Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated cross-sectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n=82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky <80) vs normal functional status (>80). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and >6 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P=0.008); limited (OR 5.5, CI 1.7-18.5, P=0.005) or extensive chronic GVHD (OR 20.3, CI 5.7-71.6, P<0.001); and decreased performance status (Karnofsky scores of < or =80) (OR 2.7, CI 1.3-5.9, P=0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI.

Total body mass, fat mass, fat-free mass, and skeletal muscle in older people: cross-sectional differences in 60-year-old persons

OBJECTIVES

To evaluate body composition parameters, including fat-free mass (FFM), appendicular skeletal muscle mass (ASMM), relative skeletal muscle mass (RSM) index, body cell mass (BCM), BCM index, total body potassium (TBK), fat mass, percentage fat mass (FM), and their differences between age groups and to evaluate the frequency of sarcopenia in healthy older subjects

DESIGN

Cross-sectional, nonrandomized study.

SETTING

Outpatient clinic.

PARTICIPANTS

Ninety-one healthy men and 100 healthy women age 60 and older.

MEASUREMENTS

FFM, ASMM, FM, and percentage fat mass by whole-body dual-energy x-ray absorptiometry; TBK, BCM, and TBK/FFM ratio by whole body potassium-40 counter.

RESULTS

All lean body mass parameters were significantly (P <.05) lower in subjects age 80 and older than in those age 70 to 79, except ASMM in women. Mean FFM was 4.2 kg (7.3%) lower in men age 80 and older than in those younger than 70 and 2.9 kg (6.8%) lower in women age 80 and older than in those younger than 70. The skeletal muscle mass, reflected by ASMM, decreased more than FFM. This suggests that nonskeletal muscle mass is proportionally preserved during aging. Forty-five percent of men and 30% of women were sarcopenic by definition of BCM index and 11.0% of men and women by definition of RSM index.

CONCLUSIONS

Significant age-related differences exist in body composition of older men and women between age 60 and 95. The greater decrease in TBK and BCM than the decrease in FFM and skeletal muscle mass suggests changing composition of FFM with age. Lack of agreement between two independent sarcopenia indexes suggests that further refinement in the definition of a sarcopenia index is necessary.

Comparison of four bioelectrical impedance analysis formulas in healthy elderly subjects

BACKGROUND

Changes of body composition occur with aging and influence health status. Thus accurate methods for measuring fat-free mass (FFM) in the elderly are essential.

OBJECTIVE

The purpose of this study was to compare FFM obtained by three bioelectrical impedance analysis (BIA) published formulas specific for the elderly and one equation intended for all age groups, with FFM derived from dual-energy X-ray absorptiometry (FFM(DXA)), in healthy elderly subjects.

METHODS

Healthy Caucasian subjects over 65 years (106 women, age 75 +/- 6.2, body mass index 25.2 +/- 4.1 and 100 men, age 74.6 +/- 6.6, body mass index 25.8 +/- 3.0) were measured by DXA (Hologic QDR-4500) and BIA (Xitron, 50 kHz). FFM(BIA) was calculated by the published formulas of Deurenberg, Baumgartner, Roubenoff and Kyle and compared to FFM(DXA) by a Bland-Altman analysis.

RESULTS

The Deurenberg and Roubenoff BIA formulas underestimated FFM compared to DXA by -7.1 and -2.9 kg in women and -6.7 and -2.3 kg in men, respectively. The Baumgartner formula overestimated FFM by 4.3 kg in women and 1.4 kg in men. The Kyle formula showed differences of 0.0 kg in women and 0.2 kg in men, and the limits of agreement of FFM(BIA (Kyle)) relative to FFM(DXA) were -3.3 and +3.3 kg for women and -3.8 and +4.3 kg for men.

CONCLUSION

The Kyle BIA formula accurately predicts FFM in elderly Swiss subjects between 65 and 94 years, with a body mass index of 17 to 34.9 kg/m(2). The other BIA formulas developed especially for the elderly are not valid in this population.

[Nutrition and HIV infection]

The HIV infection leads to many nutritional problems. For a long time, the Wasting Syndrome was one of the most frequent inaugural features of AIDS and still concerns many patients. The weight loss worsens the prognosis of the disease. The reduced dietary intakes, the increased digestive losses and energetic expenditure result in severe malnutrition. Therefore, the nutritional support and its association with orexigenes, anabolic agents and physical activity has to be carefully selected. The adverse events of new antiretroviral drugs influence the nutritional state and the patient's compliance towards their treatments. For lipodystrophy, whose etiology is still unknown, no treatment has yet been found. Metabolic disorders (dyslipidemia, glucose intolerance, diabetes, etc.) in this presently chronic disease require particular attention since they increase cardiovascular risks. In general they are sensitive to a dietary approach.

[Value of prokinetics in enteral nutrition intolerance]

Malnutrition is associated with an increase in morbidity and mortality and therefore a raise in hospitalization's costs. Nevertheless, an early nutritional support can reverse this trend. Gastrointestinal dysfunctions (gastroparesis, abdominal distension, high gastric residues) in patient on enteral nutrition, may appear and very likely generate an increasing risk of regurgitations, pulmonary aspiration and infection. These symptoms represent the main factors limiting dosage in administering enteral nutrition. Prokinectics agents (metoclopramid, cisaprid and erythromycin) which improve gastric motility are often used in order to maintain enteral nutrition and to cover the energetic needs of patients. This revenue shows some way of using prokinectics in case of enteral nutrition intolerance and propose a step-by-step guideline on how to start and increase progressively enteral nutrition.