Parkinson's disease and weight loss: A study with anthropometric and nutritional assessment

In order to investigate a putative weight loss in patients with Parkinson's disease, an anthropometric and biochemical study was undertaken. We compared body weight and indexes of fat [body mass index (BMI), tricipital skinfold] and lean [midarm muscle area (MMA), calf circumference] mass in men and women suffering from idiopathic Parkinson's disease with normal controls. We found that women suffering from Parkinson's disease exhibited a significant weight loss (–8.5%) and decreased calf circumference when compared with controls. A decrease (–4.3%) in total body weight was also found in men with Parkinson's disease but the difference did not reach the level of significance. Protein biochemical markers of nutritional status (albumin, prealbumin, retinol binding protein, transferrin) were normal in Parkinson's disease patients. The present study demonstrates the occurrence of weight loss in a large population of patients with Parkinson's disease. The putative mechanisms involved in the weight loss are discussed.     

Progressive and accelerated weight and body fat loss in Parkinson's disease: A three-year prospective longitudinal study

IntroductionAlthough weight loss is common in Parkinson's disease (PD), longitudinal studies assessing weight and body composition changes are limited.MethodsIn this three-year longitudinal study, 125 subjects (77 PD patients and 48 spousal/sibling controls) underwent clinical, biochemical and body composition assessments using dual-energy X-ray absorptiometry.ResultsPatients were older than controls (65.6 ± 8.9 vs. 62.6 ± 7.1, P = 0.049), with no significant differences in gender, comorbidities, dietary intake and physical activity. Clinically significant weight loss (≥5% from baseline weight) was recorded in 41.6% of patients, with a doubling of cases (6.5 to 13.0%) classified as underweight at study end. Over three years, patients demonstrated greater reductions in BMI (mean −1.2 kg/m², 95%CI-2.0 to −0.4), whole-body fat percentage (−2.5% points, 95%CI-3.9 to −1.0), fat mass index (FMI) (−0.9 kg/m², 95%CI-1.4 to −0.4), visceral fat mass (−0.1 kg, 95%CI-0.2 to 0.0), and subcutaneous fat mass (−1.9 kg, 95%CI-3.4 to −0.5) than in controls, with significant group-by-time interactions after adjusting for age and gender. Notably, 31.2% and 53.3% of patients had FMI<3rd (severe fat deficit) and <10th centiles, respectively. Muscle mass indices decreased over time in both groups, without significant group-by-time interactions. Multiple linear regression models showed that loss of body weight and fat mass in patients were associated with age, dyskinesia, psychosis and constipation.ConclusionsWe found progressive loss of weight in PD patients, with greater loss of both visceral and subcutaneous fat, but not muscle, compared to controls. Several associated factors (motor and non-motor disease features) were identified for these changes, providing insights on possible mechanisms and therapeutic targets.     

Estimation of energy stores of mentally retarded individuals

Average caloric intake over 6 days, age, sex, height, weight, mid arm circumference, and triceps skinfold were determined for 31 females and 49 males ages 17 to 36 living in a residential care facility for mentally retarded persons. Ideal body weight, body mass index (W/H2), percentiles for arm muscle area, arm fat area, and triceps skinfold were determined to interpret the anthropometric measurements. Pearson r correlation coefficients were calculated to compare relative merits of ideal body weight, body mass index, percentile for arm muscle area, arm fat area, and triceps skinfold as an estimation of energy stores. Correlations suggest that body mass index is a more practical tool for estimation of energy stores.     

Anthropometric measures and cognition in middle-aged HIV-infected and uninfected women. The Women’s Interagency HIV Study

This study aimed to explore the relationship of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with cognition in women with (HIV+) and without HIV (HIV?) infection. One thousand six hundred ninety participants (1,196 HIV+, 494 HIV?) in the Women’s Interagency HIV Study (WIHS) with data available on anthropometric measures comprise the analytical sample. Cross-sectional analyses using linear regression models estimated the relationship between anthropometric variables and Trails A, Trails B, Stroop interference time, Stroop word recall, Stroop color naming and reading, and Symbol Digit Modalities Test (SDMT) with consideration for age, HIV infection status, Wide Range Achievement Test score, CD4 count, insulin resistance, drug use, and race/ethnicity. Among HIV+ women, BMI?<?18.5 kg/m² was associated with poorer cognitive performance evidenced by longer Trails A and Trails B and shorter SDMT completion times. An obese BMI (30 kg/m² or higher) was related to better performance on Trails B and worse performance on the Stroop interference test. Among HIV? women, an obese BMI was related to worse performance on the Stroop color naming test. Few and inconsistent associations were observed between WC, WHR, and cognition. Among women at mid-life with chronic (at least 10 years) HIV infection, common anthropometric measures, primarily BMI, were differentially related to cognitive test performance by cognitive domain. Higher levels of BMI were associated with better cognitive function. In this era of antiretroviral therapies, restoration of health evidenced as higher BMI due to effective antiretroviral therapies, may improve cognitive function in middle-aged HIV-infected women.     

Relationship between weight loss and dysphagia in patients with Parkinson's disease]

The purpose of this study was to investigate the relationship between weight loss and dysphagia in Parkinson's disease. We compared the height, body weight and the data of self-administered questionnaires concerning food intake and deglutition feelings in patients suffering from Parkinson's disease with normal controls. A structured interview was performed by nutritionists and nutrient intakes were calculated from the reported food intake over 5 days. Biochemical parameters were chosen from the chart. The subjects were 105 patients with Parkinson's disease, 34 males with a mean age of 67.7 +/- 8.6 years and 71 females with a mean age of 69.1 +/- 10.0 years (Hoehn-Yahr stage I6, II25, III51, IV20, V3). In addition, 47 family members were used as control subjects: 26 males, 70.6 +/- 7.6 years and 21 females, 64.9 +/- 7.7 years. Body mass index (BMI) in females with Parkinson's disease (20.2 +/- 3.5 kg/m2) was significantly lower (p < 0.005) than that in control females (23.0 +/- 3.0 kg/m2). There was no significant difference in BMI in males. The BMI was 21.9 +/- 3.0 kg/m2 in male patients with Parkinson's disease and 22.6 +/- 3.1 kg/m2 in controls. The occurrences of symptoms such as choking, cough, sputum, food in sputum, wet voice and pharyngeal discomfort following food intake in patients with Parkinson's disease vs. those in controls were 22% vs. 6%, 16% vs. 2%, 7% vs. 4%, 2% vs. 0%, 5% vs. 2% and 11% vs. 0%, respectively. Concerning symptoms such as choking, cough and pharyngeal discomfort, the occurrence was significantly more frequent in patients with Parkinson's disease than in controls (p < 0.05, p < 0.05, p < 0.05). We defined the dysphagic Parkinson patients as those who have at least one symptom of dysphagia such as choking, cough, sputum, food in sputum, wet voice and pharyngeal discomfort following food intake. The dysphagic subjects were present in 31% of Parkinson patients and in 7% of control subjects (p < 0.005), although half of the dysphagic Parkinson patients did not recognize it. No relationship between the occurrence of dysphagic symptoms and the Hoehn-Yahr stage was found. In patients with Parkinson's disease. BMI in the dysphagic group (19.1 +/- 3.6 kg/m2) was significantly lower than that in the non-dysphagic group (21.6 +/- 3.0 kg/m2) (p < 0.005). There was no relationship between BMI and the dose of levodopa. Patients in the dysphagic group showed significantly lower carbohydrate intake (186 +/- 49 g) than those in the non-dysphagic group (215 +/- 52 g) (p < 0.05). Biochemical nutritional parameters were lower in the dysphagic group than those in the non-dysphagic group; 6.6 +/- 0.7 g/dl vs. 6.9 +/- 0.4 g/dl (p < 0.005) in serum total protein, 3.8 +/- 0.5 g/dl vs. 4.1 +/- 0.4 g/dl (p < 0.01) in albumin and 173.4 +/- 33.0 mg/dl vs. 199.7 +/- 40.7 mg/dl (p < 0.05) in total cholesterol. These findings suggest that dysphagia, especially unrecognized dysphagia, plays a role in weight loss in Parkinson's disease.     

Anthropometric measures: poor predictors of body fat in children with moderate to severe cerebral palsy

Aim This purpose of our study was to assess and compare anthropometric measures of adiposity and direct measurement of percentage body fat by dual emission X‐ray absorptiometry (DXA) in children with cerebral palsy (CP). We also compared our results in children with CP with results from a national sample of typically developing children from the National Health and Nutrition Examination Survey. Method Anthropometry and DXA were obtained from 58 participants with CP (25 females, 33 males; Gross Motor Function Classification System levels III–V; mean age 13y 1mo [SD 3y], range 8–18y). Height was estimated from knee height, which was measured with knee height calipers; weight was measured on a sitting scale. The relation between percentage body fat measured by DXA and z‐scores of each of the anthropometric measures (body mass index, mid‐upper arm circumference, triceps skinfold, and mid‐upper arm fat area) was assessed by linear models. Agreement analysis was performed to assess the ability of each anthropometric measure to predict percentage body fat by DXA. Results None of the anthropometric measures were adequately associated with percentage body fat by DXA. All anthropometric methods tended to underestimate percentage body fat in children with CP. Interpretation Single anthropometric measures do not perform well in predicting percentage body fat in children with or without CP. Further work is needed to develop clinically useful and simple assessments that will predict percentage body fat and to determine the relation between percentage body fat and health to guide clinical practice.     

Body composition in Parkinson's disease: a study with dual-energy X-ray absorptiometry

Some investigators have reported that patients with Parkinson's disease (PD) tend to lose weight, and have a low body mass index. For this reason, it was suggested that PD patients have an increased metabolic rate. Using dual-energy X-ray absorptiometry (DXA) we determined, the body composition in 52 unselected PD patients (28 males, 24 females) and in 80 age and sex-matched healthy controls (40 males, 40 females). The mean+/-SD duration of PD was 5.9+/-4.8 years. PD severity was assesed with the Unified PD Rating Scale (UPDRS) and Hoehn & Yahr staging. PD patients and controls did not differ significantly in height, weight and body mass index. The total fat and percentage of fat were significantly higher (p<0.01) and the lean body mass and water content were lower (p<0.001 for each) in male PD patients when compared with male controls. All these values were similar in female PD patients and female controls. Fat mass, lean body mass and water content did not correlate with the UPDRS scores and Hoehn &Yahr staging, although PD patients with higher UPDRS scores had higher percentage of fat.     

Women with OSA have higher chances of having metabolic syndrome than men: effect of gender on syndrome Z in cross sectional study

Study objectivesThis study was done to find out prevalence of Metabolic syndrome (MS) in patients with Obstructive Sleep Apnea (OSA) and whether there is any difference in prevalence of syndrome Z in male and female.MethodologyAll consecutive diagnosed patients with OSA between June 2015 and Oct 2019 were screened for metabolic syndrome and factors associated with metabolic syndrome in OSA were analyzed.ResultsDuring study period, 502 patients (357 males; 145 females) were diagnosed with OSA. Mean age was 51.88 ± 12.18 years (females and males:55.91 ± 9.74 and 50.24 ± 12.70 years, respectively). Mean BMI was 31.60 ± 11.09 kg/m² (female: 35.29 ± 7.19 and male: 30.1 ± 12.0 kg/m²) (p < 0.001). Mean AHI was 62.67 ± 35.22. Mild, moderate and severe category of OSA constituted 7.3%, 15.3% and 77.4% respectively. MS was found in 72.7% (365 out of 502) individuals with OSA. MS was found in 75.8%, 68.4 and 48.7% in severe, moderate and mild OSA patients respectively (p < 0.001). Females OSA patients had significantly high percentage (88.27%) of metabolic syndrome compared to males OSA patients (66.38%) {p < 0.001}. Female patients with SZ had higher metabolic score (p = 0.019) and were older (p < 0.001).ConclusionMetabolic syndrome is highly prevalent in OSA population (72.7%) and is much more common in female OSA patients (88%) than males OSA (68%). All OSA patients should be screened for MS so that early intervention can be done in these patients so as to prevent cardiovascular complications.     

Obesity,diabetes, and risk of Parkinson's disease

The aim of this work was to investigate whether obesity and diabetes are related to risk of Parkinson's disease. We prospectively followed 147,096 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2005. Participants provided information on anthropometric variables and medical history at baseline and on waist circumference in 1997. Incident cases of Parkinson's disease (n = 656) were confirmed by treating neurologists and medical record review. Relative risks were estimated using proportional hazards models, adjusting for age, gender, smoking, and other risk factors. Neither body mass index nor waist circumference significantly predicted Parkinson's disease risk. Relative risk comparing individuals with a baseline body mass index of ≥30 to those with a body mass index <23 was 1.00 (95% confidence interval: 0.75, 1.34; P trend: 0.79), and that comparing individuals with a waist circumference in the top category (≥40.3 inches in men and ≥35 inches in women) to those in the bottom category (<34.5 inches in men and <28 inches in women) was 1.35 (95% confidence interval: 0.95, 1.93; P trend: 0.08). History of diabetes was not significantly associated with Parkinson's disease risk (combined relative risks = 0.88; 95% confidence interval: 0.62, 1.25; P heterogeneity = 0.96). In addition, neither body mass index at age 18 nor changes in weight between age 18 and baseline were significantly associated with Parkinson's disease risk. The results did not differ significantly by gender. Our results do not provide evidence for a relationship between body mass index, weight change, waist circumference, or baseline diabetes and risk of Parkinson's disease. © 2011 Movement Disorder Society     

Chronic antiepileptic monotherapy,bone metabolism,and body composition in non‐institutionalized children

Aim The aim of this study was to determine the influence of chronic monotherapy with antiepileptic drugs (AEDs) on vitamin D levels, bone metabolism, and body composition. Method Eighty‐five children (38 males, 47 females; mean age 12y 5mo, SD 3y 4mo) were treated with valproate and 40 children (28 males, 12 females; mean age 11y 10mo, SD 3y) were treated with other AEDs (lamotrigine, sulthiame, or oxcarbazepine), comprising the non‐valproate group. Forty‐one healthy children (29 males 12 females; mean age 12y 1mo, SD 3y 5mo) served as a comparison group. Height, weight, body impedance analysis, 25‐hydroxyvitamin D, calcium, phosphate, two bone resorption markers (receptor activator of nuclear factor κB ligand [RANKL] and tartrate‐resistant acid phosphatase 5b [TRAP5b]), osteoprotegerin, and leptin were measured. Results No child was vitamin D deficient as defined by a 25‐hydroxyvitamin D (25OHD) level of less than 25nmol/l (<10ng/ml). Leptin, body fat, weight standard deviation score (SDS), and body mass index (BMI) SDS were all significantly higher (each p<0.001) in valproate‐treated children than in the non‐valproate group, as were calcium (p=0.027) and RANKL (p=0.007) concentrations. Similarly, leptin was significantly higher in the valproate group than in control participants (p<0.001), as were body fat (p=0.023), weight SDS (p=0.046), BMI SDS (p=0.047), calcium (p<0.001), and RANKL (p<0.001), whereas TRAP5b concentrations were significantly lower in the valproate‐treated group (p=0.002). Furthermore, calcium and RANKL levels were significantly higher in the non‐valproate group than in comparison participants (p<0.001 and p=0.016 respectively). Interpretation Non‐enzyme‐inducing or minimal enzyme‐inducing AED monotherapy does not cause vitamin D deficiency in otherwise healthy children with epilepsy. Valproate therapy is associated with increases in weight, body fat, and leptin concentration, as well as with a bone metabolic profile that resembles slightly increased parathyroid hormone action.     

Body fat distribution in Parkinson's disease: An MRI-based body fat quantification study

IntroductionThere is some evidence that Parkinson's Disease (PD) patients have lower body weight and lower fat mass when compared to healthy subjects and that lower body weight and fat mass influence disease risk and progression. It remains unclear, however, if weight loss of fat mass loss occurs only in a subgroup of patients and whether fat distribution is altered during PD. The aim of this study was to prospectively investigate adipose tissue content and distribution in PD patients.MethodsThe body fat composition of PD patients (N = 54) was compared with age matched healthy controls (N = 55) using a magnetic resonance imaging (MRI)-based method. A longitudinal MRI scan was acquired in 25 PD patients after a mean follow up period of 12 months.ResultsThe volume of total body fat as well as of visceral fat showed no difference between PD patients and healthy controls at baseline or at follow up. However, PD patients displayed decreased subcutaneous fat tissue (p = 0.01) and a higher visceral to subcutaneous fat ratio as compared to controls (p = 0.004). After follow up, 16 PD patients did not lose weight, while 9 PD patients lost between 0.5 and 10 kg.ConclusionFat distribution is altered in PD patients, with an increased ratio of visceral to subcutaneous fat.     

Levels ofpros-methylimidazoleacetic acid: Correlation with severity of Parkinson's disease in CSF of patients and with the depletion of striatal dopamine and its metabolites in MPTP-treated mice

Summary The cerebrospinal fluid (CSF) levels ofpros-methylimidazoleacetic acid (p-MIAA) in thirteen medication-free patients with mild to moderate Parkinson's disease were highly correlated (Spearman's =0.749, p<0.005) with the severity of signs of the disease as scored on the Columbia University Rating Scale. Levels of p-MIAA in males (n=8) and females (n=5) were each significantly correlated with scores of severity (=0.78, p<0.05 and =1.0, p<0.05, respectively). In C57BL/6 mice treated with 1-methyl-4-phenyl-1,2,3,6-tetra-hydropyridine (MPTP), levels of p-MIAA were significantly correlated with the depleted levels of dopamine (r=0.85, p<0.01), homovanillic acid (r=0.79, p<0.02), 3,4-dihydroxyphenylacetic acid (r=0.84, p<0.01) and norepinephrine (r=0.91, p<0.002) in striatum, but not in cortex of the same mice. No such correlations were observed in either striatum or cortex of salinetreated control mice. Mean levels of p-MIAA in CSF did not differ significantly between patients and age-matched controls; and mean levels of p-MIAA in striatum did not differ between MPTP-treated mice and controls. The simplest hypothesis to account for these strong correlations in the absence of differences in mean levels of p-MIAA is that accumulation of p-MIAA [or process(es) that govern its accumulation] influences a failing nigrostriatal system. It is also possible (in analogy with findings in other diseases and with other drugs) that measurements of the putative metabolite(s) of p-MIAA may distinguish the patients and the MPTP-treated mice from their respective controls. Elucidation of the processes that regulate formation and disposition of p-MIAA in brain and information on the neural effects of p-MIAA, its precursors and its putative metabolites may yield insight into factors that regulate the progression of Parkinson's disease, and may shed additional light on the cause(s) of this disease.     

Effects of topiramate use on body composition and resting metabolic rate in migraine patients

Topiramate is an anticonvulsant agent effective in the prophylaxis of migraine, which also induces weight reduction by an unknown mechanism. We investigated the effect of topiramate on resting metabolic rate, anthropometric measurements, and body composition in patients with migraine independently from any intention to lose body weight. Forty patients (18–71 years old) with migraine were treated with 100 mg of topiramate/day over a period of 3 months. Anthropometric measurements, body fat proportions and resting metabolic rates of these patients were measured before and after treatment. At the end of 3 months, we detected mean 0.8 kg reduction in body weight and 0.3 kg/m² reduction in body mass index (BMI). Waist circumference decreased significantly (p = 0.01). Body fat ratio decreased (p = 0.016). Abdominal skinfold measurements decreased after treatment (p = 0.048); however, no difference was found in other regions (p > 0.05). We did not find a significant difference in resting metabolic rate (p > 0.05).These TPM-treated patients lost weight and had reduction in their mean BMI. It was seen that patients lost weight from body fat tissue and central area. We saw that TPM’S weight-reducing effect was independent from resting metaobolic rate. The weight-reducing effect of TPM may result from changes on the hypothalamus.     

Are children and adolescents with psychiatric illness at risk for increased future body weight? A systematic review

The aim of this paper was to review the longitudinal relationship between early‐onset depression and disruptive behaviour and adult body weight. A systematic review of prospective longitudinal studies was conducted of articles in which (1) initial assessment occurred during childhood or adolescence (<18y); and (2) the primary outcome reported as body mass index (BMI), overweight (BMI>25–<30kg/m²), obesity (BMI≥30kg/m²), or depression; and (3) validated assessment measures for assessment of depressive symptoms or disruptive behaviour problems were employed. A total number of 16 articles were identified for review. Obese adolescent females are more likely to develop depressive illness in adulthood than their non‐obese peers. Conversely, depressed adolescent females, and possibly males, are more likely to become overweight adults than non‐depressed adolescents. There are insufficient data addressing future depression risk among overweight, non‐obese, adolescents to evaluate the potentially interactive nature of this relationship. Studies to date are consistent in reporting that children with behaviour problems are at increased risk of future overweight, though whether this risk is conferred by conduct symptoms, ADHD symptoms, or both, is less clear. Care providers of children with disruptive behaviour problems and depressed adolescents should monitor weight gain. Among obese adolescent females, mood should be followed.     

Sex Differences in Obstructive Sleep Apnea by Bioelectrical Impedance Analysis

Background and PurposeObesity is known of one of the risk factors for obstructive sleep apnea (OSA). Although body mass index (BMI) can be an indicator for obesity, it does not represent the actual body composition of fat or muscle. We hypothesized that bioelectrical impedance analysis (BIA) can help analyze the fat and muscle distributions in males and females with OSA.MethodsThis study screened subjects who visited the Department of Neurology, Samsung Medical Center, Seoul, Korea due to sleep disturbances with symptoms suggestive of OSA from December 2017 to December 2019. All subjects underwent overnight type I polysomnography (PSG) and BIA.ResultsPSG and BIA were completed in 2,064 OSA patients who had an apnea-hypopnea index (AHI) of ≥5/hour (77.1% males and 22.9% females). The females had remarkably higher fat indicators and lower muscle indicators. The AHI was significant correlated with all BIA parameters in all OSA patients: body fat mass (ρ=0.286, p<0.001), percentage body fat (ρ=0.130, p<0.001), visceral fat area (VFA) (ρ=0.257, p<0.001), muscle mass (ρ=0.275, p<0.001), and skeletal muscle mass (SMM) (ρ=0.270, p<0.001). The correlations in males were similar to those in all patients, where those in females were not. In females with OSA, all of the BIA fat indicators were correlated with AHI, whereas the muscle indicators were not. Adjusting age and BMI when analyzing the SMM/VFA ratio showed a strong correlation in males with OSA (p=0.015) but not in females with OSA (p=0.354).ConclusionsThis study has revealed that the body composition of fat and muscle has different patterns in OSA patients. The SMM/VFA as measured using BIA is the factor most significantly associated with AHI in males but not in females after adjusting for age and BMI.     

The relative health related quality of life of veterans with Parkinson's disease

OBJECTIVES: To use databases of the US Veterans Health Administration (VHA) to describe the impact of Parkinson's disease on health related quality of life (HRQoL) of veterans; to compare the HRQoL of veterans with Parkinson's disease with that of veterans reporting eight other neurological or chronic conditions; and to estimate the unique effect of Parkinson's disease on HRQoL. METHODS: Respondents to the VHA 1999 large national health survey of veteran enrollees with a diagnosis of Parkinson's disease in VHA treatment files for the fiscal years 1997-1999 were identified by merging databases. The survey incorporated the Veterans SF-36, a well validated generic measure of HRQoL and functional status. This was used to compare patient groups. Mean physical (PCS) and mental (MCS) component summary scores were calculated for Parkinson's disease and eight other diseases by multivariable regressions that adjusted for age, sex, race, education, and 15 mental and physical co-morbid conditions that were self reported in the survey. RESULTS: Of 887 775 survey respondents, 14 530 (1.64%) had a Parkinson's disease diagnosis. Controlling for sociodemographic factors and co-morbidities, veterans with Parkinson's disease had PCS and MCS below veterans with angina/coronary heart disease, arthritis, chronic low back pain, congestive heart failure, diabetes, and stroke. Veterans with spinal cord injury reported slightly lower PCS than veterans with Parkinson's disease (32.38 v 32.72; 0.03 of 1 SD). Veterans with depression reported markedly lower MCS than veterans with Parkinson's disease (35.94 v 41.48; 0.55 of 1 SD). The unique effect of having Parkinson's disease on HRQoL was to lower PCS and MCS by 4.10 and 3.42 points (0.41 and 0.34 of 1 SD), respectively. CONCLUSIONS: The analysis quantifies the negative impact of Parkinson's disease on HRQoL, after controlling for sociodemographic factors and co-morbidities. Compared with eight other chronic conditions, Parkinson's disease imposes a relatively heavy burden on US veterans in the VHA health care system.     

Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles

IntroductionPatients experience variable long-term improvement in chronic back pain despite successful spinal cord stimulation (SCS) trials. Iliopsoas (IP) size has been shown to differ between patients with low back pain and healthy controls. In this study, we examine whether the IP muscle cross-sectional area (CSA) is associated with SCS outcomes.Materials and MethodsWe examined patients for whom we had lumbar MRIs 6.3 years prior to SCS and baseline and one-year outcome data. Percent change from baseline to one year was calculated for Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Correlations between IP muscle CSA, ratio of iliopsoas muscle size to the vertebral body area (P/VBA), and the ratio of iliopsoas muscle size to BMI (P/BMI) were examined. Sex differences were considered.ResultsA total of 73 subjects were included in this study, including 30 females and 43 males. Males had significantly larger IP (males 15.70 ± 0.58, females 9.72 ± 0.43; p < 0.001), P/VBA (males 1.00 ± 0.04, females 0.76 ± 0.03; p < 0.001), and P/BMI ratio (males 0.51 ± 0.02, females 0.32 ± 0.01; p < 0.001) than females. In females, P/VBA predicted NRS worst pain scores (β = 0.82, p = 0.004, r² = 0.55) and BDI (β = 0.59, p = 0.02, r² = 0.24). In males, P/BMI was a significant predictor of BDI outcome scores (β = 0.45, p = 0.03, r² = 0.16). Males who had more muscle mass measured by iliopsoas size had more depression as measured using BDI (p = 0.03, r = 0.61). Females with less muscle mass measured by P/VBA also experienced more depression (p = 0.02, r = 0.74).ConclusionsOur study showed that psoas measurements correlated with various pain outcomes specifically. P/VBA was most predictive in females and P/BMI in males. Depression correlated with P/BMI, reinforcing the complex relationship between depression and constant chronic pain. Tertile analyses further showed a relationship between iliopsoas CSA and depression in males and females. We provide preliminary data of sex-specific psoas measurements as a risk factor for worse SCS outcomes.     

The effects of repetitive transcranial magnetic stimulation on body weight and food consumption in obese adults: A randomized controlled study

BackgroundAlthough some studies have reported significant reductions in food cravings following the single-session of repetitive transcranial magnetic stimulation (rTMS), there is little research on the effects of multi-session of rTMS on food consumption and body weight in obese subjects.ObjectiveWe conducted 4-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese adults.MethodsForty-three obese patients (body mass index [BMI] ≥25 kg/m²) aged between 18 and 70 years were randomized to the sham or real treatment group (21 in the TMS group and 22 in the sham treatment group). A total of 8 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 4 weeks. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite.ResultsParticipants in the rTMS group showed significantly greater weight loss from baseline following the 8 session of rTMS (−2.75 ± 2.37 kg vs. 0.38 ± 1.0 kg, p < 0.01). Consistent with weight loss, there was a significant reduction in fat mass and visceral adipose tissue at week 4 in the rTMS group compared with the control group (p < 0.01). After the 8 sessions of rTMS, the TMS group consumed fewer total kilocalories and carbohydrates per day than the control group (p < 0.05).Conclusions8 sessions of HF rTMS delivered to the left DLPFC were effective in inducing weight loss and decreasing food intake in obese patients.Trial registrationClinical trial registered with the Clinical Trials Registry at http://cris.cdc.go.kr (KCT0002548).     

Body composition in patients with schizophrenia: Comparison with healthy controls

ABSTRACT: BACKGROUND: Recently, a relationship between obesity and schizophrenia has been reported. Although fat mass and fat-free mass have been shown to be more predictive of health risk than body mass index, there are limited findings about body composition among patients suffering from schizophrenia. The aim of this study was to compare the body composition of schizophrenia patients with that of healthy subjects in Japan. METHODS: We recruited patients (n = 204), aged 41.3 +/- 13.8 (mean +/- SD) years old with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia who were admitted to psychiatric hospital using a cross-sectional design. Subjects' anthropometric measurements including weight, height, body mass index (BMI), and medications were also collected. Body fat, percentage (%) body fat, fat-free mass, muscle mass, and body water were measured using the bioelectrical impedance analysis (BIA) method. A comparative analysis was performed with schizophrenic subjects and 204 healthy control individuals. RESULTS: In a multiple regression model with age, body mass index, and dose in chlorpromazine equivalents, schizophrenia was significantly linked with more body fat, higher percentage body fat, lower fat-free mass, lower muscle mass, and lower body water among males. In females, schizophrenia had a significant association with lower percentage body fat, higher fat-free mass, higher muscle mass, and higher body water. CONCLUSIONS: Our data demonstrate gender differences with regard to changes in body composition in association with schizophrenia. These results indicate that intervention programs designed to fight obesity among schizophrenic patients should be individualized according to gender.     

Body composition and body mass index in Duchenne muscular dystrophy: Role of dietary intake

Introduction: In Duchenne muscular dystrophy (DMD) muscle is replaced by adipose tissue. The role of dietary intake (DI) in DMD has not been evaluated. In this study we examined body composition, body mass index (BMI), and adequacy of DI in patients with DMD and evaluated the influence of DI on body composition. Methods: Patients (n = 101; age 3–18 years; BMI 11.8–29.5 kg/m²) completed a dietary recall to determine DI and then underwent dual-energy X-ray absorptiometry to determine body composition. Results: Preschool-age and school-age boys with DMD had high total energy intake. Protein intake per kilogram exceeded recommendations. As age increased, the percentage of boys with abnormal BMI and fat mass increased, while lean mass decreased. Dietary intake did not predict body fat or lean mass. Discussion: Age-dependent changes in BD in boys with DMD may be due to endogenous metabolic factors related to the underlying disease process and to disease-related mobility impairments. Muscle Nerve 59 :295–302, 2019