Frailty consensus: a call to action

Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty.

Anthropometric standardisation and quality control protocols for the construction of new, international, fetal and newborn growth standards: the INTERGROWTH-21st Project

The primary aim of the INTERGROWTH-21(st) Project is to construct new, prescriptive standards describing optimal fetal and preterm postnatal growth. The anthropometric measurements include the head circumference, recumbent length and weight of the infants, and the stature and weight of the parents. In such a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes in detail the anthropometric training, standardisation and quality control procedures used to collect data for these new standards. The initial standardisation session was in Nairobi, Kenya, using newborns, which was followed by similar sessions in the eight participating study sites in Brazil, China, India, Italy, Kenya, Oman, UK and USA. The intraobserver and inter-observer technical error of measurement values for head circumference range from 0.3 to 0.4 cm, and for recumbent length from 0.3 to 0.5 cm. These standardisation protocols implemented at each study site worldwide ensure that the anthropometric data collected are of the highest quality to construct international growth standards.

Anthropometric protocols for the construction of new international fetal and newborn growth standards: the INTERGROWTH-21st Project

The primary aim of the INTERGROWTH-21(st) Project is to construct new, prescriptive standards describing optimal fetal and preterm postnatal growth. The anthropometric measurements include the head circumference, recumbent length and weight of the infants, and the stature and weight of the parents. In such a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detail, the selection of anthropometric personnel, equipment, and measurement and calibration protocols used to construct the new standards. Implementing these protocols at each study site ensures that the anthropometric data are of the highest quality to construct the international standards.

Designing pharmaceutical trials for sarcopenia in frail older adults: EU/US Task Force recommendations

An international task force of academic and industry leaders in sarcopenia research met on December 5, 2012 in Orlando, Florida to develop guidelines for designing and executing randomized clinical trials of sarcopenia treatments. The Task Force reviewed results from previous trials in related disease areas to extract lessons relevant to future sarcopenia trials, including practical issues regarding the design and conduct of trials in elderly populations, the definition of appropriate target populations, and the selection of screening tools, outcome measures, and biomarkers. They discussed regulatory issues, the challenges posed by trials of different types of interventions, and the need for standardization and harmonization. The Task Force concluded with recommendations for advancing the field toward better clinical trials.

Genome-wide linkage scan for quantitative trait loci underlying normal variation in heel bone ultrasound measures

Quantitative ultrasound (QUS) traits are correlated with bone mineral density (BMD), but predict risk for future fracture independent of BMD. Only a few studies, however, have sought to identify specific genes influencing calcaneal QUS measures. The aim of this study was to conduct a genome-wide linkage scan to identify quantitative trait loci (QTL) influencing normal variation in QUS traits. QUS measures were collected from a total of 719 individuals (336 males and 383 females) from the Fels Longitudinal Study who have been genotyped and have at least one set of QUS measurements. Participants ranged in age from 18.0 to 96.6 years and were distributed across 110 nuclear and extended families. Using the Sahara ® bone sonometer, broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI) were collected from the right heel. Variance components based linkage analysis was performed on the three traits using 400 polymorphic short tandem repeat (STR) markers spaced approximately 10 cM apart across the autosomes to identify QTL influencing the QUS traits. Age, sex, and other significant covariates were simultaneously adjusted. Heritability estimates (h²) for the QUS traits ranged from 0.42 to 0.57. Significant evidence for a QTL influencing BUA was found on chromosome 11p15 near marker D11S902 (LOD = 3.11). Our results provide additional evidence for a QTL on chromosome 11p that harbors a potential candidate gene(s) related to BUA and bone metabolism.

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly

INTRODUCTION

Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly.

METHODS

In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies.

CONCLUSION

The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Longitudinal changes in calcaneal quantitative ultrasound measures during childhood

This longitudinal study examined how calcaneal quantitative ultrasound (QUS) measures change during childhood while taking into account skeletal maturation, body mass index (BMI), and physical activity. The study reported sex differences in QUS growth curves and an inverse relationship between BMI and speed of sound (SOS) measures.

INTRODUCTION

The aim of this study was to examine how calcaneal QUS parameters change over time during childhood and to determine what factors influence these changes.

METHODS

The study sample consisted of a total of 192 Caucasian children participating in the Fels Longitudinal Study. A total of 548 calcaneal broadband ultrasound attenuation (BUA) and SOS observations were obtained between the ages of 7.6 and 18 years. The best fitting growth curves were determined using statistical methods for linear mixed effect models.

RESULTS

There are significant sex differences in the pattern of change in QUS parameters (p < 0.05). The relationship between QUS measures and skeletal age is best described by a cubic growth curve in boys and a linear pattern among girls. Boys experience their most rapid growth in BUA and SOS in early and late adolescence, while girls experience constant growth throughout childhood. Adiposity levels were significantly associated with the changes in SOS among boys (p < 0.001) and girls (p < 0.01), indicating that children with higher BMI are likely to have lower SOS over time compared to children with lower BMI. For girls, physical activity levels showed positive associations with changes in QUS measures (p < 0.05).

CONCLUSION

This study documents significant sex differences in the pattern of change in QUS measures over childhood and adolescence. Our study also shows significant influences of adiposity and physical activity on the pattern of change in QUS measures during childhood.

Left ventricular mass, abdominal circumference and age: the Fels longitudinal study

PURPOSE

To determine the relationship of abdominal circumference with increased left ventricular mass (LVM) from young adulthood into old age.

METHODS

Cross-sectional echocardiographic images were taken from 182 men and 220 women in the Fels Longitudinal Study 20 to 75 years of age to determine left ventricular mass. Left ventricular mass was divided by stature raised to the power of 2.7 (LVM/ht2.7) in order to minimize the impact of heart size variation from body size without overcompensating for the adverse effect of obesity. Abdominal circumference was measured and BMI calculated from stature and weight and categories of overweight, obesity and abdominal obesity were determined using published cut points. Regression models were used to describe the relationships of age, abdominal circumference, BMI and self-reported physical activity to LVM/ht2.7.

RESULTS

Age, abdominal circumference and BMI were each positively and significantly related to an increased LVM/ht2.7 in men and women (p < 0.05). In the men, multivariate models indicated that abdominal circumference and BMI were both significantly related to an increased LVM/ht2.7, but the inclusion of BMI in these models for the women reduced the association of abdominal circumference and physical activity below significant levels. In the men, there was also a quadratic association of abdominal circumference with LVM/ht2.7 that was significant along with BMI and physical activity. Sex-specific logistic regressions with BMI and abdominal circumference obesity categories did not change or improve the initial findings in men or women.

CONCLUSIONS

In women, increases in abdominal fatness as reflected in abdominal circumference at any age are linearly related to an increase in LVM/ht2.7, but the relationship of overall fatness as reflected in BMI with LVM/ht2.7 is stronger. In men, both abdominal fatness and overall fatness at any age are linearly related to an increase LVM/ht2.7. However, the significant curvilinear association of abdominal circumference and a linear association of BMI and physical activity with LVM/ht2.7 indicate the possible positive covariate relationship of overall muscle mass with LVM/ht2.7. This reflects the physiological changes with age and demonstrate, in part, the complexity of the interpretations of the inter associations of body composition, the cardiovascular system and the aging process, but the impact among the elderly and the known inadequacy of BMI at these ages remains an area for continued clinical study.

The first seriatim study into old age for weight, stature and BMI: the Fels Longitudinal Study

PURPOSE

To document the serial status of measures of weight, stature and BMI from birth into old age.

METHODS

Longitudinal measures of weight, stature and BMI were taken from birth to 76 years of age for 5 men and 7 women as part of the Fels Longitudinal Study.

RESULTS

Sex-specific plots of means for weight, stature and BMI are presented that describe the changes and sex differences in these measurements between birth (or the first year of life) into old age. These serial data demonstrate a continuous increase in body weight through much of adulthood and a small decline in stature starting in late middle age. The plots for BMI indicate the early onset of overweight and subsequent obesity early in adulthood and its continuance into old age for men and women.

CONCLUSIONS

These are the first plots of serial means for weight, stature and BMI measured from the same group of individuals from birth into old age. These findings demonstrate the changes in these measurements through childhood and maturity into old age. Similar data are needed for individuals from other racial/ethnic groups and countries in order to understand the aging process better.

A review of body water status and the effects of age and body fatness in children and adults

BACKGROUND

Most investigations of TBW, ECW and body composition and reports of their intra-body relationships were published prior to 1980. Distributional TBW and ECW relationships within the body have been considered fixed, but there was evidence these relationships were affected by the level of fatness. Body composition models based on past findings and assumptions could produce inaccurate estimates when the majority of the population is overweight to obese.

METHODS

TBW and ECW volumes, their proportions of body weight, FFM and percent body fat and associations with age are considered in U.S. children and adults. This review focuses on studies reporting measured body water volumes from large samples except for the national predicted values from NHANES III.

RESULTS

Measured TBW volumes for children and adults are almost exclusively from whites with the exception of the estimated values from NHANES III for non-Hispanic black and Mexican-Americans. Mean adult TBW volumes are as much as 9 liters greater than those reported prior to 1980. Low mean percentages of TBW%WT reflect the greater level of adiposity in children and adults, and this level of adiposity affects the value of TBW% FFM. Mean ECW volumes for white adults are 10 to 12 liters larger than those reported previously. With greater fatness in adults, ECW%TBW has increased to near 60%, and this implies that a calculation of FFM based on 73% and an ECW%TBW of 25-45% could produce an overestimation but more important clinically an underestimation of body fatness.

CONCLUSION

There is inadequate timely information on measured total and extra-cellular water volumes for the population. Available data indicate a coincident increase in body water with overweight and obesity, and a shifting in the proportion of ECW in TBW. Clinical and pharmacological treatments based upon past assumptions of body water volumes, proportions and relationships could produce inaccurate estimates.

Sex differences in young adulthood metabolic syndrome and physical activity: The Fels longitudinal study

OBJECTIVE

To evaluate the effects of habitual physical activity (PA) on the metabolic syndrome (MS) in young adult men and women.

RESEARCH METHODS AND PROCEDURES

Cross-sectional PA data were utilized from 249 women and 237 men, aged 18-40 years in the Fels Longitudinal Study. MS components--abdominal circumference (AC), triglycerides (TG), HDL, blood pressure (BP), and fasting glucose (FG)--were dichotomized according to the National Cholesterol Education Program's Adult Treatment Panel III revised criteria. Leisure, sport, work, and total PA scores were calculated using the Baecke Questionnaire of Habitual Physical Activity. Multiple logistic regression modeling assessed the effects of PA, age, smoking, and BMI on MS status.

RESULTS

26.9% of men and 19.3% of women had MS. For men, MS risk was reduced with increases in both total PA [OR = 0.65 (95% CI: 0.47, 0.90)] and sport PA [OR = 0.40 (95% CI: 0.23, 0.70)]. AC, TG, and HDL values also improved with total and sport PA. Among women, the risk for MS was marginally reduced by total PA [OR = 0.72 (95% CI: 0.50, 1.02)] and HDL levels were increased by both total PA [OR = 0.79 (95% CI: 0.63, 0.98)] and sport PA [OR = 0.54 (95% CI: 0.35, 0.84)].

DISCUSSION

Increased total and sport PA reduces risk for the MS in young men, though not as clearly in young women.

Is the MNA valid in different populations and across practice settings?

OBJECTIVE

The MNA is a successful screening tool in geriatric medicine, but this success is in Europe or countries with Western health care practice settings. The MNA is not directly applicable in many ethnic groups or countries or those with non-Western cultural and dietary habits or health care systems. There is an increased prevalence of type 2 diabetes, the metabolic syndrome and obesity among the elderly; however, the MNA does not include questions or measures related to these or other important health conditions affected by nutritional status. This paper addresses the relevance of anthropometry and the impact of different clinical practice settings on the MNA and discusses the development of the Chinese Nutritional Screen (CNS) in China.

CONCLUSIONS

If the MNA is to continue to be successful among groups of elderly around the world, then the MNA, CNS or similar instruments should be as country or culturally and ethnically specific as possible. The development of the CNS maintained the underlying assumptions and concept of the MNA but modified them for a country with diverse food and cultural habits and health care settings.

Lipids, lipoproteins, lifestyle, adiposity and fat-free mass during middle age: the Fels Longitudinal Study

INTRODUCTION

Although lipid profiles tend to worsen with age, it is not fully known if such age-related changes are influenced primarily by body composition and lifestyle or by other aspects of aging.

OBJECTIVE

We investigated the extent to which the fat and fat-free components of body mass index (BMI) and lifestyle factors influence patterns of change in lipids independent of age.

DESIGN

Serial data were analyzed using sex-specific longitudinal models. These models use serial data from individuals to assume a general pattern of change over time, while allowing baseline age and the rate of change to vary among individuals.

SUBJECTS

Serial data were obtained from 940 examinations of 269 healthy white participants (126 men, 143 women), aged 40-60 years, in the Fels Longitudinal Study.

MEASUREMENTS

Measurements included age, the fat (FMI) and fat-free mass (FFMI) components of BMI, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), triglycerides (TG), total cholesterol (TC), fasting glucose and insulin, physical activity, alcohol use and smoking, and women's menopausal status and estrogen use.

RESULTS

In both sexes, increased FMI was significantly associated with increased LDL-C, TG and TC, and decreased HDL-C. Increased FFMI was significantly related to decreased HDL-C and increased TG. Independent age effects remained significant only for LDL-C and TC in men and TC in women. Increased insulin was significantly related to increased TG in women. Moderate alcohol consumption was associated with higher HDL-C in men. Physical activity lowered male LDL-C and TC levels, and increased female HDL-C levels. Menopause was associated with increases in LDL-C. Premenopausal women not using estrogen had significantly lower HDL-C, TG, and TC than postmenopausal women taking estrogen.

CONCLUSIONS

(1) Age is an important independent predictor for LDL-C and TC in men, and TC in women, but it is not as influential as body composition and lifestyle on HDL-C and TG in men and women, and LDL-C in women. (2) Increasing FMI is the major contributor to elevated TC, LDL-C and TG levels, and decreased HDL-C levels in men and women. (3) FFMI significantly influences HDL and TG levels in both sexes. (4) Maintaining a lower BMI via a reduced fat component may be more beneficial in lowering CVD risks than other factors.

Validity of a new automated software program for visceral adipose tissue estimation

INTRODUCTION

Given the considerable time and research cost of analyzing biomedical images to quantify adipose tissue volumes, automated image analysis methods are highly desirable. Hippo Fat is a new software program designed to automatically quantify adipose tissue areas from magnetic resonance images without user inputs. Hippo Fat has yet to be independently validated against commonly used image analysis software programs.

OBJECTIVE

Our aim was to compare estimates of VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) using the new Hippo Fat software against those from a widely used, validated, computer-assisted manual method (slice-O-matic version 4.2, Tomovision, Montreal, CA, USA) to assess its potential utility for large-scale studies.

METHODS

A Siemens Magnetom Vision 1.5-T whole-body scanner and a T1-weighted fast-spin echo pulse sequence were used to collect multiple, contiguous axial images of the abdomen from a sample of 40 healthy adults (20 men) aged 18-77 years of age, with mean body mass index of 29 kg/m(2) (range=19-43 kg/m(2)).

RESULTS

Hippo Fat provided estimates of VAT and SAT that were highly correlated with estimates using slice-O-matic (R (2)>0.9). Average VAT was 9.4% lower and average SAT was 3.7% higher using Hippo Fat compared to slice-O-matic; the overestimation of SAT tended to be greater among individuals with greater adiposity. Individual-level differences for VAT were also substantial; Hippo Fattrade mark gave estimates of VAT ranging from 1184 cm(3) less to 566 cm(3) more than estimates for the same person using slice-O-matic.

CONCLUSION

Hippo Fat provides a rapid method of quantifying total VAT, although the method does not provide estimates that are interchangeable with slice-O-matic at either the group (mean) or individual level.

Unique and common genetic effects between bone mineral density and calcaneal quantitative ultrasound measures: the Fels Longitudinal Study

INTRODUCTION

Areal bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measures are correlated, and both traits predict osteoporotic fracture risk independently. However, few studies have examined whether common genetic effects (i.e., pleiotropy) exist between these traits in extended families. In this study, we estimated the additive genetic correlation and random environmental correlation between BMD measured at various skeletal sites and calcaneal QUS measures.

METHODS

Our sample included 537 adults (251 men and 286 women) from 110 families participating in the Fels Longitudinal Study. Total hip, femoral neck, lumbar spine, and total body BMD were measured using dual energy X-ray absorptiometry. Three measures of calcaneal structure--broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI)--were collected from the non-dominant heel using the Sahara sonometer. Applying a variance components-based maximum likelihood method, we estimated the heritability of each trait and estimated the genetic and environmental correlations between the different BMD and QUS measures.

RESULTS

Heritability estimates were significant for all measures of BMD and QUS ranging from 0.55 to 0.78. Significant non-zero genetic correlations were found between the different BMD and QUS measures. All genetic correlations were also significantly different from 1. Genetic correlations between total hip BMD and each of the QUS measures were 0.63 with BUA, 0.50 with SOS, and 0.56 with QUI. For femoral neck BMD, genetic correlations were similar to those between total hip BMD and QUS measures. Genetic correlations between BMD of the lumbar spine and QUS measures ranged from 0.34 to 0.38, and those between total body BMD and QUS measures, from 0.51 to 0.54. In contrast, all random environmental correlations were not significantly different from zero.

CONCLUSION

This study demonstrates that BMD and calcaneal QUS measures among healthy men and women are significantly heritable and are, in part, jointly influenced by a common set of underlying genes. Additionally, this study also provides evidence for a unique set of genes that independently influences each individual trait.

Quantitative genetic analysis of cellular adhesion molecules: the Fels Longitudinal Study

Circulating concentrations of inflammatory markers predict cardiovascular disease (CVD) risk and are closely associated with obesity. However, little is known concerning genetic influences on serum levels of inflammatory markers. In this study, we estimated the heritability (h2) of soluble cellular adhesion molecule (sCAM) concentrations and examined the correlational architecture between different sCAMs. The study population included 234 men and 270 women aged 18-76 years, belonging to 121 families participating in the Fels Longitudinal Study. Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sESEL-1) and P-selectin (sPSEL-1) were assayed using commercially available kits. A variance components-based maximum likelihood method was used to estimate the h2 of the different serum inflammatory markers while simultaneously adjusting for the effects of known CVD risk factors, such as age and smoking. Additionally, we used bivariate extensions of these methods to estimate genetic and random environmental correlations among sCAMs. Levels of sCAMs were significantly heritable: h2=0.24+/-0.10 for sICAM-1, h2=0.22+/-0.10 for sVCAM-1, h2=0.50+/-0.11 for sESEL-1, and h2=0.46+/-0.10 for sPSEL-1. In addition, a significant genetic correlation (rho(G)=0.63) was found between sICAM-1 and sVCAM-1 indicating some degree of shared genetic control. In the Fels Longitudinal Study, the levels of four sCAMs are significantly influenced by genetic effects, and sICAM-1 shares a common genetic background with sVCAM-1.

Development of the Chinese nutrition screen (CNS) for use in institutional settings

OBJECTIVES

To develop and validate a nutritional screening tool (CNS) for elderly Chinese subjects in the institutional setting.

DESIGN

Using the MNA as a guide, a questionnaire was developed appropriate for the Chinese health care system, diet, food customs and culture, using physician assessment for comparison.

PARTICIPANTS

200 men and 200 women aged 65 years or older, approximately equally distributed by age between two cities in China (Hong Kong and Shanghai), were recruited from hospitals and old age homes for the reliability study. 340 men and 527 women were recruited for the validity study.

RESULTS

The CNS compared with physician assessments based on two groups, normal or at risk with less than normal nutritional status, had kappa coefficients of 0.5 overall and were as high as 0.8 in Shanghai. CNS was able to identify about 90% of all persons with normal nutritional status and had about a 60% chance of correctly identifying a person at risk with a less than normal nutritional status.

CONCLUSION

The CNS can be used in a 2-group classification to identify those who have a normal nutritional status (CNS > or = 21). Those who do not fall into this group should have their nutritional status evaluated in greater detail (CNS score < or = 20). The applicability of screening tools may vary depending on the site and the population characteristics.

Body composition estimates from NHANES III bioelectrical impedance data

BACKGROUND

Body composition estimates for the US population are important in order to analyze trends in obesity, sarcopenia and other weight-related health conditions. National body composition estimates have not previously been available.

OBJECTIVE

To use transformed bioelectrical impedance analysis (BIA) data in sex-specific, multicomponent model-derived prediction formulae, to estimate total body water (TBW), fat-free mass (FFM), total body fat (TBF), and percentage body fat (%BF) using a nationally representative sample of the US population.

DESIGN

Anthropometric and BIA data were from the third National Health and Nutrition Examination Survey (NHANES III; 1988-1994). Sex-specific BIA prediction equations developed for this study were applied to the NHANES data, and mean values for TBW, FFM, TBF and %BF were estimated for selected age, sex and racial-ethnic groups.

RESULTS

Among the non-Hispanic white, non-Hispanic black, and Mexican-American participants aged 12-80 y examined in NHANES III, 15 912 had data available for weight, stature and BIA resistance measures. Males had higher mean TBW and FFM than did females, regardless of age or racial-ethnic status. Mean TBW and FFM increased from the adolescent years to mid-adulthood and declined in older adult age groups. Females had higher mean TBF and %BF estimates than males at each age group. Mean TBF also increased with older age groups to approximately 60 y of age after which it decreased.

CONCLUSIONS

These mean body composition estimates for TBW, FFM, TBF and %BF based upon NHANES III BIA data provide a descriptive reference for non-Hispanic whites, non-Hispanic blacks and Mexican Americans in the US population.

Cumulative effects of cardiovascular disease risk factors on quality of life

OBJECTIVES

The Medical Outcomes Study Short-Form Health Survey (SF-36) was used to assess the quality of life for adults who differed in level of risk for cardiovascular disease.

METHODS

Subjects were 51 men and 80 women from southwestern Ohio between the ages of 20 and 86 years. Individuals level of risk was based on the culmination of four cardiovascular disease risk factors: hypertension (i.e., systolic BP>or=140 mmHg or diastolic BP>or= 90 mmHg), obesity (i.e., BMI>or=30), high cholesterol (i.e., total cholesterol>or=240 mg/dL), and presence/absence of smoking.

RESULTS

Each risk factor was analyzed independently and cumulatively for effects on the SF-36 dimensions (i.e., Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, Mental Health). The data suggested that quality of life impairment (indicated by lower scores on the SF-36 dimensions) increased as the number of cardiovascular disease risk factors an individual had increased.

CONCLUSIONS

Cardiovascular disease risk factors unknown to the participants had differential effects on the SF-36 dimensions, and quality of life decreased as the number of risk factors individuals had increased.

Comparison of percent body fat estimates using air displacement plethysmography and hydrodensitometry in adults and children

PURPOSE

The purpose of the study was to compare estimates of body density and percentage body fat from air displacement plethysmography (ADP) to those from hydrodensitometry (HD) in adults and children and to provide a review of similar recent studies.

METHODS

Body density and percentage body fat (% BF) were assessed by ADP and HD on the same day in 87 adults aged 18-69 y (41 males and 46 females) and 39 children aged 8-17 y (19 males and 20 females). Differences between measured and predicted thoracic gas volumes determined during the ADP procedure and the resultant effects of those differences on body composition estimates were also compared. In a subset of 50 individuals (31 adults and 19 children), reliability of ADP was measured and the relative ease or difficulty of ADP and HD were probed with a questionnaire.

RESULTS

The coefficient of reliability between %BF on day 1 and day 2 was 96.4 in adults and 90.1 in children, and the technical error of measurement of 1.6% in adults and 1.8% in children. Using a predicted rather than a measured thoracic gas volume did not significantly affect percentage body fat estimates in adults, but resulted in overestimates of percentage body fat in children. Mean percentage body fat from ADP was higher than percentage body fat from HD, although this was statistically significant only in adults (29.3 vs 27.7%, P<0.05). The 95% confidence interval of the between-method differences for all subjects was -7 to +9% body fat, and the root mean square error (r.m.s.e.) was approximately 4% body fat. In the subset of individuals who were asked to compare the two methods, 46 out of 50 (92%) indicated that they preferred the ADP to HD.

CONCLUSION

ADP is a reliable method of measuring body composition that subjects found preferable to underwater weighing. However, as shown here and in most other studies, there are differences in percentage body fat estimates assessed by the two methods, perhaps related to body size, age or other factors, that are sufficient to preclude ADP from being used interchangeably with underwater weighing on an individual basis.

Total body water reference values and prediction equations for adults

BACKGROUND

The clinical interpretation of total body water (TBW) necessitates the availability of timely comparative reference data. The prediction of TBW volume in renal disease is critical in order to prescribe and monitor the dose of dialysis in the determination of Kt/V. In clinical practice, urea distribution (V) is commonly predicted from anthropometric equations that are several decades old and for white patients only. This article presents new reference values and prediction equations for TBW from anthropometry for white and black adults.

METHODS

The study sample included four data sets, two from Ohio and one each from New Mexico and New York, for a total of 604 white men, 128 black men, 772 white women, and 191 black women who were 18 to 90 years of age. The TBW concentration was measured by the deuterium or tritium oxide dilution method, and body composition was measured with a Lunar DXA machine. An all-possible-subsets of regression was used to predict TBW. The accuracy of the selected equations was confirmed by cross-validation.

RESULTS

Blacks had larger TBW means than whites at all age groups. The 75th TBW percentile for whites approximated the TBW median for blacks at most ages. The white men and black men and women had the largest TBW means ever reported for healthy individuals. The race- and sex-specific TBW prediction equations included age, weight, and stature, with body mass index (BMI) substituted for weight in the white men. The root mean square errors (RMSEs) and standard errors for the individual (SEIs) ranged from approximately 3.8 to 5.0 L for the men and from 3.3 to 3.6 L for the women. In both men and women, high values of TBW were associated with high levels of total body fat (TBF) and fat-free mass (FFM).

CONCLUSION

: TBW in these healthy adults is relatively stable through a large portion of adulthood. There are significant race and sex differences in TBW. These accurate and precise equations for TBW provide a useful tool for the clinical prediction of TBW in renal disease for white and black adults. These are the first TBW prediction equations that are specific for blacks.

Health status of children with moderate to severe cerebral palsy

The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition-specific measures, and assessments of health care use. A multicenter population-based cross-sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n = 56), IV (n = 55), and V (n = 122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty-nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health-related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well-being and should be used in combination to reflect children's overall health status.

Change of body composition over an eight year period among Japanese university students

This study examined the change of body composition in Japanese university students. Subjects were university students divided into two groups by sex for two different time periods: 67 males and 46 females for 1986-1987 and 47 males and 64 females for 1994-1995. Body height, weight, and underwater weight were measured to estimate the percentage of body fat. The fat mass index (FMI) was applied after adjusting fat mass and the fat-free mass index (FFMI) applied after adjusting fat-free mass for body physique by dividing (body height)2. The mean body mass index (BMI) increased from 1986-1987 to 1994-1995 in males and decreased in females, although there were no statistical differences between two time periods in both sexes. The FMI indicates that in 1994-1995 males had significantly more fat adjusted for body height than in 1987. Females in 1994-1995 had significantly less FFMI than those in 1986 despite FMI similar to that of 1986. Our results thus warn against a trend toward excessive thinness in collegiate females and insufficiency of evaluating body composition using the BMI alone.

Assessing the body composition of 6-17-year-old Black and White girls in field studies

The purpose of the study was to develop ethnic-specific equations for fat-free mass (FFM) from selected anthropometric dimensions and bioelectrical impedance measures of resistance (R) and reactance (Xc) for use in the NHLBI Growth and Heath Study. Using dual-energy X-ray absorptiometry measures of body composition as the dependent variable and field measures of body composition by anthropometry and bioelectrical impedance as the explanatory variables, ethnic-specific prediction equations were developed on a sample of girls representing a wide range of ages and BMI. The equations were cross-validated using (1) the Prediction of Sum of Squares (PRESS) statistic and (2) an independent sample of 20 girls of each race from a study conducted at the National Institute of Child Health and Human Development (NICHD). Subjects were 65 White and 61 Black girls 6-17 years of age. The best race-specific equations for FFM each explained 99% and 97% of the variance in the White and Black girls, respectively. Root mean square errors (RMSE) ranged from 1.14 to 1.95 kg. The equation for Black girls used Stature2/Resistance (R), weight, and reactance (Xc) as predictor variables; the equation for White girls used Stature2/R, weight, and triceps skinfold thickness. The results indicate that (1) equations to predict FFM in girls should be ethnic-specific and that (2) accurate values for TBF and %BF can be calculated from the predicted FFM.

Childhood body composition in relation to body mass index

OBJECTIVE

The aim is to describe body composition in relation to body mass index (BMI; body weight/stature(2)) to provide health care professionals insight into the meaning, significance, and limitations of BMI as an index of adiposity during childhood.

METHODS

Data from 387 healthy, white children 8 to 18 years of age from the Fels Longitudinal Study were analyzed. Measurements were scheduled annually and each child was examined 1 to 11 times, totaling 1748 observations. Total body fat (TBF) and fat-free mass (FFM) were determined from hydrodensitometry. Stature and weight were measured using standard methods and BMI and the components of BMI, TBF/stature(2), and FFM/stature(2) were calculated. Analyses included correlations between BMI and body composition variables; age-related patterns of BMI, TBF/stature(2), and FFM/stature(2); and annual changes in BMI, TBF/stature(2), and FFM/stature(2).

RESULTS

Generally, correlations between BMI and body composition variables were strong and significantly different from zero. Means for BMI throughout childhood were similar for boys and girls, although significantly larger values were observed for girls at ages 12 to 13 years. Age-related patterns of TBF/stature(2) and FFM/stature(2) differed between sexes. In each sex, annual increases in BMI were driven primarily by increases in FFM/stature(2) until late adolescence, with increases in TBF/stature(2) contributing to a larger proportion of the BMI increases in girls than in boys.

CONCLUSIONS

Unlike adults, annual increases in BMI during childhood are generally attributed to the lean rather than to the fat component of BMI. Because the properties of BMI vary during childhood, health care professionals must consider factors such as age and sex when interpreting BMI.

Evaluation of anthropometric equations to assess body-composition changes in young women

BACKGROUND

Healthy young women who engage in an exercise program may lose fat that is not reflected in body weight changes because of concurrent gains in fat-free mass (FFM).

OBJECTIVE

This study addressed the question of how well anthropometry-based predictive equations can resolve these changes.

DESIGN

Several widely used skinfold-thickness- or circumference-based equations were compared by using dual-energy X-ray absorptiometry to study 150 healthy young women before and after 8 wk of Army basic combat training (average energy expenditure: 11.7 MJ/d).

RESULTS

Women lost 1.2 +/- 2.6 kg fat (mean +/- SD) and gained 2.0 [corrected] +/- 1.5 kg FFM. Fat loss (r = 0.47), but not FFM gain (r = 0.01), correlated with initial fatness. Thus, for many women who lost fat, body weight did not change or increased. Fat loss was associated with a reduction in abdominal circumference but this alone was not a consistent marker of fat loss. One circumference equation and one skinfold-thickness equation yielded the smallest residual SDs (2.0% and 1.9% body fat, respectively) compared with the other equations in predicting body fat. The sensitivity and specificity of the best equations in predicting changes in percentage body fat were not better than 55% and 66%, respectively.

CONCLUSIONS

These data suggest that for women, anthropometry can provide better estimates of fatness than body mass index but it is still relatively insensitive to short-term alterations in body composition. Not surprisingly, the circumference equation that includes the most labile sites of female fat deposition (ie, waist and hips instead of upper arm or thigh) proved to be the most reliable.

Sex differences in bone mass acquisition during growth: the Fels Longitudinal Study

Risk of osteoporosis in later life may be determined during adolescence and young adulthood. The present study used longitudinal data to examine the accumulation of bone mineral content (BMC) and bone mineral density (BMD) in Caucasian subjects ages 6-36 yr. Growth in BMC and BMD (measured by dual X-ray absorptiometry; Lunar, Madison, WI) of 94 males and 92 females was monitored for a mean period of 4.29 yr. The main findings were that there were no sex differences in BMC or BMD during the prepubertal stage; however, females had significantly higher BMD of the pelvis and BMC and BMD of the spine during puberty, and postpubertal males generally had significantly higher BMC and BMD than their female counterparts. In addition, the longitudinal rate of bone accumulation in both sexes increased rapidly during childhood and adolescence and was nearly complete at the end of puberty. Finally, peak BMC and BMD was achieved between the ages of 20 and 25 and occurred earlier in females than in males. The rates of growth and timing of peak bone mass as reported here define the crucial period during which intervention protocols should be developed for maximizing skeletal mass to prevent the development of osteoporosis.

Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposity: the Fels Longitudinal Study

BACKGROUND

Childhood overweight develops during 'critical periods', but the relationship of body mass index (BMI) patterns during 'critical periods' from childhood into adulthood with subsequent overweight and adiposity has not been previously investigated. BMI patterns during early childhood, pubescence and post-pubescence and their independent effects on overweight and body fatness at 35-45 y of age were examined along with birth weight and the effects of adult lifestyle factors.

METHODS

BMI parameters describing the timing, velocity minimum (min) and maximum (max) values from 2 to 25 y of age were related to adulthood BMI values and total and percentage body fat (TBF, %BF) at 35-45 y. These data were from 180 males and 158 females in the Fels Longitudinal Study.

RESULTS

There was no sex difference in the timing of BMI rebound, but the age of BMI maximum velocity and maximum BMI were both earlier in girls. Children with an earlier BMI rebound had larger BMI values at rebound and at maximum velocity. Children who reached maximum BMI at later age had larger maximum BMI values. Maximum BMI was a strong predictor for adult BMI and in females, a strong predictor of adulthood TBF and %BF. Maximum BMI was closely related to maximum BMI velocity in females and in males, BMI at maximum velocity is a strong predictor of TBF and %BF.

CONCLUSIONS

Changes in childhood BMI were related to adult overweight and adiposity more so in females than males. BMI rebound is a significant important period related to overweight at 35-45 y in females but not in males. However BMI patterns during and post-adolescence were more important than the BMI rebound for adulthood TBF and %BF status. There is marked tracking in BMI from approximately 20 y into 35-45 y. The pattern of BMI changes from 2 to 25 y had stronger effects on subsequent adult overweight than birth weight and adult lifestyle variables.

Lifetime overweight status in relation to serial changes in body composition and risk factors for cardiovascular disease: The Fels Longitudinal Study

OBJECTIVE

The aims were to determine if 1) individuals who became and maintained overweight during their entire lifetime differ from those who were never-overweight in terms of annual changes in adiposity and concurrent changes in cardiovascular disease (CVD) risk factors; 2) the changes and their relationships to each other varied between these groups or by sex within the groups; and 3) alcohol usage, smoking habits, and level of physical activity differed between groups.

RESEARCH METHODS AND PROCEDURES

Data from 16,315 examinations of 414 individuals were utilized to assess lifetime overweight (body mass index [BMI] > 25 kg/m2) status. A regressive analytic approach was used to determine the average annual changes for each individual over an adult serial interval ranging from 4 to 20 years.

RESULTS

Men and women who have become and maintained overweight have higher blood pressure and a poorer lipid/lipoprotein risk profile than those who have never been overweight. There is an accelerated deterioration in the atherogenic profile of overweight men and women as indicated by annual changes in CVD risk factors about double that of their never-overweight counterparts. In women, increased risk is derived from increasing systolic and diastolic blood pressure, whereas in men the increased risk comes not only from increasing diastolic blood pressure but also cholesterol, triglycerides, and low-density lipoprotein cholesterol levels and, to a lesser extent, decreasing high-density lipoprotein cholesterol.

DISCUSSION

The reduced physical activity observed in the overweight adults may be related to their accumulation of adipose tissue at a rate about double their never-overweight counterparts, and this may be driving the higher rate of increase of CVD risk factors in the overweight groups.

Effects of self-perceived hair loss in a community sample of men

BACKGROUND

Few studies have quantified the psychosocial effects of hair loss using standardized instruments in men not seeking treatment for hair loss.

OBJECTIVE

Examine self-perception of hair loss and its effects on men from the community.

METHODS

Men 18-50 years of age recruited without regard to hair loss, from households near Dayton, Ohio, completed a questionnaire assessing self-perception of hair loss, satisfaction with hair appearance, hair-loss-specific effects and general health status.

RESULTS

Men with greater hair loss had more bother, concern about getting older, perceived noticeability to others and greater dissatisfaction with their hair appearance than men with less hair loss. These effects decreased with age for men with hair loss, but regardless of age, perceived noticeability of hair loss increased monotonically with degree of hair loss.

CONCLUSIONS

Men with greater hair loss report more negative effects due to their hair loss across all age groups, but the effects were more pronounced in younger men.

Epidemiological applications of body composition. The effects and adjustment of measurement errors

The amounts of fat and fat-free mass (FFM) are functions of lifestyle, diseases, increasing age, and genetics. The levels of these body compartments are established risk factors for cardiovascular and related chronic diseases. Body composition can be assessed by several methods. The measurements for each method have inherent variations, which can be due to error in the measurement or biological variation. This presentation focuses on the reliability and precision of body composition measurements and the impact of these errors on epidemiological and population-based studies. The effects of these errors in applying body composition to epidemiological studies include the following: (1) the association of cardiovascular risk factors with body composition in cross-sectional studies; (2) changes in body composition in longitudinal or intervention studies; (3) association of changes in body composition with cardiovascular risk factors; and (4) comparison of levels of body composition among subgroups in cross-sectional studies and in intervention studies.

Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study

BACKGROUND

The relationship between the protein-energy nutritional status and renal function was assessed in 1785 clinically stable patients with moderate to advanced chronic renal failure who were evaluated during the baseline phase of the Modification of Diet in Renal Disease Study. Their mean +/- SD glomerular filtration rate (GFR) was 39.8 +/- 21.1 mL/min/1.73 m2.

METHODS

The GFR was determined by 121I-iothalamate clearance and was correlated with dietary and nutritional parameters estimated from diet records, biochemistry measurements, and anthropometry.

RESULTS

The following parameters correlated directly with the GFR in both men and women: dietary protein intake estimated from the urea nitrogen appearance, dietary protein and energy intake estimated from dietary diaries, serum albumin, transferrin, percentage body fat, skinfold thickness, and urine creatinine excretion. Serum total cholesterol, actual and relative body weights, body mass index, and arm muscle area also correlated with the GFR in men. The relationships generally persisted after statistically controlling for reported efforts to restrict diets. Compared with patients with GFR > 37 mL/min/1.73 m2, the means of several nutritional parameters were significantly lower for GFR between 21 and 37 mL/min/1.73 m2, and lower still for GFRs under 21 mL/min/1.73 m2. In multivariable regression analyses, the association of GFR with several of the anthropometric and biochemical nutritional parameters was either attenuated or eliminated completely after controlling for protein and energy intakes, which were themselves strongly associated with many of the nutritional parameters. On the other hand, few patients showed evidence for actual protein-energy malnutrition.

CONCLUSIONS

These cross-sectional findings suggest that in patients with chronic renal disease, dietary protein and energy intakes and serum and anthropometric measures of protein-energy nutritional status progressively decline as the GFR decreases. The reduced protein and energy intakes, as GFR falls, may contribute to the decline in many of the nutritional measures.

Bioelectrical impedance methods in clinical research: a follow-up to the NIH Technology Assessment Conference

In 1994, the National Institutes of Health (NIH) convened a Technology Assessment Conference "to provide physicians with a responsible assessment of bioelectrical impedance analysis (BIA) technology for body composition measurement." In 1997, Serono Symposia USA, Inc., organized an invited panel of scientists and clinicians, with extensive research and clinical experience with BIA, to provide an update. Panel members presented reviews based on their own work and published studies for the intervening years. Updates were provided on the single and multifrequency BIA methods and models; continued clinical research experiences; efforts toward establishing population reference norms; and the feasibility of establishing guidelines for potential diagnostic use of BIA in a clinical setting. This report provides a summary of the panel's findings including a consensus on several technical and clinical issues related to the research use of BIA, and those areas that are still in need of additional study.

Aging, body composition, and lifestyle: the Fels Longitudinal Study

BACKGROUND

Changes in body composition in men and women occur with age, but these changes are affected by numerous covariate factors.

OBJECTIVE

The study examined patterns of change in body composition and determined the effects of long-term patterns of change in physical activity in older men and women and in menopausal status and estrogen use in women.

DESIGN

Serial measures of height, weight, body mass index (BMI), total body fat (BF), percentage BF, and fat-free mass (FFM) from underwater weighing of 102 men and 108 women enrolled in the Fels Longitudinal Study were analyzed. Physical activity levels and menopausal status were included as covariates.

RESULTS

There were significant age-related decreases in FFM and height and increases in total BF, percentage BF, weight, and BMI. Physical activity was associated with decreases in total BF, percentage BF, weight, and BMI in men and were associated with increases in FFM and decreases in total BF and percentage BF in women. Postmenopausal women had significantly higher total BF and percentage BF than did pre- and perimenopausal women. The longer the time since menopause the greater were the increases in weight, BMI, total BF, and percentage BF; however, estrogen use attenuated these increases.

CONCLUSIONS

Low FFM can be improved by increased physical activity. The effects of an intervention program on body composition can be masked if only body weight or BMI is measured. The effects of physical activity were more profound in postmenopausal than in premenopausal women, and estrogen use had beneficial effects on body composition.

Tracking of body mass index in children in relation to overweight in adulthood

Body mass index (BMI; in kg/m2) values at or above the 75th percentile are associated with increased morbidity and mortality in adulthood, and there are significant correlations between BMI values in childhood and in adulthood. The present study addresses the predictive value of childhood BMI for overweight at 35 +/- 5 y, defined as BMI >28 for men and BMI >26 for women. Analyses of data from 555 white children showed that overweight at age 35 y could be predicted from BMI at younger ages. The prediction is excellent at age 18 y, good at age 13 y, but only moderate at ages <13 y. For 18-y-olds with BMIs above the 60th percentile, the probability of overweight at age 35 y is 34% for men and 37% for women. A clinically applicable method is provided to assign an overweight child to a group with a known probability of high BMI values in adulthood.

Total body water data for white adults 18 to 64 years of age: the Fels Longitudinal Study

BACKGROUND

Total body water (TBW) volume is reported to decrease with age, but much of the published data are 20 to almost 50 years old and are cross-sectional. Proper interpretation of clinical levels of TBW and trends with age necessitates the availability of current longitudinal data from healthy individuals.

METHODS

Mixed longitudinal data for TBW of 274 white men and 292 white women (18 to 64 years of age) in the Fels Longitudinal Study were collected on a regular schedule over a recent eight-year period. The concentration of deuterium was measured by deuterium nuclear magnetic resonance spectroscopy. Body composition estimates were made with dual-energy x-ray absorptiometry, and random effect models were used to determine the patterns of change over time with and without covariates.

RESULTS

The mean TBW data for the Fels men are either similar to or approximately 2 to as much as 6 liters greater than that reported by most other investigators 20 to 50 years ago. For Fels women, the mean TBW ranges from approximately 2 to as much as 5 liters less than that reported previously. These comparisons with much earlier studies reflect cohort effects and the secular changes in overall body size that have occurred during the past 60 to 70 years. These findings are reinforced by the fact that some early data sets included individuals born almost 140 years ago. After adjusting for the covariate effects of total body fat (TBF) and fat-free mass (FFM) with age, there were no significant age or age-squared effects on TBW in the men. In the women, after adjusting for the covariate associations of TBF and FFM with age, there was a small, but significant, negative linear association of TBW with age. In the men and women, the mean ratio of TBW to weight declined with age as a function of an increase in body fatness and more so for the men than the women.

CONCLUSION

The findings from these mixed longitudinal data indicate that TBW volume, on average, maintains a reasonable degree of stability in men and women through a large portion of adulthood. These TBW data are recommended as current reference data for healthy adults.

Serum leptin concentration, body composition, and gonadal hormones during puberty

BACKGROUND

Recent evidence has suggested that leptin concentration is associated with gonadal hormone levels, and that changes in leptin concentration may trigger the onset of reproductive function in children. However, the concurrent changes in body composition during puberty make the independent associations between leptin and gonadal hormone concentrations in children difficult to resolve.

METHODS

To investigate the nature of associations between leptin levels and pubertal maturation, serum concentrations of leptin, estradiol, and testosterone and body composition measures were examined in a sample of 152 healthy pre-pubertal, pubertal, and post-pubertal children.

RESULTS

Leptin concentration was nearly three-fold higher in post-pubertal girls than in pre-pubertal girls, but was relatively similar in pre- and post-pubertal boys. Significant sex differences in leptin concentration existed in prepubertal, pubertal and post-pubertal children, and these remained significant after controlling for adiposity. After adjusting for total body fat, fat-free mass and age, testosterone concentration was negatively associated with leptin levels in pubertal boys, while estradiol concentration was positively associated with leptin level in pubertal girls.

CONCLUSIONS

Girls have higher serum leptin concentration before, during, and after puberty than boys, even after accounting for the development of greater female adiposity. Although other factors may be involved, sexual dimorphism in leptin concentrations during puberty appears to be partly due to a stimulatory effect of estradiol on leptin concentration in females and a suppressive effect of testosterone on leptin concentration in males.

Body mass and bone mineral quality

During adulthood, the amount and quality of muscle and bone mineral decreases, whereas fat increases. Persons with low muscle mass and bone quality may not have the physical or structural strength to support the body. The dual-energy x-ray absorptiometer is used to measure the amount of muscle, fat, and the quality of bone mineral. Men have larger average amounts of muscle and bone, and greater average bone density than women. In women, the normal decrease of body mass and bone quality is accentuated by menopause. On average, blacks have a larger amount of muscle and more dense bones than whites. A person with a high peak bone mass can lose bone normally with age and still maintain good bone quality. Lifestyle, diet, and exercise are important to maintaining a healthy body and good bone quality. Physically active persons have increased levels of muscle and bone density. Age, sex, race, and lifestyle affect the level of, and changes in, body mass and bone mineral density.

Nutritional support and aging in preoperative nutrition

In the past 20 years, an increased interest geriatric nutrition has induced researchers to document the distribution and magnitude of nutritional problems in the elderly population. It has been observed that the prevalence of malnutrition is greatly affected by the general health status and autonomy of the elderly. Among free-living healthy elderly persons, the prevalence of protein-caloric undernutrition is low. As health and functional capacities deteriorate with age, however, the prevalence increases dramatically to 30-65% of those in home care, nursing homes or in hospital. Formal nutritional assessment has typically been absent from most published programmes of geriatric evaluation and comprehensive geriatric assessment. This is frequently because of the lack of a specific validated tool to assess nutritional status in older persons and, at least partly, to explain this phenomenon. The Mini Nutritional Assessment was developed and validated on large representative samples of elderly persons to address these specific issues. Recent experimental studies have shown that advanced malnutrition is much more difficult to treat in the elderly than in younger adults. Trials of nutritional support using oral supplements or enteral tube feeding have shown improved outcome in those identified as malnourished on admission to hospital.

Prevalence of male pattern hair loss in 18-49 year old men

BACKGROUND

Previous studies investigating the prevalence of male pattern hair loss (MPHL) typically used biased samples of men recruited from clinical populations which may limit generalizability of findings to broader populations.

OBJECTIVE

To obtain an updated and improved estimate of the occurrence of MPHL in healthy men residing in the community.

METHODS

Community-based sample of healthy men aged 18-49 years participated in a study investigating the effects of MPHL. Participants completed a brief questionnaire self reporting degree of hair loss, general health-related quality of life (HRQL) and hair-loss-specific measures. A trained observer also rated each participant using standardized classification for MPHL.

RESULTS

The proportion of men with moderate to extensive hair loss (type III or greater) was 42%. The proportion of men with moderate to extensive hair loss increased with increasing age, ranging from 16% for men 18-29 years of age to 53% of men 40-49. Twelve percent of the men were classified as having predominantly frontal baldness (type A variants).

CONCLUSIONS

MPHL, especially frontal baldness, may be more common than previously reported.