Assessment methods in human body composition

A new estimation equation to assess body composition in an athletic population

BACKGROUND

Research has shown air displacement plethysmography (ADP) to be a valid and reliable alternative to dual-energy X-ray absorptiometry (DXA) in the general population; however, its validity and reliability indicate conflicting evidence in an athletic population. The purpose of this study is to develop a novel estimation equation using body density obtained from ADP in an athletic population to assess body fat percent (BF%) more accurately.

METHODS

One hundred and thirty (males, n = 69; females, n = 61) National Collegiate Athletic Association Division I athletes participated in this study. Thirty athletes were randomly withheld for the hold-out sample, and the remaining 100 athletes were used in the development of the equation. Body composition was evaluated using ADP and DXA. Linear regression was used to develop a new prediction equation (Equation 1) with body density (ADP) as the independent variable and BF% (DXA) as the dependent variable. Repeated measures analysis of variance was used to identify differences between ADP-Brozek, DXA, and Equation 1. Interclass correlation coefficients (ICCs) were assessed to evaluate the reliability of the equation.

RESULTS

Significance was set to p < 0.05. Linear regression was conducted to create Equation 1, which explained 90.5% of the variance. ADP-Brozek reported lower BF% than Equation 1 (p < 0.001) in the development and hold-out samples; however, BF% from Equation 1 and DXA were not different from each other (p = 0.999). ICCs were strong in both samples (original sample: ICC = 0.975, p < 0.001; hold-out sample: ICC = 0.964, p < 0.001).

CONCLUSION

The newly proposed equation may be used with ADP measurements to interpret BF% in an athletic population.

Body composition and chemotherapy toxicities in breast cancer: a systematic review of the literature

PURPOSE

Breast cancer is the most diagnosed cancer in women with chemotherapy being a common treatment. Toxicities due to chemotherapy can result in dose reduction, delay, and early cessation of treatment, which along with causing distress for individuals during their cancer treatment might also reduce the therapeutic effect. The purpose of this systematic review is to examine the role of body composition on chemotherapy toxicities in women with breast cancer.

METHODS

A systematic search of the literature was completed on electronic databases Pubmed, Embase, CINHAHL, and Cochrane. Studies were included if the direct effect of body composition on chemotherapy toxicities was reported and excluded if body composition could not be isolated. A critical appraisal of the studies included was performed using McMasters University Critical Review Form for Quantitative Studies.

RESULTS

Eleven studies were included with a total of 2881 female participants. All studies reported significant relationships between body composition and chemotherapy toxicities; however, individual parameters differed between the studies. Adding to the heterogeneity, different thresholds were reported to determine both sarcopenia and myosteatosis, making it difficult to identify a common finding.

CONCLUSION

This review suggests that body composition may be an important factor in predicting the severity of chemotherapy toxicities during treatment for breast cancer; however, the lack of international consensus as to thresholds in the literature for sarcopenia and myosteatosis may result in bias. The review supports the need for further prospective studies, allowing for more robust, pre-determined data collection, to better understand the implications of body composition on toxicities and benefits of using body composition to individualize chemotherapy dosing.

IMPLICATIONS FOR CANCER SURVIVORS

Toxicities due to chemotherapy can result in treatment being unable to be completed as planned, potentially resulting in poorer survival outcomes. Improved knowledge in this area may give rise to a more reliable way of individualizing chemotherapy dosage to help mitigate this risk.

Unveiling the relation between swallowing muscle mass and skeletal muscle mass in head and neck cancer patients

PURPOSE

Sarcopenia, characterized by loss of skeletal muscle mass (SMM) and strength, often leads to dysphagia in the elderly. This condition can also worsen treatment outcomes in head and neck cancer (HNC) patients, who are susceptible to swallowing difficulties. This study aimed to establish the correlation between swallowing muscle mass (SwMM) and SMM in HNC patients.

METHODS

Data from 157 HNC patients in the OncoLifeS biobank of the University Medical Center Groningen were analyzed using pre-treatment neck CT scans. The SwMM was assessed by the cross-sectional area (CSA) of the tongue complex muscles (TCM), and SMM was indicated by the skeletal muscle index (SMI), calculated from corrected CSA at the third lumbar vertebra (L3). Correlations between SwMM and SMM were analyzed using Pearson or Spearman tests, and multivariable linear regression with SMI as dependent variable was performed.

RESULTS

SwMM was moderately correlated with SMI (r = 0.600, p < 0.001), CSA at C3 (r = 0.538, p < 0.001), and CSA at L3 (r = 0.651, p < 0.001). The CSA at C3 strongly correlated with SMI (r = 0.871, p < 0.001). In multivariable regression analysis, age, sex, and weight were strong predictors of SMI, while the TCM area was a less robust predictor (p = 0.059). Models with CSA at C3 and L3 showed all variables as significant predictors (p < 0.001).

CONCLUSIONS

Although SwMM was significantly correlated with SMI and holds clinical utility, it is not strong enough to be considered interchangeably with C3 for predicting SMI, suggesting that swallowing muscles represent a different entity than skeletal muscles and not reflect accurately the general muscle mass.

Monitoring MUAC reflects the adequacy of nutrition support in critically ill children with a longer intensive care unit stay: A single-center prospective cohort study

BACKGROUND

Children who are critically ill frequently experience inadequate nutrition, resulting in changes in body composition. We investigated the nutrition status and body composition changes among children with prolonged stays in the pediatric intensive care unit (PICU), utilizing midupper arm circumference (MUAC), and triceps skinfold thickness (TSF) measurements.

METHODS

A single-center prospective cohort study monitored nutrition support for children admitted to the PICU for over 6 days. MUAC and TSF were measured at admission and every other day through the 15th day of the PICU stay. Target energy was caculated using the Schofield formula without stress correction, and recommended protein intake was set at 1.5 g/(kg/d). Factors influencing changes in anthropometry were analyzed through pairwise correlation and regression analysis.

RESULTS

Sixty children with a median PICU stay of 9 days were included. MUAC decreased by 2.53% in the first week and by 7.42% over 2 weeks. During the first week, average energy and protein intakes were only 53.0% and 41.3% of recommended levels, respectively. Decreases in MUAC correlated with mean cumulative energy deficits (1 week: r = 0.310 [P = 0.016]; 2 weeks: r = 0.504 [P = 0.023]) and mean cumulative protein deficits (1 week: r = 0.304 [P = 0.018]).

CONCLUSIONS

Many children with longer PICU stays did not met energy and protein recommendations. Decreases in MUAC were associated with deficits in energy and protein intake. Monitoring MUAC is a valuable tool for assessing nutrition support adequacy in children with longer PICU stays.

Comparison between adult comorbidity evaluation-27 and Charlson Comorbidity Index in head and neck oncology

OBJECTIVES

To determine whether Adult Comorbidity Evaluation-27 (ACE-27) or Charlson Comorbidity Index (CCI) is more accurate in predicting overall survival in head and neck squamous cell cancer (HNSCC) patients.

METHODS

A retrospective study was conducted on all patients with a primary HNSCC diagnosis and treatment between January 1st, 2010, and December 31th, 2013 at ErasmusMC, the Netherlands. Medical records were reviewed for patient data. The following covariables were considered: sex, age, subsite of the index HNSCC, treatment, TNM-stage, tobacco use and alcohol use. Significant covariables were identified with Kaplan-Meier analyses. Two Cox-regression models were made including the covariables and each comorbidity model. The primary endpoint was the c-statistic, with overall survival as the dependent variable and the covariables as the independent variables in the comorbidity models.

RESULTS

A total of 1,193 patients were included in the study, with an average age of 63.9 years (SD:10.7). In the Kaplan-Meier analysis, all variables, except sex, demonstrated a significant correlation with 5-year-overall survival. According to the Cox regression analysis, there was a HR of 2.462 (95 %CI:1.630-3.718) for a CCI of ≥ 5. The HR at an ACE-27 score of 3 was 1.969 (95 %CI:1.457-2.660). The model that incorporated the CCI score resulted in an average c-statistic of 0.6783 (range:0.6524-0.6935), while the mean c-statistic for the model with the ACE-27 was 0.6790 (range:0.6364-0.6973).

CONCLUSION

In individuals diagnosed with HNSCC, both the ACE-27 and CCI serve as independent factors that reflect overall survival. Their predictive capabilities are comparable, allowing for their interchangeable use in both clinical and research contexts.

One Year Changes in Body Composition and Musculoskeletal Health Following Metabolic/Bariatric Surgery

CONTEXT

There are limited comparative studies between one-anastomosis gastric bypass (OAGB) vs Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on body composition and musculoskeletal health.

OBJECTIVE

To compare changes in body composition, areal bone mineral density (aBMD), muscle strength, and physical function in the first year following OAGB, RYGB, and SG within a UK-based healthcare setting.

METHODS

This is a secondary analysis of the BARI-LIFESTYLE trial in 119 adults (77% women; mean ± SD age 45.9 ± 10.3 years; body mass index 43.6 ± 5.5 kg/m2) who underwent OAGB (n = 19), RYGB (n = 39), and SG (n = 61). Body composition and aBMD by dual energy x-ray absorptiometry, handgrip strength, sit to stand (STS) test and 6-minute walking test (6MWT) were assessed presurgery and at 12 months postsurgery.

RESULTS

OAGB, RYGB, and SG exhibited similar reductions in body weight, body fat, and lean mass (within-group comparisons, P < .001). All surgery types were associated with reductions in aBMD at the total hip, femoral neck, and lumbar spine, which were more pronounced after OAGB and RYGB than after SG (all P < .03), though there was no difference between OAGB and RYGB. Despite reductions in absolute handgrip strength, relative handgrip strength, STS test, and 6MWT improved postsurgery (all P < .02), with no differences by surgical procedure.

CONCLUSION

OAGB, RYGB, and SG resulted in comparable weight loss, changes in body composition and improvements in relative muscle strength and physical function. OAGB and RYGB, compared with SG, led to greater BMD reductions at clinically relevant sites. Future long-term studies should explore whether these BMD reductions translate into a greater fracture risk.

Childhood obesity: The threatening apprentice of the adiposity empire

Childhood obesity is a global health problem, with its prevalence having tripled since 1975. The increase in its prevalence has been predominantly in developing countries, but also in those with high economic status. Nowadays, there are multiple obesity definitions, however, one of the most accurate is the one which defines obesity as the accumulation of excessive body adiposity and not as an body weight excess. Nevertheless, the body mass index (BMI) is the most frequently used tool for its classification, according to the cut-off points established by the Center for Disease Control and World Health Organization tables. In children and adolescents an adiposity excess is related to the appearance of cardiovascular disease in adulthood and with many comorbidities such as metabolic syndrome, insulin resistance, type 2 diabetes, hypertension and metabolic dysfunction-associated steatotic liver disease, among others. Currently, there is still controversy about which is the ideal indicator for measuring overweight and obesity. BMI is still used as a standardized measure but may miss cases in which body composition is pathological despite a BMI within the normal-weight category. An adequate knowledge of the impact on health of dysfunctional adiposity as well as its accurate diagnosis will allow health professionals to address this condition in a more precise and comprehensive manner, and substantially improve the associated cardiometabolic risk and prognosis.

The diagnostic utility of bioelectrical impedance analysis in distinguishing precocious puberty from premature thelarche

OBJECTIVES

Clinical (assessing breast development), laboratory (FSH, LH, estradiol, and GnRH stimulation test), and radiological methods (bone age and pelvic ultrasonography) are used to distinguish central precocious puberty (CPP) from premature thelarche (PT). We examined also via bioelectrical impedance analysis (BIA).

METHODS

The fat mass (FM), fat-free mass (FFM), muscle mass (MM), bone mass (BM), total body water, and percentages (%), basal metabolic rate, phase angle (PhA), muscle-to-fat ratio (MFR), sarcopenic index, and segmental body proportions were determined via Tanita MC-780 MA model measuring device.

RESULTS

A total of 111 girls, 34 with CPP, 35 with PT, and 42 with healthy controls, were included. Although the baseline weight, height, and BMI SDS of the groups were not statistically different, the FM (%) was found to be lower (p=0.021), and the FFM (%) (p=0.021), MM (%) (p=0.015), BM (%) (p=0.022), and MFR values (p=0.017) were higher in CPP group. In CPP group, right arm FM (%) (p=0.016), left arm FM (%) (p=0.007), and trunk FM (%) (p=0.008) were lower than other groups.

CONCLUSIONS

We detected a MFR cutoff value of (2.96) with 58.8 % sensitivity and 58.4 % specificity, a cutoff value of (3.57) with 50 % sensitivity and 82 % specificity to differentiate CPP cases from others (PT and healthy controls). These rates are relatively low, but these are the first results in this field and may be guiding for studies conducted in large series.

Sarcopenia and the management of spinal disease in the elderly

Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.

Physical exercise for primary sarcopenia: an expert opinion

Sarcopenia is the age-related loss of skeletal muscle mass and function. Recently, research has focused on defining diagnostic criteria for this condition, now recognized as a muscle disease with a specific identifying code (ICD-10: M62.84). The diagnostic process for sarcopenia involves several stages, including the use of dedicated questionnaires and objective measurements of muscle strength and mass. According to international guidelines, therapeutic exercise is recommended to improve muscle mass, muscle strength, and physical performance. However, much of the supporting evidence comes from studies on non-sarcopenic elderly patients. Among types of therapeutic exercise, guidelines mainly emphasize muscle strengthening. The prescription of therapeutic exercise must consider the clinical and functional conditions of the patient (e.g., the presence of severe sarcopenia) and patient preferences. Muscle strengthening should target large muscle groups and include low-intensity resistance exercise for strength improvement, or high-intensity resistance exercise for additional benefits in muscle mass and function. Evidence suggests that an ideal therapeutic exercise program for sarcopenic patients should be multimodal, incorporating muscle strengthening, aerobic exercise, and balance control programs. This approach could enhance patient adherence by offering variety. Although multimodal therapeutic exercise improves muscle mass and function, these benefits can be lost during prolonged physical inactivity. Therefore, the exercise prescription must define intensity, volume (repetitions and sets), frequency, rest intervals, and duration, tailored to the type of exercise. Aerobic training programs improve endurance and optimize mitochondrial function. Balance training, important for reducing the risk of falls, should be done at least three times a week. Muscle strengthening should be done at least two days a week, starting at 50%-60% of 1 repetition maximum (RM) and progressing to 60%-80% of 1 RM, with approximately 10 exercises per session. Adopting comprehensive prescription protocols, such as those proposed in this paper, can significantly aid in the functional recovery and well-being of patients with sarcopenia.

A systematic review of the impact of Elexacaftor/Tezacaftor/Ivacaftor on body composition in people with cystic fibrosis

Elexacaftor/Tezacaftor/Ivacaftor (ETI) has led to improved lung function, life expectancy, and body mass index for people with Cystic Fibrosis (CF). The aim of this systematic review was to evaluate the impact that ETI has had on body composition in people with CF. A systematic review was performed using MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. Quality assessment using the Joanna Briggs Institute critical appraisal tools were performed. Results were summarised narratively. Five observational cohort studies involving a total of 185 participants were reviewed. Three studies showed an increase in fat mass (7.0-8.6 kg, 13.2-14.3 kg, and 13.4-15.5 kg). Two studies reported an increase in fat-free mass (49.4-50.1 kg, 52.5-55 kg), while one reported a decrease (50.5-48.9 kg). Two studies found an increase in fat mass index (4.1-6.3 kgm/2 and 4.7-5.4 kg/m2) and fat-free mass index (17.4-17.7 kg/m2 and 18.1-18.8 kg/m2). Two studies observed an increase in percentage body fat mass (12.1-15.4% and 23.1-27.6%). Four studies were classified as low quality, while one was considered medium quality. This review suggest that commencing ETI results in changes in body composition. Firm conclusions about the type and distribution of change in body composition cannot be made due to limited studies, high heterogeneity, and methodical weaknesses. It highlights the necessity for higher quality and longer-term studies to explore the impact that ETI is having on body composition.

The Prospective Applications of Bioelectrical Impedance Analysis in Postpartum Women

Bioelectrical impedance analysis (BIA) has a wide range of applications. For over 25 years, it has primarily been utilized for assessing body composition. This method is non-invasive, portable, widely available, cost-effective, and user-friendly, offering the advantage of repeatability and minimal dependence on patient cooperation. BIA measures the impedance of the whole body, specifically the body's resistance to alternating current. In postpartum women, who undergo significant physiological changes following childbirth, BIA can serve as a valuable diagnostic and monitoring tool. It is commonly employed to track body weight and fat reduction, and it facilitates the differentiation of fat mass, muscle mass, and body water content. This enables the customization of nutritional plans and the development of individualized training regimens tailored to the patient's health status. Additionally, BIA aids in the assessment of hydration status, which is particularly critical during the postpartum period when women often experience fluid retention. Furthermore, optimal hydration is essential for lactation and maintaining favorable conditions for breastfeeding. BIA is also invaluable for evaluating nutritional status, micronutrient balance, and preventing both overweight and malnutrition. Moreover, BIA supports physical recovery by monitoring muscle mass, thereby assisting in the assessment of pelvic floor muscle regeneration following childbirth.

Quantification of Lateralized Overgrowth and Genotype-Driven Tissue Composition

Lateralized overgrowth (LO) is characterized by excessive growth of one side of the body compared to the other. LO can present as isolated (ILO) or within syndromes, like Beckwith-Wiedemann Spectrum (BWSp) and PIK3CA-related overgrowth spectrum (PROS). Currently, the diagnosis of LO relies on clinical evaluation and lacks a standardized method. In this study, we evaluated total body dual-energy X-ray absorptiometry (TB-DXA) as a potential tool for standardizing LO assessment. Patients with LO underwent both clinical evaluation and TB-DXA. TB-DXA data, including total mass, mass of the three main tissue components (adipose, muscle, and bone), total mass discrepancy ratio, relative tissue composition, and discrepancy of relative tissue composition were calculated and compared with clinical findings. Differences between affected regions and the contralateral side were assessed. A total of 46 patients (61% PROS, 24% BWSp, 15% ILO) were included in this study. TB-DXA detected overgrowth regions aligned with clinical evaluation in 91% of cases and was able to identify localized overgrowth even when clinically overlooked. Additionally, TB-DXA revealed differences in tissue composition between affected and unaffected regions for symmetrical body areas, with these differences varying by diagnostic subgroup. Different patterns of tissue composition overgrowth were observed among different conditions, with PROS predominantly showing adipose tissue overgrowth, while BWSp/ILO mainly osteo-muscular overgrowth. TB-DXA is an accurate, safe, and reproducible tool in the clinical setting providing an objective method for identifying and quantifying LO. It offers valuable guidance for clinicians in the diagnosis and management of LO.

Beyond Traditional Body Composition Metrics: Load-Capacity Indices Emerge as Predictors of Cardiometabolic Outcomes-A Systematic Review and Meta-Analysis

The adaptive and independent interrelationships between different body composition components have been identified as crucial determinants of disease risk. On the basis of this concept, the load-capacity model of body composition, which utilizes measurements obtained through nonanthropometric techniques such as dual-energy X-ray absorptiometry, was proposed. This model is typically operationalized as the ratio of metabolic load (adipose mass) to metabolic capacity (lean mass). In recent years, a series of load-capacity indices (LCIs) have been utilized to identify abnormal body composition phenotypes such as sarcopenic obesity (SO) and to predict the risk of metabolic, cardiovascular, and cognitive disorders. In this review, we comprehensively review the characteristics of different LCIs used in previous studies, with a specific focus on their applications, especially in identifying SO and predicting cardiometabolic outcomes. A systematic literature search was performed using PubMed, MEDLINE, PsycINFO, Embase, and the Cochrane Library. Two meta-analyses were conducted to 1) estimate the overall prevalence of SO mapped by LCIs, and 2) assess the association of LCIs with cardiometabolic outcomes. A total of 48 studies (all observational) were included, comprising 22 different LCIs. Ten studies were included in the meta-analysis of SO prevalence, yielding a pooled prevalence of 14.5% [95% confidence interval (CI): 9.4%, 21.6%]. Seventeen studies were included in the meta-analysis of the association between LCIs and adverse cardiometabolic outcomes, which showed a significant association between higher LCI values and increased risk (odds ratio = 2.22; 95% CI: 1.81, 2.72) of cardiometabolic diseases (e.g. diabetes and metabolic syndrome). These findings suggest that the load-capacity model of body composition could be particularly useful in the identification of SO cases and prediction of cardiometabolic risk. Future longitudinal studies are needed to validate the association of LCIs with chronic cardiometabolic and neurodegenerative diseases. This systematic review and meta-analysis has been registered with PROSPERO (CRD42024457750).

Association between the development of intensive care unit-acquired weakness and body composition at intensive care unit admission: A descriptive study

PURPOSE

To evaluate differences in body composition at intensive care unit (ICU) admission between patients with and without ICU-acquired weakness (ICU-AW).

MATERIALS AND METHODS

This single-center, retrospective cohort study was conducted at Tsukuba Memorial Hospital's mixed ICU in Japan. We included patients who could walk unassisted before admission, received rehabilitation post-admission, and survived for at least 48 h. Body composition was assessed using bioelectrical impedance analysis (BIA) at ICU admission. Patients were classified into ICU-AW and non-ICU-AW groups, and their characteristics, outcomes, and body compositions were compared.

RESULTS

Of the 282 patients analyzed, 28 (9.9 %) developed ICU-AW. ICU-AW patients were older (79 [72-86] vs. 70 [61-77], P < 0.01) and had higher SOFA scores (8 [5-13][ vs. 3 [2-6], P < 0.01). BIA showed a higher extracellular water to total body water ratio (0.408 [0.391-0.414] vs. 0.388 [0.380-0.400], P < 0.01) and a lower phase angle (3.7 [3.3-4.9] vs. 4.9 [4.2-5.7], P < 0.01) in the ICU-AW group. Skeletal muscle mass was similar between groups (23.2 [18.9-26.0] vs. 24.8 [20.5-28.3], P = 0.07).

CONCLUSIONS

ICU-AW patients had poorer cellular nutritional status but similar skeletal muscle mass at ICU admission compared to non-ICU-AW patients.

Body composition assessment measured via bioelectrical impedance analysis in euthyroid children with newly diagnosed Hashimoto's thyroiditis

OBJECTIVES

The effects of thyroid hormones on body composition are well-known. We aimed to examine the body composition of children with and without Hashimoto's thyroiditis (HT) by bioelectrical impedance analysis (BIA) while they were still euthyroid.

METHODS

Between the ages of 5 and 18, 53 girls and 12 boys in each group, 65 children with HT, and 65 healthy children were included in this study. The Tanita MC-780 MA model was used to evaluate body composition parameters. These are fat mass (FM), fat-free mass (FFM), muscle mass (MM), bone mass (BM), total body water (TBW), phase angle, the ratio of muscle mass to fat mass (MFR), basal metabolic rate (BMR), and sarcopenic index (SI). Weight, height, body mass index standard deviation scores (SDSs), and pubertal status were examined. Additionally, TSH, Free-T4, Free-T3, Anti-TPO, Anti-Tg, serum lipid levels, and thyroid volumes were compared.

RESULTS

We observed that TBW (27.5 ± 7.5 kg vs. 24.8 ± 6.6 kg; p=0.029) and BMR (1,403 ± 253 kcal vs. 1,324 ± 200 kcal; p=0.049) were higher in the HT group. These differences are due to differences in age and muscle mass in the male group. The FM, FFM, MM, BM, MFR, SI, and phase angle scores did not differ between females with and without HT in euthyroid children by the BIA method.

CONCLUSIONS

There is no significant change in body composition in euthyroid females with HT at admission.

Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients

Nutritional support in critically ill patients has been acknowledged as a pillar of ICU care, playing a pivotal role in preserving muscle mass, supporting immune function, and promoting recovery during and after critical illness. Providing effective nutritional support requires adapting it to the patient's diagnosis, unique characteristics, and metabolic state to minimize the risks of overfeeding or underfeeding while mitigating muscle loss. This level of care requires a comprehensive nutritional assessment and the establishment of a nutrition-focused protocol. Regular, consistent and detailed nutritional evaluation can influence both therapeutic decisions and clinical interventions, thus ensuring that the specific needs of critically ill patients are met from the acute phase through their entire recovery process. Bioelectrical impedance analysis (BIA) is increasingly recognized as a valuable tool for enhancing nutritional care in critically ill patients. By delivering precise, real-time insights into key aspects of body composition, BIA is thought to provide clinicians with a more comprehensive understanding of the complex physiological changes that occur during critical illness. This narrative review highlights the potential of BIA in offering these precise assessments, facilitating the development of more accurate and personalized nutritional strategies for critically ill patients. If BIA can reliably assess dynamic shifts in hydration and tissue integrity, it holds the promise of further advancing individualized care and optimizing clinical outcomes in this vulnerable population.

Anthropometric Measurements and Laboratory Methods for Pregnancy: An Update Review to Evaluation of Body Composition

PURPOSE OF REVIEW

The aim of this review is to summarize and put into context the current evidence on anthropometric measurements and laboratory methods used in the evaluation of body composition in pregnancy, in the light of current studies.

RECENT FINDINGS

Protecting women's health during pregnancy, childbirth and the postnatal period is important for maternal health. Pregnancy is a critical period during which the female body undergoes significant changes to support fetal growth and development. Maternal changes in body composition are associated with fatal development and maternal health during pregnancy. Anthropometry is a simple, reliable, and low-cost method that can be applied globally in primary care for evaluating maternal nutritional status. Maternal anthropometry is important in predicting various complications that may occur during pregnancy, such as intrauterine growth retardation and the risk of low birth weight. In this context, anthropometric measurements such as body weight, skinfold thickness, and middle upper arm circumference, and laboratory methods such as body water, body density, bioelectrical impedance analysis, ultrasound, dual-energy X-ray absorptiometry, and magnetic resonance imaging are frequently used in estimating the body composition of pregnant women. In addition to body weight gain monitoring, it is possible to determine the body composition of a pregnant woman by using different anthropometric measurements and the proposed equations. Accurate evaluation of anthropometric measurements and body composition in pregnant women is important in protecting the health of the mother and baby and in the early diagnosis of complications that may occur during pregnancy.

Compared to dual-energy X-ray absorptiometry, bioelectrical impedance effectively monitors longitudinal changes in body composition in children and adolescents with obesity during a lifestyle intervention

Accurate and efficient body composition assessment is essential for diagnosing and monitoring childhood obesity in clinical and research settings. This study evaluated the agreement between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in assessing body composition and its changes during a long-term lifestyle intervention in children and adolescents with obesity. We hypothesized that BIA is comparable to DXA in tracking longitudinal changes in body composition in this population. The study included 92 children and adolescents 5 to 17 years of age (mean 10.5 ± 2.9 years) classified as obese at the time of measurement (body mass index-standard deviation score ≥ 2 SD). From January 1, 2014, to December 31, 2017, they participated in a lifestyle intervention at Randers Regional Hospital. Body composition was assessed using BIA and DXA at baseline and follow-up (mean 20.5 ± 9.3 months). Bland-Altman plots, correlation- and concordance analyses were used to evaluate the agreement between methods. Bland-Altman plots demonstrated wide limits of agreement without significant bias for longitudinal changes in fat mass (FM), FM%, fat-free mass (FFM), and FFM% (0.39 kg (CI -0.14, 0.93), -0.39% (CI -1.06, 0.26), -0.21 kg (CI -0.73, 0.31), and 0.39% (CI -0.27, 1.05), respectively). Correlations between methods for changes in FM, FM%, FFM, and FFM% were 0.93, 0.83, 0.88, and 0.83, respectively. In cross-sectional assessments, BIA underestimated FM and FM% and overestimated FFM and FFM% compared to DXA. Conclusively, BIA effectively monitors longitudinal changes in body composition at a group level in a pediatric population with obesity. However, caution is needed for individual assessments.

Infant body composition trajectories differ by in utero exposure to gestational diabetes mellitus: a prospective cohort from birth to 12 months

BACKGROUND

Infants exposed to gestational diabetes mellitus (GDM) in utero are known to have higher fat mass (FM) and less fat-free mass (FFM) at birth, but little is known about how their adiposity changes over the first year of life.

OBJECTIVES

We identified growth and body composition patterns across the first year and evaluated for differences by GDM exposure status.

METHODS

Among 198 infants (52% GDM exposed), growth and body composition with total body electrical conductivity were obtained from birth to 1 y. Latent class mixed modeling (LCMM) trajectories were fit for weight-, length-, and body mass index (BMI)-for-age World Health Organization z-scores, as well as percent body fat, FM, and FFM. Adjusted associations between GDM with trajectory classes were evaluated with multiple logistic regression.

RESULTS

At birth, infants exposed to GDM had higher FM, higher percent body fat, and a higher BMI compared with infants unexposed. A larger proportion of infants exposed to GDM were classified into LCMM growth trajectory classes that experienced less FM (67% GDM exposed) and percent body fat gain (79% GDM exposed), compared with the other classes (Χ2P values <0.05). In adjusted models, infants exposed to GDM were 69% less likely (Relative Risk Ratios (RRR) = 0.39, 95% confidence interval: 0.11, 0.82) to belong in the highest FM trajectory that reached 4 kg of FM at 1 y of age. In adjusted models, GDM exposure was not associated with FFM, weight-, length-, or BMI-for-age trajectories.

CONCLUSIONS

In a cohort of infants exposed and unexposed to GDM in utero, infants exposed had increased weight, FM, and percent body fat at birth. However, more infants exposed to GDM had less fat accrual over the first year of life, compared with those unexposed. The long-term effects of these growth patterns in the first year challenge current concepts and support further investigation of neonatal body composition.

Development and clinical application of bioelectrical impedance analysis method for body composition assessment

Obesity, which is characterized by excessive body fat, increases the risk of chronic diseases, such as type 2 diabetes, cardiovascular diseases, and certain cancers. Sarcopenia, a decline in muscle mass, is also associated with many chronic disorders and is therefore a major concern in aging populations. Body composition analysis is important in the evaluation of obesity and sarcopenia because it provides information about the distribution of body fat and muscle mass. It is also useful for monitoring nutritional status, disease severity, and the effectiveness of interventions, such as exercise, diet, and drugs, and thus helps assess overall health and longevity. Computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry are commonly used for this purpose. However, they have limitations, such as high cost, long measurement time, and radiation exposure. Instead, bioelectrical impedance analysis (BIA), which was introduced several decades ago and has undergone significant technological advancements, can be used. It is easily accessible, affordable, and importantly, poses no radiation risk, making it suitable for use in hospitals, fitness centers, and even at home. Herein, we review the recent technological developments and clinical applications of BIA to provide an updated understanding of BIA technology and its strengths and limitations.

Bioimpedance spectroscopy: Is a picture worth a thousand words?

Volume status can be difficult to assess in dialysis patients. Peripheral edema, elevated venous pressure, lung crackles, and hypertension are taught as signs of fluid overload, but sensitivity and specificity are poor. Bioimpedance technology has evolved from early single frequency to multifrequency machines which apply spectroscopic analysis (BIS), modeling data to physics-based mixture theory. Bioimpedance plots can aid the evaluation of hydration status and body composition. The challenge remains how to use this information to manage dialysis populations, particularly as interventions to improve over hydration, sarcopenia, and adiposity are not without side effects. It is therefore of no surprise that validation studies for BIS use in peritoneal dialysis patients are limited, and results from clinical trials are inconsistent and conflicting. Despite these limitations, BIS has clinical utility with potential to accurately evaluate small changes in body tissue components. This article explains the information a BIS plot ("picture") can provide and how it can contribute to the overall clinical assessment of a patient. However, it remains the role of the clinician to integrate information and devise treatment strategies to optimize competing patient risks, fluid and nutrition status, effects of high glucose PD fluids on membrane function, and quality of life issues.

Nutritional Challenges in Paediatric Oncology: Screening and Managing Malnutrition and Sarcopenia

Sarcopenia and malnutrition can coexist in pediatric patients with neoplasia, worsening the patient's prognosis. The classification of primary and secondary sarcopenia may be helpful in clinical practice, as it can help with timely initiation of appropriate and tailored dietary treatments to address it. This review summarizes the current state of the art of assessing skeletal muscle function in children and adolescents with cancer and discusses the role of nutritional interventions in the management of children with cancer. It highlights the urgent need for comprehensive nutritional support and interventions to mitigate the impact of malnutritions on both treatment outcomes and patients' well-being.

Glucagon-like peptide-1 receptor agonist-based agents and weight loss composition: Filling the gaps

Excess adiposity is at the root of type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as first-line treatments for T2D based on significant weight loss results. The composition of weight loss using most diets consists of <25% fat-free mass (FFM) loss, with the remainder from fat stores. Higher amounts of weight loss (achieved with metabolic bariatric surgery) result in greater reductions in FFM. Our aim was to assess the impact that GLP-1RA-based treatments have on FFM. We analysed studies that reported changes in FFM with the following agents: exenatide, liraglutide, semaglutide, and the dual incretin receptor agonist tirzepatide. We performed an analysis of various weight loss interventions to provide a reference for expected changes in FFM. We evaluated studies using dual-energy X-ray absorptiometry (DXA) for measuring FFM (a crude surrogate for skeletal muscle). In evaluating the composition of weight loss, the percentage lost as fat-free mass (%FFML) was equal to ΔFFM/total weight change. The %FFML using GLP-1RA-based agents was between 20% and 40%. In the 28 clinical trials evaluated, the proportion of FFM loss was highly variable, but the majority reported %FFML exceeding 25%. Our review was limited to small substudies and the use of DXA, which does not measure skeletal muscle mass directly. Since FFM contains a variable amount of muscle (approximately 55%), this indirect measure may explain the heterogeneity in the data. Assessing quantity and quality of skeletal muscle using advanced imaging (magnetic resonance imaging) with functional testing will help fill the gaps in our current understanding.

Systematic Exploration of the Association Between Vitamin A Intakes and Sarcopenia Prevalence in American Adults

Sarcopenia, characterized by an age-related progressive loss of muscle mass and strength, presents significant health concerns. Recommending dietary nutrition emerges as a viable strategy to counteract muscle deterioration. Vitamin A, indispensable throughout the human life cycle and unattainable through endogenous synthesis, necessitates intake via diet. However, the direct correlation between sarcopenia prevalence and vitamin A intake remains unclear. This study systematically investigated the relationship between sarcopenia prevalence and vitamin A intake, including retinol and some carotenoids, across diverse races and genders utilizing multiple statistical analyses. Mixture analysis revealed significant positive correlations between total vitamin A intake and muscle mass among American adult males (Male: OR: 1.019, 95% CI: 1.010-1.027, p < 0.001). We also observed the gender-specific results, with retinol playing a more significant role in enhancing muscle mass for males, while certain carotenoids were found to be more influential in females. Moreover, inflammation and oxidative stress mediated the relationship between vitamin A intake and sarcopenia prevalence in both genders. There may be a gender- and race-specific relationship between dietary vitamin A intake and sarcopenia. Further prospective studies are imperative to elucidate the association between vitamin A intake and sarcopenia prevalence.

MRI-Based Phenotyping for Osteosarcopenic Adiposity in Subjects from a Population-Based Cohort

Objective: Imaging biomarkers of bone, muscle, and fat by magnetic resonance imaging (MRI) may depict osteopenia, sarcopenia, and adiposity as the three different conditions of osteosarcopenic adiposity (OSA). Methods: Subjects from a prospective, population-based case-control study underwent a health assessment and 3 Tesla whole-body MRI scan. Imaging biomarkers of bone (bone marrow fat-fraction (BMFF)), skeletal muscle (skeletal muscle FF (SMFF)), and fat (total adipose tissue (TAT)) were determined. Participants were allocated to one phenotype according to the OSA complex. Results: Among 363 participants forming the study cohort, 81 (22.3%, 48.1% males, 62.4 ± 6.9 years) were allocated into the OSA subgroup. Participants with an OSA phenotype were significantly older compared to all remaining subjects and showed the highest grades of SMFF (all p < 0.005). Together with subjects from the osteopenic sarcopenia group, OSA subjects exhibited the highest amounts of BMFF and together with the three other adiposity-containing subgroups also exhibited the highest BMIs. The highest prevalence of an impaired glucose tolerance as well as significantly higher blood pressure, blood dyslipidemia, and hepatic steatosis was found in the OSA subgroup (all p < 0.005). Conclusions: MR biomarkers of bone, skeletal muscle and fat are feasible for body composition phenotyping and may allow for targeted risk stratification in suspected OSA syndrome.

Combination of body mass index and body fat percentage in middle and late pregnancy to predict pregnancy outcomes in patients with gestational diabetes in Wenzhou, China: a single-centre retrospective cohort study

OBJECTIVES

The present study aimed to evaluate whether body mass index (BMI) and body fat percentage (BFP) could be used to predict pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

DESIGN

Retrospective cohort study.

SETTING

Wenzhou Medical University Affiliated Second Hospital (Zhejiang Province, China). Clinical data were collected from electronic medical records.

PARTICIPANTS

Data from 683 patients with GDM admitted to the Wenzhou Medical University Affiliated Second Hospital between January 2019 and December 2021 were retrospectively analysed.

OUTCOME MEASURES

Pregnancy outcomes.

RESULTS

The results showed that pregnant women with BFP ≥33% were more prone to abnormal amniotic fluid volume, abnormal blood pressure and anaemia (p<0.05). Additionally, these patients were more likely to experience postpartum haemorrhage and macrosomia, as well as risk factors associated with caesarean section at labour (p<0.05). BMI exhibited a strong predictive value for abnormal blood pressure (OR 1.170; 95% CI 1.090 to 1.275), anaemia (OR 1.073; 95% CI 1.016 to 1.134), caesarean section (OR 1.150; 95% CI 1.096 to 1.208) and macrosomia (OR 1.169; 95% CI 1.063 to 1.285). Additionally, classified BFP had a predictive value for abnormal amniotic fluid volume (OR 3.196; 95% CI 1.294 to 7.894), abnormal blood pressure (OR 2.321; 95% CI 1.186 to 4.545), anaemia (OR 1.817; 95% CI 1.216 to 2.714), and caesarean section (OR 1.734; 95% CI 1.270 to 2.367).

CONCLUSIONS

The results suggest that patients with GDM with BFP ≥33% were more likely to experience unfavourable pregnancy outcomes, undergo caesarean section and develop macrosomia. The combination of BMI with classified BFP could better predict abnormal blood pressure and caesarean section in patients with GDM during the middle and late stages of pregnancy.

Dysphagia and Body Composition in Cornelia de Lange Syndrome

BACKGROUND/OBJECTIVES

Limited research had investigated nutritional status in patients with Cornelia de Lange Syndrome (CdLS) (OMIM 122470, 300590, 300882, 610759, 620568 and 614701). Body composition assessed via bioelectric impedance (BIA) is a particularly under-explored issue. In this cross-sectional study, we hypothesize that body composition imbalance is frequent in CdLS and may be associated with dysphagia. We aimed to determine dysphagia prevalence in CdLS. Dysphagia may be a sign or a complication of GERD (gastroesophageal reflux disease), which is the most frequent gastroenterological disorder in CdLS patients; Methods: Fourteen Polish patients with a clinical or genetic diagnosis of CdLS were included in the study. We performed body composition analysis via bioelectric impedance taking into account the phase angle (PhA) and Body Cell Mass (BCM) in patients who cooperated and were able to sit still. The patients' caregivers completed the pediatric version of the Eating Assessment Tool (PEDI-EAT-10). Based on the questionnaire scoring, we divided the patients into dysphagic and non-dysphagic groups. Body compartments of those two groups were compared. Statistical correlations between PhA and the PEDI-EAT-10 score were calculated; Results: Eleven of the fourteen CdLS patients had abnormalities in the BIA analysis in terms of fat mass (FM), fat free mass (FFM) and skeletal muscle mass (SMM). Six patients had excessive FM and four patients were deficient in FM. Two had deficiency in FFM and two had excessive FFM. We noted prevalence of dysphagia at 28.57%, with four patients having an PEDI-EAT-10 score higher or equal to 3, categorized as dysphagic. The dysphagic and non-dysphagic groups were not significantly different in terms of the proportion of patients with FM, FFM, SMM and BCM in the small cohort presented here. A statistically significant inverse correlation was found between the PhA and PEDI-EAT-10 score (rho = -0.72; p = 0.003); Conclusions: CdLS patients require investigation for dysphagia and nutritional status imbalance, as they are both frequent in this syndrome. The most prevalent are abnormalities in FM, both excess and deficit. PhA deviations observed in the bioimpedance study deepen with the severity of dysphagia. These findings require further investigation in a larger cohort.

Body composition assessment in 6-month-old infants: A comparison of two- and three-compartment models using data from the Baby-bod study

BACKGROUND/OBJECTIVES

An appreciation of infant body composition is helpful to understand the 'quality' of growth in early life. Air displacement plethysmography (ADP) using PEA POD and the deuterium dilution (DD) technique are commonly used body composition approaches in infants. We evaluated the comparability of body composition assessed using both techniques with two-compartment (2C) and three-compartment (3C) models in 6-month-old infants.

SUBJECTS/METHODS

Infant fat mass (FM) and percent fat mass (%FM) obtained from a 2C model using PEA POD (2C-PP) and a 2C model using the deuterium dilution technique (2C-DD) were compared to those derived from a 3C model, and to each other, using Bland-Altman analysis and Deming regression.

RESULTS

Measurements were available from 68 infants (93% Caucasian, 53% male). The mean biases were not significant between any of the method comparisons. However, significant constant and proportional biases were identified in 2C-DD vs 3C and 2C-PP vs 2C-DD, but not in the 2C-PP vs 3C comparison. Furthermore, we observed significant associations between the mean differences and infants' percent total body water (%TBW).

CONCLUSIONS

While no significant between-method mean differences were found in body composition estimates, some comparisons revealed significant constant and proportional biases and notable associations between the mean differences and %TBW were observed. Our results emphasise the importance of method choice, ensuring methodological uniformity in long-term studies, and carefully considering and regulating multiple pre-analytical variables, such as the hydration status of the participants.

Body composition, metabolic syndrome, and lifestyle in treatment-naïve gender-diverse youth in Israel

BACKGROUND

There is a scarcity of published studies evaluating transgender/gender-diverse youth before initiating gender-affirming hormones.

AIM

To study the body composition, metabolic syndrome (MetS) components and lifestyle habits in treatment-naïve transgender youth.

METHODS

Cross-sectional study evaluating 153 transgender youth [median age 15.7 years, 94 transgender males] who attended The Israeli Children and Adolescents Gender Clinic between 6/2021-12/2022. Clinical, metabolic data and lifestyle habits (diet, physical activity and sleep patterns) were retrieved from the medical files. Body composition was determined by bioelectrical impedance analysis. Body mass index and muscle-to-fat ratio z-scores were calculated by sex designated at birth.

RESULTS

Weight categories differed between genders, with a greater proportion of subjects classified as underweight among transgender females, and a greater proportion affected by overweight/obese/severe obese among transgender males (p = 0.035). The odds for MetS components were increased by 2.2 for every 1 standard deviation decrease in the muscle-to-fat ratio z-score (95%CI: 1.45 to 3.26, p < 0.001). About one-third of the cohort did not meet any of the three lifestyle recommendations. Transgender males had increased odds for MetS components by 3.49 (95%CI: 1.63 to 7.44, p = 0.001).

CONCLUSIONS

Treatment-naïve transgender-male adolescents have an imbalance between muscle and adipose tissue, which places them at increased susceptibility for MetS components even prior to hormonal treatment.

Technical and Biological Reliability of pQCT Measured Bone and Muscle Tissue Quality Across the Age-Span

INTRODUCTION

Reliable peripheral quantitative computed tomography (pQCT) assessment is essential to the accurate longitudinal reporting of bone and muscle quality. However, the between-day reliability of pQCT and the influence of age on outcome reliability is currently unknown.

OBJECTIVE

To quantify the same- and between-day reliability of morphological pQCT at proximal and distal segments of the forearm, shank, and thigh, and explore the influence of participant body size, age, and sex on outcome reliability.

METHODS

Men and women (49 % female, 18-85 years, n=72-86) completed two consecutive-day pQCT testing sessions, where repeat measurements were conducted on day-one for technical error, and between-day for biological error quantification. Testing was undertaken following best practice body composition testing guidance, including standardized presentation and consistent time-of-day.

RESULTS

All measurements of bone were classified as having 'good' to 'excellent' reliability [intraclass correlation coefficient (r=0.786- 0.999], as were measurements of muscle area (ICC r=0.991-0.999) and total fat (r=0.996-0.999). However, between- and same-day muscle density measurements at the thigh and forearm were classified as 'poor' (r=0.476) and 'moderate' (r=0.622), respectively. Likewise, intramuscular fat area at the thigh was classified as 'moderate' (r=0.737) for between-day measurement. Biological error was inflated compared to technical error by an average of 0.4 % for most measurements. Error values tended to increase proportionally with the amount of tissue quantified and males had significantly greater biological error for measurement of distal tibial bone (p<0.002) and trabecular area (p<0.002). Biological error was inflated among older adults for measurement of forearm muscle density (p<0.002).

CONCLUSIONS

Most pQCT outcomes can be implemented with confidence, especially outcomes that assess bone area and density at any of the radial, tibial, and femoral sites investigated herein. However, it is important to account for the influence of biological measurement error in further studies, especially for muscle and intramuscular fat outcomes derived by pQCT.

Assessing skeletal muscle mass and lean body mass: an analysis of the agreement among dual X-ray absorptiometry, anthropometry, and bioelectrical impedance

Introduction

Methods of body composition estimation such as dual-energy X-ray absorptiometry (DXA), anthropometry, and bioimpedance (BIA) are used for the estimation of skeletal muscle mass (SMM) and lean body mass (LBM). No previous studies have examined whether these methods generate comparable results, or whether they are valid by using DXA as the reference. The aims of the present investigation were: (a) to assess the differences between DXA, anthropometry, and BIA in the estimation of SMM and LBM, taking into consideration the impact of sex and hydration status; and (b) to examine the agreement of anthropometry and BIA as compared to DXA for the estimation of SMM and LBM.

Methods

A descriptive cross-sectional design was followed with 262 healthy young adults (159 males and 103 females). LBM and SMM were assessed by anthropometry with the formulas from Lee et al. and Kulkarni et al. for LBM; and Kerr (opt a), Kerr (opt b), Lee et al., Poortmans, Matiegka, Martin et al., Drinkwater and Ross, and Heymsfield et al. for SMM; by BIA with the formula reported by the TANITA MC-780-MA software for LBM and SMM; and DXA with the formula reported by the Hologic Horizon software for LBM, and the conversion by Kim et al. for SMM.

Results

Significant differences were found for both SMM and LBM in kg, and percentages between most methods and formulas for the overall sample (p < 0.001-0.003) and divided by sex (p < 0.001-0.035). Hydration status did not have a significant effect on the differences between methods and formulas (p = 0.058-0.870). Lin's coefficient revealed limited agreement among the majority of formulas and methods (CCC = 0.007-0.880). The Bland-Altman analysis showed significant differences in most methods and formulas, both in the overall sample and divided by sex, when using SMM and LBM with DXA as the reference (p < 0.001-0.030).

Conclusion

There is a lack of agreement between methods and formulas for assessing SMM and LBM. Sex was found to be a significant factor in this analysis. Furthermore, significant differences were observed between most formulas and methods as compared to DXA, except for the equations to estimate SMM with anthropometry by Poortmans.

Can physical activity counteract the negative effects of sedentary behavior on the physical and mental health of children and adolescents? A narrative review

Background

The increase in sedentary behavior (SB) in children and adolescents is one of the major threats to global public health, and the relationship between physical activity (PA) and SB has always been a key topic.

Methods

The literature search was conducted through PubMed, Web of Science, CNKI, Wanfang, and Scopus, and 121 pieces of literature were included in this study after screening and evaluation.

Results

(1) SB caused by screen time such as mobile phones and TVs has varying degrees of negative impact on obesity, cardiovascular metabolism, skeletal muscle development, and cognitive, and psychological disorders in children and adolescents. (2) Regular physical activity could effectively prevent, offset, or improve the harm of SB to the physical and mental health of children and adolescents, mainly by reducing the incidence of obesity, and cardiovascular and metabolic risks, promoting skeletal muscle development, and improving cognitive function and mental health. (3) The mechanism of physical activity to prevent or ameliorate the harm of SB was relatively complex, mainly involving the inhibition or activation of neurobiomolecules, the improvement of blood and cell metabolic factors, and the enhancement of brain functional connectivity.

Conclusions

Children and adolescents should avoid excessive SB, and through a variety of moderate to vigorous physical activity (MVPA) to replace or intermittent SB, which could effectively prevent or improve the harm of SB to physical and mental health.

Vitamin D deficiency, insulin resistance, and antimüllerian hormone level: a tale of trio in the expression of polycystic ovary syndrome

OBJECTIVE

To study the association between altered vitamin D profiles and different indices as well as clinical features of polycystic ovary syndrome (PCOS), including antimüllerian hormone (AMH) levels, phenotypes (A [hyperandrogenism {HA} + ovulatory dysfunction {OD} + polycystic ovarian morphology {PCOM}], B [HA + OD], C [HA + PCOM], and D [OD + PCOM]), insulin resistance, oligomenorrhea, hyperandrogenism, obesity indices, and stress biomarkers in the ethnic population of West Bengal.

DESIGN

Case-control observational study.

SETTING

Outpatient department of gynecology and obstetrics and environing.

PARTICIPANTS (PATIENTS AND CONTROL)

Sample size: case group (PCOS, n = 160), age: 16-38 years, and their gender, age, as well as ethnicity-matched healthy control (n = 160).

INTERVENTION(S)

In this observational study, a structured questionnaire for menstrual status and to determine the scores of cutaneous manifestations, a bioelectrical impedance analyzer for measurement of anthropometric indices, relevant biochemical assessments (vitamin D, AMH, insulin, glucose, and other associated hormonal profiles), statistical software for the social sciences, and Microsoft Office Excel were used to evaluate as well as analyze different indices.

MAIN OUTCOME MEASURE(S)

Study of the association of vitamin D deficiency with differential manifestations of PCOS such as phenotypes of the syndrome, altered AMH levels, and risk of insulin resistance. An attempt has been made to determine the cutoff value of AMH of the patients with PCOS belonging to the ethnic population of West Bengal using receiver operating characteristic (ROC).

RESULT(S)

Vitamin D deficiency was found to be directly correlated with AMH level in PCOS phenotype A (67%), oligomenorrhea, and PCOM, along with a substantial agonistic relationship with insulin resistance in the PCOS population under study. In the PCOS phenotype B, the AMH level was highest, with a cutoff value of 5.27 ng/mL (asymptotic sig. = 0.000, 95% confidence interval: 8.37-9.95, derived by ROC analysis, with area under the ROC curve- area under the curve value = 0.949, sensitivity=0.882, and specificity = 0.880). Oligomenorrhic women with PCOS possess significantly higher values of AMH levels (8.70 ± 3.66 > 3.09 ± 1.86 ng/mL) level than the regular menstrual rhythm within the same group. Patients with PCOS had significantly less skeletal muscle mass and greater subcutaneous fat content than the control group.

CONCLUSION(S)

25-hydroxy-vitamin D might be intermeshed with the underlying pathophysiology and severity of PCOS, as well as associated metabolic disorders like insulin resistance. The AMH level is finely tuned by most of the plausible effectors of PCOS and contends to be a promising biomarker for the diagnosis as well as prognosis of PCOS.

Association of changes in predicted body composition with subsequent risk of dementia

OBJECTIVE

The effect of body composition change on the risk of dementia is not clear. This study analyzed the associations of changes in predicted lean body mass index (pLBMI), predicted appendicular skeletal muscle mass index (pASMI), and predicted body fat mass index (pBFMI) with the risk of dementia.

METHODS

In this nationwide cohort study, data were obtained from the Korean National Health Insurance Service database. The exposure was defined as changes in pLBMI, pASMI, and pBFMI derived from validated prediction equations. The outcome was dementia, defined based on the dementia diagnosis with prescription of anti-dementia medication. Cox proportional hazards regression analyses were performed to obtain the hazard ratio with a 95% confidence interval for risk of dementia according to changes in predicted body composition.

RESULTS

A total of 13,215,208 individuals with no prior record of dementia who underwent health screenings twice between 2009-2010 and 2011-2012 were included. A 1-kg/m2 increase in pLBMI and pASMI had an association with reduced risk of dementia (aHR: 0.85, 95% CI 0.84-0.87; aHR: 0.70, 95% CI 0.69-0.72, respectively for men, and aHR: 0.69, 95% CI 0.67-0.71; aHR: 0.59, 95% CI 0.57-0.61, respectively for women). A 1-kg/m2 increase in pBFMI had an association with a raised risk of dementia (aHR: 1.19, 95% CI 1.17-1.21 for men and aHR: 1.53, 95% CI 1.48-1.57 for women). These results remained consistent regardless of sex or weight change.

INTERPRETATION

Increase in pLBMI or pASMI, or reduction in pBFMI was linked to lower risk of dementia.

Study of Body Composition by Biphotonic X-ray Absorptiometry in a Moroccan Female Population, an Indicator of Obesity?

INTRODUCTION

Our purpose was to study the body composition in a healthy female Moroccan adult group, and to help physicians to evaluate nutritional status.

MATERIALS AND METHODS

Five hundred and nineteen healthy women aged from 20 to 80 years were included in the study. Bone mineral density at the hip and lumbar spine and the body composition parameters were measured by dual-energy X-ray absorptiometry: fat mass (FM), fat-free mass (FFM), and percentage (%) of body fat. The FFM index (FFMI) and the FM index (FMI) were calculated. We analyzed the population by age and body mass index (BMI) defined groups.

RESULTS

The mean age of the population was 53.14 ± 13.69 years with an average BMI of 29.30 ± 5.04 kg/m2. Means of FM and FFM were 33.93 ± 9.18 kg and 36.91 ± 5 kg, respectively, with FM and FFMI of 13.65 ± 3.66 kg/m2 and 14.85 ± 1.91 kg/m2, respectively. The % FM, FFM, and their corresponding indices increased with age; a statistically significant difference was observed between the 20 and 39 age categories and the two other categories. The BMI category analysis showed that FFMI and FMI increased in obese women with a statistically significant difference between the four groups. Age and BMI were correlated significantly with the different parameters.

CONCLUSION

This is the first Moroccan study to present body composition indexes in healthy Moroccan female adults. These reference values may be useful for the clinical evaluation of body composition and nutritional status.

Prediction of resting energy expenditure for adolescents with severe obesity: A multi-centre analysis

BACKGROUND AND OBJECTIVES

Resting energy expenditure (REE) assessments can help inform clinical treatment decisions in adolescents with elevated body mass index (BMI), but current equations are suboptimal for severe obesity. We developed a predictive REE equation for youth with severe obesity and obesity-related comorbidities and compared results to previously published predictive equations.

METHODS

Data from indirect calorimetry, clinical measures, and body composition per Dual x-ray absorptiometry (DXA) were collected from five sites. Data were randomly divided into development (N = 438) and validation (N = 118) cohorts. A predictive equation was developed using Elastic Net regression, using sex, race, ethnicity, weight, height, BMI percent of the 95th%ile (BMIp95), waist circumference, hip circumference, waist/hip ratio, age, Tanner stage, fat and fat-free mass. This equation was verified in the validation cohort and compared with 11 prior equations.

RESULTS

Data from the total cohort (n = 556, age 15 ± 1.7 years, 77% female, BMIp95 3.3 ± 0.94) were utilized. The best fit equation was REE = -2048 + 18.17 × (Height in cm) - 2.57 × (Weight in kg) + 7.88 × (BMIp95) + 189 × (1 = male, 0 = female), R2 = 0.466, and mean bias of 23 kcal/day.

CONCLUSION

This new equation provides an updated REE prediction that accounts for severe obesity and metabolic complications frequently observed in contemporary youth.

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILE-HF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.

Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity

Obesity reflects excessive fat deposits. At-risk individuals are guided by healthcare professionals to eat fewer calories and exercise more, often using body mass index (BMI; weight/height2) thresholds for screening and to guide progress and prognosis. By conducting a mini-narrative review of original articles, websites, editorials, commentaries, and guidelines, we sought to place BMI in the context of its appropriate use in population health, clinical screening, and monitoring in clinical care. The review covers studies and publications through 2023, encompassing consensus reviews and relevant literature. Recent consensus reviews suggest that BMI is a valuable tool for population surveys and primary healthcare screening but has limitations in predicting the risk of chronic diseases and assessing excess fat. BMI can guide nutritional and exercise counseling, even if it is inadequate for reliable individual risk prediction. BMI cut-offs must be reconsidered in populations of varying body build, age, and/or ethnicity. Since BMI-diagnosed overweight persons are sometimes physically and physiologically fit by other indicators, persons who are overweight on BMI should be more fully evaluated, diagnosed, and monitored with combined anthropometric and performance metrics to better clarify risks. The use of combined anthropometric and performance metrics involves integrating measurements of body composition with assessments of physical function and fitness to provide a more comprehensive evaluation of an individual's health and fitness status. Eligibility for bariatric surgery or semaglutide satiety/appetite-reduction medications should not be determined by BMI alone. Awareness of the advantages and limitations of using BMI as a tool to assess adult obesity can maximize its appropriate use in the context of population health and in rapid clinical screening and evaluation.

Body composition assessment with ultrasound muscle measurement: optimization through the use of semi-automated tools in colorectal cancer

Colorectal cancer (CRC) is a disease with a high prevalence and major impact on global health. Body composition (BC) data are of great importance in the assessment of nutritional status. Ultrasound (US) is an emerging, accessible and non-invasive technique that could be an alternative when it is not feasible to perform computed tomography (CT). The aim of this study is to evaluate the correlation between CT, as a reference technique, and US of the rectus femoris (RF) as a "proof of concept," in a cohort of patients with CRC and assess the optimisation of results obtained by US when performed by our new semi-automated tool. A single-centre cross-sectional study including 174 patients diagnosed with CRC and undergoing surgery was carried out at the Vall d'Hebron Hospital. We found a strong correlation between CT and US of the RF area (r = 0.67; p < 0.005). The latter, is able to discriminate patients with worse prognosis in terms of length of hospital stay and discharge destination (AUC-ROC = 0.64, p 0.015). These results improve when they are carried out with the automatic tool (area AUC-ROC = 0.73, p 0.023), especially when normalised by height and eliminating patients who associate overflow. According to our results, the US could be considered as a valuable alternative for the quantitative assessment of muscle mass when CT is not feasible. These measurements are improved when measuring software is applied, such as "Bat" software.

Body composition in adults born preterm with very low birth weight

BACKGROUND

Studies on body composition in preterm very low birth weight (VLBW < 1500 g) survivors are inconsistent and trajectories later in life unknown. We assessed body composition and its change from young to mid-adulthood in VLBW adults.

METHODS

We studied 137 VLBW adults and 158 term-born controls from two birth cohorts in Finland and Norway at mean age 36 years. Body composition was assessed by 8-polar bioelectrical impedance. We compared results with dual-energy x-ray absorptiometry measurements at 24 years.

RESULTS

In mid-adulthood, VLBW women and men were shorter than controls. Fat percentage (mean difference in women 1.1%; 95% CI, -1.5% to 3.5%, men 0.8%; -2.0% to 3.6%) and BMI were similar. VLBW women had 2.9 (0.9 to 4.8) kg and VLBW men 5.3 (2.7 to 8.1) kg lower lean body mass than controls, mostly attributable to shorter height. Between young and mid-adulthood, both groups gained fat and lean body mass (p for interaction VLBW x age>0.3).

CONCLUSION

Compared with term-born controls, VLBW adults had similar body fat percentage but lower lean body mass, largely explained by their shorter height. This could contribute to lower insulin sensitivity and muscular fitness previously found in VLBW survivors and predispose to functional limitations with increasing age.

IMPACT

In mid-adulthood, individuals born preterm with very low birth weight had similar body fat percentage but lower lean body mass than those born at term. This was largely explained by their shorter height. First study to report longitudinal assessments of body size and composition from young to mid-adulthood in very low birth weight adults. Lower lean body mass in very low birth weight adults could contribute to lower insulin sensitivity and muscular fitness and lead to earlier functional limitations with increasing age.

Development and cross-validation of a circumference-based predictive equation to estimate body fat in an active population

Objective

The U.S. Army uses sex-specific circumference-based prediction equations to estimate percent body fat (%BF) to evaluate adherence to body composition standards. The equations are periodically evaluated to ensure that they continue to accurately assess %BF in a diverse population. The objective of this study was to develop and validate alternative field expedient equations that may improve upon the current Army Regulation (AR) body fat (%BF) equations.

Methods

Body size and composition were evaluated in a representatively sampled cohort of 1904 active-duty Soldiers (1261 Males, 643 Females), using dual-energy X-ray absorptiometry (%BFDXA), and circumferences obtained with 3D imaging and manual measurements. Sex stratified linear prediction equations for %BF were constructed using internal cross validation with %BFDXA as the criterion measure. Prediction equations were evaluated for accuracy and precision using root mean squared error, bias, and intraclass correlations. Equations were externally validated in a convenient sample of 1073 Soldiers.

Results

Three new equations were developed using one to three circumference sites. The predictive values of waist, abdomen, hip circumference, weight and height were evaluated. Changing from a 3-site model to a 1-site model had minimal impact on measurements of model accuracy and performance. Male-specific equations demonstrated larger gains in accuracy, whereas female-specific equations resulted in minor improvements in accuracy compared to existing AR equations. Equations performed similarly in the second external validation cohort.

Conclusions

The equations developed improved upon the current AR equation while demonstrating robust and consistent results within an external population. The 1-site waist circumference-based equation utilized the abdominal measurement, which aligns with associated obesity related health outcomes. This could be used to identify individuals at risk for negative health outcomes for earlier intervention.

Prediction of fat-free mass from body surface area in young basketball players

BACKGROUND

Fat Free Mass (FFM) is an important and essential indicator in various sports populations, since greater muscle and bone mass generates greater strength, endurance and speed in athletes.

OBJECTIVE

The purpose of the study was to validate Body Surface Area (BSA) as an anthropometric indicator to estimate FFM in young basketball players.

METHODS

A descriptive cross-sectional study was carried out in 105 male basketball players of the Brazilian Basketball Confederation of Sao Paulo (Campinas), Brazil. The age range was 11 to 15 years. Weight and height were evaluated. BSA, body mass index (BMI) and maturity status (MS) were calculated. Total body scanning was performed by dual X-ray absorptiometry (DXA). The components were extracted: Fat mass (FM), Fat free mass (FFM), percentage of fat mass (%FM) and bone mass (BM). The data were analyzed using the correlation coefficient of concordance (CCC) in terms of precision and accuracy.

RESULTS

Three regression equations were generated: equation 1 had age and body weight as predictors [FFM= -30.059+(2.926*age)+(0.625*Weight)] (R2 = 92%, precision = 0.96 and accuracy = 0.99), equation 2 used age and BSA [FFM=-45.719+(1.934*age)+(39.388*BSA)] (R2 = 94%, precision = 0.97 and accuracy = 0.99) and equation 3 was based on APHV and BSA [FFM=-15.284+(1.765*APHV)+(37.610*(BSA)] (R2 = 94%, precision = 0.96 and accuracy = 0.99).

CONCLUSIONS

The results suggest the use of anthropometric equation using decimal age and BSA to estimate FFM in young basketball players. This new method developed can be used to design, evaluate and control training programs and monitor the weight status of athletes.

Sex differences in the associations between relative fat mass and all-cause and cardiovascular mortality: A population-based prospective cohort study

BACKGROUND AND AIMS

The novel sex-specific anthropometric equation relative fat mass (RFM) is a new estimator of whole-body fat %. The study aimed to investigate the predictive role of RFM in cardiometabolic abnormalities, cardiovascular disease (CVD), all-cause and cardiovascular mortality, and explored potential sex differences.

METHODS AND RESULTS

The study analyzed data from 26,754 adults in NHANES 1999-2010, with a median follow-up of 13.8 years. The correlation between RFM and body composition as well as fat distribution assessed by dual-energy X-ray absorptiometry was investigated. Weighted multivariable generalized linear models, Cox proportional hazards models and restricted cubic spline were applied to investigate the predictive role of RFM in metabolic markers, cardiovascular risk factors, CVD, all-cause and cardiovascular mortality. RFM exhibited a robust correlation with both whole-body fat % and trunk fat %. Higher RFM exhibited a stronger association with impaired glucose homeostasis, serum lipids, the incidence of hypertension, and coronary heart disease in males, while a stronger association with C-reactive protein in females. A U-shaped association between RFM and all-cause mortality was observed only in males. The hazard ratio (HR) of all-cause and cardiovascular mortality in males increased rapidly when RFM exceeded 30. However, in females, the HR of all-cause and cardiovascular mortality fluctuated until RFM exceeded 45, after which it increased rapidly.

CONCLUSION

RFM was a sex-specific estimator for both general and central obesity, sex-specific differences in predicting cardiometabolic abnormalities and adverse events using RFM might be partially attributed to differences in body composition and fat distribution between sexes.

Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer

Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.

Socioeconomic status and adiposity in childhood cancer survivors: A cross-sectional retrospective study

This is a retrospective cross-sectional study examining the association between unemployment, cancer type, treatment and total body fat percentage of childhood cancer survivors recruited at St. Anne's University Hospital in Brno, Czech Republic. A total of 55 survivors aged 18-49 who were in remission of cancer and fulfilled the criteria for body composition measurements by the BIA and completed questionnaires investigating their socioeconomic status, employment status, and history. There was a significant relationship between the employment status and central nervous system-directed treatment (c2(1) = 7.53, p = 0.006, Cramér's V = 0.38) and between the type of cancer and employment status (c2(3) = 7.83, p = 0.049, Cramér's V = 0.38), the highest unemployment rate was recorded for brain and spine survivors (72.7%) compared to survivors with other diagnosis (35.7%) (uLR(1) = 4.91, p = 0.027; OR = 4.80, 95% CI:1.10-20.86, p = 0.036); these survivors did not have a significantly different body fat percentage compared to survivors with other diagnoses (t(53) = 1.29, p = 0.202, Cohen's d = 0.41) Interestingly, the survivors reporting having a partner also had a significantly higher percentage of body fat (t(53) = 2.90, p = 0.005, Cohen's d = 0.81). A linear regression model was used to model the percentage of body fat in relation to a set of selected variables and the we observed a significant effect of sex (female vs male: b = 6.37, 95% CI: 1.82-10.93, p = 0.007), partnership status (yes vs no: b = 5.65, 95% CI: 0.67-10.62, p = 0.027) and category of diagnosis (Brain and spinal column tumors vs Other solid tumors: b = 12.40, 95% CI: 0.59-24.21, p = 0.040; Brain and spinal column tumors vs Lymphoma: b = 14.02, 95% CI: 2.06-25.97, p = 0.023). Employment status and risk of adiposity in childhood cancer survivors depends on the type of treatment and diagnosis group, which may significantly impact their lifestyle and overall quality of life after treatment. Trial registration: This study was registered on July 29, 2022, at ClinicalTrials.gov (NCT05481229).

Biomarkers of Body Composition

The importance and impact of imaging biomarkers has been increasing over the past few decades. We review the relevant clinical and imaging terminology needed to understand the clinical and research applications of body composition. Imaging biomarkers of bone, muscle, and fat tissues obtained with dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasonography are described.

Changes in Body Composition and Athletic Performance in National Collegiate Athletic Association Division I Female Field Hockey Athletes Throughout a Competitive Season

ABSTRACT

Summer, LC, Cheng, R, Moran, JT, Lee, M, Belanger, AJ, TaylorIV, WL, and Gardner, EC. Changes in body composition and athletic performance in National Collegiate Athletic Association Division I female field hockey athletes throughout a competitive season. J Strength Cond Res 38(1): 146-152, 2024-The purposes of this study were (a) to analyze the changes in total and regional body composition measurements in a National Collegiate Athletic Association (NCAA) Division I female field hockey team throughout a 17-game competitive season using dual X-ray absorptiometry (DXA); (b) to examine improvements, if any, in athletic performance measures after a season; and (c) to report on the relationship between these body composition changes and changes in athletic performance. Preseason and postseason dual-energy DXA and performance data from the 2019-2020 season were retrospectively identified for 20 field players (forwards, midfielders, and defenders). Body composition data included total and regional fat mass, lean mass, and body fat percentage, whereas athletic performance measures included the vertical jump, 10-yard dash, and pro-agility (5-10-5) shuttle run. All variables were quantitative and analyzed using paired t -tests or its nonparametric equivalent and an alpha level of p < 0.05 was used to determine significance. After a competitive season, athletes had significant decreases in fat mass and increases in lean mass in their arms, legs, trunks, gynoids, and total body measurements. Android fat mass and body fat percentage also decreased. Athletes performed significantly better on the pro-agility shuttle run at the end of the season, but no significant differences were observed in other performance metrics. Moderate correlations were observed between changes in body composition (total fat mass and total lean mass) and changes in athletic performance. Our study provides a novel, longitudinal assessment of body composition and athletic performance for elite female field hockey athletes that will help trainers and coaches better understand how these variables change throughout a season and allow them to better prepare their players for competitive success.