposed to chemotherapy for early breast cancer. Clin Nutr ESPEN 2021; 42:105-116. [DOI: 10.1016/j.clnesp.2021.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022]
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Tsaousi G, Panagidi M, Papakostas P, Grosomanidis V, Stavrou G, Kotzampassi K. Phase Angle and Handgrip Strength as Complements to Body Composition Analysis for Refining Prognostic Accuracy in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2020; 35:2424-2431. [PMID: 33189535 DOI: 10.1053/j.jvca.2020.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population. DESIGN Prospective, cohort study. SETTING Tertiary university hospital. PARTICIPANTS Patients undergoing cardiac surgery procedures. INTERVENTIONS Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality. RESULTS Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II. CONCLUSIONS Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality.
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Affiliation(s)
- Georgia Tsaousi
- Department of Anesthesiology and ICU, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Mary Panagidi
- Department of Cardiosurgery, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Pyrros Papakostas
- Department of Surgery, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Vasilios Grosomanidis
- Department of Anesthesiology and ICU, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - George Stavrou
- Department of Surgery, Aristotle University Thessaloniki, Thessaloniki, Greece
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Matyjek A, Literacki S, Niemczyk S, Rymarz A. Protein energy-wasting associated with nephrotic syndrome - the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease. BMC Nephrol 2020; 21:346. [PMID: 32795277 PMCID: PMC7427894 DOI: 10.1186/s12882-020-02003-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/03/2020] [Indexed: 01/29/2023] Open
Abstract
Background Nephrotic syndrome (NS) is associated with a hypercatabolic state expressed as an exacerbated degradation of muscle mass. However, the clinical significance of this phenomenon has not yet been investigated. The aim of the study was to evaluate the nutritional status of patients with severe NS (defined as nephrotic range proteinuria with hypoalbuminemia ≤2.5 g/dL) and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2 in comparison to patients in different stages of chronic kidney disease (CKD). Methods Twenty men with severe NS (NS group) and 40 men without proteinuria similar in term of serum creatinine (control group) were included into the study. A retrospective cohort of 40 men with CKD stage G4 (PreD group) and 20 haemodialysis men (HD group) were added to the analysis after matching for age, height and weight using propensity score matching. The bioimpedance spectroscopy and biochemical nutritional markers were evaluated. Results Nephrotic patients had a significantly lower lean tissue mass (LTM; p = 0.035) and index (a quotient of LTM over height squared, LTI; p = 0.068), with an expected deficiency of LTM by 3.2 kg, and LTI by 0.9 kg/m2 when compared to the control group. A significant lean tissue deficit (defined as LTI below the lower limit of the reference range by 1.0 kg/m2) was observed in 12.5% of patients in the control group in comparison to 31.7% with advanced CKD (PreD+HD; p = 0.032) and 50% with NS (p = 0.003). NS group presented with higher phosphorus (p = 0.029), uric acid (p = 0.002) and blood urea (p = 0.049) than the control group. Blood urea was strongly negatively correlated with LTM in NS (r = − 0.64, p = 0.002). Nine nephrotic patients (45%) were identified as hypercatabolic based on severe hyperphosphatemia (> 5.0 mg/dL) and/or hyperuricemia (> 8.0 mg/dL), and were characterized by higher blood urea and lower prealbumin, as well as LTM lower by 5.6 kg than in less catabolic individuals. Conclusions In term of lean tissue amount, NS group was more similar to advanced CKD than to the control group. We concluded that specific metabolic pattern with elevated phosphorus, uric acid and blood urea, and lean tissue deficiency may be defined as protein-energy wasting associated with nephrotic syndrome (neph-PEW).
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Affiliation(s)
- Anna Matyjek
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland.
| | - Slawomir Literacki
- Department of Laboratory Diagnostic, Military Institute of Medicine, Warsaw, Poland
| | - Stanislaw Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland
| | - Aleksandra Rymarz
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland
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Zanella PB, Àvila CC, Chaves FC, Gazzana MB, Berton DC, Knorst MM, de Souza CG. Phase Angle Evaluation of Lung Disease Patients and Its Relationship with Nutritional and Functional Parameters. J Am Coll Nutr 2020; 40:529-534. [PMID: 32780649 DOI: 10.1080/07315724.2020.1801535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to determine the value of phase angle (PhA) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and its association with nutritional and functional parameters. METHODS A cross-sectional study of 77 patients under follow-up at the pulmonary outpatient clinic of a public hospital. Anthropometric measurements and functional assessments of physical and pulmonary capacity were performed, and a regular physical activity questionnaire was administered. RESULTS The sample consisted of 38 patients with COPD (mean age, 63.8 ± 9.9 years; 68.4% female) and 39 patients with PH (mean age, 46.6 ± 14.4 years; 79.5% female). There was no difference in anthropometric measurements between patients with COPD and PH. Patients with COPD had mild to moderate limitations of pulmonary function, while patients with PH had only mild limitations (p < 0.01). Although the median distance covered in the 6-minute walk test (6MWT) was different between the COPD and PH groups (p < 0.05), it was considered adequate for these populations. Mean PhA was within the range considered adequate in patients with COPD (6.3°±1°) and PH (6.2°±0.8°) (p > 0.05). In the statistical analyses, although the correlations were weak, adequate PhA correlated with fat free mass index, 6MWT, disease staging, forced vital capacity, and forced expiratory volume in the first second. CONCLUSION The anthropometric profile of both patient groups was very similar, and PhA values were within the expected range. Despite weak correlations, PhA is a clinical component to be followed and investigated in patients with lung disease.
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Affiliation(s)
- Priscila Berti Zanella
- Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Camila Coutinho Àvila
- Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernanda Cardoso Chaves
- Department of Nutrition, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcelo Basso Gazzana
- Pulmonology Unit - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegr, RS, Brazil
| | - Danilo Cortozi Berton
- Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Pulmonology Unit - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegr, RS, Brazil
| | - Marli Maria Knorst
- Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Pulmonology Unit - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegr, RS, Brazil
| | - Carolina Guerini de Souza
- Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Food and Nutrition Research Center, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Binay Safer V, Tasci I, Safer U. Crohn's disease, visceral obesity and sarcopenia. Clin Nutr 2020; 39:2315-2316. [PMID: 32536584 DOI: 10.1016/j.clnu.2020.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation Sancaktepe Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ilker Tasci
- University of Health Sciences Turkey, Gulhane Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey; Gulhane Training and Research Hospital, Internal Medicine Clinic, Ankara, Turkey
| | - Umut Safer
- Department of Internal Medicine, Sancaktepe Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey; Department of Palliative Care, Sancaktepe Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey.
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Cioffi I, Imperatore N, Di Vincenzo O, Santarpia L, Rispo A, Marra M, Testa A, Contaldo F, Castiglione F, Pasanisi F. Association between Health-Related Quality of Life and Nutritional Status in Adult Patients with Crohn's Disease. Nutrients 2020; 12:E746. [PMID: 32168964 PMCID: PMC7146465 DOI: 10.3390/nu12030746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022] Open
Abstract
This study aimed to assess health related quality of life (HRQoL) in adult patients with Crohn's disease (CD), considering disease severity and gender differences, and also its relationship with nutritional status. Consecutive adult patients aged 18-65 years with CD were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in active and quiescent phases. HRQoL was evaluated using the validated short form (SF)-36 questionnaire for the Italian population. Additionally, anthropometry, bioimpedance analysis, and handgrip-strength (HGS) were performed. Findings showed that 135 patients (79 men and 56 women) were included, having a mean age of 38.8 ± 14 years and a BMI of 23.2 ± 3.7 kg/m2. Overall, active CD patients had a lower perception of their QoL compared to those clinically quiescent, while gender differences emerged mostly in the quiescent group. Interestingly, HRQoL was significantly associated with many nutritional variables, and muscle strength was the main predictor. Therefore, HRQoL is perceived lower in active compared to quiescent patients, but women experienced poorer QoL than men, especially in the quiescent phase. Finally, higher QoL scores were found in subjects being in clinical remission phase with a preserved muscle function. However, further studies are still required to verify these findings.
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Affiliation(s)
- Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Olivia Di Vincenzo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Maurizio Marra
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Anna Testa
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131 Naples, Italy
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Cioffi I, Imperatore N, Di Vincenzo O, Pagano MC, Santarpia L, Pellegrini L, Testa A, Marra M, Contaldo F, Castiglione F, Pasanisi F. Evaluation of nutritional adequacy in adult patients with Crohn's disease: a cross-sectional study. Eur J Nutr 2020; 59:3647-3658. [PMID: 32072266 PMCID: PMC7669764 DOI: 10.1007/s00394-020-02198-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 02/06/2020] [Indexed: 12/14/2022]
Abstract
Purpose Inadequate oral intake may play an important role in the onset of malnutrition in patients with Crohn’s disease (CD). The aims of this cross-sectional study were: (1) to compare dietary intake in clinically active and quiescent CD patients, and (2) to assess patients’ nutritional adequacy relative to the dietary reference values (DRVs) for the Italian population using LARN (Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana). Methods Patients aged between 18 and 65 years with a diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record. Disease activity was clinically defined using the Crohn’s disease activity index (CDAI). Results Overall, 117 patients, 71 males and 46 females, with a mean age of 39.6 ± 13.8 years and a mean body weight of 65.4 ± 11.8 kg, were ultimately included. Our findings showed that the amount of nutrients was similar between patients with active and quiescent disease. The mean intake of macronutrients was adequate, except for fiber, while dietary micronutrients were insufficient. Median intakes of sodium, phosphorus, and fluorine met LARN recommendations in both sexes, and the DRVs were accomplished by many patients (53/117; 104/117 and 98/117, respectively). Interestingly, dietary amounts of iron and zinc were barely acceptable in males but not in females. However, a few of the patients (< 15) met the LARN for potassium, calcium, and magnesium, regardless of sex and CDAI. With respect to vitamins, no relevant difference was found between the active and quiescent groups, and none of them met recommended values in both sexes. Conclusions This study showed that the assessment of dietary intake can be crucial for optimizing dietary intervention with focused nutrition counseling, to improve nutritional status in CD patients.
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Affiliation(s)
- Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy.
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131, Naples, Italy
| | - Olivia Di Vincenzo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
| | - Lucienne Pellegrini
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131, Naples, Italy
| | - Anna Testa
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131, Naples, Italy
| | - Maurizio Marra
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via Pansini 5, 80131, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy
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Marra M, Cioffi I, Morlino D, Vincenzo OD, Pagano MC, Imperatore N, Alfonsi L, Santarpia L, Castiglione F, Scalfi L, Pasanisi F. New Predictive Equations for Estimating Resting Energy Expenditure in Adults With Crohn's Disease. JPEN J Parenter Enteral Nutr 2020; 44:1021-1028. [PMID: 32010994 PMCID: PMC7496798 DOI: 10.1002/jpen.1790] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increased resting energy expenditure (REE) has been hypothesized to be a potential cause of weight loss in individuals with Crohn's disease (CD). This study aimed to develop and validate new predictive equations for estimating REE in adults with CD. METHODS Adults, ages 18-65 years, with CD were recruited. Anthropometry, indirect calorimetry, and bioimpedance analysis were performed in all patients. Disease activity was assessed by Crohn's Disease Activity Index. The new predictive equations were generated using different regression models. Prediction accuracy of the new equations was assessed and compared with the most commonly used equations. RESULTS A total of 270 CD patients (159 males, 111 females) were included and randomly assigned to the calibration (n = 180) and validation groups (n = 90). REE was directly correlated with weight and bioimpedance index, whereas the relation with both age and disease activity was inverse. The new equations were suitable for estimating REE at population level (bias: -0.2 and -0.3, respectively). Individual accuracy was good in both models (≥80%, respectively), especially in females; and similar results were shown by some of the selected equations. But, when accuracy was set within ±5%, the new equations gave the highest prediction. CONCLUSION The new, disease-specific, equations for predicting REE in individuals with CD give a good prediction accuracy as far as those proposed in the literature for the general population. However, the new ones performed better at the individual level. Further studies are needed to verify the reliability and usefulness of these new equations.
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Affiliation(s)
- Maurizio Marra
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Delia Morlino
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Olivia Di Vincenzo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Santarpia L, Alfonsi L, Castiglione F, Pagano MC, Cioffi I, Rispo A, Sodo M, Contaldo F, Pasanisi F. Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn's Disease. Nutrients 2019; 11:nu11122947. [PMID: 31817074 PMCID: PMC6950059 DOI: 10.3390/nu11122947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM). METHODS Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed. RESULTS After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored. CONCLUSIONS This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
- Correspondence: ; Tel./Fax: +39-081-746-2333
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maurizio Sodo
- General and Transplantation Surgery, Department of Public Health, Federico II University Hospital, 80131 Naples, Italy;
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
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