Active Gains in brain Using Exercise During Aging (AGUEDA): protocol for a randomized controlled trial.

Alzheimer's disease is currently the leading cause of dementia and one of the most expensive, lethal and severe diseases worldwide. Age-related decline in executive function is widespread and plays a key role in subsequent dementia risk. Physical exercise has been proposed as one of the leading non-pharmaceutical approaches to improve executive function and ameliorate cognitive decline. This single-site, two-arm, single-blinded, randomized controlled trial (RCT) will include 90 cognitively normal older adults, aged 65-80 years old. Participants will be randomized to a 24-week resistance exercise program (3 sessions/week, 60 min/session, n = 45), or a wait-list control group (n = 45) which will be asked to maintain their usual lifestyle. All study outcomes will be assessed at baseline and at 24-weeks after the exercise program, with a subset of selected outcomes assessed at 12-weeks. The primary outcome will be indicated by the change in an executive function composite score assessed with a comprehensive neuropsychological battery and the National Institutes of Health Toolbox Cognition Battery. Secondary outcomes will include changes in brain structure and function and amyloid deposition, other cognitive outcomes, and changes in molecular biomarkers assessed in blood, saliva, and fecal samples, physical function, muscular strength, body composition, mental health, and psychosocial parameters. We expect that the resistance exercise program will have positive effects on executive function and related brain structure and function, and will help to understand the molecular, structural, functional, and psychosocial mechanisms involved.

Neck adipose tissue accumulation is associated with higher overall and central adiposity, a higher cardiometabolic risk, and a pro-inflammatory profile in young adults.

OBJECTIVES: Neck adipose tissue (NAT) volume increases with general adiposity, with fat accumulating in different neck tissue compartments. In patients with certain malignant/benign tumours, the accumulation of NAT, and certain NAT distributions, have been associated with cardiometabolic risk (CMR). However, it is unknown whether the same relationships exist in healthy people, and whether NAT accumulation and distribution are related to the inflammatory status. METHODS: In this cross-sectional study, 139 young healthy adults (68% women) underwent a computed tomography scan to quantify the volume of compartmental (i.e., subcutaneous, intermuscular and perivertebral) and total NAT at the height of vertebra C5. Anthropometric indicators were measured, and body composition determined using dual energy X-ray absorptiometry. Information on CMR factors (i.e., blood glycaemic and lipid markers, blood pressure and physical fitness) was also gathered, and a CMR score calculated. Several plasma cytokines and serum components of the innate immune system were measured to determine the inflammatory status. RESULTS: Compartmental and total NAT volumes were directly related to body mass index (BMI), and lean, fat, and visceral adipose tissue (VAT) masses (all, P ≤ 0.05). Larger compartmental (especially intermuscular) and total NAT volumes were directly associated with the CMR score, several CMR factors (i.e., glycaemic and lipid markers and blood pressure), and the C3, C4 and leptin concentrations. They were, however, inversely correlated with the CMR factors high density lipoprotein-cholesterol (HDL-C) and physical fitness, and with the adiponectin concentration (all P ≤ 0.05). Several of these associations remained statistically significant (P ≤ 0.05) after adjustment for BMI, body fat percentage or VAT mass. Overall, results did not change after applying false discovery rate correction. CONCLUSIONS: NAT volume and its distribution among different tissue compartments is associated with the CMR and inflammatory profile of young healthy adults. Total NAT volume appears to be as valuable as VAT mass in terms of predicting CMR and inflammatory status.

Supraclavicular skin temperature measured by iButtons and 18F-fluorodeoxyglucose uptake by brown adipose tissue in adults.

Currently, 18 [F]-Fluorodeoxyglucose (18F-FDG) in combination with a positron emission tomography/computed tomography (PET/CT) scan analysis is the most commonly used method to quantify human BAT volume and activity. However, this technique presents several drawbacks which negatively affect participant's health. The aim of the present work is to determine whether supraclavicular skin temperature can be used as an indirect marker of cold-induced BAT and skeletal muscle 18F-FDG uptake in adults, while taking into account body composition. We performed a personalized cooling protocol just before an 18F-FDG-PET/CT scan, and we measured supraclavicular skin temperature before (in warm conditions) and after the cooling protocol in 88 adults (n = 57 women, mean age: 21.9 ±â€¯2.1 years old, body mass index: 24.5 ±â€¯4.3 km/m2). We found that supraclavicular skin temperature at the warm and cold periods was weakly and positively associated with BAT activity (SUVmean and SUVpeak: ß = 3.000; R2 = 0.072; P = 0.022 and ß = 2.448; R2 = 0.060; P = 0.021), but not with skeletal muscle 18F-FDG uptake, after controlling for body composition. We performed further analyses and the positive associations persisted only in the group of women. In conclusion, supraclavicular skin temperature in warm and cold conditions seems to be related with cold-induced 18F-FDG uptake by BAT only in women, although the low explained variance of these associations means that there are other factors involved in the supraclavicular skin temperature.

Association between brown adipose tissue and bone mineral density in humans.

BACKGROUND: Brown adipose tissue (BAT) seems to play a role in bone morphogenesis. A negative association has been reported between BAT and bone mineral density (BMD) in women, but not in men. A panel of experts has recently published a set of recommendations for BAT assessment, and thus, to re-address previously reported associations is needed. This study aimed to investigate the association between cold-induced BAT 18F-Fluorodeoxyglucose (18F-FDG) uptake and BMD in young healthy adults. METHODS: Ninety-eight healthy adults (68 women; 22 ± 2.2 years old; 24.3 ± 4.5 kg/m2) cold-induced BAT was assessed by means of an 18F-FDG positron emission tomography-computed tomography (PET-CT) scan preceded by a personalized cold stimulation. The cold exposure consisted in 2 h in a mild cold room at 19.5-20 °C wearing a water perfused cooling vest set 4 °C above the individual shivering threshold. Total body and lumbar spine BMD were assessed by a whole-body DXA scan. RESULTS: We found no association between BMD and cold-induced BAT volume, mean, and maximal activity (all P > 0.1) in neither young and healthy men nor women. These results remained unchanged when adjusting by height, by body composition, and by objectively assessed physical activity. Sensitivity analyses using the criteria to quantify cold-induced BAT-related parameters applied in previous studies did not change the results. CONCLUSIONS: In summary, our study shows that there is no association between cold-induced BAT and BMD in young healthy adults. Moreover, our data support the notion that previously shown associations between BAT and BMD in healthy non-calorically restricted individuals, could be driven by methodological issues related to BAT assessment and/or sample size limitations.

Brown Adipose Tissue and Skeletal Muscle 18F-FDG Activity After a Personalized Cold Exposure Is Not Associated With Cold-Induced Thermogenesis and Nutrient Oxidation Rates in Young Healthy Adults.

Cold induced thermogenesis (CIT) in humans results mainly from the combination of both brown adipose tissue (BAT) and skeletal muscle thermogenic activity. The relative contribution of both tissues to CIT and to cold induced nutrient oxidation rates (CI-NUTox) remains, however, to be elucidated. We investigated the association of BAT and skeletal muscle activity after a personalized cold exposure with CIT and CI-NUTox in 57 healthy adults (23.0 ± 2.4 years old; 25.1 ± 4.6 kg/m2; 35 women). BAT and skeletal muscle (paracervical, sternocleidomastoid, scalene, longus colli, trapezius, parathoracic, supraspinatus, subscapular, deltoid, pectoralis major, and triceps brachii) metabolic activity were assessed by means of a 18Fluorodeoxyglucose positron emission tomography-computed tomography scan preceded by a personalized cold exposure. The cold exposure consisted in remaining in a mild cold room for 2 h at 19.5-20°C wearing a water perfused cooling vest set at 3.8°C above the individual shivering threshold. On a separate day, we estimated CIT and CI-NUTox by indirect calorimetry under fasting conditions for 1 h of personalized cold exposure. There was no association of BAT volume or activity with CIT or CI-NUTox (all P > 0.2). Similarly, the skeletal muscle metabolic activity was not associated either with CIT or CI-NUTox (all P > 0.2). The results persisted after controlling for sex, the time of the day, and the date when CIT was assessed. Our results suggest that human BAT activity and skeletal muscle 18F-FDG activity are not associated to CIT in young healthy adults. Inherent limitations of the available radiotracers for BAT detection and muscle activity quantification may explain why we failed to detect a physiologically plausible association.

A New Personalized Cooling Protocol to Activate Brown Adipose Tissue in Young Adults.

Brown adipose tissue (BAT) activity is induced when humans are exposed to cold. Therefore, cold exposure prior to the 18F-FDG-PET/CT scan is used as a tool to quantify BAT. Several cooling protocols, including fixed and personalized ones are currently in use. The aim of the present study was to determine the effect of a new personalized cooling protocol where the shivering threshold was measured on a separate day, on BAT volume and activity in young adults. A total of 47 adults (n = 28 women) aged 22 ± 2 years participated in the study. We determined participants' shivering threshold (visually and self-reported) using a water perfused cooling vest in an air-conditioned cold room. 48-72 h later, participants wore the cooling vest set at ~4°C above the shivering threshold for 60 min prior to injection of 18F-FDG and ~5°C above the shivering threshold for ~60 min after injection, until PET/CT scan. We quantified BAT following BARCIST 1.0 recommendations. We identified 40 participants (85%, n = 25 women) as PET+ and 7 (n = 3 women) as PET-. The PET+ group presented significantly higher BAT volume and activity than PET- group (all P < 0.05). PET+ women had higher BAT mean activity than PET+ men (SUVmean: 5.0 ± 1.6 vs. 3.6 ± 0.9 g/ml respectively, P = 0.003), and there were no significant sex differences in BAT volume (P = 0.161). A total of 9 out of 47 participants did not shiver during the shivering threshold test. Our findings are similar to previous cold-stimulated human BAT studies; therefore, we conclude that our personalized cooling protocol is able to activate BAT in young adults.

Activating brown adipose tissue through exercise (ACTIBATE) in young adults: Rationale, design and methodology.

AIMS: The energy expenditure capacity of brown adipose tissue (BAT) makes it an attractive target as a therapy against obesity and type 2 diabetes. BAT activators namely catecholamines, natriuretic peptides and certain myokines, are secreted in response to exercise. ACTIBATE will determine the effect of exercise on BAT activity and mass measured by positron emission tomography/computed tomography (PET/CT, primary outcome) in young adults. ACTIBATE will also investigate the physiological consequences of activating BAT (secondary outcomes). METHODS: ACTIBATE will recruit 150 sedentary, healthy, young adults (50% women) aged 18-25 years. Eligible participants will be randomly assigned to a non-exercise group (n ≈ 50) or one of two exercise groups (n=50 each). Participants in the exercise groups will perform aerobic and strength training 3-4 days/week at a heart rate equivalent to 60% of heart rate reserve (HRres), and at 50% of 1 repetition maximum (RM) for the moderate-intensity group, and at 80% of HRres and 70% RM for the vigorous-intensity group. Laboratory measures completed at baseline and 6 months include BAT activity and mass, resting energy expenditure, meal and cold-induced thermogenesis, body temperature regulation and shivering threshold, body composition and cardiovascular disease risk factors. We will also obtain biopsies from abdominal subcutaneous white adipose tissue and skeletal muscle to analyse the expression of genes encoding proteins involved in the thermogenic machinery. DISCUSSION: Findings from ACTIBATE will have significant implications for our understanding of exercise and its protective effects against the development of type 2 diabetes, obesity and related metabolic diseases. ClinicalTrials.gov ID: NCT02365129.

Optimización del procedimiento enfermero para la inyección de fluordesoxiglucosa en Medicina Nuclear / Optimizing the nursing procedure for the injection of fluorodeoxyglucose in Nuclear Medicine

Este trabajo presenta las posibles modificaciones susceptibles de ser realizadas en el procedimiento enfermero en la tomografía por emisión de positrones (PET) con el isótopo radioactivo fluordesoxiglucosa(18F-FDG), con la finalidad de optimizar los recursos materiales, humanos y de tiempo, así como la confortabilidad del paciente y la seguridad del personal sanitario involucrado. Los autores del presente artículo, siguiendo un estudio realizado en 2010 con una muestra de 8.640 pacientes recogida durante un periodo de 18 meses, han continuado el trabajo iniciado, llevándose a cabo, asi mismo, los cambios necesarios para la seguridad del personal sanitario involucrado.El objetivo del presente artículo es describir y analizar cómo se han optimizado los recursos y el tiempo empleado en dicho procedimiento y, al mismo tiempo, conocer cómo se ha mejorado el bienestar del paciente durante su necesaria estancia en el servicio para la aplicación de esta técnica. Los resultados indican que los cambios introducidos conllevan menor uso de material, menor tiempo de exposición y, consecuentemente,menor riesgo de radiación, así como una mejora en el bienestar del paciente durante la aplicación del procedimiento (AU)

This paper presents the possible changes that could be made in the nursing process in positron emission tomography (PET) with the radioactiveisotope fluorodeoxyglucose (18F-FDG), in order to optimize the material and human resources and time, as well as the patient'scomfort and the safety of the health care personnel involved.The authors of this article, following a study conducted in 2010 using a sample of 8640 patients and data collected over a period of 18 months, have continued the work started, carrying out also the changes necessary to ensure the safety of the health care personnel involved.The aim of this paper is to describe and analyze how resources and the time employed in the said procedure were optimized and, at the same time, how patient comfort was improved during the patients stay in the department for the application of this technique. The results indicate that the changes involve less use of materials, less exposure time and, consequently, less risk of radiation, as well as improved patient comfort during application of the procedure (AU)