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Clinical Nutrition (Edinburgh, Scotland) Feb 2022Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC.
METHODS
Electronic databases and trial registries were searched through July 2021 to perform random-effects meta-analyses. Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS
Twenty-nine studies (4443 patients) were included; 28 used computed tomography and one used dual-energy X-ray absorptiometry to assess body composition. Eighteen studies reported the impact of pre-operative sarcopenia on postoperative outcomes; namely, sarcopenia increased postoperative complications (risk ratio = 1.23, 95% confidence interval [CI] = 1.07 to 1.41; I = 2%), and decreased recurrence-free survival (hazard ratio [HR] = 2.20, 95% CI = 1.75 to 2.75; I = 0%) in multivariable analyses. Low muscle quantity (HR = 2.26, 95% CI = 1.75 to 2.92; I = 66%) and quality (HR = 1.75, 95% CI = 1.33 to 2.29; I = 50%) decreased overall survival in multivariable analyses. The certainty of the evidence was low because of heterogeneity and imprecision.
CONCLUSIONS
In sarcopenia, low muscle quantity and quality by body composition conferred an independent risk of morbidity and mortality in patients with BTC. Further studies are needed to confirm these findings and mitigate risk.
Topics: Absorptiometry, Photon; Aged; Biliary Tract Neoplasms; Body Composition; Female; Humans; Male; Middle Aged; Muscle, Skeletal; Postoperative Complications; Proportional Hazards Models; Risk Factors; Sarcopenia; Tomography, X-Ray Computed
PubMed: 34999326
DOI: 10.1016/j.clnu.2021.12.005 -
Nutrition Journal Feb 2019Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD...
BACKGROUND
Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD.
METHODS
This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q (p < 0.05) and I index were presented to reveal the heterogeneity.
RESULTS
54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn't have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9-20.5%] (Cochrane Q = 7.889, p = 0.96, I = 49.29%), and osteopenia was 39.6% [31.1-48.8%] (Cochrane Q = 14.24, p = 0.07, I = 71.92%), respectively.
CONCLUSION
Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case -control studies with more sample size and consideration of confounding factors.
Topics: Adult; Aged; Bone Density; Bone Diseases, Metabolic; Brazil; Celiac Disease; Female; Fractures, Bone; Humans; Hungary; India; Male; Middle Aged; Osteoporosis; Poland; Premenopause; Risk Factors; United Kingdom
PubMed: 30732599
DOI: 10.1186/s12937-019-0434-6 -
Bone Sep 2021Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray absorptiometry (DXA) is the current reference standard for evaluating bone density, as recommended by the International Society for Clinical Densitometry (ISCD). Various bone imaging modalities, such as quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), high-resolution peripheral quantitative computed tomography (HR-pQCT), magnetic resonance imaging (MRI), and digital X-ray radiogrammetry (DXR) have been developed to further quantify bone health in children and adults. The purpose of this review, with meta-analysis, was to systematically research the literature to compare the various imaging methods and identify the best modality for assessing bone status in healthy papulations and children and young people with chronic disease (up to 18 years).
METHODS
A systematic computerized search of Medline, PubMed, and Web of Science databases was conducted to identify English-only studies published between 1st January 1990 and 1st December 2019. In this review, clinical studies comparing imaging modalities with DXA were chosen according to the inclusion criteria. The risk of bias and quality of articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The meta-analysis to estimate the overall correlation was performed using a Fisher Z transformation of the correlation coefficient. Additionally, the diagnostic accuracy measures of different imaging methods compared with DXA were calculated.
RESULTS
The initial search strategy identified 13,412 papers, 29 of which matched the inclusion and exclusion criteria. Of these, twenty-two papers were included in the meta-analysis. DXA was compared to QUS in 17 papers, to DXR in 7 and to pQCT in 4 papers. A single paper compared DXA, DXR, and pQCT. The meta-analysis demonstrated that the strongest correlation was between DXR and DXA, with a coefficient of 0.71 [95%CI: 0.43; 1.00, p-value < 0.001], while the correlation coefficients between QUS and DXA, and pQCT and DXA were 0.57 [95%CI: 0.25; 0.90, p-value < 0.001] and 0.57 [95%CI: 0.46; 0.67, p-value < 0.001], respectively. The overall sensitivity and specificity were statistically significant 0.71 and 0.80, respectively.
CONCLUSION
No current imaging modality provides a full evaluation of bone health in children and young adults, with each method having some limitations. Compared to QUS and pQCT, DXR achieved the strongest positive relationship with DXA. DXR should be further evaluated as a reliable method for assessing bone health and as a predictor of fractures in children and young people.
Topics: Absorptiometry, Photon; Adolescent; Bone Density; Bone and Bones; Child; Humans; Tomography, X-Ray Computed; Ultrasonography; Young Adult
PubMed: 34029779
DOI: 10.1016/j.bone.2021.116013 -
JAMA Network Open Aug 2019Hormone therapy (HT) has been suggested for protection against age-related muscle weakness in women. However, the potential for HT-associated health risks necessitates a... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Hormone therapy (HT) has been suggested for protection against age-related muscle weakness in women. However, the potential for HT-associated health risks necessitates a better understanding of the direction and magnitude of the association between HT and health outcomes, such as lean body mass (LBM).
OBJECTIVE
To determine whether HT was associated with reduced LBM loss compared with not receiving HT among postmenopausal women aged 50 years and older.
DATA SOURCES
MEDLINE, Embase, AgeLine, CINAHL, and SportDiscus (searched from inception until April 25, 2018).
STUDY SELECTION
For this systematic review and meta-analysis, randomized clinical trials including postmenopausal women undergoing HT and control groups of women not receiving HT were selected by 2 reviewers. Studies were included if LBM or fat-free mass were measured as an outcome. Studies with participants from hospitals, long-term care facilities, or with specific diseases were excluded.
DATA EXTRACTION AND SYNTHESIS
Information regarding study characteristics and outcome measures were extracted by 1 reviewer and verified by another. Risk of bias was evaluated. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to abstract data and assess data quality/validity. Data were pooled using a fixed-effects model.
MAIN OUTCOMES AND MEASURES
The primary study outcome was the overall absolute change in LBM (measured in kilograms), captured by dual-energy x-ray absorptiometry, dual-photon absorptiometry, or bioelectrical impedance analysis imaging.
RESULTS
Of 8961 studies that met selection criteria, 12 were included, with a total of 4474 recruited participants. Of the participants, mean (SD) age was 59.0 (6.1) years. Data on ethnicity were collected by 2 of the studies. Of the 22 HT intervention arms, 15 used estrogen-progesterone combination HT and 7 used estrogen-only HT. Control participants were women who received no HT at all or who received placebo. The median follow-up duration was 2 years (range, 6 months to 6 years). Seven treatment arms showed a loss of LBM, and 14 were protective. Overall, HT users lost 0.06 kg (95% CI, -0.05 to 0.18) less LBM compared with control participants, but the difference was not statistically significant (P = .26). The results were unchanged when stratified based on treatment type and dosage, duration of follow-up, time since menopause, study quality, and type of LBM measurement, with HT users losing between 0.06 kg more to 0.20 kg less LBM compared with control participants for all strata. The quality of evidence based on GRADE was low.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis did not show a significant beneficial or detrimental association of HT with muscle mass. Although muscle retention in aging women is of crucial importance, these findings suggest that interventions other than HT should be explored.
Topics: Absorptiometry, Photon; Aged; Body Composition; Case-Control Studies; Electric Impedance; Estrogen Replacement Therapy; Estrogens; Female; Follow-Up Studies; Hormone Replacement Therapy; Humans; Middle Aged; Muscle Weakness; Muscle, Skeletal; Outcome Assessment, Health Care; Placebos; Postmenopause; Prospective Studies; Randomized Controlled Trials as Topic
PubMed: 31461147
DOI: 10.1001/jamanetworkopen.2019.10154 -
Lung Cancer (Amsterdam, Netherlands) Jul 2012Studies exploring the association between emphysema detected on chest computed tomography (CT) and lung cancer have yielded mixed results. Our objective was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies exploring the association between emphysema detected on chest computed tomography (CT) and lung cancer have yielded mixed results. Our objective was to systematically review the evidence for this association.
METHODS
We searched MEDLINE, EMBASE and the Cochrane Library for the terms "lung cancer", "emphysema" and "computed tomography" without language restriction. Bibliographies were also reviewed and authors contacted for additional information. Human studies in which CTs were performed and assessed for emphysema and in which subjects were evaluated systematically for lung cancer were included. Qualitative synthesis of evidence was performed followed by pooling of effect estimates using a random-effects model.
RESULTS
Of 187 citations, 7 were included in the qualitative synthesis and 5 in the meta-analysis. Three studies assessing emphysema visually observed an association with lung cancer, independent of smoking history and airflow obstruction. Three studies using densitometry to detect emphysema found no association with lung cancer. Another study directly comparing automated and visual emphysema detection techniques found only the latter to associate with lung cancer. Among 7368 subjects included in the meta-analysis, 2809 had emphysema on CT and 870 were diagnosed with lung cancer. The pooled adjusted odds ratio for lung cancer in the presence of emphysema on CT was 2.11 (95% CI 1.10-4.04); stratification by detection method yielded OR of 3.50 (95% CI 2.71-4.51) with visually detected emphysema and 1.16 (95% CI 0.48-2.81) with densitometric emphysema.
CONCLUSION
Systematic literature review shows emphysema detected visually on CT to be independently associated with increased odds of lung cancer. This association did not hold with automated emphysema detection.
Topics: Cohort Studies; Humans; Lung Neoplasms; Odds Ratio; Pulmonary Emphysema; Risk Factors; Tomography, X-Ray Computed
PubMed: 22437042
DOI: 10.1016/j.lungcan.2012.02.019 -
BJU International Jan 2018Androgen-deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for... (Review)
Review
Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures.
Androgen-deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for fractures. This review compared the efficacy of available treatments to provide prescribing guidance to healthcare professionals. This is the first review to compare the effectiveness of different osteoporotic treatments (bisphosphonates, denosumab, toremifene, and raloxifene) on BMD in patients with non-metastatic prostate cancer on ADT using network meta-analysis. Results suggest that all evaluated treatments are effective in improving BMD compared to placebo. Zoledronic acid (ZA) was found to have a greater improvement in BMD compared to other active treatments at all three studied sites, except for risedronate, which had better BMD improvement compared to ZA at the femoral neck site in one small study. Our study did not identify evidence that one drug is unequivocally more effective than another. All drugs appeared to be effective in reducing the rate of bone loss. Healthcare professionals should also consider patient preference, costs, and local availability as part of the decision process.
Topics: Absorptiometry, Photon; Aged; Androgen Antagonists; Bone Density; Bone Density Conservation Agents; Diphosphonates; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Network Meta-Analysis; Osteoporosis; Osteoporotic Fractures; Prognosis; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome
PubMed: 28921820
DOI: 10.1111/bju.14015 -
Physiotherapy Canada. Physiotherapie... 2011To systematically review the literature related to bone health in older adults with type 2 diabetes mellitus (T2DM). (Review)
Review
PURPOSE
To systematically review the literature related to bone health in older adults with type 2 diabetes mellitus (T2DM).
METHODS
We conducted a systematic review of the literature from January 2005 until February 2010, using keywords related to T2DM and bone-health imaging technology in older adults (aged ≥60 years) to search PubMed, OVID MEDLINE, Ageline, CINAHL, Embase, and PsycINFO.
RESULTS
We found a total of 13 studies that met the inclusion criteria for this review. The majority of the studies used dual X-ray absorptiometry (DXA) and showed either higher or similar areal bone mineral density (aBMD) for older adults with T2DM relative to healthy controls. Studies using more advanced imaging suggested that there may be differences in bone geometry between older adults with and without T2DM.
CONCLUSIONS
Older adults with T2DM have similar or higher aBMD at the hip relative to older adults without T2DM, despite previous literature reporting an increased risk of low-trauma fractures. Recent studies with advanced imaging have suggested that there may be differences in bone geometry between older adults with T2DM and those without. Health professionals, especially physiotherapists, should be aware of the increased risk and include assessment of fall risk factors and exercise prescription for fall prevention for older adults with T2DM.
Topics: Absorptiometry, Photon; Bone Density; Bone and Bones; Diabetes Mellitus, Type 2; Humans; Osteoporotic Fractures
PubMed: 22210975
DOI: 10.3138/ptc.2010-23bh -
Stem Cells Translational Medicine Apr 2022The effects of neural stem/progenitor cells (NSPCs) have been extensively evaluated by multiple studies in animal models of Parkinson's disease (PD), but the therapeutic... (Meta-Analysis)
Meta-Analysis
The effects of neural stem/progenitor cells (NSPCs) have been extensively evaluated by multiple studies in animal models of Parkinson's disease (PD), but the therapeutic efficacy was inconsistent. Here, we searched 4 databases (PubMed, Embase, Scopus, and Web of Science) and performed a meta-analysis to estimate the therapeutic effects of unmodified NSPCs on neurological deficits in rodent animal models of PD. Data on study quality score, behavioral outcomes (apomorphine or amphetamine-induced rotation and limb function), histological outcome (densitometry of TH+ staining in the SNpc), and cell therapy-related severe adverse events were extracted for meta-analysis and systematic review. Twenty-one studies with a median quality score of 6 (range from 4 to 9) in 11 were examined. Significant improvement was observed in the overall pooled standardized mean difference (SMD) between animals transplanted with NSPCs and with control medium (1.22 for apomorphine-induced rotation, P < .001; 1.50 for amphetamine-induced rotation, P < .001; 0.86 for limb function, P < .001; and -1.96 for the densitometry of TH+ staining, P < .001). Further subgroup analysis, animal gender, NSPCs source, NSPCs dosage, and pretreatment behavioral assessment were closely correlated with apomorphine-induced rotation and amphetamine-induced rotation. In conclusion, unmodified NSPCs therapy attenuated behavioral deficits and increased dopaminergic neurons in rodent PD models, supporting the consideration of early-stage clinical trial of NSPCs in patients with PD.
Topics: Animals; Apomorphine; Disease Models, Animal; Humans; Parkinson Disease; Rodentia; Stem Cell Transplantation
PubMed: 35325234
DOI: 10.1093/stcltm/szac006 -
Obesity Reviews : An Official Journal... Aug 2020Accurate measurement of body composition is required to improve health outcomes in children and adolescents with overweight or obesity. This systematic review aimed to...
Accurate measurement of body composition is required to improve health outcomes in children and adolescents with overweight or obesity. This systematic review aimed to summarize the reliability and validity of field and laboratory body composition techniques employed in pediatric obesity studies to facilitate technique selection for research and clinical practice implementation. A systematic search in MEDLINE (via PubMed), EMBASE, CINAHL, and SPORTDiscus from inception up to December 2019 was conducted, using a combination of the following concepts: body composition, pediatric overweight/obesity, and reliability/validity. The search strategy resulted in 66 eligible articles reporting reliability (19.7%), agreement between body composition techniques cross sectionally (80.3%), and/or diagnostic test accuracy (10.6%) in children and adolescents with overweight or obesity (mean age range = 7.0-16.5 years). Skinfolds, air-displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA), and ultrasound presented as reliable techniques. DXA, ADP, and isotope dilution showed similar and the best agreement with reference standards. Compared with these laboratory techniques, the validity of estimating body composition by anthropometric equations, skinfolds, and BIA was inferior. In conclusion, the assessment of body composition by laboratory techniques cannot be replaced by field techniques due to introduction of measurement errors, which potentially conceal actual changes in body components.
Topics: Absorptiometry, Photon; Anthropometry; Body Composition; Child; Humans; Pediatric Obesity; Plethysmography; Reproducibility of Results
PubMed: 32374499
DOI: 10.1111/obr.13041 -
Health Technology Assessment... Aug 2014Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits... (Review)
Review
Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity.
BACKGROUND
Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials.
OBJECTIVE
To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions.
DATA SOURCES
Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases.
REVIEW METHODS
Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework.
RESULTS
Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness.
LIMITATIONS
Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs.
CONCLUSIONS
The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Absorptiometry, Photon; Body Mass Index; Humans; Outcome Assessment, Health Care; Pediatric Obesity; Reproducibility of Results
PubMed: 25125212
DOI: 10.3310/hta18510