Body mass index (BMI), body composition and mortality of nursing home elderly residents

The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index = value/height²), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI = 0.73-2.89; OR = 1.73) and 0.63 (95% CI = 0.33-1.60; OR = 0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR = 2.42, 95% CI = 0.36-16.18; OR = 2.55 and RR = 3.22, 95% CI = 0.78-13.32; OR = 3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.     

Total body mass, fat mass, fat-free mass, and skeletal muscle in older people: cross-sectional differences in 60-year-old persons

OBJECTIVES: To evaluate body composition parameters, including fat-free mass (FFM), appendicular skeletal muscle mass (ASMM), relative skeletal muscle mass (RSM) index, body cell mass (BCM), BCM index, total body potassium (TBK), fat mass, percentage fat mass (FM), and their differences between age groups and to evaluate the frequency of sarcopenia in healthy older subjects DESIGN: Cross-sectional, nonrandomized study. SETTING: Outpatient clinic. PARTICIPANTS: Ninety-one healthy men and 100 healthy women age 60 and older. MEASUREMENTS: FFM, ASMM, FM, and percentage fat mass by whole-body dual-energy x-ray absorptiometry; TBK, BCM, and TBK/FFM ratio by whole body potassium-40 counter. RESULTS: All lean body mass parameters were significantly (P <.05) lower in subjects age 80 and older than in those age 70 to 79, except ASMM in women. Mean FFM was 4.2 kg (7.3%) lower in men age 80 and older than in those younger than 70 and 2.9 kg (6.8%) lower in women age 80 and older than in those younger than 70. The skeletal muscle mass, reflected by ASMM, decreased more than FFM. This suggests that nonskeletal muscle mass is proportionally preserved during aging. Forty-five percent of men and 30% of women were sarcopenic by definition of BCM index and 11.0% of men and women by definition of RSM index. CONCLUSIONS: Significant age-related differences exist in body composition of older men and women between age 60 and 95. The greater decrease in TBK and BCM than the decrease in FFM and skeletal muscle mass suggests changing composition of FFM with age. Lack of agreement between two independent sarcopenia indexes suggests that further refinement in the definition of a sarcopenia index is necessary.     

Associations between dietary nutrient intake and muscle mass and strength in community-dwelling older adults: the Tasmanian Older Adult Cohort Study

OBJECTIVES: To describe associations between dietary nutrient intake and progression of sarcopenia, the age‐related loss of muscle mass and strength. DESIGN: Prospective cohort study of community‐dwelling older adults. SETTING: Southern Tasmania, Australia. PARTICIPANTS: Seven hundred forty noninstitutionalized older adults (50% female; mean age 62±7) randomly sampled from electoral rolls. MEASUREMENTS: Dietary nutrient intake was examined at baseline and follow‐up (2.6±0.4 years later) using The Cancer Council Victoria's Food Frequency Questionnaire (FFQ). Appendicular lean mass (aLM) was assessed using dual X‐ray absorptiometry and muscle strength of the knee extensors using a dynamometer. RESULTS: Failing to meet the recommended dietary intake for protein was associated with significantly lower aLM at baseline (?0.81 kg, 95% confidence interval (CI)=?1.54 to ?0.08) and follow‐up (?0.79 kg, 95%CI=?1.42 to ?0.17). Energy‐adjusted protein intake was a positive predictor of change in aLM over 2.6 years (β=0.10, P=.003). Energy‐adjusted intake of iron (β=0.07, P=.02), magnesium (β=0.07, P=.02), phosphorus (β=0.07, P=.047), and zinc (β=0.08, P=.02) were positive predictors of change in aLM, whereas retinol (β=?0.09, P=.005) was a negative predictor of change in aLM after adjustment for protein intake. No significant associations were observed between nutrient intake and muscle strength. CONCLUSION: Protein and several other dietary nutrients are associated with muscle mass and rate of muscle loss (but not strength) in older adults, suggesting that multiple dietary components may ameliorate the progression of sarcopenia.     

Decline in skeletal muscle mass is associated with cognitive decline in type 2 diabetes mellitus

AimsTo examine the longitudinal association between skeletal muscle mass (SMM) loss and cognitive decline over time in type 2 diabetes mellitus (T2DM).MethodsWe conducted a prospective cohort study of 453 patients from SMART2D cohort with follow-up intervals of 1.6 to 6.4 years. Baseline and follow-up measurements included bio-impedance analysis (BIA) measure of skeletal muscle mass index (SMI) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measure of cognitive function. We examined the association between annual rate of SMI and RBANS scores using linear regression, adjusting for demographics, education, depression, clinical co-variables and presence of apolipoprotein E4 (APOE) _?4 allele.ResultsThe mean age of participants was 60.3 ± 7.4 years. Compared to patients with Tertile 1 SMI change, the group with greater SMI decline (Tertile 3 SMI change) experienced 0.30 decline in RBANS total score (95%CI ?0.57 to ?0.03; p = 0.030) in the adjusted analysis. RBANS scores for subdomains in immediate memory and visuo-spatial/construction were lower in Tertile 3 SMI change group with corresponding coefficients ?0.54 (95%CI ?1.01 to ?0.06; p = 0.026), and ?0.71 (95%CI ?1.30 to ?0.12; p = 0.019) respectively.ConclusionIn patients with T2DM, BIA measure of muscle mass loss over time was independently associated with cognitive decline globally and in the domains of memory and visuo-spatial/construction.     

Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review,meta‐analysis and meta‐regression

A systematic review, meta‐analysis and meta‐regression were conducted to evaluate the effectiveness of behavioural weight management programmes and examine how programme characteristics affect mean weight loss. Randomized controlled trials of multicomponent behavioural weight management programmes in overweight and obese adults were included. References were obtained through systematic searches of electronic databases (conducted November 2012), screening reference lists and contacting experts. Two reviewers extracted data and evaluated risk of bias. Thirty‐seven studies, representing over 16,000 participants, were included. The pooled mean difference in weight loss at 12 months was ?2.8 kg (95% confidence interval [CI] ?3.6 to ?2.1, P < 0.001). I² indicated that 93% of the variability in outcome was due to differences in programme effectiveness. Meta‐analysis showed no evidence that supervised physical activity sessions (mean difference 1.1 kg, 95% CI ?2.65 to 4.79, P = 0.08), more frequent contact (mean difference ?0.3 kg, 95% CI ?0.7 to 0.2, P = 0.25) or in‐person contact (mean difference 0.0 kg, 95% CI ?1.8 to 1.8, P = 0.06) were related to programme effectiveness at 12 months. In meta‐regression, calorie counting (?3.3 kg, 95% CI ?4.6 to ?2.0, P = 0.027), contact with a dietitian (?1.5 kg, 95% CI ?2.9 to ?0.2, P < 0.001) and use of behaviour change techniques that compare participants' behaviour with others (?1.5 kg, 95% CI ?2.9 to ?0.1, P = 0.032) were associated with greater weight loss. There was no evidence that other programme characteristics were associated with programme effectiveness. Most but not all behavioural weight management programmes are effective. Programmes that support participants to count calories or include a dietitian may be more effective, but the programme characteristics explaining success are mainly unknown.     

Mortality risk in older men associated with changes in weight, lean mass, and fat mass

OBJECTIVES: To evaluate risk of all‐cause mortality associated with changes in body weight, total lean mass, and total fat mass in older men. DESIGN: Longitudinal cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Four thousand three hundred thirty‐one ambulatory men aged 65 to 93 at baseline. MEASUREMENTS: Repeated measurements of body weight and total lean and fat mass were taken using dual‐energy X‐ray absorptiometry 4.6 ± 0.4 years apart. Percentage changes in these measures were categorized as gain (+5%), loss (–5%), or stable (?5% to +5%). Deaths were verified centrally according to death certificate reviews, and proportional hazard models were used to estimate the risk of mortality. RESULTS: After accounting for baseline lifestyle factors and medical conditions, a higher risk of mortality was found for men with weight loss (hazard rat (HR)=1.84, 95% confidence interval (CI)=1.50–2.26), total lean mass loss (HR=1.78, 95% CI=1.45–2.19), and total fat mass loss (HR=1.72, 95% CI=1.34–2.20) than for men who were stable for each body composition measure. Men with total fat mass gain had a slightly greater mortality risk (HR=1.29, 95% CI=0.99–1.67) than those who remained stable. These associations did not differ according to baseline age, obesity, or self‐reported health status (P for interactions >.10), although self‐reported weight loss intent altered mortality risks with total fat mass (P for interaction=.04) and total lean mass (P for interaction=.09) change. CONCLUSION: Older men who lost weight, total lean mass, or total fat mass had a higher risk of mortality than men who remained stable.     

Vitamin D receptor genotype is associated with fat-free mass and sarcopenia in elderly men

We investigated the association of vitamin D receptor (VDR) genotype with fat-free mass (FFM) in a cohort of 302 older (aged 58-93 years) Caucasian men who underwent body composition analysis by dual-energy X-ray absorptiometry, and completed questionnaires addressing comorbidities, physical activity, and dietary intake. All participants were genotyped for a VDR translation start site (FokI) polymorphism [FF (37.7%), Ff (48.4%), and ff (13.9%)] and the previously studied BsmI polymorphism [BB (24.9%), Bb (37.7%), and bb (37.4%)]. The BsmI polymorphism was not associated with FFM in any analysis; however, the FokI polymorphism was significantly associated with total FFM, appendicular FFM, and relative (kg/m(2)) appendicular FFM (all p <.05), with the FF group demonstrating significantly lower FFM than the Ff and ff groups (e.g., total FFM: FF = 57.6 +/- 0.4, Ff = 59.4 +/- 0.4, ff = 59.4 +/- 0.7 kg; p <.02). Age-adjusted logistic regression revealed a 2.17-fold higher risk for sarcopenia (defined previously as appendicular FFM <7.26 kg/m(2)) in FF homozygotes (95% CI [confidence interval] = 1.19-3.85; p =.03) compared to men with one or more f alleles. The VDR translation start site (FokI) polymorphism is significantly associated with FFM and sarcopenia in this cohort of older Caucasian men.     

Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index

AIM:To investigate whether central obesity is associated with nonalcoholic fatty liver disease(NAFLD) formation after adjusting for general obesity.METHODS:The online databases Pub Med,EMBASE,and ISI Web of Science were searched for studies estimating the influence of central obesity on NAFLD occurrence published through April 2014.Studies that did not adjust for body mass index(BMI) were excluded.In addition,the independent effect of BMI was also assessed with the included studies.The pooled effect sizes and 95% confidence intervals(CIs) were calculated using random- or fixed-effects models based on the degree of heterogeneity.Furthermore,subgroup analyses,meta-regression,sensitivity analyses,and publication bias were performed.RESULTS:Twenty eligible studies were identified.The summary odds ratio(OR) values per-unit increase in waist circumference(WC) and BMI for NAFLD formation were 1.07(95%CI:1.03-1.10,I2 = 73.9%,n = 11 studies) and 1.25(95%CI:1.13-1.38,I2 = 88.7%,n = 11 studies),respectively.When the indices were expressed as binary variables(with the non-obesity group as reference),the pooled OR in WC,waist-tohip ratio,and BMI were 2.34(95%CI:1.83-3.00,I2 = 41.8%,n = 7 studies),4.06(95%CI:1.53-10.79,I2 = 65.7%,n = 3 studies),and 2.85(95%CI:1.60-5.08,I2 = 57.8%,n = 5 studies),respectively.Using the same studies as the latter(n = 5),pooled OR in WC was 3.14(95%CI:2.07-4.77),which is greater than that in BMI.CONCLUSION:Central obesity may pose a greater threat to national health than general obesity,although both are independently associated with increased risk of NAFLD.     

Low Skeletal Muscle Mass Is Associated With the Presence,Incidence, and Progression of Coronary Artery Calcification

BackgroundLow skeletal muscle mass (SMM) is an emerging risk factor of cardiovascular disease (CVD). We investigated the association between SMM and coronary artery calcification (CAC).MethodsWe enrolled 19,728 adults free of CVD who underwent computed tomographic estimation of Agatston CAC scores for cross-sectional analysis. Among them, 5,401 subjects who had at least 2 follow-up CAC scores were included in longitudinal analysis. Relative SMM is presented as the skeletal muscle mass index [SMI (%) = total appendicular muscle mass (kg)/body weight (kg) × 100]. CAC presence and incidence were defined as CAC score > 0, and CAC progression was defined as √CAC score (follow-up) − √CAC score (baseline) > 2.5.ResultsAmong all of the subjects (mean age 53.4 years, 80.8% male), the prevalence of CAC was 36.7%. The incidence of CAC was 17.4% during a mean of 3.6 years, and the progression of CAC was 49.9% during a mean of 2.3 years. The lowest SMI quartile was significantly associated with an increased risk of CAC presence (adjusted odds ratio 2.75, 95% confidence interval [CI] 2.45-3.05; P < 0.001), incidence (adjusted hazard ratio [AHR] 1.99, 95% CI 1.36-2.91; P < 0.001), and progression (AHR 1.48, 95% CI 1.25-1.77; P < 0.001) compared with the highest quartile. SMI as a continuous value was also significantly inversely associated with CAC. SMI was the best parameter to be related to CAC among other quantitative indices such as height or body mass index adjusted.ConclusionsLow SMM is significantly associated with an elevated risk of CAC, independently of other cardiometabolic parameters.     

Six-week improvements in muscle mass and strength during androgen therapy in older men

BACKGROUND: The purpose of our study was to assess the early effects of a potent anabolic androgen on muscle mass and strength, lower extremity power, and functional performance in older men. METHODS: Thirty-two men 72 +/- 6 years of age were randomized to receive oxandrolone (10 mg twice daily) or matching placebo in a 2:1 manner for 12 weeks. Total and appendicular lean body mass (LBM) were assessed by dual-energy x-ray absorptiometry (DEXA). Lower extremity muscle volume was determined by magnetic resonance imaging to validate DEXA changes. RESULTS: Total LBM increased by 2.7 +/- 1.6 kg after 6 weeks with oxandrolone (p <.001), which was greater (p <.001) than the decline in LBM (-0.5 +/- 0.9 kg) with placebo. Appendicular LBM increased by 1.2 +/- 0.9 kg after just 6 weeks with oxandrolone (p <.001), which was greater (p <.001) than the decline in LBM (-0.4 +/- 0.5 kg) with placebo. These changes were >90% of the gains in total and appendicular LBM (3.0 +/- 1.5 kg and 1.3 +/- 0.9 kg, respectively) after 12 weeks. Total thigh and hamstring muscle volume increased by 111 +/- 29 mm(3) (p =.001) and 75 +/- 18 mm(3) (p =.001), respectively, after 12 weeks. Maximal strength increased for the leg press 6.3 +/- 5.6% (p =.003), leg curl 6.7 +/- 8.6% (p =.01), chest press 6.9 +/- 6.5% (p =.001), and latissimus pull-down 4.8 +/- 6.3% (p =.009) with oxandrolone after 6 weeks; these increases were different than those with placebo (p <.001) and were 93%, 96%, 74%, and 94% of the respective gains at week 12. There were no improvements in functional measures. CONCLUSION: Treatment with a potent anabolic androgen may produce significant increases in muscle mass and strength after only 6 weeks in healthy older men. However, such treatment did not improve leg muscle power or walking speed.     

The interaction between detectable plasma viral load and increased body mass index on hypertension among persons living with HIV

ABSTRACT

Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (<25 and ≥25?kg/m²) and pVL (<200 and ≥200 copies/ml). Multiplicative interaction was assessed using logistic regression; addictive interaction was assessed using three measures: Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy index (S). Compared to the participants with normal BMI and undetectable pVL, those who had increased BMI with an undetectable pVL had an elevated risk of hypertension with OR [95%CI]?=?1.80 [1.02, 3.20]; the risk was further increased for those who had increased BMI with detectable pVL with OR [95%CI]?=?3.54 [1.71, 7.31]. The multiplicative interaction was significant (p?=?0.01). Results from additive interaction indicated RERI [95%CI] =1.89 [0.76, 4.79] and AP [95%CI]?=?0.64 [0.32, 0. 95]. The interaction effects of increased BMI and detectable pVL on hypertension on both multiplicative and additive scales suggested that PLWH with increased BMI and detectable pVL should be intensively managed and monitored for hypertension prevention and treatment.     

Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis

AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m 2 ] or overweight (BMI ≥ 25 kg/m 2 ). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software. RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m 2 ; 4897 with BMI ≥ 25 kg/m 2 ). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay. CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.     

Changes in fat-free mass during significant weight loss: a systematic review

OBJECTIVE: To identify the proportion of weight lost as fat-free mass (FFM) by various weight loss interventions. METHODS: Medline and Embase were systematically searched for reliable measurements of FFM before and after weight loss of >10 kg and eligible data were pooled. In a fixed effect model of % FFM loss/weight loss (%FFML), linear regression analysis was used to determine the influence of degree of caloric restriction, exercise, magnitude of weight loss, initial body mass index (BMI) and type of surgery. RESULTS: Data were included from 26 cohorts treated with dietary and behavioral interventions and 29 cohorts of bariatric surgery patients. The degree of caloric restriction was positively associated with %FFML (r (2)=0.31, P=0.006) and in three randomized controlled trials exercise was shown to decrease %FFML. Compared with laparoscopic adjustable gastric banding (LAGB), biliopancreatic diversion (BPD) and roux en Y gastric bypass (RYGB) caused greater log(e) (natural log) %FFML (r (2)=0.453, P<0.001). Differences in log(e) %FFML between surgical procedures were independent of initial BMI and magnitude of weight loss. CONCLUSIONS: The degree of caloric restriction, exercise and rate of weight loss influence the proportion of weight lost as FFM after non-surgical interventions. For surgical interventions, BPD and RYGB result in greater %FFML than LAGB.     

Effects of exercise and tea catechins on muscle mass,strength and walking ability in community‐dwelling elderly Japanese sarcopenic women: A randomized controlled trial

Aim: To investigate the effects of exercise and/or tea catechin supplementation on muscle mass, strength and walking ability in elderly Japanese women with sarcopenia. Methods: A total of 128 women aged over 75 years were defined as sarcopenic and randomly assigned into four groups: exercise and tea catechin supplementation (n = 32), exercise (n = 32), tea catechin supplementation (n = 32) or health education (n = 32). The exercise group attended a 60‐min comprehensive training program twice a week and the tea catechin supplementation group ingested 350 mL of a tea beverage fortified with catechin daily for 3 months. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength, balance and walking ability, were collected at baseline and after the 3‐month intervention. Results: There were significant group × time interactions observed in timed up & go (P < 0.001), usual walking speed (P = 0.007) and maximum walking speed (P < 0.001). The exercise + catechin group showed a significant effect (odds ratio 3.61, 95% confidence interval 1.05–13.66) for changes in the combined variables of leg muscle mass and usual walking speed compared with the health education group. Conclusions: The combination of exercise and tea catechin supplementation had a beneficial effect on physical function measured by walking ability and muscle mass. Geriatr Gerontol Int 2013; 13: 458–465 .     

Peripheral muscle weakness and exercise capacity in children with cystic fibrosis

Exercise intolerance in cystic fibrosis (CF) is attributed to diminished nutritional and pulmonary function. We studied the pathophysiology of such intolerance in relation to muscle force and fat-free mass (FFM), in 15 children with moderately severe symptoms of CF (FEV1 < 80% predicted and/or weight for age < -1 SD of reference median), 13 children with mild symptoms of CF (FEV1 and weight above these thresholds), and 13 healthy controls. Cycle maximal workload (Wmax) and V O2max were assessed. Maximal peripheral muscle force was measured, and FFM was calculated from skinfolds. Patients with mild CF, as compared with matched controls, had lower values of Wmax per kilogram of FFM (3.9 +/- 0.5 versus 4.6 +/- 0.3 W/kg [mean +/- SD], respectively; difference = 0.7 [95% CI = 0.4 to 1.1]), and diminished maximal muscle force (2.7 +/- 0.4 kN versus 3.1 +/- 0.7 kN; difference = 0.44 [95% CI = 0.03 to 0.87]), but similar V O2max. Patients with moderate CF had lower FFM, muscle force, and exercise tolerance than did the other groups. Oxygen cost of work was elevated in both groups of CF patients. Muscle force showed a strong positive correlation with Wmax in patients and controls, with disproportionately lower regression slopes in the CF patients. In children with CF, muscle force is decreased and associated with diminished maximal work load, even in the absence of diminished pulmonary or nutritional status.     

The effect of (L‐)carnitine on weight loss in adults: a systematic review and meta‐analysis of randomized controlled trials

This study provides a systematic review and meta‐analysis of randomized controlled trials, which have examined the effect of the carnitine on adult weight loss. Relevant studies were identified by systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies. Nine studies (total n = 911) of adequate methodological quality were included in the review. Trials with mean difference (MD) of 95% confidence interval (CI) were pooled using random effect model. Results from meta‐analysis of eligible trials revealed that subjects who received carnitine lost significantly more weight (MD: ?1.33 kg; 95% CI: ?2.09 to ?0.57) and showed a decrease in body mass index (MD: ?0.47 kg m^?2; 95% CI: ?0.88 to ?0.05) compared with the control group. The results of meta‐regression analysis of duration of consumption revealed that the magnitude of weight loss resulted by carnitine supplementation significantly decreased over time (p = 0.002). We conclude that receiving the carnitine resulted in weight loss. Using multiple‐treatments meta‐analysis of the drugs and non‐pharmacotherapy options seem to be insightful areas for research. © 2016 World Obesity     

Body mass index and the incidence of influenza-associated pneumonia in a UK primary care cohort

Please cite this paper as: Blumentals WA. et al. (2012) Body mass index and the incidence of influenza‐associated pneumonia in a UK primary care cohort. Influenza and Other Respiratory Viruses 6(1), 28–36. Background Accumulating data suggest an association between increased BMI/obesity and morbidity in patients with pandemic (H1N1) 2009 influenza. Information on metabolic status and prognosis in seasonal influenza is lacking, however. Methods A retrospective cohort study was carried out using the UK General Practice Research Database. Patients aged ≥18 with ≥1 recorded BMI in the 12–58 kg/m² range between January 1, 2000, and December 31, 2007, were observed for an influenza‐associated pneumonia diagnosis after the date of baseline BMI, including ‘influenza with pneumonia’ or a diagnosis of ‘pneumonia’ up to 30 days after a diagnosis of ‘influenza’. Results A total of 1 074 315 patients were included, of whom 73·2% were within the reference BMI range or overweight and 2·2% were underweight (<18·5 kg/m²). Pneumonia rates were 32·33–37·48/100 000 in all BMI categories except the underweight (98·29/100 000). Relative to patients with acceptable weight, those who were underweight had an increased pneumonia rate [adjusted IRR = 2·32 (95% CI 1·80–2·94)], while being overweight (BMI = 25·0–29·9 kg/m²) or obese (BMI ≥ 30·0 kg/m²) was associated with a decreased pneumonia rate [adjusted IRR = 0·77 (95% CI 0·68–0·86) and 0·85 (95% CI 0·73–1·00), respectively]. On the other hand, women and obese women with type 2 diabetes had increased pneumonia rates [adjusted IRR = 1·37 (95% CI 1·08–1·72) and 1·47 (95%CI 1·01–2·06), respectively]. Conclusions In contrast to initial data from pandemic influenza, influenza pneumonia, and pneumonia following influenza were the most common in underweight persons, and an apparent decreased rate of pneumonia was noted with increasing BMI categories. Women with type 2 diabetes had increased rates of pneumonia.     

Targeting epicardial adipose tissue with exercise,diet, bariatric surgery or pharmaceutical interventions: A systematic review and meta‐analysis

Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) are metabolically active fat depots implicated in cardiovascular disease, and EAT has potential as a novel cardiac risk factor, suitable as a target for interventions. The objective of this systematic review and meta‐analysis was to investigate the evidence whether EAT and PAT volume can be reduced by weight‐loss interventions (exercise, diet, bariatric surgery or pharmaceutical interventions). A systematic literature search identified 34 studies that were included in the qualitative synthesis (exercise, n = 10, diet, n = 5, bariatric surgery, n = 9 and pharmaceutical interventions, n = 10). Of the 34 studies, 10 reported sufficient data to be included in the meta‐analysis. The meta‐analysis was only conducted for changes in EAT volume, since only few controlled studies reported changes in PAT (n = 3) or total cardiac adipose tissue volume (n = 1). A significant pooled effect size (ES) for reduction in EAT volume was observed following weight‐loss interventions as compared with control interventions (ES = ?0.89, 95% CI: ?1.23 to ?0.55, P < 0.001). When comparing the effect of exercise training versus control on EAT volume reduction, there was a significant pooled ES favouring exercise training (ES: ?1.11, 95% CI: ?1.57 to ?0.65, P < 0.001). Similarly, the ES of pharmaceutical versus control interventions on EAT volume reduction was significant, favouring pharmaceutical interventions (ES: ?0.79, 95% CI: ?1.37 to ?0.21, P < 0.0072). In conclusion, this systematic review and meta‐analysis provides evidence that exercise, diet, bariatric surgery and pharmaceutical interventions can reduce cardiac adipose tissue volume.     

Body composition and energy expenditure: relationship and changes in obese subjects before and after biliopancreatic diversion

Changes in total and segmental body composition were studied in 101 obese women before and 2, 6, 12, and 24 months after biliopancreatic diversion (BPD) and data 24 months after surgery were matched to 53 control subjects. The patients were studied by anthropometry, indirect calorimetry, and double-emission x-ray absorptiometry (DXA). The combination of calorimetry and body composition analysis allowed estimation of visceral and muscle lean mass. We observed a significant (analysis of variance [ANOVA]: P <.05) progressive reduction of fat and lean body mass (LBM) following BPD, with stabilization of both parameters between 12 and 24 months at levels not different from controls. Fat loss was significant in the arms, legs, and trunk segments. After 24 months, there was no significant difference in segmental fat mass between post-BPD patients and controls. Calorimetric data seem to confirm lean body mass (LBM) reduction. Visceral lean mass (kg) was significantly reduced from 8.1 +/- 2.2 in obese subjects to 6.5 +/- 1.8 in post-BPD patients at 24 months (P <.05); the control value was 7.2 +/- 1.8. Muscular lean mass (kg) was also significantly reduced, from 50.2 +/- 5.8 to 39.8 +/- 5.7 in the same subjects (P <.05), with a control value of 42.5 +/- 5.9. The decrease in muscle and visceral LBM reached control values without significant differences. Viscera/muscle ratio in pre-BPD patients was preserved in post-BPD patients at 24 months, but it was reduced during weight loss. Body composition studies showed a logarithmic relationship between fat and lean mass and a physiological contribution of lean mass to weight loss in the BPD patients. In conclusion, weight loss after BPD was achieved with an appropriate decline of LBM and with all parameters reaching, at stable weight, values similar to weight-matched controls.     

Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta‐analysis of randomized controlled trials

Motivational interviewing, a directive, patient‐centred counselling approach focused on exploring and resolving ambivalence, has emerged as an effective therapeutic approach within the addictions field. However, the effectiveness of motivational interviewing in weight‐loss interventions is unclear. Electronic databases were systematically searched for randomized controlled trials evaluating behaviour change interventions using motivational interviewing in overweight or obese adults. Standardized mean difference (SMD) for change in body mass, reported as either body mass index (BMI; kg m^?2) or body weight (kg), was the primary outcome, with weighted mean difference (WMD) for change in body weight and BMI as secondary outcomes. The search strategy yielded 3540 citations and of the 101 potentially relevant studies, 12 met the inclusion criteria and 11 were included for meta‐analysis. Motivational interviewing was associated with a greater reduction in body mass compared to controls (SMD = ?0.51 [95% CI ?1.04, 0.01]). There was a significant reduction in body weight (kg) for those in the intervention group compared with those in the control group (WMD = ?1.47 kg [95% CI ?2.05, ?0.88]). For the BMI outcome, the WMD was ?0.25 kg m^?2 (95% CI ?0.50, 0.01). Motivational interviewing appears to enhance weight loss in overweight and obese patients.