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Archives of Disease in Childhood Jul 2023Reference centile charts are widely used for the assessment of growth and have progressed from describing height and weight to include body composition variables such as...
OBJECTIVE
Reference centile charts are widely used for the assessment of growth and have progressed from describing height and weight to include body composition variables such as fat and lean mass. Here, we present centile charts for an index of resting energy expenditure (REE) or metabolic rate, adjusted for lean mass versus age, including both children and adults across the life course.
DESIGN, PARTICIPANTS AND INTERVENTION
Measurements of REE by indirect calorimetry and body composition using dual-energy X-ray absorptiometry were made in 411 healthy children and adults (age range 6-64 years) and serially in a patient with resistance to thyroid hormone α (RTHα) between age 15 and 21 years during thyroxine therapy.
SETTING
NIHR Cambridge Clinical Research Facility, UK.
RESULTS
The centile chart indicates substantial variability, with the REE index ranging between 0.41 and 0.59 units at age 6 years, and 0.28 and 0.40 units at age 25 years (2nd and 98th centile, respectively). The 50th centile of the index ranged from 0.49 units (age 6 years) to 0.34 units (age 25 years). Over 6 years, the REE index of the patient with RTHα varied from 0.35 units (25th centile) to 0.28 units (<2nd centile), depending on changes in lean mass and adherence to treatment.
CONCLUSION
We have developed a reference centile chart for an index of resting metabolic rate in childhood and adults, and shown its clinical utility in assessing response to therapy of an endocrine disorder during a patient's transition from childhood to adult.
Topics: Child; Adult; Humans; Adolescent; Young Adult; Middle Aged; Basal Metabolism; Life Change Events; Energy Metabolism; Body Weight; Body Composition; Absorptiometry, Photon; Body Mass Index
PubMed: 36863849
DOI: 10.1136/archdischild-2022-325249 -
The Spine Journal : Official Journal of... Aug 2023Recently published studies have revealed a correlation between MRI-based vertebral bone quality (VBQ) score and bone mineral density (BMD) measured using dual X-ray...
BACKGROUND CONTEXT
Recently published studies have revealed a correlation between MRI-based vertebral bone quality (VBQ) score and bone mineral density (BMD) measured using dual X-ray absorptiometry (DXA) or quantitative computed tomography (QCT). However, no studies have determined if differences in field strength (1.5 vs 3.0 T) could affect the comparability of the VBQ score among different individuals.
PURPOSE
To compare the VBQ score obtained from 1.5 T and 3.0 T MRI (VBQ vs VBQ) in patients undergoing spine surgery and assess the predictive performance of VBQ for osteoporosis and osteoporotic vertebral fracture (VCF).
DESIGN
A nested case‒control study based on an ongoing prospective cohort study of patients undergoing spine surgery.
PATIENT SAMPLE
All older patients (men aged >60 years and postmenopausal women) with available DXA, QCT and MR images within 1 month were included.
OUTCOME MEASURES
VBQ score, DXA T-score, and QCT derived vBMD.
METHODS
The osteoporotic classifications recommended by the World Health Organization and American College of Radiology were used to categorize the DXA T-score and QCT-derived BMD, respectively. For each patient, the VBQ score was calculated using T1-weighted MR images. Correlation analysis between VBQ and DXA/QCT was performed. Receiver operating characteristic (ROC) curve analysis, including determination of the area under the curve (AUC), was performed to assess the predictive performance of VBQ for osteoporosis.
RESULTS
A total of 452 patients (98 men aged >60 years and 354 postmenopausal women) were included in the analysis. Across different BMD categories, the correlation coefficients between the VBQ score and BMD ranged from -0.211 to -0.511, and the VBQ score and QCT BMD demonstrated the strongest correlation. The VBQ score was a significant classifier of osteoporosis detected by either DXA or QCT, with VBQ showing the highest discriminative power for QCT-osteoporosis (AUC=0.744, 95% CI=0.685-0.803). In ROC analysis, the VBQ threshold values ranged from 3.705 to 3.835 with a sensitivity between 48% and 55.6% and a specificity between 70.8% and 74.8%, while the VBQ threshold values ranged from 2.59 to 2.605 with a sensitivity between 57.6% and 67.1% and a specificity between 67.8% and 69.7%.
CONCLUSIONS
VBQ exhibited better discriminability between patients with and without osteoporosis than VBQ. Considering the non-negligible difference in osteoporosis diagnosis threshold values between the VBQ and VBQ scores, it is essential to clearly distinguish the magnetic field strength when assessing the VBQ score.
Topics: Male; Humans; Female; Aged; Bone Density; Case-Control Studies; Prospective Studies; Osteoporosis; Spine; Absorptiometry, Photon; Osteoporotic Fractures; Lumbar Vertebrae
PubMed: 37031891
DOI: 10.1016/j.spinee.2023.03.016 -
Translational Vision Science &... Jul 2023The purpose of this study was to assess in vivo regional variability in the densitometry parameters of corneal stroma and the modulating effect of age on those...
PURPOSE
The purpose of this study was to assess in vivo regional variability in the densitometry parameters of corneal stroma and the modulating effect of age on those parameters using statistical characterization of optical coherence tomography (OCT) speckle.
METHODS
OCT imaging of central and peripheral cornea was performed in a group of 20 younger (24 to 30 years old) and 19 older (50 to 87 years old) subjects. The sample size was estimated using normal assumptions and previously reported data on speckle parameter variability. Statistical parameters of corneal OCT speckle were calculated in the regions of interest (ROI) encompassing central and peripheral stroma as well as taking into account their anterior and posterior subregions. Both parametric (Burr-2 parameters: α and k) and a nonparametric approach (contrast ratio [CR]) were considered. Two-way analysis of variance was used to test for differences in densitometry parameters with respect to ROI position and age.
RESULTS
Both approaches showed statistically significant differences within the ROI positions (all P < 0.001 for α, k, and CR) and age (P < 0.001, P = 0.002, and P = 0.003, for α, k, and CR, respectively) indicating substantial stromal asymmetry. Additionally, CR showed statistically significant differences between anterior and posterior subregions (P < 0.001).
CONCLUSIONS
Corneal OCT-based densitometry is inherently asymmetrical and are influenced by age. The results indicate that regional variability of stromal structure is not limited to the central and peripheral regions but that differences exist also between the nasal and temporal parts of the cornea.
TRANSLATIONAL RELEVANCE
The in vivo acquired parameters of corneal OCT speckle can be used to indirectly assess corneal structure.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Tomography, Optical Coherence; Cornea; Corneal Stroma; Densitometry
PubMed: 37405797
DOI: 10.1167/tvst.12.7.4 -
Frontiers in Endocrinology 2023Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to...
INTRODUCTION
Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to different diagnostic criteria and assess the elements of sarcopenia in children and adolescents with obesity.
METHODS
A total of 95 children and adolescents with obesity (diagnosed with the use of International Obesity Task Force (IOTF) criteria) with a mean age of 12.7( ± 3) years participated in the study. Body composition was assessed with the use of bioelectrical impedance-BIA (Tanita BC480MA) and dual-energy X-ray absorptiometry-DXA (Hologic). Fat mass (FM) and appendicular skeletal muscle mass (SMMa) were expressed as kilograms (kg) and percentage (%). Muscle-to-fat ratio (MFR) was defined as SMMa divided by FM. A dynamometer was used in order to measure grip strength. Six-minute walk test (6MWT) and a timed up-and-go test (TUG) were used to assess physical performance.
RESULTS
The presence of SO ranged from 6.32% to 97.89%, depending on the criteria used to define sarcopenia. Children with sarcopenia, defined as a co- occurrence of low skeletal muscle mass % (SMM%) measured by DXA (≤9th centile) according to McCarthy et al. and weak handgrip strength (≤10th centile) according to Dodds et al., had significantly lower SMMa measured by both DXA and BIA, lower maximal handgrip strength, and lower physical performance. Maximal handgrip was positively correlated with SMMa (kg) and SMMa% derived from both DXA and BIA and BIA-MFR. Maximal handgrip was negatively correlated with waist-to-height ratio (WHtR). The distance of 6MWT correlated positively with BIA-measured SMMa% and BIA-MFR. 6MWT distance correlated negatively with BIA-FM% and body mass index (BMI) z-score. TUG was positively correlated with BIA-FM%, BMI z-score, WHtR, and IOTF categories and negatively correlated with BIA-SMMa% and BIA-MFR.
DISCUSSION
The presence of sarcopenia in our study varied depending on the diagnostic criteria used. This is one of the first studies evaluating muscle mass, muscle strength, and physical performance in children and adolescents with obesity. The study highlighted the need for the implementation of a consensus statement regarding SO diagnostic criteria in children and adolescents.
Topics: Adolescent; Humans; Child; Sarcopenia; Pediatric Obesity; Hand Strength; Absorptiometry, Photon; Muscle Strength; Muscle, Skeletal
PubMed: 37859982
DOI: 10.3389/fendo.2023.1252853 -
The Journal of Clinical Endocrinology... Sep 2023Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at...
CONTEXT
Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners.
OBJECTIVE
To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength.
DESIGN
Cross-sectional.
SETTING
Clinical research center.
PARTICIPANTS
39 men (20 runners, 19 controls), ages 16-30 years.
MAIN OUTCOME MEASURES
Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability.
RESULTS
Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA
CONCLUSIONS
Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
Topics: Humans; Male; Female; Leptin; Cross-Sectional Studies; Calcium; Bone Density; Absorptiometry, Photon; Lumbar Vertebrae; Testosterone; Estradiol
PubMed: 37079740
DOI: 10.1210/clinem/dgad215 -
Swiss Medical Weekly Jun 2024Patients with inflammatory bowel disease (IBD) are prone to reduced bone mineral density and elevated overall fracture risk. Osteopenia affects up to 40% of patients... (Review)
Review
Patients with inflammatory bowel disease (IBD) are prone to reduced bone mineral density and elevated overall fracture risk. Osteopenia affects up to 40% of patients with IBD (high regional variability). Besides disease activity, IBD specialists must consider possible side effects of medication and the presence of associated diseases and extraintestinal manifestations. Osteopenia and osteoporosis remain frequent problems in patients with IBD and are often underestimated because of widely differing screening and treatment practices. Malnutrition, chronic intestinal inflammation and corticosteroid intake are the major pathophysiological factors contributing to osteoporosis. Patients with IBD are screened for osteoporosis using dual-energy X-ray absorptiometry (DXA), which is recommended for all patients with a prolonged disease course of more than three months, with repeated corticosteroid administration, aged >40 years with a high FRAX risk score or aged <40 years with multiple risk factors. From a therapeutic perspective, besides good disease control, vitamin D supplementation and glucocorticoid sparing, several specific osteological options are available: bisphosphonates, receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors (denosumab), parathyroid hormone (PTH) analogues and selective estrogen receptor modulators. This review provides an overview of the pathophysiology, diagnosis, prevention and treatment of IBD-associated bone loss.
Topics: Humans; Inflammatory Bowel Diseases; Osteoporosis; Bone Density; Bone Diseases, Metabolic; Absorptiometry, Photon; Risk Factors; Vitamin D; Bone Density Conservation Agents; Diphosphonates
PubMed: 38875461
DOI: 10.57187/s.3407 -
Turkish Journal of Ophthalmology Aug 2023To investigate the effects of pupil diameter on the evaluation of lens and corneal densitometry measured by Scheimpflug tomography.
OBJECTIVES
To investigate the effects of pupil diameter on the evaluation of lens and corneal densitometry measured by Scheimpflug tomography.
MATERIALS AND METHODS
This cross-sectional and comparative study used the right eyes of 32 participants. Corneal and lenticular optical densitometries, corneal volume, anterior segment volume, and anterior chamber depth measurements were taken with the Scheimpflug imaging system when the pupils were mid-dilated and fully dilated. The results were statistically compared.
RESULTS
The mean lens density was 19.20±3.05 when the pupils were mid-dilated (mean pupil diameter 2.98±0.89 mm) and 23.25±3.88 at full dilation (mean pupil diameter 5.01±0.92 mm) (p<0.001). The mean corneal density was 16.15±0.99 with mid-dilated pupils and 16.38±0.95 with fully dilated pupils (p=0.065). Anterior chamber depth and anterior segment volume measurements increased with larger pupil diameter (p<0.05).
CONCLUSION
The lens densitometry values increased with an increase in pupil diameter. The corneal density measurements increased minimally but the differences were not statistically significant. This study revealed that lens densitometry was significantly affected by pupil diameter.
Topics: Humans; Cross-Sectional Studies; Cornea; Pupil; Densitometry
PubMed: 37602578
DOI: 10.4274/tjo.galenos.2022.42724 -
Wiener Medizinische Wochenschrift (1946) Oct 2023Chronic kidney disease (CKD): abnormalities of kidney structure or function, present for over 3 months. Staging of CKD is based on GFR and albuminuria (not graded).... (Review)
Review
[Diagnosis and treatment of osteoporosis in patients with chronic kidney disease : Joint guidelines of the Austrian Society for Bone and Mineral Research (ÖGKM), the Austrian Society of Physical and Rehabilitation Medicine (ÖGPMR) and the Austrian Society of Nephrology (ÖGN)].
DEFINITION AND EPIDEMIOLOGY
Chronic kidney disease (CKD): abnormalities of kidney structure or function, present for over 3 months. Staging of CKD is based on GFR and albuminuria (not graded). Osteoporosis: compromised bone strength (low bone mass, disturbance of microarchitecture) predisposing to fracture. By definition, osteoporosis is diagnosed if the bone mineral density T‑score is ≤ -2.5. Furthermore, osteoporosis is diagnosed if a low-trauma (inadequate trauma) fracture occurs, irrespective of the measured T‑score (not graded). The prevalence of osteoporosis, osteoporotic fractures and CKD is increasing worldwide (not graded). PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF CHRONIC KIDNEY DISEASE-MINERAL AND BONE DISORDER (CKD-MBD): Definition of CKD-MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; renal osteodystrophy; vascular calcification (not graded). Increased, normal or decreased bone turnover can be found in renal osteodystrophy (not graded). Depending on CKD stage, routine monitoring of calcium, phosphorus, alkaline phosphatase, PTH and 25-OH-vitamin D is recommended (2C). Recommendations for treatment of CKD-MBD: Avoid hypercalcemia (1C). In cases of hyperphosphatemia, lower phosphorus towards normal range (2C). Keep PTH within or slightly above normal range (2D). Vitamin D deficiency should be avoided and treated when diagnosed (1C).
DIAGNOSIS AND RISK STRATIFICATION OF OSTEOPOROSIS IN CKD
Densitometry (using dual X‑ray absorptiometry, DXA): low T‑score correlates with increased fracture risk across all stages of CKD (not graded). A decrease of the T‑score by 1 unit approximately doubles the risk for osteoporotic fracture (not graded). A T-score ≥ -2.5 does not exclude osteoporosis (not graded). Bone mineral density of the lumbar spine measured by DXA can be increased and therefore should not be used for the diagnosis or monitoring of osteoporosis in the presence of aortic calcification, osteophytes or vertebral fracture (not graded). FRAX can be used to aid fracture risk estimation in all stages of CKD (1C). Bone turnover markers can be measured in individual cases to monitor treatment (2D). Bone biopsy may be considered in individual cases, especially in patients with CKD G5 (eGFR < 15 ml/min/1.73 m) or CKD 5D (dialysis).
SPECIFIC TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH CKD
Hypocalcemia should be treated and serum calcium normalized before initiating osteoporosis therapy (1C). CKD G1-G2 (eGFR ≥ 60 ml/min/1.73 m): treat osteoporosis as recommended for the general population (1A). CKD G3-G5D (eGFR < 60 ml/min/1.73 m to dialysis): treat CKD-MBD first before initiating osteoporosis treatment (2C). CKD G3 (eGFR 30-59 ml/min/1.73 m) with PTH within normal limits and osteoporotic fracture and/or high fracture risk according to FRAX: treat osteoporosis as recommended for the general population (2B). CKD G4-5 (eGFR < 30 ml/min/1.73 m) with osteoporotic fracture (secondary prevention): Individualized treatment of osteoporosis is recommended (2C). CKD G4-5 (eGFR < 30 ml/min/1.73 m) and high fracture risk (e.g. FRAX score > 20% for a major osteoporotic fracture or > 5% for hip fracture) but without prevalent osteoporotic fracture (primary prevention): treatment of osteoporosis may be considered and initiated individually (2D). CKD G4-5D (eGFR < 30 ml/min/1.73 m to dialysis): Calcium should be measured 1-2 weeks after initiation of antiresorptive therapy (1C).
PHYSICAL MEDICINE AND REHABILITATION
Resistance training prioritizing major muscle groups thrice weekly (1B). Aerobic exercise training for 40 min four times per week (1B). Coordination and balance exercises thrice weekly (1B). Flexibility exercise 3-7 times per week (1B).
Topics: Humans; Chronic Kidney Disease-Mineral and Bone Disorder; Calcium; Osteoporotic Fractures; Nephrology; Austria; Osteoporosis; Renal Insufficiency, Chronic; Bone Density; Vitamin D; Minerals; Phosphorus; Physical and Rehabilitation Medicine; Intercellular Signaling Peptides and Proteins
PubMed: 36542221
DOI: 10.1007/s10354-022-00989-0 -
BMC Endocrine Disorders Sep 2023Metabolic dysfunction associated with fatty liver disease (MAFLD) is often correlated with obesity and hyperuricemia. The present study aimed to determine the...
BACKGROUND
Metabolic dysfunction associated with fatty liver disease (MAFLD) is often correlated with obesity and hyperuricemia. The present study aimed to determine the association between serum uric acid (SUA) and central fat distribution in patients with MAFLD.
METHODS
A total of 485 patients were classified into the following groups: (1) controls without MAFLD and hyperuricemia (HUA), (2) MAFLD with normal SUA, and (3) MAFLD with HUA. DUALSCAN HDS-2000 was used to measure visceral fat (VAT) and subcutaneous fat (SAT). Dual-energy X-ray absorptiometry (DEXA) was used to measure body fat distribution.
RESULTS
MAFLD patients with HUA had remarkably higher BMI, fasting insulin, OGIRT AUC, ALT, AST, TG, VAT, SAT, Adipo-IR, trunk fat mass, android fat, and total body fat than MAFLD patients with normal SUA (all p < 0.05). The increase in VAT, SAT, CAP, Adipo-IR, upper limbs fat mass, trunk fat mass, and android fat, as well as the percentage of MAFLD, were significantly correlated with the increase in SUA. The percentage of MAFLD patients with HUA increased significantly with increasing VAT or SAT, as determined by the Cochran-Armitage trend test (all p < 0.05). Furthermore, VAT (OR = 1.01 CI: 1.00, 1.03; p < 0.05) and adipo-IR (OR = 1.09 CI: 1.00, 1.19; p < 0.05) were associated with circling SUA in MAFLD after adjusting for sex, age, TG, TC, HOMA-IR, and BMI.
CONCLUSION
Abdominal fat promotes the co-existence of HUA and MAFLD, while weight loss, especially, decreasing VAT, is of great importance to decrease SUA levels and manage MAFLD.
Topics: Humans; Hyperuricemia; Uric Acid; Abdominal Fat; Absorptiometry, Photon; Body Fat Distribution; Non-alcoholic Fatty Liver Disease
PubMed: 37749567
DOI: 10.1186/s12902-023-01447-7 -
Revista Da Associacao Medica Brasileira... 2023The aim of this study was to compare the distribution of fat tissue in non-obese women with polycystic ovary syndrome and those without the syndrome using dual-energy...
OBJECTIVE
The aim of this study was to compare the distribution of fat tissue in non-obese women with polycystic ovary syndrome and those without the syndrome using dual-energy radiological densitometry.
METHODS
This was a case-control study in which we enrolled women aged 14-39 years with polycystic ovary syndrome according to the Rotterdam criteria with a body mass index between 18.5 and 30 kg/m2. The control group comprised women with the same profile, but without polycystic ovary syndrome. Patients were treated at the Endocrinological Gynecology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Irmandade da Santa Casa de Misericórdia de São Paulo between 2019 and 2022. Anthropometric measurements were taken and the assessment of body composition was performed using dual-energy radiological densitometry.
RESULTS
The sample comprised 57 women: 37 in the polycystic ovary syndrome group and 20 in the control group. The mean age of the polycystic ovary syndrome group was 24.9 years (±6.9) with a mean body mass index of 60.8 kg/m2 (±8.5), and for the control group, it was 24.2 years (±6.9) with a mean body mass index of 58 kg/m2 (±8.4). Body composition was evaluated using dual-energy radiological densitometry and showed a higher value of trunk fat in the polycystic ovary syndrome group (44.1%, ±9.0) compared to the control group (35.2%, ±11.4), which was statistically significant (p=0.002).
CONCLUSION
Our study showed that non-obese polycystic ovary syndrome patients have a higher concentration of abdominal fat, which is a risk factor for increased cardiovascular risk and insulin resistance.ClinicalTrials.gov ID: NCT02467751.
Topics: Female; Humans; Young Adult; Adult; Polycystic Ovary Syndrome; Case-Control Studies; Brazil; Body Composition; Insulin Resistance; Body Mass Index; Abdominal Fat
PubMed: 37909624
DOI: 10.1590/1806-9282.20230874