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Nutrients Aug 2016Obesity is defined as an abnormal or excessive fat accumulation that may impair health. Dual-energy X-ray absorptiometry (DEXA) has been suggested as the gold standard... (Meta-Analysis)
Meta-Analysis Review
Obesity is defined as an abnormal or excessive fat accumulation that may impair health. Dual-energy X-ray absorptiometry (DEXA) has been suggested as the gold standard to define obesity, but because its use is complex and expensive, anthropometric measures such as body mass index (BMI) or the waist-to-height ratio (WtHr) have been used as alternatives. The aim of this study was to review the published literature and investigate the correlation of BMI and WtHr with body fat (BF) measured by DEXA in pediatric populations. References were sought in PubMed/Medline and Embase datasets. Five original articles, published between 2013 and 2015, were finally included in this review. Their sample size ranged from 83 to 5355, and the age of participants ranged from 4.9 to 19 years old. The most frequently reported association measurements were the coefficients of determination (R²), followed by correlation coefficients and least-squares regression coefficients. BF measured by DEXA was strongly correlated with both BMI (R² ranging from 0.32 to 0.91) and WtHr (R² ranging from 0.49 to 0.73). Thus, either BMI or WtHr may be useful to define obesity when more sophisticated techniques are not available. Our systematic review of the available literature found that neither index demonstrated superiority in assessing obesity in children.
Topics: Absorptiometry, Photon; Adiposity; Adolescent; Adult; Body Mass Index; Child; Child, Preschool; Humans; Overweight; Waist-Height Ratio
PubMed: 27556485
DOI: 10.3390/nu8080512 -
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 -
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 -
European Journal of Pediatrics Oct 2023Fontan circulation is a highly abnormal circulatory state that may affect various organ systems. The effect on body composition is an important factor to assess the... (Review)
Review
Fontan circulation is a highly abnormal circulatory state that may affect various organ systems. The effect on body composition is an important factor to assess the condition of the patient. This systematic review assesses body composition and possibly related adverse outcomes in patients with a Fontan circulation, to provide an overview of current insights. Studies evaluating body composition by compartment (either fat mass or lean/muscle mass) in Fontan patients published up to April 2023 were included in this systematic review. Of 1392 potential studies, 18 studies met the inclusion criteria. In total, body composition measurements of 774 Fontan patients were included. Body composition was measured using dual-energy X-ray absorptiometry (DXA) (n = 12), bioelectrical impedance analysis (BIA) (n = 5), computer tomography (CT) (n = 1), or magnetic resonance imaging (MRI) (n = 1). All studies reported a normal body mass index (BMI) in Fontan patients, compared to controls. Five out of nine studies reported significantly higher body fat values, and twelve out of fifteen studies reported significantly lower muscle or lean mass values in the Fontan population compared to the healthy population. Unfavorable body composition in Fontan patients was associated with decreased exercise capacity, worse cardiac function, and adverse outcomes including hospital admissions and death. Conclusions: Despite having a normal BMI, Fontan patients have an increased fat mass and decreased muscle mass or lean mass compared to the healthy population. This unfavorable body composition was associated with various adverse outcomes, including a decreased exercise capacity and worse cardiac function. What is Known: • Patients with a Fontan circulation have a decreased exercise capacity compared to healthy peers, an unfavorable body composition might be a contributor to their impaired exercise capacity. What is New: • Fontan patients are predisposed to an unfavorable body composition, characterized by increased fat mass and decreased muscle mass accompanied by a normal BMI compared to the healthy population. • Among others, unfavorable body composition was associated with decreased exercise capacity, cardiac function, and increased morbidity in patients with a Fontan circulation.
Topics: Humans; Body Composition; Adipose Tissue; Magnetic Resonance Imaging; Absorptiometry, Photon; Electric Impedance; Body Mass Index
PubMed: 37542012
DOI: 10.1007/s00431-023-05100-2 -
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 -
Annals of Internal Medicine Nov 2014Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it. (Review)
Review
BACKGROUND
Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it.
PURPOSE
To update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk.
DATA SOURCES
Multiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies.
STUDY SELECTION
Trials, observational studies, and systematic reviews.
DATA EXTRACTION
Duplicate extraction and assessment of data about study characteristics, outcomes, and quality.
DATA SYNTHESIS
From more than 52 000 titles screened, 315 articles were included in this update. There is high-strength evidence that bisphosphonates, denosumab, and teriparatide reduce fractures compared with placebo, with relative risk reductions from 0.40 to 0.60 for vertebral fractures and 0.60 to 0.80 for nonvertebral fractures. Raloxifene has been shown in placebo-controlled trials to reduce only vertebral fractures. Since 2007, there is a newly recognized adverse event of bisphosphonate use: atypical subtrochanteric femur fracture. Gastrointestinal side effects, hot flashes, thromboembolic events, and infections vary among drugs.
LIMITATIONS
Few studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed.
CONCLUSION
Good-quality evidence supports that several medications for bone density in osteoporotic range and/or preexisting hip or vertebral fracture reduce fracture risk. Side effects vary among drugs, and the comparative effectiveness of the drugs is unclear.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality and RAND Corporation.
Topics: Absorptiometry, Photon; Adult; Antibodies, Monoclonal, Humanized; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Density Conservation Agents; Comparative Effectiveness Research; Denosumab; Female; Fractures, Bone; Humans; Male; Neoplasms; Osteoporosis; Osteoporotic Fractures; Teriparatide
PubMed: 25199883
DOI: 10.7326/M14-0317 -
Children (Basel, Switzerland) Jul 2021During the last trimester of pregnancy, about 80% of the infant's calcium is incorporated, and for this reason, preterm infants have less bone mineralization compared to... (Review)
Review
BACKGROUND
During the last trimester of pregnancy, about 80% of the infant's calcium is incorporated, and for this reason, preterm infants have less bone mineralization compared to those born at term. The aim of the present systematic review was to identify, evaluate and summarize the studies that deal with the effect of physiotherapy modalities in the prevention and treatment of osteopenia in preterm infants.
METHODS
A comprehensive search (09/2019-02/2021) using PubMed, Web of Science, SCOPUS, ProQuest, SciELO, Latindex, ScienceDirect, PEDro and ClinicalTrials.gov was carried out. The following data were extracted: The number of participants, characteristics of the participants, design, characteristics of the intervention, outcome measures, time of evaluation and results. A non-quantitative synthesis of the extracted data was performed. The methodological quality and risk of bias were assessed using a PEDro scale and ROB-2 scale, respectively.
RESULTS
A total of 16 studies were analyzed, presenting a methodological quality that ranged from 3 to 8 points, and all showed some concerns regarding their risk of bias. Almost all studies (15/16) used passive mobilizations with joint pressure to prevent osteopenia, but they differed in the intensity and frequency of application.
CONCLUSIONS
A daily exercise program of passive mobilizations with joint pressure, improves bone mineralization in preterm infants admitted to neonatal units.
PubMed: 34438555
DOI: 10.3390/children8080664 -
International Journal of Stroke :... Aug 2012Stroke survivors have less muscle mass in their paretic limbs compared with nonparetic limbs, which may or may not be accompanied by changes in regional and/or whole... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stroke survivors have less muscle mass in their paretic limbs compared with nonparetic limbs, which may or may not be accompanied by changes in regional and/or whole body fat mass.
AIM
To examine the current evidence regarding differences in regional fat mass between paretic and nonparetic limbs and changes in whole body fat mass over time in stroke survivors.
METHODS
A systematic search of relevant databases. Studies measuring whole body or regional fat mass using dual-energy X-ray absorpiometry, computed tomography, or magnetic resonance imaging were included.
RESULTS
Eleven trials were identified. Fat mass differences between paretic and nonparetic limbs and change in fat mass over time were not consistent. Meta-analyses were conducted using dual-energy X-ray absorpiometry-derived data from 10 trials (n = 324). There were no differences in fat mass between paretic and nonparetic legs (pooled mean difference 31·4 g, 95% confidence interval -33·9 to 96·6, P = 0·35), and slightly greater fat mass in the paretic arms compared with nonparetic arms (pooled mean difference 84·0 g, 95% confidence interval 30·7 to 137·3, P = 0·002). Whole body fat mass did not increase significantly between one-month and six-months poststroke (pooled mean difference 282·3 g, 95% confidence interval -824·4 to 1389, P = 0·62), but there was an increase between six- and 12 months poststroke (pooled mean difference 1935 g, 95% confidence interval 1031 to 2839, P < 0·001).
CONCLUSIONS
There were inconsistent findings regarding changes in fat mass after stroke. Large, well-designed studies are required to further investigate the impact of body composition changes on the health of stroke survivors.
Topics: Absorptiometry, Photon; Adipose Tissue; Aged; Body Composition; Cross-Sectional Studies; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Middle Aged; Muscle, Skeletal; Muscular Diseases; Paresis; Stroke; Survivors; Tomography, X-Ray Computed
PubMed: 22594664
DOI: 10.1111/j.1747-4949.2012.00824.x -
International Journal of Technology... Jul 2014The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step... (Review)
Review
OBJECTIVES
The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed.
METHODS
Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment program, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist.
RESULTS
Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in two articles. In one article it was found to be lower. In three studies, the results were not conclusive. These articles were characterized by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis.
CONCLUSIONS
The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.
Topics: Absorptiometry, Photon; Cost-Benefit Analysis; Evidence-Based Medicine; Female; Humans; Osteoporosis, Postmenopausal; Ultrasonography
PubMed: 25100174
DOI: 10.1017/S0266462314000257 -
Aging Clinical and Experimental Research Jan 2023Centenarians often represent one of the best examples of aging successfully. However, the role of body composition or hydration status assessed with bioelectrical...
BACKGROUND
Centenarians often represent one of the best examples of aging successfully. However, the role of body composition or hydration status assessed with bioelectrical impedance analysis (BIA) is poorly explored in this population. Therefore, the aim of this systematic review was to better understand the use and the role of BIA for evaluating body composition and hydration status in centenarians.
METHODS
We conducted a systematic review of the literature up to the 1st of May, 2022 for published articles providing data on BIA to evaluate body composition parameters or hydration status in centenarians. Data were summarized descriptively because a meta-analysis was not possible due to the scarcity of available studies.
RESULTS
Among 2222 articles screened, four were eligible including 291 centenarians (mean age: 100.5 years) who were mainly women (88%). In one study, BIA overestimated fat-free mass and underestimated fat mass when compared to deuterium oxide dilution. Another study carried out in Italy including 14 centenarians found a significant correlation between BIA and fat-free mass evaluated using anthropometric tools. In one study, BIA showed a significant agreement with anthropometric measures of fat mass. In the same sample, sarcopenia and dehydration, evaluated with BIA, had a high prevalence.
CONCLUSION
BIA may be used for assessing body composition in centenarians, but research is limited to a few studies suggesting the need of future research in this area.
Topics: Aged, 80 and over; Humans; Female; Male; Centenarians; Electric Impedance; Body Composition; Anthropometry; Aging; Body Mass Index; Absorptiometry, Photon
PubMed: 36287324
DOI: 10.1007/s40520-022-02282-x