Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

Association between phase angle and body composition: New equations to predict fat mass and skeletal muscle mass

OBJECTIVE

The aim of this cross-sectional study was to develop new regression equations for estimating fat mass (FM) and skeletal muscle mass (SMM) in a heterogeneous Caucasian population, using the phase angle (PhA) as a bioelectrical parameter and DXA as the reference method. We also aimed to cross-validate the new equations, and to compare them with the manufacturers' equations.

METHODS

The 212 healthy Caucasian participants aged 20-65 years were randomly distributed into two groups: development group (n = 141) and validation group (n = 71). Bioelectrical parameters were obtained with a 50 kHz foot-to-hand phase-sensitive body composition analyzer. The new FM percentage (FM%) and SMM percentage (SMM%) equations were developed by performing multiple forward regression analyses. Agreement between DXA and the different equations was assessed by mean differences, coefficient of determination, standard error of the estimate (SEE), concordance correlation coefficient (CCC), and Bland-Altman plots.

RESULTS

The proposed equations explained 89.2% of the variance in the DXA-derived FM% and 91.8% in the DXA-derived SMM%, with low random errors (SEE = 3.04% and 1.92%, respectively), and a very strong agreement (CCC = 0.93 and 0.94, respectively). In addition, they demonstrated no fixed bias and a relatively low individual variability. However, the manufacturer's equations described a lower percentage of the variance, with higher random errors, obtained fixed bias of -5.77% for FM% and 4.91% for SMM%, as well as higher individual variability.

CONCLUSIONS

The new regression equations, which include the PhA as a bioelectrical parameter, can accurately predict DXA-derived FM% and SMM% in a heterogeneous Caucasian population, and are better options than the manufacturer's equations.

Moderate intensity continuous training, combined moderate-intensity continuous training vs combined high-intensity interval training in adults with hypertension: Randomized controlled trial

BACKGROUND AND PURPOSE

Despite all efforts to treat hypertension, it is still responsible for 10.8 million deaths annually. The aim of this study was to compare the effects of continuous moderate-intensity training, strength training combined with continuous moderate-intensity training and strength training combined with high-intensity interval training in adults with high blood pressure.

METHODS

A 12-week randomized control trial was performed. A total of 100 volunteers, 51 women and 49 men with hypertension participated. The sample was randomly assigned into three intervention groups and one control group.

RESULTS

All intervention groups significantly improved their hemodynamic parameters, body composition, lipid profile, glucose, and physical fitness as compared to the control group. Both combined training groups showed greater improvements than the moderate-intensity continuous training group. However, the strength group combined with the moderate-intensity continuous group showed the greatest benefits in systolic, diastolic and mean arterial pressure, of -13.4 mmHg, -6.8 mmHg and -8.9 mmHg respectively, abdominal circumference, upper and lower limb strength and VO₂peak, versus the continuous moderate-intensity group; it also achieved greater reductions in systolic and mean blood pressure, up to -6.8 mmHg and 4.3 mmHg respectively, than the strength group combined with the high intensity interval group.

CONCLUSION

Performing a strength training program combined with continuous moderate intensity training, 2 days per week for 12 weeks, produces significant improvements in cardiometabolic biomarkers, body composition, and physical condition of adults with hypertension, with these adaptations being superior to those produced by continuous moderate-intensity training and strength training combined with high-intensity intervallic training.

Brachial arterial adaptations in college baseball players: Differences between pitchers and fielders

OBJECTIVES

Although exercise-induced vascular adaptations have been extensively reported in racket sports athletes, the applicability of these findings to athletes in other overhead sports is unclear. This study aimed to investigate exercise-induced vascular adaptations in college male baseball players. Furthermore, since the training frequency of the upper arm may differ by baseball playing position, this study also focused on playing position-specific differences in brachial arterial adaptations.

DESIGN

Cross-sectional study.

METHODS

Seventy-five baseball players and 23 sedentary young men aged 18-23 years participated in this study. The participants' brachial artery diameter, blood flow velocity, and blood flow volume were measured using an ultrasonic diagnostic imaging system. Brachial hemodynamic measurements of both hands were obtained randomly in a seated resting position.

RESULTS

Baseball players demonstrated significantly greater brachial lean mass, circumference, arterial diameter, and blood flow volume than sedentary control participants. Statistically significant differences in brachial artery diameters between the non-dominant and dominant arms were observed only in the baseball pitcher group. Furthermore, body surface area- and brachial lean mass-corrected artery diameters in the dominant arm were also significantly larger than those in the non-dominant arm in the baseball pitcher group. A simple correlation analysis revealed a positive association between brachial lean mass/circumference and arterial diameter in all participants.

CONCLUSIONS

These findings suggest asymmetrical exercise-induced vascular adaptations in the brachial artery of baseball players, particularly pitchers, indicating the potential role of playing position-specific demands in vascular remodeling. Understanding these adaptations may inform training strategies and help prevent injuries in baseball players.

Validity between dual-energy x-ray absorptiometry and bioelectrical impedance for segmental fat analysis and a novel low-cost model developed using anthropometry in young adults

BACKGROUND

Accurate body fat distribution assessment is essential for managing cardiovascular disease and metabolic disorders. Although several methods are available for segmental fat analysis, few studies have examined the validity of affordable methods such as Bioelectrical Impedance Analysis (BIA) against the reference method, Dual-Energy X-ray Absorptiometry (DXA). This study aimed to assess the validity of BIA as compared to DXA for segmental fat mass assessment, and to develop anthropometric multivariate regression models that offer a cost-effective alternative for health professionals in clinical and public health settings.

METHODS

Cross-sectional study that included 264 young adults (161 males, mean age = 23.04 ± 5.61 years; and 103 females, mean age = 22.29 ± 5.98 years). Segmental fat mass was measured using DXA and BIA, and anthropometric measurements were collected following the ISAK protocol.

RESULTS

Significant differences were found between DXA and BIA for segmental fat mass (p < 0.001). Sex significantly influenced the results (p < 0.05), while BMI and hydration status had no significant impacts. The Bland-Altman analysis revealed significant differences (p < 0.001) between BIA and DXA for fat mass in the upper and lower limbs. Trunk fat mass also differed significantly in males and females (p < 0.001), except for the overall sample (p = 0.088). Anthropometric multivariate regression models showed a high predictive accuracy for both females (R²=0.766-0.910; p < 0.001) and males (R²=0.758-0.887; p < 0.001). Key predictors of segmental fat mass included body mass (r = 0.606-0.867; p < 0.001), skinfold thickness (r = 0.688-0.893; p < 0.001), and waist girth (r = 0.883 - 0.810; p < 0.001). Peripheral skinfolds were highly predictive for upper and lower limbs, while waist girth was relevant for trunk fat mass.

CONCLUSIONS

DXA and BIA are not interchangeable for segmental fat analysis due to the significant differences observed. However, the anthropometric multivariate regression models developed provide a cost-effective and reliable alternative for predicting segmental fat mass in clinical settings where DXA is unavailable.

TRIAL REGISTRATION

Not applicable.

Investigating the impact of multidisciplinary prehabilitation on deconditioning in patients eligible for haematopoietic allogenic stem cell transplantation: protocol for a feasibility trial

BACKGROUND

Assessing multidisciplinary prehabilitation strategies becomes crucial to pre-emptively counter the physical, psychological and social negative impacts experienced during an allogenic haematopoietic stem cell transplant (allo-HSCT) among acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Current evidence is restricted to studies during induction chemotherapy, omitting rehabilitation interventions and predominantly using exercise-only approaches without a multidisciplinary framework. The aim of this study is to investigate the feasibility, safety and preliminary efficacy of multidisciplinary prehabilitation in adults offered allo-HSCT.

METHODS AND ANALYSIS

This 8-week single-group pre-post feasibility study aims to pilot a multidisciplinary prehabilitation intervention for participants undergoing allo-HSCT, with a focus on feasibility and safety. Participants, aged 18 or older, diagnosed with AML or MDS, and offered allo-HSCT, will be recruited between June 2023 and July 2024. The multidisciplinary prehabilitation intervention, conducted by the cancer allied health team at the Royal Adelaide Hospital, includes exercise physiology, physiotherapy, dietetics, social work, occupational therapy and psychology interventions. Consistent with a multidisciplinary treatment approach, each component is tailored to address different aspects of patient care, and adherence calculations will assess patient engagement and compliance. In addition, participants will continue to receive usual care from cancer allied health staff. The primary outcome of the study is to assess the feasibility of a multidisciplinary prehabilitation intervention by evaluating intervention uptake, retention, adherence, acceptability and safety. Secondary outcomes are leg strength, upper-body strength, aerobic fitness, falls risk, anthropometry, nutritional status, quality of life, anxiety, depression, self-efficacy for coping with cancer and distress.

ETHICS AND DISSEMINATION

Ethics approval for this study has been provided by the Central Adelaide Local Health Network (HREC 2022/HRE00284). Recruitment for the study commenced in June 2023 and will continue until July 2024. The methods have been designed and are reported according to the SPIRIT and CONSORT-pilot study checklist.

TRIAL REGISTRATION NUMBER

The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000052639.

Normative values for body composition in 22,191 healthy Norwegian adults 20-99 years: The HUNT4 study

BACKGROUND

Body mass, body mass index (BMI), and body composition components are essential for health and longevity. Considering the influence of demographic factors on body composition, there is a need for tailored reference values based on age-, sex-, and geography. We aimed to construct a comprehensive reference material on body composition in healthy Norwegian adults.

METHODS

In this cross-sectional study, we estimated age- and sex-specific reference values for body-, fat-, and muscle mass variables using multi-frequency bioelectrial impedance analysis (such as body fat percentage, skeletal muscle mass and visceral fat area) in 22,191 healthy adults aged 20-99 years participating in the Trøndelag Health Study 4 (HUNT4). We calculated the fat mass and skeletal muscle mass index as the total fat and muscle mass relative to height squared and used general linear models to explore the associations between physical activity (PA), BMI, and age.

RESULTS

With a BMI (kg/m2) of 25.4 (SD 5.1) and 26.0 (4.5) for women and men, respectively, the youngest age group (20-39 yrs) had a lower BMI compared to their counterparts aged 40-59 years (26.3 [4.5] and 27.5 [3.8]) and ≥ 60 years (25.7 [4.1] and 26.5 [3.4]), respectively. Those aged 20-39 years also had the lowest values for the different body fat variables measured. Fat mass index (kg/m2) was 8.41 (4.00) and 5.81 (3.29) for women and men aged 20-39 years, respectively, compared to 9.25 (3.21) and 6.86 (2.46) for those aged ≥60 years. The oldest age group had the lowest values for the various muscle mass variables; women and men aged 60+ years had a skeletal muscle mass index (kg/m2) of 8.91 (0.85) and 10.96 (1.00), respectively. Corresponding values for those aged 20-39 years were 9.33 (0.97) and 11.49 (1.15). For all age groups and both sexes, regular physical activity was associated with lower levels of fat mass, whereas the association between muscle mass and PAwas less conclusive. When using body fat percentage as an obesity measure, we observed a much higher obesity prevalence (41.2%) in the study population compared to BMI (17.3%).

CONCLUSIONS

Our study offers a comprehensive reference for body composition among healthy adults in Norway, aiding the identification of abnormal fat and muscle mass values across age groups. We also highlight that BMI often misclassifies individuals with adiposity levels in the overweight or obese category as lean. Therefore, incorporating body composition when defining obesity could enable early intervention to prevent cardiometabolic diseases.

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children

Background

Childhood obesity tends to persist into adulthood, predisposing individuals to cardiometabolic risk (CMR). This study aims to investigate the mediating role of cardiorespiratory fitness (CRF) in the associations between multiple fatness indicators and individual CMR markers and clustered CMR-score, and explore sex differences.

Methods

We recruited 1,557 children (age: 8 to 10, male/female: 52.7%/47.3%) in September 2022 in Ningbo, China. Physical examinations, overnight fasting blood test, and CRF was evaluated. The CMR-score was calculated by summing age- and sex-specific z scores of four CMR markers, including mean arterial blood pressure, triglycerides, the total cholesterol to high-density lipoprotein cholesterol ratio, and homeostatic model assessment for insulin resistance. Generalized linear mixed models were used to identify the associations, mediation analyses were performed to dissect the function of CRF.

Results

Partial correlation analyses revealed positive associations between high fatness indicators (including body mass index [BMI], BMI z score, body fat mass index [BFMI] and waist-to-height ratio [WHtR]) and increased CMR markers, whereas high CRF was associated with decreased CMR markers (all P < 0.05). In the mediation analyses, CRF emerged as a partial mediator, attenuating the relationship between four fatness indicators and CMR-score. Specifically, CRF mediated 6.5%, 7.7%, 5.3%, and 12.5% of the association between BMI, BMI z score, BFMI, WHtR and CMR-score (all P < 0.001). And the mediating effects of CRF between WHtR and four individual CMR markers was particularly robust, ranging from 10.4% to 21.1% (all P < 0.05). What's more, CRF mediates the associations between WHtR and CMR-score more pronounced in girls than boys with a mediation effect size of 17.3% (P < 0.001).

Conclusion

In Chinese children, CRF partially mitigates the adverse effects of fatness on CMR, underscoring the significance of enhancing CRF in children.

Contactless exercise intervention in prenatal and postnatal period during COVID-19 lowers the risk of postpartum depression

The COVID-19 pandemic has had a substantial adverse impact on the physical and mental health of pregnant and postpartum women, thereby increasing the risk of postpartum depression (PPD). This study aimed to evaluate the effectiveness of a continuous contactless exercise intervention in reducing the risk of depression during the prenatal and postnatal periods. The study utilized an interactive contactless exercise program consisting of Pilates movement over a 16-week period, with 8 weeks during pregnancy and 8 weeks after childbirth. Metabolic and psychological factors related to postpartum depression, including pain, stress, and stress-response markers, were analyzed. The results showed that the exercise intervention significantly alleviated postpartum depression by improving pain (Oswestry Disability Index: Non-exercise, 11.4 ± 14.8 versus Exercise, - 63.1 ± 18.4, p < .001) and stress factors (Edinburgh Postnatal Depression Scale: Non-exercise, 8.8 ± 8.72 versus Exercise, - 37.6 ± 9.13, p < .001; Perceived Stress Scale: Non-exercise, 9.21 ± 9.35 versus Exercise, - 20.7 ± 14.4, p < .001) caused by physical/structural imbalances in postpartum women. Additionally, the intervention improved the metabolic imbalances commonly observed after childbirth, including reductions in triglyceride (Interaction effect, p = .017), insulin (Interaction effect, p = .032), and cortisol levels (Interaction effect, p < .001), which are recognized risk factors for postpartum depression. Taken together, these findings suggest that contactless online exercise interventions can mitigate postpartum depression by addressing metabolic dysregulation that frequently occurs after delivery, especially in situations of social isolation caused by the pandemic.

Development and validation of new bioelectrical impedance equations to accurately estimate fat mass percentage in a heterogeneous Caucasian population

Fat mass percentage (%FM) is frequently determined by nutritionists and personal trainers with bioelectrical impedance analysis (BIA) devices. The aims of the present study were: (1) to develop new regression equations using dual-energy X-ray absorptiometry (DXA) as the reference method for estimating %FM in a heterogeneous Caucasian population with a foot-to-hand device (BIA-101) and a hand-to-hand device (BIA-TELELAB) and (2) to compare the new equations with the manufacturers' equations. We hypothesized that the new equations would lead to more accurate estimations compared with DXA. A total of 218 healthy Caucasian participants aged 18 to 65 years were divided into a development group and a validation group. The accuracy of the different equations was assessed by mean differences, coefficient of determination, standard error of the estimate (SEE), intraclass correlation coefficients (ICC), and Bland-Altman plots. The proposed equation for BIA-101 explained 90.0% of the variance in the DXA-derived %FM, with a low random error (SEE = 2.98%), excellent agreement (ICC = 0.94), no fixed bias, and relatively low individual variability (5.86%). For BIA-TELELAB, the proposed equation explained 88.0% of the variance in the DXA-derived %FM, with a low random error (SEE = 3.27%), excellent agreement (ICC = 0.93), no fixed bias, and relatively low individual variability (6.37%). The results obtained for the manufacturers' equations confirm that these equations are not a good option for %FM assessment. As hypothesized, the new regression equations for BIA-101 and BIA-TELELAB devices can accurately estimate %FM in a heterogeneous Caucasian population with a broad age range.

Body composition analysis via spatially resolved NIR spectroscopy with multifrequency bioimpedance precision

Near-infrared spectroscopy (NIRS) is often criticized due to its insufficient accuracy in determining body composition compared to the gold standard methods. In this work, we show that the use of multiple source-detector distances, as well as the simultaneous use of physiological and optical features, can significantly improve the accuracy of determination of fat and lean mass percentage in the human body using NIR spectroscopy. The study performed on the n = 292 cohort revealed the mean absolute errors of 3.5% for fat content and 3.3% for soft lean mass percentage prediction (r = 0.93) using the multifrequency bioimpedance analysis (BIA) as a reference. Hence, NIRS can serve as an independent reliable method for body composition analysis with precision close to that of advanced multifrequency BIA.

Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes

Background

Anemia is one of the common complications of diabetes and is associated with mortality. Phase angle (PhA), ratio of extracellular water to total body water (ECW/TBW) and skeletal muscle mass index (SMI) estimated by bioelectrical impedance analysis (BIA) have been used as prognostic indicators for various chronic diseases and frailty. We aimed to clarify the clinical significance of PhA, ECW/TBW and SMI for anemia in patients with diabetes.

Materials and methods

The values of PhA, ECW/TBW and SMI were estimated by a portable BIA device and blood samples were collected in 371 Japanese patients with diabetes. The relationships of PhA, ECW/TBW and SMI with hemoglobin (Hgb) and hematocrit (Hct) were statistically evaluated.

Results

In simple linear regression analysis, PhA and SMI were positively correlated with Hgb and Hct levels in total subjects, male subjects and female subjects. In contrast, ECW/TBW was negatively correlated with Hgb and Hct levels regardless of sex. Multivariate regression analysis showed that both PhA and ECW/TBW but not SMI independently contributed to Hgb and Hct levels after adjustment of clinical confounding factors in both males and females.

Conclusions

PhA and ECW/TBW but not SMI were associated with levels of Hgb and Hct in patients with diabetes. Therefore, aberrant values of PhA and ECW/TBW suggest a risk of anemia in diabetic patients.

Hand Grip Strength Relative to Waist Circumference as a Means to Identify Men and Women Possessing Intact Mobility in a Cohort of Older Adults with Type 2 Diabetes

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

Association of polymorphisms rs2303729, rs10880, and rs1131620 of LTBP4 with sarcopenia in elderly patients with type 2 diabetes mellitus

BACKGROUND

Latent TGFβ binding protein 4 (LTBP4) modifies skeletal muscle function, and polymorphisms in this gene have been associated with a longer ambulation time in patients with Duchenne muscular dystrophy. However, no studies associate these polymorphisms with an acquired muscle condition.

AIM

The study aims to determine whether three functional variants within the LTBP4 were associated with sarcopenia in patients with type 2 diabetes mellitus (T2DM).

SUBJECTS AND METHODS

We performed an analysis with 144 elderly individuals with T2DM, including 101 without sarcopenia and 43 with sarcopenia. Polymorphism frequency was determined by real-time PCR allelic discrimination TaqMan assay.

RESULTS

Under different genetic models, the univariant analysis did not show a significant association of any polymorphism with sarcopenia. But the multivariate model analysis showed that variant rs1131620 (OR 7.852, 95% CI 1.854-33.257, p = 0.005) was significantly associated with sarcopenia under a dominant model. Under the same analysis, the variants rs2303729 and rs10880 had a more discrete association (OR 3.537 95% CI 1.078-11.607, p = 0.037; OR 5.008, 95% CI 1.120-22.399, p = 0.035, respectively).

CONCLUSIONS

Our study highlights the importance of studying LTBP4 polymorphisms associated with sarcopenia. These findings suggest that the rs1131620 polymorphism of the LTBP4 may be part of the observed sarcopenia process in patients with T2DM.