The relationship between 30-year developmental patterns of body fat and body fat distribution and its vascular properties: the Amsterdam Growth and Health Longitudinal Study.

INTRODUCTION: Although body fat and body fat distribution are known to be related to cardiovascular diseases (CVDs), it is unknown whether specific 30-year developmental patterns of body fat are associated with CVDs. This study examines the existence of distinct developmental patterns of total fat measured by the sum of four skinfolds (S4SFs) and body fat distribution measured by the skinfold thickness ratio (SFratio), and relates these patterns to micro- and macrovascular functions. METHODS: In 2006, 259 apparently healthy subjects were examined on micro- and macrovascular functions, using video microscopy and carotid ultrasound sonography. Body fat, using both S4SFs and SFratio, was measured for 10 times over 30 years, from 13 years onwards. Latent class growth analyses (LCGA) were used to obtain distinct developmental patterns of S4SFs and SFratio. This is a data-drive hypothesis-generating approach and could possibly give a new perspective on body fatness over time. In addition, a mixed-method approach is used to obtain individual growth parameters. Linear regression analyses were used to examine the relationship of these patterns and individual growth parameters with micro- and macrovascular functions. RESULTS: LCGA identified normal and unfavourable developmental patterns in S4SFs and SFratio. Both men and women with an unfavourable developmental pattern of S4SFs showed impaired carotid compliance (ß=-0.216, P=0.004 and ß=-0.109, P=0.039, respectively), carotid distensibility (ß=-5.078, P=0.001 and ß=-5.118, P<0.001, respectively) and Young's elastic modulus (ß=0.066, P=0.065 and ß=0.107, P<0.001, respectively). In contrast, no relationship for microvascular function with developmental patterns of S4SFs was found. Developmental patterns of the SFratio were associated with neither measures of micro- nor macrovascular functions. No associations were using the individual growth parameters. CONCLUSIONS: For macrovascular function, there is a relationship of 30-year developmental patterns of S4SFs, whereas no such relationship was found for the 30-year developmental patterns of S4SFs or SFratio with microvascular function.

Prognostic factors and outcome in relapsed multiple myeloma after nonmyeloablative allo-SCT: a single center experience.

For relapsed multiple myeloma (MM) patients, allo-SCT is a possible treatment option, but recent data obtained using a nonmyeloablative (NMA) conditioning regimen are scarce. We retrospectively collected data from 38 relapsed MM patients who received a NMA allo-SCT from October 2001 to January 2008. In total, 18 patients (48%) were transplanted using a matched unrelated donor. The median follow-up is 2.3 years. In 16 patients (42%) the response improved and eight patients (21%) were rapidly progressive within 6 months after allo-SCT. In total, 15 patients (39%) were in CR after allo-SCT. The median PFS was 1.4 years (range, 0.1-4.9), and having a CR after allo-SCT or having chronic GVHD resulted in longer PFS. Median OS was 3.1 years (range, 0.2-7.2) and again having a CR after allo-SCT or chronic GVHD was associated with a better OS. Six patients (16%) have died from treatment-related diseases. These results indicate that NMA allo-SCT is a treatment option in relapsed MM patients and that results may be improved by strategies that enhance the CR rate after allo-SCT.

Maternal temperature during labour.

OBJECTIVE: The aim of this study was to describe the variation of normal maternal temperature during labour. Design A prospective cohort study. SETTING: Two hospitals in Amsterdam, the Netherlands. POPULATION: All women with a live singleton pregnancy and a gestational age of 36 weeks or more admitted to the delivery ward from June 2000 to January 2002. METHODS: Maternal temperature was measured rectally every 2-3 hours from admission until the beginning of second stage, and 1-hour postpartum. Normal labour (n = 843) was defined as gestational age > or =37 weeks, spontaneous onset of labour, rupture of membranes <18 hours before birth, normal progress of labour without the need for augmentation or epidural analgesia and spontaneous vaginal delivery of a healthy infant. The remaining group was classified as abnormal (n = 2209). MAIN OUTCOME MEASURES: Rectal measured temperature in degrees Celsius. RESULTS: The mean temperature during labour in the complete study population increased from 37.1 degrees C at the beginning of labour to 37.4 degrees C after 22 hours. Temperature in the abnormal labour group was equal to the normal labour group during the first 3 hours of labour (P > 0.05) but increased thereafter. CONCLUSIONS: At the beginning of labour, temperature was 37.1 degrees C. Temperature increased slowly during labour and was 37.4 degrees C (2SD 1.2) after 22 hours. The upper 2SD limit for normal temperature did not follow a circadian pattern and time of day is not relevant for the classification of normal versus elevated temperature.

Validity of total and segmental impedance measurements for prediction of body composition across ethnic population groups.

OBJECTIVES: To test the impact of body build factors on the validity of impedance-based body composition predictions across (ethnic) population groups and to study the suitability of segmental impedance measurements. DESIGN: Cross-sectional observational study. SETTINGS: Ministry of Health and School of Physical Education, Nanyang Technological University, Singapore. SUBJECTS: A total of 291 female and male Chinese, Malays and Indian Singaporeans, aged 18-69, body mass index (BMI) 16.0-40.2 kg/ m2. METHODS: Anthropometric parameters were measured in addition to impedance (100 kHz) of the total body, arms and legs. Impedance indexes were calculated as height2/impedance. Arm length (span) and leg length (sitting height), wrist and knee width were measured from which body build indices were calculated. Total body water (TBW) was measured using deuterium oxide dilution. Extra cellular water (ECW) was measured using bromide dilution. Body fat percentage was determined using a chemical four-compartment model. RESULTS: The bias of TBW predicted from total body impedance index (bias: measured minus predicted TBW) was different among the three ethnic groups, TBW being significantly underestimated in Indians compared to Chinese and Malays. This bias was found to be dependent on body water distribution (ECW/TBW) and parameters of body build, mainly relative (to height) arm length. After correcting for differences in body water distribution and body build parameters the differences in bias across the ethnic groups disappeared. The impedance index using total body impedance was better correlated with TBW than the impedance index of arm or leg impedance, even after corrections for body build parameters. CONCLUSIONS: The study shows that ethnic-specific bias of impedance-based prediction formulas for body composition is due mainly to differences in body build among the ethnic groups. This means that the use of 'general' prediction equations across different (ethnic) population groups without prior testing of their validity should be avoided. Total body impedance has higher predictive value than segmental impedance.

A study of "white spotted kidneys" in cattle.

A study was performed at an abattoir in Australia, in an attempt to correlate focal chronic interstitial nephritis (FCIN) producing the so-called "white spotted kidney", with Leptospira spp. and other pathogens in cattle. Samples of kidneys, urine and blood were collected immediately after slaughter from 46 two-year-old heifers, and 72 cows and bulls with gross lesions consistent with FCIN. The same samples were also collected from nine heifers and 12 cows with no gross kidney lesions. Aqueous humour was also collected from the eye of 17 of the adult animals. The sera were processed by a microscopic agglutination test for leptospira antibodies, while all the other samples were cultured for Leptospira spp. and also processed for routine aerobic and anaerobic culture for other pathogens. Sub-samples from all the kidneys were fixed in 10% buffered formalin and processed histologically. Antibody titers of 1:400 or higher for Lepstospira borgpeterseni serovar hardjo were found in six adult animals with FCIN and in one adult animal with no gross kidney changes, while antibody titers of 1:400 to L. borgpeterseni serovar tarassovi were found in only one animal with FCIN. L. borgpeterseni serovar hardjo was isolated from the urine and kidney of one adult animal and from the urine of another adult animal, both with FCIN. No pathogens were isolated from any of the other samples. The histological lesions were consistent in most cases with FCIN. The results suggest that neither Leptospira spp. nor active infection by other bacteria are associated with the so-called "white spotted kidneys".

Multi-frequency impedance for the prediction of extracellular water and total body water.

The relationship between total body water (TBW) and extracellular water (ECW), measured by deuterium oxide dilution and bromide dilution respectively, and impedance and impedance index (height2/impedance) at 1, 5, 50 and 100 kHz was studied. After correction for TBW, ECW was correlated only with the impedance index at 1 and 5 kHz. After correction for ECW, TBW was best correlated with the impedance index at 100 kHz. The correlation of body-water compartments with impedance values obtained with modelling programs was lower than with measured impedance values. Prediction formulas for ECW (at 1 and 5 kHz) and TBW (at 50 and 100 kHz) were developed. The prediction errors for ECW and TBW were 1.0 and 1.7 kg respectively (coefficient of variation 5%). The residuals of both ECW and TBW were related to the ECW/TBW value. Application of the prediction formulas in a population, independently measured, revealed a slight overestimation of TBW and ECW, which could be largely explained by differences in the validation group in body-water distribution and in body build. The ratio of impedance at 1 kHz to impedance at 100 kHz was correlated with body-water distribution (ECW/TBW). The relation is however not strong enough to be useful as a predictor. It is concluded that an independent prediction of ECW and TBW, using impedance at low and high frequency respectively, is possible, but that the bias depends on the body-water distribution and body build of the measured subject.

Validity of predicted total body water and extracellular water using multifrequency bioelectrical impedance in an Ethiopian population.

Total body water (TBW) and extracellular water (ECW) were measured by deuterium oxide dilution and bromide dilution, respectively, in a group of 24 male and 20 female healthy Ethiopians, living in the capital Addis Ababa. Body weight, body height, skinfolds and total body impedance at 1 and at 100 kHz were also measured. TBW and ECW were predicted from impedance values at 1 and 100 kHz, respectively, using prediction equations developed in a Dutch adult population. ECW was overestimated by 1.3 +/- 1.0 kg (p < 0.05) and 0.6 +/- 0.8 kg (p < 0.05) in males and females, respectively. TBW was accurately predicted in males (0.1 +/- 1.9 kg, n.s.), but overestimated in females (1.0 +/- 1.3 p < 0.05). TBW/height and ECW/height were substantially lower in the Ethiopians compared to values recently published in Dutch and Italian adult subjects, indicating a different, more slender body build of the Ethiopians. After correcting for these differences in body build and for the slight differences in body water distribution (ECW/TBW), the differences between measured and predicted TBW and ECW decreased and were no longer significant. The results indicate that the validity of predicted body water from impedance depends on the body build of the subjects, which should be taken into account to avoid systematic errors when applying prediction formulas from a reference population to another population under study.

No substantial reduction of the thermic effect of a meal during pregnancy in well-nourished Dutch women.

To investigate changes in the thermic effect of a meal (TEM) during pregnancy, metabolic rate was measured in the fasting state and during the first 180 min after consumption of a standardized test meal in twenty-seven women before, and in each trimester of pregnancy. Resting metabolic rate (RMR) showed a steady increase over pregnancy: values in weeks 24 and 35 of pregnancy were significantly higher than the prepregnancy baseline (Tukey's studentized range test). The pattern of changes of postprandial metabolic rate (PPMR) was similar to that of RMR. Consequently TEM, calculated as PPMR minus RMR, did not change over pregnancy; mean TEM values (kJ/180 min) before and in weeks 13, 24 and 35 of pregnancy were 117.3 (SD 19.4), 116.4 (SD 23.7), 111.6 (SD 24.4) and 111.5 (SD 26.7) respectively. We consider changes in TEM of less than 15% to be of little importance physiologically. If true changes in TEM over pregnancy are 15% or more we would have had a 90% chance of observing significant changes in TEM in the present study, given the number of subjects and the methods used. Therefore, we conclude that no substantial reduction in TEM occurs during pregnancy.

Visceral fat accumulation in obese subjects: relation to energy expenditure and response to weight loss.

Seventy-eight healthy obese subjects, 40 premenopausal women and 38 men aged 27-51 yr received a 4.2 MJ/day energy-deficit diet for 13 wk. Resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were measured by indirect calorimetry. Abdominal subcutaneous and visceral fat areas were calculated from magnetic resonance imaging scans before and after weight loss. Before weight loss, visceral fat accumulation was positively correlated with higher levels of RMR (P < 0.05) and DIT (P < 0.01) in women but not in men. The mean weight reduction was 12.2 +/- 3.5 (SD) kg. In men but not in women, an initially large visceral fat depot was associated with a reduced loss of weight and total fat mass (P < 0.05). Within each sex, an initial abundance of visceral fat was significantly related to a larger loss of visceral fat (P < 0.001) and in men to a smaller loss of subcutaneous fat (P < 0.05). These results suggest that there may be gender differences in the associations between visceral fat accumulation and components of energy expenditure (RMR and DIT) in obese subjects. Obese subjects with an initial abundance of visceral fat do not lose more body weight but more visceral fat than subjects with less visceral fat.

Loss of total body water and extracellular water assessed by multifrequency impedance.

Fat-free mass (FFM), total body water (TBW), extracellular water (ECW) and bioelectrical impedance at 15 selected frequencies, ranging from 1 kHz to 1350 kHz, were determined in 12 subjects before and 3 h after the use of a diuretic drug to induce loss of ECW. Weight loss and urine loss were recorded, and these were assumed to be equal to loss of FFM and TBW, respectively. From the excretion of sodium the amount of excreted ECW was calculated. Prediction formulae at all frequencies were developed for FFM, TBW and ECW from impedance data before the use of the diuretic drug. With these formulae the changes in FFM, TBW and ECW were predicted and compared with the losses of body weight, urine and ECW. At all frequencies FFM, TBW and ECW could be well predicted, with comparable values of explained variance and standard errors of estimate. However, the losses in FFM and TBW were significantly overestimated using the low-frequency impedance formulae. At higher frequencies the predicted losses were no longer significantly different from the weight and urine losses, respectively. The change in ECW was only adequately predicted at 1 kHz. Prediction formulae for ECW at higher frequencies underestimated the loss of ECW. It is concluded that multifrequency impedance offers the possibility of distinguishing between body fluid compartments and of assessing changes in body fluid compartments with a reasonable error.

Body impedance is largely dependent on the intra- and extra-cellular water distribution.

Electrical impedance measurements were performed in fasting blood samples and analysed in relation to packed cell volume and calculated intra- and extra-cellular water distribution. The total blood impedance was shown to be strongly dependent on the ratio of intra-cellular water to total water (r = 0.97, P less than 0.0001). In a group of 515 subjects, with a large variation in age and body composition, the relation between the body impedence corrected for fat-free mass and body height (the specific body impedance) and the calculated ratio of intra-cellular water to total body water, was found to be similar to that in blood. From these observations a regression model was developed and applied to body compositional data of several groups of subjects before and after weight loss caused by water losses. It was possible to calculate at a group level the losses of intra- and extra-cellular water, which confirms the applicability of the model. It is concluded that the validity of the predicted fat-free mass or total body water from body impedance is largely dependent on the water distribution in the measured subjects. This means that age- and sex-specific prediction formulas have to be used for the assessment of the body composition and that the bio-electrical impedance method is only with caution applicable in subjects with a disturbed water distribution as in oedema, pregnancy and dehydration.

Standardization of serum cholesterol assays by use of serum calibrators and direct addition of Liebermann-Burchard reagent.

Serum cholesterol concentrations of subjects in epidemiological studies were measured after direct addition of Liebermann-Burchard reagent; results were calibrated with human serum pools assayed according to Abell et al. (J. Biol. Chem. 195:357-366, 1952). Accuracy and precision were monitored for six years by analysis of internal-control pools and blind external-control pools. For various internal-control pools, the imprecision (CV) of the long-term averages of run means ranged from 0.5 to 0.9%. The within-run CV for internal control and patients' sera was about 1%. For blind control sera with different concentrations (provided by the Centers for Disease Control, Atlanta, GA, over the same period), the average difference per three-month period between the values found and the target values was usually between -0.5% and +0.7% for medium-concentration pools and between -2% and +2% for low- and high-concentration pools (extreme values: -2.4% and +2.5%). The CV per three-month period ranged from 0.6 to 2.7%. Sera from subjects on diets of high or low linoleic acid content were analyzed to study the effect of the fatty acid portion of serum cholesterol esters; the differences between values obtained with the comparison method and the direct method was insignificant on both diets. We conclude that the use of serum calibrators eliminates the bias inherent in the direct method.

Methods for the estimation of high density cholesterol, comparison between two laboratories.

The determination of HDL by quantification of HDL-cholesterol was investigated using different methods and employing the Abell method as reference. The routinely applied direct method of Huang (calibrated on Abell standardized sera) and the enzymatic method of Röschlau were tested. Results show that with the Huang method, as compared to Abell values, a total laboratory error of less than 4.5 mg/100 can be achieved in 95% of the cases. The enzymatic method gave rise to erroneous results. Comparisons between two laboratories in experiments using random and pool sera are presented.