Body composition in nonobese individuals according to vitamin D level.

Obesity is associated with lower 25-hydroxyvitamin D (25OHD) levels, but the association between 25OHD deficiency and specific body composition (BC) patterns remains unclear. The aim of this study was to analyze the correlation between 25OHD levels and BC in a population of healthy, nonobese individuals. Cross-sectional, observational study including a convenience sample of community-dwelling healthy individuals aged ≥18 years who responded to a study advertisement and were randomly selected. The participants filled out a questionnaire and had fasting blood drawn and anthropometric indices taken. Dual-energy x-ray absorptiometry was performed for BC analysis (fat and lean body mass). The subjects were divided according to 25OHD levels into three groups: I (≤20 ng/mL, vitamin D deficient), II (>20 and <30 ng/mL, vitamin D insufficient), and III (≥30 ng/mL, vitamin D sufficient). Of 299 individuals selected, 51 were excluded, yielding a final sample of 248 (128 women) who had serum 25OHD levels measured. Women presented higher 25OHD levels than men (27.8±12.0 ng/mL and 24.8±11.3 ng/mL, respectively; p = 0.03). Including both sexes, Group I had greater body mass index (BMI; 26.6±2.5 kg/m2) and waist circumference (WC; 91.8.8±9.1 cm) compared with the other groups. Group I also had 75.7% and 65.3% of abnormal BMI and WC values, respectively, (p<0.05 for both) and a higher percentage of trunk and android fat confirmed by multivariate analysis. No differences in BC were observed in individuals with insufficient versus sufficient 25OHD levels. Individuals with lower 25OHD levels had increased fat in the android region and trunk. This study confirms the association of lower 25OHD levels with greater BMI and WC and increased deposition of fat in body compartments, which, even in nonobese individuals, are commonly associated with increased metabolic risk.

Multivariate quasi-beta regression models for continuous bounded data.

We propose a multivariate regression model to deal with multiple continuous bounded data. The proposed model is based on second-moment assumptions, only. We adopted the quasi-score and Pearson estimating functions for estimation of the regression and dispersion parameters, respectively. Thus, the proposed approach does not require a multivariate probability distribution for the variable response vector. The multivariate quasi-beta regression model can easily handle multiple continuous bounded outcomes taking into account the correlation between the response variables. Furthermore, the model allows us to analyze continuous bounded data on the interval [0, 1], including zeros and/or ones. Simulation studies were conducted to investigate the behavior of the NORmal To Anything (NORTA) algorithm and to check the properties of the estimating function estimators to deal with multiple correlated response variables generated from marginal beta distributions. The model was motivated by a data set concerning the body fat percentage, which was measured at five regions of the body and represent the response variables. We analyze each response variable separately and compare it with the fit of the multivariate proposed model. The multivariate quasi-beta regression model provides better fit than its univariate counterparts, as well as allows us to measure the correlation between response variables. Finally, we adapted diagnostic tools to the proposed model. In the supplementary material, we provide the data set and R code.

Sarcopenia in heart failure with reduced ejection fraction.

AIMS: To evaluate the prevalence of pre-sarcopenia and sarcopenia and their relationship with clinical variables, physical activity, quality of life, and diet in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). METHODS: We performed a cross-sectional study in patients with HFrEF and matched controls. Clinical, laboratory analysis, dual-emission X-ray densitometry, handgrip strength, and physical activity level questionnaire assessments were performed. Echocardiography, quality of life, gait speed, and 24-hour nutritional recall questionnaire were also analyzed. Pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People with the cut-off points of the Foundation for the National Institute of Health. RESULTS: 79 patients and 143 controls were enrolled. Pre-sarcopenia was found in 30.4%, and sarcopenia in 10.1% of the patients. Pre-sarcopenic patients were older and shorter, and had more fractures, higher calcemia, and creatinine (P < 0.05). Sarcopenic patients were older and had higher creatinine and TSH (P < 0.05). After multiple logistic regression analysis, only age was associated with pre-sarcopenia (OR: 1.046; CI 1.004-1.095; P = 0.04) and SP (OR: 1.119; CI 1.039-1.229; P = 0.008). Women with HFrEF presented higher lean mass than controls (P < 0.001), but were weaker (P < 0.001), while men presented lower lean mass (P < 0.001). Low gait speed was associated with right ventricular dysfunction (P = 0.016) and lower left ventricular ejection fraction (P = 0.037). CONCLUSION: Pre-sarcopenia and sarcopenia were associated with aging. Despite having higher lean mass, women with HFrEF were weaker. Low gait speed was associated with biventricular systolic dysfunction.

Sarcopenia: a chronic complication of type 2 diabetes mellitus.

BACKGROUND: Diabetics are at increased risk for impaired mobility and strength, frequently related to the disease control. Sarcopenia is the reduction of muscle mass associated with the decrease in muscle strength and/or performance, resulting in worse morbidity in chronic diseases. METHODS: The objectives of this paper was to assess the prevalence of sarcopenia in patients with type 2 diabetes mellitus (T2DM) and determine its association with diabetes characteristics, progression, and complications, as well as changes in bone mineral density. The sample consisted of patients with T2DM followed at the outpatient clinics of the Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, from March to August 2016. Participants were men and women above 18 years with T2DM diagnosed at least 1 year earlier. Individuals with chronic diseases, users of any drug that modifies body composition, patients with body mass index (BMI) > 35 or < 18 kg/m2, and users of illicit drugs or hormonal or nutritional supplementation were excluded. The selected patients answered questionnaires about demographics, eating habits, and disease characteristics, and performed a bone densitometry exam in a dual energy absorptiometry (total body; spine and femur (total and neck)), a handgrip test by manual dynamometer, and an evaluation of the abdominal circumference (AC). The medical records were reviewed seeking diabetes data and laboratory test results. Patients were matched for sex, age, and race with healthy controls [Control Group (CG)]. The diagnosis of sarcopenia was conducted according to the criteria of the Foundation for National Institute of Health. RESULTS: The final sample consisted of 83 patients in the DG and 83 in the CG. The DG had higher BMI, WC, past history of fractures and lower calcium and healthy diet intake (p < 0.005), compared to the CG. The DG presented a higher frequency of abnormal BMD (osteopenia in 45 (53%), and osteoporosis in 14 (19%)) and comorbidities than the CG (p < 0.005). Pre-sarcopenia was not different between groups, but muscle weakness was present in 25 diabetics (18 women) and only in 5 controls (4 men) (p = 0.00036). Sarcopenia was diagnosed in 13 (16.2%) patients in the DG and 2 (2.4%) in the CG (p = 0.01168). Pre-sarcopenia and sarcopenia were associated with altered BMD (p < 0.005), with no association with diabetes duration or control. Body mass index and osteoporosis increased the likelihood to have sarcopenia, but hypertension and healthy diet decreased it. CONCLUSION: The DG had altered BMD associated with worse glycemic control, and a higher prevalence of sarcopenia, suggesting the need to look for their presence in diabetics.

Body composition and sarcopenia in patients with chronic obstructive pulmonary disease.

PURPOSE: Changes in body composition are commonly present in chronic obstructive pulmonary disease (COPD). The main aim of this study were to evaluate changes in body composition and the prevalence of pre-sarcopenia and sarcopenia in patients with COPD, compared with two control groups and correlate these parameters with indices of COPD severity (VEF1 and GOLD) and prognosis (BODE). METHODS: This was a cross-sectional study in COPD patients (DG) that undergone body composition assessment by DXA. Two control groups were used, smokers individuals without COPD (smokers group, SG), and healthy never smokers individuals (never smokers group, NSG). RESULTS: DG comprised 121 patients (65 women, mean age 67.9 ± 8.6 years). The percentage of total body fat mass (TFM) was significantly lower in DG in both genders, despite no difference in BMI. Both BMI and relative skeletal muscle mass index (RSMI) decreased according to the worsening of GOLD in men and women, as well as the TFM and total lean mass (TLM) in men. As BODE get worse, BMI and RSMI decreased in both sexes, as well as TLM in men. The prevalence of pre-sarcopenia in the DG was 46.3% and no different with controls. In DG 12.4% were sarcopenic. Patients with sarcopenia were older and had worse prognosis. Higher BODE prognostic index, higher the prevalence of sarcopenia (OR 3.5, 95% CI 1.06-11.56, p = 0.035). CONCLUSIONS: This study showed alterations in body composition parameters in patients with COPD. A high prevalence of sarcopenia and the association with worse prognostic index.

Osteomalácia oncogênica: cintilografia com sestamibi-99mTc na localização do tumor / Oncogenic osteomalacia: localization of underlying peripheral tumor with99mTc-sestamibi scintigraphy

A osteomalácia oncogênica hipofosfatêmica (OOH) é uma síndrome paraneoplásica induzida por tumor, de tecidos mole ou ósseo. Apresenta-se com dor e fraturas, acompanhada de hipofosfatemia, hiperfosfatúria e concentrações plasmáticas de 1,25(OH)2D3 inapropriadamente normais/diminuídas. Após a remoção do tumor, a completa resolução das anormalidades clínicas e bioquímicas é sua maior característica. Uma mulher de 44 anos de idade é descrita no caso com dificuldade para caminhar por causa de dores nos membros inferiores, fraqueza muscular generalizada e hipofosfatemia com relativa hiperfosfatúria. A cintilografia de corpo total com sestamibi-99mTc mostrou acúmulo do radiofármaco no terço superior de coxa esquerda onde pequeno tumor foi detectado no exame pelo ultra-som. Com a retirada do tumor, um lipoma, os sintomas melhoraram após um mês, com recuperação completa ao redor do quarto mês. Neste caso, a cintilografia de corpo inteiro com sestamibi-99mTc foi decisiva na localização do tumor causador da osteomalácia oncogênica.

Oncogenic osteomalacia is a paraneoplastic syndrome usually induced by bone or soft tissue tumors. It is presented by the development of pain and fractures with hypophosphatemia, hyperphosphaturia, and inappropriate normal/low plasma 1,25(OH)2D3 concentration. After the removal of the tumor the complete resolution of all biochemical and clinical abnormalities is the main characteristic. A case of a 44-year-old female with difficulty in walking due to leg pain and generalized muscle weakness and hypophosphatemia, with relative hyperphosphaturia, is described. A whole-body 99mTc-sestamibi scintigraphy showed accumulation in the left thigh region, and a small tumor was detected by ultrasound examination. By removal of the tumor, a lipoma, the symptoms improved significantly after a month, with complete recovery by the fourth month. In this case, 99mTc-sestamibi scintigraphy was useful in identifying the location of the tumor, which caused oncogenic osteomalacia.

[Oncogenic osteomalacia: localization of underlying peripheral tumor with 99mTc-sestamibi scintigraphy]. / Osteomalácia oncogênica: cintilografia com sestamibi-99mTc na localização do tumor.

Oncogenic osteomalacia is a paraneoplastic syndrome usually induced by bone or soft tissue tumors. It is presented by the development of pain and fractures with hypophosphatemia, hyperphosphaturia, and inappropriate normal/low plasma 1,25(OH)2D3 concentration. After the removal of the tumor the complete resolution of all biochemical and clinical abnormalities is the main characteristic. A case of a 44-year-old female with difficulty in walking due to leg pain and generalized muscle weakness and hypophosphatemia, with relative hyperphosphaturia, is described. A whole-body 99mTc-sestamibi scintigraphy showed accumulation in the left thigh region, and a small tumor was detected by ultrasound examination. By removal of the tumor, a lipoma, the symptoms improved significantly after a month, with complete recovery by the fourth month. In this case, 99mTc-sestamibi scintigraphy was useful in identifying the location of the tumor, which caused oncogenic osteomalacia.