Dapagliflozin cardiovascular effects on end-stage kidney disease (DARE-ESKD-2) trial: rationale and design.

Purpose: Sodium glucose co-transporter 2 inhibitors (SGLT2i) remarkably reduced the incidence of hospitalization for heart failure and cardiovascular death of conservatively managed chronic kidney disease. We hypothesized that adding SGLT2i to standard treatment would yield cardiovascular benefits also in end-stage kidney disease (ESKD) individuals on dialysis. Methods: The DARE-ESKD-2 Trial (NCT05685394) is an ongoing, single-center, open-label, controlled trial aimed at assessing the cardiovascular effects of dapagliflozin in ESKD on dialysis. Eligible patients are adults on renal replacement therapy for more than 3 prior to enrollment. Exclusion criteria encompass pregnancy, liver failure, and current use of a SGLT2i. After signing an informed consent form, participants are randomized 1:1 to either dapagliflozin 10mg PO plus standard treatment or standard treatment alone for 6 months. Echocardiogram, anthropometry, blood sample collection, 6-min walk test, gait speed, and Kansas City Cardiomyopathy Questionnaire (KCCQ), are performed at baseline and at study termination. Participants are contacted monthly during treatment for outcomes disclosure. The primary endpoint of our study is the between-groups differences in posttreatment changes in plasma levels of N-terminal pro-B natriuretic peptide. Secondary endpoints include the differences between groups in the changes of echocardiography measurements, cardiopulmonary tests performance, body composition. The incidence of safety endpoints will also be diligently compared between study arms. Conclusion: The DARE-ESKD-2 trial will provide unprecedented data on the cardiovascular safety and efficacy of SGLT2i in ESKD individuals on dialysis. This study will pave the grounds for improving clinical outcomes of dialysis recipients.

Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players.

OBJECTIVE: The aim of this study was to evaluate the association of food consumption and body composition on bone parameters in adolescent soccer players. METHODS: There were 148 male soccer players 12 to 18 y who participated in the study. Body composition was assessed by dual energy x-ray absorptiometry, comprising bone mineral density (BMD) and bone mineral content (BMC) of total body without head (TBLH), lumbar spine (L1-L4), and right femoral neck (RFN). The bone geometry variables measured were femoral strength index (FSI), buckling ratio (BR), section modulus (Z), cross-sectional moment of inertia (CSMI), and cross-sectional area (CSA). Food intake was analyzed using the 24-h food recall. Somatic maturation was estimated by the peak height velocity equation. For the statistical analysis, the stepwise multiple linear regression was used, with P < 0.05. RESULTS: Regarding food consumption, there was a high protein intake and low calcium intake. Lean mass was a predictor of BMC of TBLH (R2 = 0.524), L1-L4 (R2 = 0.492), and RFN (R2 = 0.405); BMD of L1-L4 (R2 = 0.407) and RFN (R2 = 0.27); Z (R2 = 0.683), CSMI (R2 = 0.630), and CSA (R2 = 0.640). There was a negative correlation between protein intake with bone mass and bone geometry parameters. CONCLUSION: In adolescent soccer players, lean mass was a predictor of bone parameters, and high protein intake was negatively associated with bone mass and geometry.

Effect of Physical Training on Body Composition in Brazilian Military.

The military are selected on the basis of physical standards and are regularly involved in strong physical activities, also related to particular sports training. The aims of the study were to analyze the effect of a 7-month military training program on body composition variables and the suitability of specific 'bioelectrical impedance vector analysis' (spBIVA), compared to DXA, to detect the changes in body composition. A sample of 270 male Brazilian cadets (19.1 ± 1.1 years), composed of a group practicing military physical training routine only (MT = 155) and a group involved in a specific sport training (SMT = 115), were measured by body composition assessments (evaluated by means of DXA and spBIVA) at the beginning and the end of the military routine year. The effect of training on body composition was similar in SMT and MT groups, with an increase in LST. DXA and spBIVA were correlated, with specific resistance (Rsp) and reactance (Xcsp) positively related to fat mass (FM), FM%, LST, and lean soft tissue index (LSTI), and phase angle positively related to LST and LSTI. Body composition variations due to physical training were recognized by spBIVA: the increase in muscle mass was indicated by the phase angle and Xcsp increase, and the stability of FM% was consistent with the unchanged values of Rsp. Military training produced an increase in muscle mass, but no change in FM%, independently of the sample characteristics at baseline and the practice of additional sports. SpBIVA is a suitable technique for the assessment of body composition in military people.

Physical training over 6 months is associated with improved changes in phase angle, body composition, and blood glucose in healthy young males.

OBJECTIVES: The aim of this study was to evaluate the association between phase angle, body composition, and blood glucose changes in healthy young males after 6 months of physical training. METHODS: Volunteers, 98 healthy males (18.8 ± 0.5 years), had 6 months of progressive physical training (5 days a week, 90 minutes a day). Resistance, reactance, and phase angle were obtained by bioelectrical impedance analysis, body composition (fat mass, bone mineral content [BMC], and lean soft tissue [LST]) by dual-energy X-ray absorptiometry, and blood glucose by reflectance photometry. Measurements were made at rest and in a fasted state, both before and after the training period. RESULTS: Phase angle, reactance, BMC, and LST significantly increased (0.6°, 3.8 Ω, 0.1 kg, and 1.9 kg, respectively; P < .01), whereas resistance and blood glucose decreased (-11.2 Ω and -4.1 mg/dL; P < .01). Changes in resistance and reactance explained those changes observed in LST (R2 = .26 and .16, respectively), but phase angle changes were not related to body composition and blood glucose alterations (P < .05). CONCLUSIONS: A 6-month period of physical training was associated with positive changes in phase angle, body composition, and blood glucose in healthy young males, reinforcing the importance of maintaining a physically active lifestyle.

Effect of 7 Months of Physical Training and Military Routine on the Bone Mass of Young Adults.

INTRODUCTION: Physical activity (PA) has a great influence on bone mineral density (BMD) and bone mineral content (BMC), however longitudinal studies that seek to relate bone mass to physical activity are scarce and have a small sample size. The aim of this study was to evaluate and compare the effect of 7 months of military physical training (MPT), impact sports (IS), and swimming in the bone mass of young military adults. MATERIALS AND METHODS: A prospective study was conducted with 213 military school students (male and aged 19.2 ± 1.2 years) divided into three groups: MPT (n = 144), IS (n = 56), and Swimming (n = 13). Dual-energy X-ray absorptiometry was used to determine body composition (percentage of fat, fat mass, and fat-free mass) and bone mass (BMD, BMD Z-Score, total BMC, arm BMC, leg BMC, and trunk BMC), at the beginning of the military service and after 7 months of training. RESULTS: It was observed a significant increase in BMD, BMD Z-Score, total BMC and BMC of all segments analyzed for all groups (p < 0.01). There was a significantly greater variation in BMD of the IS group in relation to the MPT group (p < 0.01), and in the arm BMC of the MPT group in relation to the IS group (p < 0.05). CONCLUSION: After 7 months of training, there were significant increases in BMC and BMD of all the groups evaluated. The bone response was associated with the muscular group used in the physical exercise and the IS group showed greater gain in BMD.

Adaptive thermogenesis and changes in body composition and physical fitness in army cadets.

BACKGROUND: To analyze the association between a 34-week military training on body composition, physical fitness and compensatory changes in resting energy expenditure (REE) recognized as adaptive thermogenesis (AT). We also explored if regional body composition changes were related to AT. METHODS: Twenty-nine male army cadets, aged 17 to 22 years were tested at baseline (T0) and after 34-weeks military training (T1). Physical training was performed 5 days/week during 90 minutes/day. Measurements included body composition by dual-energy x-ray absorptiometry; physical fitness by 3000-m running, pull-up, 50-m freestyle swimming, push-up and sit-up tests; REE measured by indirect calorimetry (REEm) and predicted from fat-free mass (FFM), fat mass (FM) and ethnicity at T0 (REEp). %AT was calculated using values at T1: 100(REEm/REEp-1); and AT (kcal/day) as %AT/100 multiplied by baseline REEm. RESULTS: Physical training was associated with increases of lean soft tissue (LST) (∆1.2±1.3 kg), FM (∆1.4±1.3 kg), FFM (∆1.2±1.3 kg) and physical fitness (P<0.01), but no REE changes (∆59.6±168.9 kcal/day) and AT were observed (P>0.05). Though a large variability was found, AT was partially explained by trunk LST (r2=0.17, P=0.027). Individuals showing a higher AT response demonstrated a higher trunk LST increase (∆0.8±0.7 kg, P<0.05). CONCLUSIONS: The military training increased LST, FM, FFM and physical fitness. Though no mean changes in AT occurred, a large individual variability was observed with some participants increasing REE beyond the expected body composition changes, suggesting a spendthrift phenotype. Changes of trunk LST may play an important role in the AT response observed in these individuals.

Can anthropometric, body composition, and bone variables be considered risk factors for musculoskeletal injuries in Brazilian military students?

BACKGROUND: Musculoskeletal injuries are the main cause of premature discharge from military service and can sometimes lead to permanent disabilities. Some intrinsic risk factors are well discussed in the literature. However, the relation between body composition variables and the risk for musculoskeletal injury is not well known or recognized. METHODS: This prospective study evaluated 205 Brazilian military students. At the beginning of military service, health status and sports experience prior to military service were registered. Anthropometric variables were evaluated, and bone and body composition variables were measured using dual-energy X-ray absorptiometry. The occurrence of musculoskeletal injuries throughout the year was registered at the military physiotherapy service. At the end of 1 year of follow-up, risk factors were analysed by comparing the variables between the injured and non-injured students. RESULTS: No difference in previous health status was found between injured and non-injured groups, whereas sports experience prior to military service was identified as a protective factor (Odds Ratio (OR) 0.323; 95% CI: 0.108-0.968; p = 0.044). Anthropometric, bone, and body composition variables could not be identified as risk factors for musculoskeletal injuries in Brazilian military students. CONCLUSION: Anthropometric, bone, and body composition variables could not be considered risk factors for musculoskeletal injuries in Brazilian military students.

Accuracy of Bioelectrical Impedance Analysis in Estimated Longitudinal Fat-Free Mass Changes in Male Army Cadets.

Introduction: Bioelectrical impedance analysis (BIA) is a practical and rapid method for making a longitudinal analysis of changes in body composition. However, most BIA validation studies have been performed in a clinical population and only at one moment, or point in time (cross-sectional study). The aim of this study is to investigate the accuracy of predictive equations based on BIA with regard to the changes in fat-free mass (FFM) in Brazilian male army cadets after 7 mo of military training. The values used were determined using dual-energy X-ray absorptiometry (DXA) as a reference method. Materials and Methods: The study included 310 male Brazilian Army cadets (aged 17-24 yr). FFM was measured using eight general predictive BIA equations, with one equation specifically applied to this population sample, and the values were compared with results obtained using DXA. The student's t-test, adjusted coefficient of determination (R2), standard error of estimation (SEE), Lin's approach, and the Bland-Altman test were used to determine the accuracy of the predictive BIA equations used to estimate FFM in this population and between the two moments (pre- and post-moment). Results: The FFM measured using the nine predictive BIA equations, and determined using DXA at the post-moment, showed a significant increase when compared with the pre-moment (p < 0.05). All nine predictive BIA equations were able to detect FFM changes in the army cadets between the two moments in a very similar way to the reference method (DXA). However, only the one BIA equation specific to this population showed no significant differences in the FFM estimation between DXA at pre- and post-moment of military routine. All predictive BIA equations showed large limits of agreement using the Bland-Altman approach. Conclusion: The eight general predictive BIA equations used in this study were not found to be valid for analyzing the FFM changes in the Brazilian male army cadets, after a period of approximately 7 mo of military training. Although the BIA equation specific to this population is dependent on the amount of FFM, it appears to be a good alternative to DXA for assessing FFM in Brazilian male army cadets.

Dual-energy x-ray absorptiometry metabolic maps to resting energy expenditure estimation, and body size dependence in Brazilian young men.

OBJECTIVES: The model most suitable for estimating resting energy expenditure (REE) using dual-energy X-ray absorptiometry (DXA) metabolic maps is not known; moreover, the applicability in individuals with different body sizes also is uncertain. The aim of this study was to test the accuracy of REE estimation from models of DXA metabolic maps with four, five, and six tissue-organ components in young men, stratified by body size. METHODS: We studied 52 young men between the ages of 18 and 29 y. Participants were clustered to small (SW; n = 32) and large (LW; n = 20) weight, and small (SWH; n = 25) and large (LWH; n = 27) weight-height. REE was measured by indirect calorimetry (REEm), and predicted from DXA metabolic maps with four (REEc1), five (REEc2) and six (REEc3) tissue-organ components. RESULTS: REEc1, REEc2, and REEc3 explained 54% (P < 0.001), 56% (P < 0.001), and 58% (P < 0.001) of REEm variance in all participants, respectively. However, REEc2 showed mean difference between REEm (P < 0.001), and REEc3 showed trends in estimating the REE (P < 0.05). In contrast, REEc1 showed limits of agreement (95%) of -248.3 to 285.8 kcal/d, 18.7 ± 136.3 kcal/d of bias, and no trends in the Bland-Altman analysis. The relationship between all predicted models and measured REE decreased in LW and LWH. CONCLUSIONS: REEc1 can be considered the best accurate model of REE estimation in Brazilian young men, providing the REE and metabolically active tissue-organ of four components. Caution should be exercised with the use of DXA metabolic maps in populations with greater weight and greater weight-height.

Validity of Bioelectrical Impedance Analysis to Estimation Fat-Free Mass in the Army Cadets.

BACKGROUND: Bioelectrical Impedance Analysis (BIA) is a fast, practical, non-invasive, and frequently used method for fat-free mass (FFM) estimation. The aims of this study were to validate predictive equations of BIA to FFM estimation in Army cadets and to develop and validate a specific BIA equation for this population. METHODS: A total of 396 males, Brazilian Army cadets, aged 17-24 years were included. The study used eight published predictive BIA equations, a specific equation in FFM estimation, and dual-energy X-ray absorptiometry (DXA) as a reference method. Student's t-test (for paired sample), linear regression analysis, and Bland-Altman method were used to test the validity of the BIA equations. RESULTS: Predictive BIA equations showed significant differences in FFM compared to DXA (p < 0.05) and large limits of agreement by Bland-Altman. Predictive BIA equations explained 68% to 88% of FFM variance. Specific BIA equations showed no significant differences in FFM, compared to DXA values. CONCLUSION: Published BIA predictive equations showed poor accuracy in this sample. The specific BIA equations, developed in this study, demonstrated validity for this sample, although should be used with caution in samples with a large range of FFM.

Minimum Time to Achieve the Steady State and Optimum Abbreviated Period to Estimate the Resting Energy Expenditure by Indirect Calorimetry in Healthy Young Adults.

BACKGROUND: The optimum abbreviated period for measurement by indirect calorimetry (IC) to estimate the resting energy expenditure (REE), including the acclimation period, in healthy individuals has not been established. This study aimed to determine the acclimation time required to achieve the REE steady state during a 30-minute IC measurement and to define the optimum abbreviated measurement period in the steady state to estimate the REE in healthy young adults. METHODS: Thirty-nine volunteers (27 men and 12 women; age, 18-31 years) were recruited. The REE was obtained by IC over 30 minutes. Friedman's test was used to compare the coefficient of variation (CV%) among all 5-minute intervals (REE5). To compare the REE values obtained during the first REE5 interval in the steady state with the REE average values of the subsequent measurements, Student paired t test, linear regression, and Bland-Altman test were used. RESULTS: The CV% of the first REE5 (mean ± standard deviation: 19.9% ± 13.2%) was significantly higher (P < .0001) than that of all other REE5 (second REE5: 7.4% ± 3.8%; third: 7.8% ± 5.2%; fourth: 7.1% ± 3.9%; fifth: 8.0% ± 5.7%; sixth: 8.0% ± 4.5%). No significant difference was found between the second REE5 and the REE average values of the last 20 minutes. The second REE5 explained 90% of the REE average of the last 20 minutes, with the 95% limits of agreement by the Bland-Altman test ranging from -142.92 to 150.44 kcal/d. CONCLUSION: Ten minutes can be used as an abbreviated alternative for IC measurements in healthy young adults, and values of the first 5-minute interval should be discarded.

Body composition as a frailty marker for the elderly community.

BACKGROUND: Body composition (BC) in the elderly has been associated with diseases and mortality; however, there is a shortage of data on frailty in the elderly. OBJECTIVE: To investigate the association between BC and frailty, and identify BC profiles in nonfrail, prefrail, and frail elderly people. METHODS: A cross-sectional study comprising 235 elderly (142 females and 93 males) aged ≥65 years, from the city of Amparo, State of São Paulo, Brazil, was undertaken. Sociodemographic and cognitive features, comorbidities, medication, frailty, body mass index (BMI), muscle mass, fat mass, bone mass, and fat percent (%) data were evaluated. Aiming to examine the relationship between BC and frailty, the Mann-Whitney and Kruskal-Wallis nonparametric tests were applied. The statistical significance level was P<0.05. RESULTS: The nonfrail elderly showed greater muscle mass and greater bone mass compared with the prefrail and frail ones. The frail elderly had greater fat % than the nonfrail elderly. There was a positive association between grip strength and muscle mass with bone mass (P<0.001), and a negative association between grip strength and fat % (P<0.001). Gait speed was positively associated with fat mass (P=0.038) and fat % (P=0.002). The physical activity level was negatively associated with fat % (P=0.022). The weight loss criterion was positively related to muscle mass (P<0.001), bone mass (P=0.009), fat mass (P=0.018), and BMI (P=0.003). There was a negative association between fatigue and bone mass (P=0.008). DISCUSSION: Frailty in the elderly was characterized by a BC profile/phenotype with lower muscle mass and lower bone mass and with a higher fat %. The BMI was not effective in evaluating the relationship between BC and frailty. The importance of evaluating the fat % was verified when considering the tissue distribution in the elderly BC.

Efeito de 13 semanas de treinamento físico militar sobre a composição corporal e o desempenho físico dos alunos da escola preparatória de cadetes do exército / Effect of 13 weeks of military exercise training on the body composition and physical performance of espcex students

INTRODUÇÃO: Exércitos do mundo inteiro reconhecem a importância de uma boa condição física para o desempenho das funções militares. O treinamento físico militar (TFM) tenta proporcionar auxílio nessa busca por uma melhor condição física e corporal. OBJETIVO: Verificar o efeito de 13 semanas de TFM na composição corporal e no desempenho físico dos alunos da Escola Preparatória de Cadetes do Exército (EsPCEx). MÉTODOS: A amostra foi constituída de 287 alunos do sexo masculino da EsPCEx com idade média de 18,33 ± 1,26 anos. Tais alunos cumpriram uma rotina de internato, com horários, refeições e atividades definidas, da qual eram liberados somente nos finais de semana. O TFM foi realizado numa frequência semanal de cinco dias e englobou treinamentos aeróbicos e resistivos. Foram realizadas no período pré e pós-treinamento medidas da massa corporal, altura, dobras cutâneas (tricipital, abdominal e suprailíaca) e realizados os seguintes testes: corrida de 12 minutos, abdominal parafuso, flexão de braço e flexão na barra fixa. Com os dados antropométricos coletados, foi calculado o percentual de gordura, massa livre de gordura (MLG) e massa gorda (MG) baseado no protocolo de três dobras de Guedes. RESULTADOS: Quando comparados os valores dos dados antropométricos e da composição corporal dos períodos inicial e final de treinamento foi observada redução significativa na MG, no percentual de gordura, nas dobras cutâneas tricipital e abdominal e aumento na dobra cutânea suprailíaca e na MLG. Ocorreram melhoras significativas também em todos os testes físicos realizados, nos quais um melhor desempenho foi alcançado. CONCLUSÃO: Os dados obtidos sugerem melhora significativa na composição corporal e no desempenho físico através da realização do TFM, com frequência semanal de cinco dias.

INTRODUCTION: Armies from all over the world acknowledge the importance of good physical fitness for the performance of military duties. The Military Exercise Training (MET) attempts to provide assistance to this search for better physical fitness and performance. OBJECTIVE: To verifying the effect on the body composition and physical performance of the students at ESPCEX (Military School for Preparation of Army Cadets) after 13 weeks of MET. METHODS: The sample was formed by 287 male students from the ESPCEX, whose average age was 18.33 ±1.26. Such students accomplished a boarding school routine, having defined schedules, meals and activities from which they were only released during the weekends. The MET was accomplished five days a week and it comprised both aerobic and resistance training. Measurement of body mass, height, skinfold (triceps, abdominal and suprailiac) was accomplished during pre and post training periods, and the following tests were performed: 12-minutes-run, oblique sit up, arm push up and pull up. Fat percentage, fat-free body mass and fat body mass were calculated using the anthropometric data based on the Guedes 3 skinfold protocol. RESULTS: Significant reduction in fat body mass, fat percentage and in triceptal and abdominal skinfold, as well as increase in suprailiac skinfold and fat-free body mass was observed when anthropometric and body composition data were compared, during the initial and the final periods of training. Significant improvement also occurred in all prformed physical tests, in which better performance was achieved. CONCLUSION: The acquired data suggest that performance of MET 5 days a week brought significantly improved body composition as well as physical performance.