The Relationship between Bone Mineral Densitometry and Visceral Adiposity Index in Postmenopausal Women / A relação entre a densitometria mineral óssea e o índice de adiposidade visceral em mulheres na pós-menopausa

Abstract Objective It was aimed to compare visceral adiposity index (VAI) levels in patients with normal bone mineral density (BMD), osteopenia, and osteoporosis. Methods One hundred twenty postmenopausal women (40 with normal BMD, 40 with osteopenia, and 40 with osteoporosis) between the ages of 50 to 70 years were included in the study. For females, the VAI was calculated using the formula (waist circumference [WC]/[36.58 + (1.89 x body mass index (BMI))]) x (1.52/High-density lipoprotein [HDL]-cholesterol [mmol/L]) x (triglyceride [TG]/0.81 [mmol/L]). Results The time of menopause from the beginning was similar in all groups. Waist circumference was found to be higher in those with normal BMD than in the osteopenic and osteoporotic groups (p = 0.018 and p < 0.001, respectively), and it was also higher in the osteopenic group than in the osteoporotic group (p = 0.003). Height and body weight, BMI, blood pressure, insulin, glucose, HDL-cholesterol, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were similar in all groups. Triglyceride levels were found to be higher in the normal BMD group, compared with the osteoporotic group (p = 0.005). The level of VAI was detected as higher in those with normal BMD, compared with the women with osteoporosis (p = 0.002). Additionally, the correlation analysis showed a positive correlation between dual-energy X-ray absorptiometry (DXA) spine T-scores, WC, VAI, and a negative correlation between DXA spine T-scores and age. Conclusion In our study, we found higher VAI levels in those with normal BMD, compared with women with osteoporosis. We consider that further studies with a larger sample size will be beneficial in elucidating the entity.

Resumo Objetivo O objetivo foi comparar os níveis de índice de adiposidade visceral (IVA) em pacientes com densidade mineral óssea (DMO) normal osteopenia e osteoporose. Métodos Cento e vinte mulheres na pós-menopausa (40 com DMO normal 40 com osteopenia e 40 com osteoporose) com idades entre 50 e 70 anos foram incluídas no estudo. Para o sexo feminino o VAI foi calculado pela fórmula (circunferência da cintura [CC]/[36 58 + (1 89 x índice de massa corporal (IMC))]) x (1 52/lipoproteína de alta densidade [HDL]-colesterol [mmol/L]) x (triglicerídeo [TG]/0 81 [mmol/L]). Resultados O tempo de menopausa desde o início foi semelhante em todos os grupos. A circunferência da cintura foi maior naqueles com DMO normal do que nos grupos osteopênicos e osteoporóticos (p = 0 018 e p < 0 001 respectivamente) e também foi maior no grupo osteopênico do que no grupo osteoporótico (p = 0 003) . Altura e peso corporal IMC pressão arterial insulina glicose HDL-colesterol e os níveis de avaliação do modelo de homeostase-resistência à insulina (HOMA-IR) foram semelhantes em todos os grupos. Os níveis de triglicerídeos foram maiores no grupo DMO normal em comparação com o grupo osteoporótico (p = 0 005). O nível de VAI foi detectado como maior naquelas com DMO normal em comparação com as mulheres com osteoporose (p = 0 002). Além disso a análise de correlação mostrou uma correlação positiva entre a absorciometria de raios-X de dupla energia (DXA) nas pontuações T da coluna CC VAI e uma correlação negativa entre as pontuações T da coluna DXA e a idade. Conclusão Em nosso estudo encontramos níveis mais elevados de VAI naquelas com DMO normal em comparação com mulheres com osteoporose. Consideramos que novos estudos com maior tamanho amostral serão benéficos na elucidação da entidade.

Comparison on Performance of Quantitative Ultrasound and Dual-Energy X-ray Absorptiometry in Evaluating Bone Health of Adults Aged 18-40 Years / 中国医学科学院学报

Objective To compare the consistency of quantitative ultrasound(QUS)and dual-energy X-ray absorptiometry(DXA)in measuring bone mineral density(BMD)of adults aged 18-40 years in Guangzhou and evaluate the diagnostic value of QUS for identifying low bone mass.Methods DXA was employed to measure the BMD and QUS to measure the speed of sound(SOS)in 731 participants.The Bland-Altman analysis was performed to evaluate the consistency of Z scores between SOS and BMD.With the BMD Z ≤-2.00 as the diagnostic criterion for low bone mass,the receiver operating characteristics curve of QUS was established,and the area under the curve(AUC)and the sensitivity,specificity,and correct diagnostic index for the optimal cut-off of SOS Z score were calculated.Results The results of Bland-Altman analysis showed that the mean differences in the Z scores of SOS and BMD in males and females were 1.27(-0.94 to 3.47)and 0.93(-1.33 to 3.18),respectively.The AUC of SOS Z score in the diagnosis of low bone mass in males and females was 0.734(95%CI=0.380-0.788)and 0.679(95%CI=0.625-0.732),respectively.In males,the optimal cut-off of SOS Z score for low bone mass was -0.35,with the sensitivity,specificity,and correct diagnostic index of 64.1%,68.6%,and 0.327,respectively.In females,the optimal cut-off value of SOS Z scores for low bone mass was -1.14,with the sensitivity,specificity,and correct index of 73.9%,54.8%,and 0.285,respectively.Conclusion QUS and DXA show poor consistency in the diagnosis of BMD in the adults aged 18-40 years in Guangzhou,while QUS demonstrates an acceptable value in identifying low bone mass.

Efectos de la proteína whey, leucina y entrenamiento de fuerza en la composición corporal / Effects of whey protein, leucine and resistance training on body composition

INTRODUCCIÓN: Los deportistas y las personas activas que entrenan la fuerza para lograr un aumento de su masa muscular tienen requerimientos calóricos y proteicos aumentados, por esta razón emplean diversas estrategias como la suplementación con proteína whey aislada y aminoácidos aislados como la leucina después del entrenamiento sustentados en la premisa de que promueven el incremento en la síntesis de proteínas musculares, y por ende un aumento de la masa magra. OBJETIVO: Comparar cambios de la composición corporal aplicando el método de Absorciometría Dual de Rayos X (DEXA) en personas físicamente activas expuestas a un programa de entrenamiento de la fuerza con la suplementación de proteína whey aislada y/o leucina durante 12 semanas. METODOLOGÍA: estudio aleatorizado prospectivo longitudinal en un grupo de 10 varones físicamente activos, los cuales fueron asignados al azar en 3 grupos de suplementación con proteína whey aislada, leucina o la mezcla de ambas bajo el mismo protocolo de entrenamiento de la fuerza. Se evaluó la composición corporal en 3 momentos: semana 0, semana 6 y semana 12 de la intervención. RESULTADOS: En las condiciones evaluadas no se observaron cambios estadísticamente significativos de las variables de composición corporal y fuerza en los diferentes protocolos de suplementación: leucina, proteína whey aislada con leucina y proteína whey aislada. CONCLUSIONES: Se observaron resultados superiores de la masa magra y la fuerza en el grupo de la suplementación de proteína whey aislada con leucina con respecto a los demás grupos, cabe aclarar que por el tamaño de muestra no alcanzó a ser estadísticamente significativo.

INTRODUCTION: Athletes and active people who work hard to increase their muscle mass have increased caloric and protein requirements. For this reason, they use different strategies such as whey protein isolate supplementation and/or branched-chain amino acids after sustained training on the premise that they promote an increase in muscle protein synthesis, and therefore an increase in lean mass. OBJECTIVE: To compare body composition changes in physically active people exposed to a strength training program withwhey protein isolate and/or leucine supplementation for 12 weeks. METHODS: Longitudinal prospective randomized study in a group of 10 physically active males, which were randomly assigned to 3 supplementation groups with whey protein isolate, leucine, or a mixture of both, under the same strength training protocol. Body composition was evaluated in 3 moments: week 0, week 6 and week 12 of the intervention. RESULTS: In the evaluated conditions, no statistically significant changes were observed in the variables of body composition and strength based on the different supplementation protocols: Leucine, protein with leucine and protein. CONCLUSIONS: Compared with the other groups, higher results were observed in lean mass and strength in group using the whey protein isolate supplementation with leucine. It should be noted that due to the size of the sample, the difference was not statistically significant.

Dual-energy X-ray absorptiometry and adiposity index are sensitive methods to evaluate central fat accumulation in women with polycystic ovary syndrome and normal body mass index

ABSTRACT Objective: This study aimed to determine the differences in body fat distribution and central obesity indicators using dual-energy X-ray absorptiometry (DXA), adiposity indices, and anthropometric indices between women with and without polycystic ovary syndrome (PCOS). Materials and methods: Clinical and laboratory examination history, including transvaginal ultrasound, fasting blood samples, anthropometric measurements, and DXA scans were conducted in 179 women with PCOS (PCOS group) and 100 without PCOS (non-PCOS group). The volunteers were grouped by body mass index (BMI): normal (18-24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (>30 kg/m2). The visceral adiposity index (VAI) and lipid accumulation product (LAP) were calculated, regions of interest (ROIs) were determined, and the fat mass index (FMI) was calculated using DXA. Results: VAI, LAP, ROIs, FMI, and adiposity indices by DXA were higher in women with PCOS and normal BMI. In both PCOS and non-PCOS groups, the ROIs progressively increased from normal BMI to overweight and obese, and from overweight to obese. Obese women with PCOS showed high trunk fat mass. However, obesity was not able to modify these trunk/periphery fat ratios in PCOS from overweight to higher BMI. These variables were associated with the incidence of PCOS. Conclusion: In women with PCOS and normal BMI, both DXA and the adiposity indices, VAI and LAP, are more sensitive methods to evaluate total body fat and fat accumulation in the central abdominal region. It was also observed that as BMI increased, the differences in measurements between women with and without PCOS decreased.

Update on trabecular bone score

ABSTRACT Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A low TBS indicates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use of TBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS complements BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. While TBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy. There is also a growing body of evidence indicating that TBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions associated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impact TBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assessment and management of several clinical conditions.

Estimation of body fat in children with intellectual disability: development and cross-validation of a simple anthropometric method

Abstract Objective Population-level monitoring of body composition requires accurate, biologically-relevant, yet feasible methods for estimating percent body fat (%BF). The aim of this study was to develop and cross-validate an equation for %BF from Body Mass Index (BMI), age, and sex among children with intellectual disability (ID). This study further aimed to examine the performance of an existing BMI-based equation (Deurenberg equation) for %BF in children with ID. Method Participants were 107 children (63 boys; aged 6-15 years) with ID randomly allocated to development (n= 81) and cross-validation (n= 26) samples. Dual-Energy X-Ray Absorptiometry provided the criterion %BF. Results The model including BMI, age, and sex (0 = male; 1 = female) had a significant goodness-of-fit in determining %BF (p< 0.001; R2= 0.69; SEE =5.68%). The equation was: %BF = - 15.416 + (1.394 × BMI) + (4.538 × age) - (0.262 × age2) + (5.489 × sex). The equation was cross-validated in the separate sample based on (i) strong correlation (r = 0.82; p< 0.001) and non-significant differences between actual and predicted %BF (28.6 ± 9.6% and 30.1 ± 7.1%, respectively); (ii) mean absolute error (MAE) = 4.4%; and (iii) reasonable %BF estimations in Bland-Altman plot (mean: 1.48%; 95% CI: 12.5, -9.6). The Deurenberg equation had a large %BF underestimation (mean: -7.1%; 95% CI: 5.3, -19.5), significant difference between actual and estimated %BF (28.6 ± 9.7% and 21.5 ± 7.0%, respectively; p< 0.001), and MAE = 8.1%. Conclusions The developed equation with BMI, sex, and age provides valid %BF estimates for facilitating population-level body fat screening among children with ID.

Application and progress of dual-energy X-ray absorptiometry / 中华内分泌代谢杂志

Dual-energy X-ray absorptiometry(DXA) has been widely used for more than 30 years with continuous technological innovations, which makes DXA a reliable and feasible tool for clinical use. In addition to the measurement of bone mineral density for osteoporosis, DXA has a variety of applications, such as vertebral fracture analysis, grading of abdominal aortic calcifications, atypical femur fracture, trabecular bone score, hip structures analysis, finite element analysis and body composition etc. This review is aimed to provide updates on aforementioned application.

Consistency between multifrequency bioelectrical impedance analysis and dual-energy x-ray absorptiometry for muscle mass assessment in elderly patients with advanced chronic kidney disease / 中华老年医学杂志

Objective:To compare the consistency between bioelectrical impedance analysis(BIA)and dual-energy X-ray absorptiometry(DXA)in skeletal muscle mass assessment in elderly patients with advanced chronic kidney disease(CKD), and to provide a basis for accurate clinical diagnosis of sarcopenia.Methods:Elderly patients with advanced CKD at the Department of Nephrology of Shanghai Sixth People's Hospital were included.Parameters for physical performance included handgrip strength and gait speed, and body muscle mass was measured by DXA and multifrequency BIA.The consistency between the two methods was assessed by the intraclass correlation coefficient, Bland-Altman analysis and kappa coefficient test.Results:This study included 67 elderly patients with advanced CKD with a mean age of(70.7±6.1)years and an average BMI of(24.6±3.5)kg/m 2.The proportion of enrolled male patients was 61.2% and the mean estimated glomerular filtration rate was(27.7±12.7)ml·min -1·1.73m -2.The intraclass correlation coefficients of muscle mass and appendicular skeletal-muscle mass index(ASMI)measured by BIA and DXA ranged from 0.81 to 0.90.Bland-Altman analysis showed that BIA overestimated muscle mass against DXA, and the mean difference in ASMI was(0.44±0.13)kg/m 2.In addition, there was a moderate agreement between the two measurement methods for determining muscle loss(Kappa=0.47). Conclusions:BIA and DXA offer a fair level of consistency in the assessment of muscle mass in elderly patients with advanced CKD.However, compared with DXA, BIA overestimates muscle mass in elderly patients with CKD.

Development and validation of equations to estimate visceral adipose tissue in military men / Desenvolvimento e validação de equações de estimar o tecido adiposo visceral em militares / Desarrollo y validación de ecuaciones para estimar el tejido adiposo visceral en militares

ABSTRACT Introduction It has been suggested that visceral adipose tissue (VAT) is associated with several non-communicable chronic diseases, but measuring it is difficult. Thus, anthropometry could be used because is easily applied in clinical practice. Objectives The present study aimed to develop and validate VAT estimation equations (Eq) in military men. Methods The sample consisted of 409 (mean age, 36.5 ± 6.7 years) military men in the Brazilian Army (BA) divided into an equation group (EG) ( n = 270; mean age, 37.0 ± 6.3 years) and a validation group (VG) ( n =139; mean age, 36.0 ± 7.2 years). Anthropometric, hemodynamic and DXA body composition evaluations ( GE iLunar ) were performed. The Student's t test, Pearson's correlation, and stepwise general linear regression were applied. Bland-Altman graphics were used to assess the concordance between VAT by Eq and by DXA. The level of significance was 95% ( p < 0.05). Results Age, waist circumference (WC), hip circumference and body mass index presented the main significant positive correlations with the VAT-DXA. Four Eq were created Eq1 ( r 2 = 0.793), Eq2 ( r 2 = 0.810), Eq3 ( r 2 = 0.817), and Eq 4 ( r 2 = 0.823) ( p < 0.05). No differences were observed between VAT by DXA and VAT by Eq ( p = 0.982, p = 0.970, p = 0.495 and p = 0.698). Bland-Altman analysis also presented good concordance as the bias was close to zero and was not statistically significant. Conclusion Eq2 (age*13.0 + WC*60.0 - 4975,.5) was more suitable because it is easier to apply, has a higher predictive power (81.0%), less bias (1.86) and validation yielded average VAT values close to those found in DXA. It may still be considered a valuable tool for other extensive epidemiological studies in military men in the BA and can be used in adult men. Evidence Level I: Development of diagnostic criteria on consecutive patients (with universally applied reference ''gold'' standard).

RESUMO Introdução A literatura científica tem sugerido que o tecido adiposo visceral (TAV) está associado a doenças crônicas não transmissíveis, mas é difícil fazer sua mensuração. Assim, a antropometria pode ser empregada por ser de fácil aplicação na prática clínica. Objetivos Este estudo teve como objetivo desenvolver e validar equações de estimativa (Eq) do TAV em militares. Métodos A amostra consistiu em 409 (média de idade 36,5 ± 6,7 anos) militares do Exército Brasileiro (EB) divididos em Grupo equação (GE) (n = 270; média de idade 37,0 ± 6,3 anos) e Grupo validação (GV) (n = 139; média de idade 36,0 ± 7,2 anos). Foram realizadas avaliações antropométricas, hemodinâmicas e de composição corporal por DXA (GE iLunar). O teste t de Student, a correlação de Pearson e a regressão linear geral Stepwise foram aplicados. Os gráficos de Bland-Altman foram usados para avaliar a concordância entre os resultados de TAV pela Eq e por DXA. O nível de significância adotado foi de 95% (p <0,05). Resultados Idade, circunferência da cintura (CC), circunferência do quadril e o índice de massa corporal apresentaram as principais correlações positivas e significativas com TAV-DXA. Foram criadas quatro equações: Eq1 (r2 = 0,793), Eq2 (r2 = 0,810), Eq3 (r2 = 0,817) e Eq 4 (r2 = 0,823), p < 0,05. Não foram observadas diferenças entre o TAV por DXA pelas Eq (p = 0,982, p = 0,970, p = 0,495 e p = 0,698). A análise de Bland-Altman também apresentou boa concordância, porque o viés foi próximo de zero e não estatisticamente significativo. Conclusões A Eq2 (idade*13,0 + CC*60,0 - 4975,5) foi mais adequada, porque é mais fácil de aplicar, tem maior poder preditivo (81,0%), menor viés (1,86) e a validação forneceu valores médios de TAV próximos aos encontrados no DXA. Além disso, pode ser considerada uma ferramenta valiosa para outros estudos epidemiológicos extensos em militares do EB e pode ser usada em homens adultos. Nível de Evidência I; Teste de critérios diagnósticos desenvolvidos anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

RESUMEN Introducción La literatura científica ha sugerido que el tejido adiposo visceral (TAV) está asociado a enfermedades crónicas no transmisibles, pero es difícil hacer su medición. Así, la antropometría puede ser empleada por ser de fácil aplicación en la práctica clínica. Objetivos Este estudio tuvo como objetivo desarrollar y validar ecuaciones de estimativa (Ec) del TAV en militares. Métodos La muestra consistió en 409 (promedio de edad 36,5 ± 6,7 años) militares del Ejército Brasileño (EB) divididos en Grupo de ecuación (GE) (n = 270; promedio de edad 37,0 ± 6,3 años) y Grupo validación (GV) (n = 139; promedio de edad 36,0 ± 7,2 años). Fueron realizados análisis antropométricos, hemodinámicos y de composición corporal por DXA (GE iLunar). Fueron aplicados el teste t de Student, la correlación de Pearson y la regresión linear general Stepwise. Los gráficos de Bland-Altman fueron usados para evaluar la concordancia entre los resultados de TAV por la Ec y por DXA. El nivel de significancia fue de 95% (p <0,05). Resultados Edad, circunferencia de cintura (CC), circunferencia de la cadera y el índice de masa corporal presentaron las principales correlaciones positivas y significativas con TAV-DXA. Fueron creadas cuatro ecuaciones: Ec1 (r2 = 0,793), Ec2 (r2 = 0,810), Ec3 (r2 = 0,817) y Ec4 (r2 = 0,823), p <0,05. No fueron observadas diferencias entre el TAV por DXA por las Ec (p = 0,982, p = 0,970, p = 0,495 y p = 0,698). El análisis de Bland-Altman también presentó buena concordancia, porque el sesgo fue próximo de cero y no estadísticamente significativo. Conclusiones La Ec2 (edad*13,0 + CC*60,0 - 4975.5) fue más adecuada, porque que es más fácil de aplicar, tiene mayor poder predictivo (81,0%), menor sesgo (1,86) y la validación suministró valores promedio de TAV próximos a los encontrados en el DXA. Además, puede ser considerada una herramienta valiosa para otros estudios epidemiológicos extensos en militares del EB y puede ser usada en hombres adultos. Nivel de Evidencia I: Test de criterios diagnósticos desarrollados anteriormente en pacientes consecutivos (con patrón de referencia "oro" aplicado).

Validación y generación de ecuaciones para estimar masa grasa corporal en adultos chilenos, formuladas a partir de bioimpedanciometría, en un amplio rango de edad e índice de masa corporal

Background: Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated. Aim: To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample. Material and Methods: In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA: Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression. Results: FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope β < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope β < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients. Conclusions: Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.

Cambios de composición corporal posterior a un programa de rehabilitación cardíaca fase II / Changes in body composition after a phase II cardiac rehabilitation programme

Resumen Objetivo: Identificar los cambios en la composición corporal posterior a un programa de rehabilitación cardíaca fase II. Materiales y métodos: Se siguió un grupo de 20 pacientes luego de al menos 36 sesiones de ejercicio supervisado dentro de un programa de rehabilitación cardiaca. Se midió la composición corporal (masa magra y grasa) antes y después por medio de Absorciometría de Energía Dual de Rayos X. Resultados: Se encontró que el cambio en la masa grasa total no fue significativo; sin embargo, la disminución en la masa grasa total en hombres tuvo una correlación positiva fuerte con la disminución del tejido adiposo visceral con r = 0,85 (p 0,0002). Hubo aumento significativo en masa magra total de 1,76% (p 0,053), destacado en la masa magra de piernas en 5,21% (p 0,001). El índice de masa muscular esquelética tuvo un aumento estadísticamente significativo 2,27% (p 0,016), más notable en hombres. Se encontró un aumento no significativo del peso de 0,38 kg en promedio. Hubo un aumento de cambio significativo en equivalentes metabólicos con aumento de 2,62 a 6,35 MET (p < 0,0001) y aumento de 1,22% (p 0,031) en la tasa metabólica basal. Conclusión: Un programa de rehabilitación cardíaca mejora significativamente la tolerancia al ejercicio y aumenta la masa magra total, de piernas y el índice de masa muscular esquelética; no modifica el índice de masa corporal, el perímetro de cintura, ni la masa grasa total en forma significativa.

Abstract Objective: To identify changes in body composition after a phase II cardiac rehabilitation programme. Materials and methods: A group of 20 patients was followed up after at least 36 supervised sessions of exercise within a cardiac rehabilitation programme. The body composition (lean mass and fat mass) was measured before and after the programme using Dual Energy X-ray Absorptiometry. Results: Although it was found that the change in total fat mass was not significant, there was a strong positive correlation between the decrease in total fat mass in males and the decrease in visceral adipose tissue, with an r=0.85 (P=.0002). There was a significant increase in total lean mass of 1.76% (P=.053), highlighted in the lean mass of the legs with 5.21% (P=.001). The skeletal muscle mass index showed a statistically significant increase of 2.27% (P=.016), more notable in males. There was a non-significant increase (0.38 kg) in the mean weight. There was a significant change in metabolic equivalents (METS), with an increase from 2.62 to 6.35 MET (P<.0001), and an increase of 1.22% (P=.031) in basal metabolic rate. Conclusion: Although there was no change in body mass index, waist circumference, or total body fat, a cardiac rehabilitation programme significantly improved the tolerance to exercise. It also produced an increase in the skeletal muscle mass index, as well as the total lean mass, mainly in the legs.

Osteopenia and osteoporosis among treatment-experienced people living with HIV

Abstract Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age≥18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37-35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94-7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.

A study on WHO Frax score to predict fracture risk in predialysis patients of chronic kidney disease

Background: Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity and decreased quality of life. These disturbances include renal osteodystrophy and CKD-Mineral and Bone Disorder (CKD-MBD). The Frax tool developed by WHO is an attempt to better estimate the fracture risk. It calculates a 10 year probability of osteoporotic fractures of spine, forearm, hip or shoulder based on clinical risk factors with or without BMD measurements.Methods: It is a Cross sectional observational study which was done from 01 November 2013 to 31 March 2015. The study group included 60 cases of pre dialysis Chronic Kidney Disease attending OPD, Emergency or admitted in medicine wards of Dr. RML Hospital, New Delhi. Bone mineral density measured by dual-energy X-ray absorptiometry and all patients were classified according to World Health Organization criteria. DEXA SCAN (manufacturer-Hologic INC.) was done of the lumbar spine, radius bone and neck of the femur. Frax score was calculated as per WHO guidelines.Results: On using the Indian Frax calculator the average 10 year probability for major osteoporotic fractures in stage 4 (9.47±2.62%) was found to be significantly higher (p<0.0001) than that in stage 3 (1.92±0.8%).Similarly, the average 10 year probability for hip fracture in stage 4 (4.61±1.45%) was also found to be significantly higher (p< 0.0001) than that in the stage 3 (0.75±0.49%).Conclusions: The study confirmed the high incidence of low BMD in patients of CKD. The 10 year fracture risk in these patients as predicted by Frax score was significantly higher in CKD patients irrespective of whether the Chinese or the Indian calculator was used.

Concordance in prediction body fat percentage of Brazilian women in reproductive age between different methods of evaluation of skinfolds thickness

ABSTRACT Objective To assess the utility of bioimpedance (BIA) and skinfolds thickness (SF) in body fat percentage measuring (%BF) compared to the reference method dual-energy x-ray absorptiometry (DXA) in Brazilian reproductive age women, as well as to estimate of inter- and intra-observer precision for SF. Subjects and methods 170 women aged 18-37 years with BMI between 18 and 39.9 kg/m2 were selected for this cross-sectional study. Body density was evaluated through equations proposed by Jackson, Pollock and Ward (1980) (EqJPW) and Petroski (1995) (EqPET), and %BF was estimated by BIA, DXA and Siri's formula (1961). The SF were measured by two separate observers: A and B (to determine inter-observer variability), who measured the folds at three times with 10-minute interval between them (to determine intra-observer variability - we used only observer A). Results The %BF by DXA was higher than those measured by SF and BIA (p<0.01, for all) of 90 volunteers. The Lin coefficient of agreement was considered satisfactory for %BF values obtained by EqJPW and BIA (0.55) and moderate (0.76) for sum of SF (ΣSF) values obtained by EqJPW and EqPET. No agreement was observed for the values obtained by SF (EqJPW and EqPET), BIA and DXA. Analysis of inter- and intra-observer of 59 volunteers showed that different measures of SF thickness met acceptability standards, as well as the % BF. Conclusion BIA and SF measurements may underestimate %BF compared with DXA. In addition, BIA and SF measurements are not interchangeable with DXA. However, our results suggest the equation proposed by Jackson, Pollock and Ward (three skinfolds) compared to BIA are interchangeable to quantify the %BF in Brazilian women in reproductive age. Furthermore, our results show acceptable accuracy for intra- and inter-observer skinfold measurements. Arch Endocrinol Metab. 2020;64(3):257-68

The comparison of bone mineral density in primary hyperparathyroidim, vitamin D induced secondary hyperparathyroidism, and patients with both condition: a single center experience

Background: To compare bone mineral densities via dual energy X-ray absorptiometry method (DXA) between various hyperparathyroidism (HPT) types such as primary, vitamin D induced secondary, and both conditions.Methods: Participants who were aged between 18-45 years and had elevated parathyroid hormone levels were included. After initial evaluations, patients were divided into 3 groups according to diagnoses: primary HPT (pHPT), vitamin D induced secondary HPT (sHPT), and combined (primary+secondary) one. In addition to the bone mineral density (BMD), demographic and laboratory datas were recorded.Results: Of 166 patients, 147 of the patients were female, 19 were male, and average age was 38.10±7.24 years. Significant difference was found in terms of age (p=0.03) between pHPT and sHPT. Blood calcium, PTH, 25-OH vitamin D, and daily urine calcium excretion levels were significantly higher and phosphorus levels were lower in the pHPT group compared to the sHPT and combined disease group. Both T and Z scores of the pHPT group were significantly lower than the sHPT group especially in the lumbar region. However, no significant difference was noted between pHPT and combined disease group with respect to T and Z scores in all regions.Conclusions: The results of this study indicate that pHPT has a significantly worse impact on skeletal mineral density particularly in the lumbar region than sHPT. The addition of vitamin D deficiency to the clinical picture seems to have no significant influence on BMD in pHPT. To confirm and clarify these findings, prospective studies with larger number of participants are needed.

Study of serum vitamin D2 and calcium in young and middle aged healthy male smokers in rural tertiary care center

Background: Smoking is an essential determinant of various diseases. The study is aimed to understand the influence of smoking on serum vitamin D2/D3 levels and serum calcium levels in healthy young/middle-aged men.Methods: Prospective observational study was done among young and middle-aged healthy male smokers in a rural territory care center. Two hundred patients were studied and analyzed, who fulfill the inclusion and exclusion criteria.Results: The prevalence of vitamin D deficiency (25(OH)D <20 ng/ml) was 50.3%. Only 8.8% of the participants had vitamin D sufficiency (25 hydroxyvitamin D ?30 ng/ml). There is a strong correlation between 25(OH)D and smoking in the participants (p<0.001). 25 hydroxyvitamin D level was lower by approximately 4.3 ng/ml (p<0.001) in a smoker compared to a non-smoker among the total participants, this value increased to 9.2 ng/ml in the 40-50y subgroup (p=0.003). A multinomial logistic regression model demonstrated that a young smoker (20-29y) had a 58% increased likelihood of having vitamin D deficiency compared to a non-smoker of the same age group (p=0.041). Irrespective of age and chronicity of smoking, there was a significantly increased level of serum calcium and significant vitamin D2/D3 deficiency in smokers.Conclusion: A high prevalence of vitamin D deficiency was identified in young and middle-aged male smokers, which is not likely to be explained by other confounding lifestyle factors. The depression of the vitamin D-PTH system seen among smokers may represent another potential mechanism for the harmful effects of smoking on the skeleton

Discuss about Key Issues of Dual Energy X-ray Absorptiometry Evaluation / 中国医疗器械杂志

The Dual energy X-ray absorptiometry is the most commonly used for measuring bone mineral density. This method involves core clinical functions, phantom and database. This article discusses the three key issues of dual energy X-ray absorptiometry evaluation, including core clinical functions, phantom and database. This article aims at helping manufacturers to scientifically carry out relevant processes during research and development and also manufacturers may refer to this article when they apply for registration.

Relationship of body mass index with bone mineral density in postmenopausal women: an Indian perspective

Background: Osteoporosis is a common health problem that affects postmenopausal females, leading to increased susceptibility to fractures. Body mass index (BMI) has been shown to be an important predictor of bone mineral density (BMD) with increased body weight correlating with positive influence on bone metabolism. Low BMI predisposes postmenopausal females to rapid bone loss and low bone mass, crucial in the pathogenesis of osteoporosis. However, a specific BMI value chart to accurately predict osteoporosis remains to be fully established. The present study aimed to investigate the relationship of BMI and BMD in postmenopausal Indian females.Methods: 90 healthy postmenopausal females with 1-5 years of menopause were enrolled in the study. Subjects were categorized according to their BMI into normal, overweight and obese. BMD was assessed using dual energy X-ray absorptiometry (DEXA) scan at L1-L4 vertebrae and femoral neck and expressed as T-scores. Quantitative variables were compared using ANOVA/Kruskal Wallis Test.Results: Bone mineral density was significantly higher in the obese group as compared to normal BMI group at both lumbar spine (p=0.001) and femoral neck (p=0.001). BMD at lumbar spine was lower than that at femoral neck across all the three groups of BMI.Conclusions: BMI and body weight are important factors affecting BMD. Postmenopausal females with low BMI are more likely to have osteopenia and osteoporosis and are thus at an increased risk of pathological fractures. Routine BMD monitoring in postmenopausal females with low BMI may be necessary to initiate early clinical interventions for osteoporosis.

Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome

ABSTRACT Objective To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters. Subjects and methods This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution. Results Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein. Conclusion LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Prevalence of osteoporosis in China: a multicenter, large-scale survey of a health checkup population / 中华健康管理学杂志

Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58％) and in the lumbar spine in females (23.38％). The age-standardized prevalence of osteoporosis at any site was 6.46％ in males and 29.13％ in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46％ in males and 29.13％ in females aged 50 years and older.