Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis

Background and objectivesThe effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF).MethodsSeven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge’s g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics.ResultsThe pooled effect size was −0.36 (p < .001) on BMI, −0.52 (p < .001) on WC, −1.20 (p < .004) on weight loss, and −0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (−0.37, p = .027; −.24, p = .065) and weight loss (−1.91, p = .027; −0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (−2.65 vs −0.39, p < .001).ConclusionOur findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.     

Adiposity Adversely Influences Quality of Life Among Adolescents

ObjectiveWe aimed to investigate the cross-sectional and longitudinal relationship between body mass index (BMI), waist circumference, percent body fat (%BF), and weight status (overweight/obese) with health-related quality of life (QOL) in adolescents.MethodsOf 2,353 children (median age 12.7 years) examined, 1,213 (51.7%) with complete data were resurveyed 5 years later, and an additional 475 adolescents were newly recruited. Weight, height, waist circumference, %BF, and body mass index were obtained and defined using standardized protocols. QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL).ResultsIn cross-sectional analyses, obese boys differed significantly from normal weight boys in the PedsQL physical summary only (multivariable-adjusted p = .005). Boys with the highest %BF (≥95th percentile) compared to their peers in the 6th to 94th percentiles had a significantly lower total PedsQL score (7.7-unit difference, p = .0003), and had adjusted mean scores: 7.92, 7.54, 7.35, 6.51, and 8.56 units lower in the physical summary (p = .0003), psychosocial summary (p = .004), emotional (p = .03), social (p = .02), and school (p = .04) domains, respectively. Nonsignificant cross-sectional associations were observed in girls. Adolescents who remained obese (n = 41) compared to those who were non-overweight/obese (n = 704) over the study period, had lower PedsQL physical summary score 5 years later: 85.6 versus 90.5 (p = .03). Conversely, individuals who were overweight/obese at baseline but who became non-overweight/obese at follow-up (n = 92), had significantly higher physical summary scores than those who remained obese 5 years later (n = 41), 91.4 versus 85.6 (p = .03).ConclusionAdiposity in adolescent boys, but not girls, was associated with poorer QOL.     

The role of protein intake in the relationship between egg consumption and body composition in young adults. A mediation analysis

Background & aimsTo date, the literature examining the effects of whole-egg consumption on health outcomes focuses primarily on cardiovascular health markers; however, a significant gap exists in the literature about how egg consumption may influence body composition indicators. The aim of this study was to estimate the association between egg consumption and body composition indicators and to examine whether this relationship is mediated by protein intake in young adults.MethodsA cross-sectional study was conducted involving 355 first-year university students (aged 18–30 years) from a Spanish public university. Body composition was measured using bioimpedance and dual-energy X-ray absorptiometry (DXA) and fitness components were determined using the course-navette test. Egg consumption and protein intake (both in g/day/kg of body weight) were determined using a 137-item Food-Frequency Questionnaire. ANCOVA models were used to test the mean differences in body composition indicators (body mass index [BMI], ratio waist circumference/height [WC/height], body fat mass percentage, and body lean mass percentage) by egg consumption categories (<1 egg/week, 1–4 eggs/week, ≥5 eggs/week). Hayes's PROCESS macro was used for mediation analyses.ResultsParticipants reporting high egg consumption (≥5 eggs/week) showed significantly lower BMI, WC/height and body fat mass percentage values and higher body lean mass percentage values than those reporting low egg consumption (<1 egg/week) (p < 0.05). However, these relationships were not maintained after adjusting for protein intake. Protein intake acted as a full mediator of the relationships of egg consumption with BMI (indirect effect [IE] = ?1.19; 95% CI [?3.33; ?0.36]), WC/height (IE = ?0.01; 95% CI [?0.04; ?0.01]) and body lean mass percentage (IE = 2.99; 95% CI [1.26; 5.73]) as a partial mediator of the relationship be-tween egg consumption and body fat mass percentage (IE = ?2.19; 95% CI [?4.92; ?0.46]).ConclusionsThe association between egg consumption and body composition is mediated by protein intake. This finding is important from a public health perspective, suggesting that higher egg consumption (≥5 eggs/week) may lead to a healthier body composition, especially due to higher protein intake.     

Yeast hydrolysate can reduce body weight and abdominal fat accumulation in obese adults

ObjectiveThe aim of this study was to examine the effect of yeast hydrolysate on the abdominal fat in obese humans.MethodsWe observed the effects of yeast hydrolysate that had a molecular weight below 10 kDa on the anti-abdominal fat accumulation in obese men and women ages 20 to 50 y for 10 wk. The abdominal fat mass was assessed by computed tomographic scans.ResultsBy the sixth week, the reductions in energy intake in the yeast group (yeast hydrolysate 1 g/d) were significantly greater than those in the control group (placebo 1 g/d) (P < 0.05). The body weight and body mass index (BMI) were significantly reduced by week 10 compared with baseline in the yeast group, and these differences were significantly greater than those in the control group: body weight 0.83 kg versus −2.60 k g (P < 0.001), BMI 0.29 kg/m² versus −0.90 kg/m² (P < 0.001). Despite the increased loss of body weight in the yeast group, lean body mass did not significantly differ between the two groups. Body fat mass in the control group did not significantly change between baseline and week 10. However, the yeast group lost a significant amount of body fat mass after 10 wk of treatment (P < 0.01). The differences in abdominal fat thickness and abdominal circumference between the two groups were significant after 10 wk of treatment (P < 0.001). The total abdominal fat area in the yeast group was significantly lower than in the control group after 10 wk of treatment (−7.06 cm² versus −17.34 cm²; P < 0.01).ConclusionsYeast hydrolysate can reduce body weight and the accumulation of abdominal fat without an adverse effect on lean body mass in obese adults, regardless of sex, via the reduction of energy intake.     

Exploring the Role of Muscle Mass,Obesity, and Age in the Relationship Between Muscle Quality and Physical Function

BackgroundDivergent conclusions emerge from the literature regarding the relationship between muscle quality (defined as muscle strength per unit of muscle mass) and physical function. These contrasted results may be due to the influence of factors such as age, obesity, and muscle mass itself. Consequently, the aim of the present study was to explore the role of these factors in the relationship between muscle quality (MQ) and physical function.MethodsData are from 312 individuals (97 men and 215 women) aged 50 years and older. Body composition (dual energy X-ray absorptiometry) and knee extension strength of the right leg (1 repetition maximum) were assessed. Appendicular lean body mass index (AppLBMI) and MQ (knee extension strength /right leg lean mass) were calculated. A composite score of physical function was created based on the timed up-and-go, alternate step, sit-to-stand, and balance tests.ResultsMQ was significantly associated with physical function when AppLBMI (β = 0.179; P = .004) and body mass index (BMI) (β = 0.178; P = .003), but not age (β = 0.065; P = .26), were included in regression analysis. AppLBMI (β = 0.221; P < .001), BMI (β = 0.234; P < .001), and age (β = 0.134; P = .018) significantly interacted with MQ to determine physical function.ConclusionsOur results show that muscle mass, obesity, and age influence the relationship between MQ and physical function, suggesting that these factors should be taken into account when interpreting MQ. Even so, higher levels of MQ were associated with higher physical function scores. Nutritional and physical activity interventions may be designed in this regard.     

Sex differences in the association between dietary restraint,insulin resistance and obesity

Background & aimsRestrained food consumption may alter metabolic function and contribute to eventual weight gain; however, sex differences in these relationships have not been assessed. The objective of this study was to examine the relationship between restrained eating and insulin resistance and the influence of body mass index and sex on this relationship in a large community sample of both men and women. We hypothesized that restrained eating would be related to insulin resistance and this relationship would be influenced by sex and body mass index.MethodsIn this cross-sectional, observational study, we studied 487 individuals from the community (men N = 222, women N = 265), who ranged from lean (body mass index 18.5–24.9 kg/m², N = 173), overweight (body mass index 25–29.9 kg/m², N = 159) to obese (body mass index > 30 kg/m², N = 155) weight categories. We assessed restrained eating using the Dutch Eating Behavior Questionnaire and obtained fasting morning plasma insulin and glucose on all subjects.ResultsIn men, but not in women, restrained eating was related to homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.0001). Furthermore, HOMA-IR was significantly higher in men who were high- versus low-restrained eaters (p = 0.0006).ConclusionsThis study is the first to report sex differences with regard to the relationship between restrained eating and insulin resistance. Our results suggest that high restrained eating is associated with insulin resistance in men but not in women.     

Correlates of nutritional behavior in individuals with multiple sclerosis

BackgroundAdults with multiple sclerosis (MS) have many health problems that can interfere with healthy nutritional behaviors. Self-management activities (e.g., strategies used to manage emotions and functional limitations) may help facilitate engagement in healthy nutritional behaviors. However, few studies have documented such relationships.ObjectiveIdentify predictors of nutritional behaviors from among a set of variables (i.e., personal characteristics, health status indicators, and self-management activities) linked to the International Classification of Function.MethodsData were obtained from an online survey of 292 individuals with MS. Significant bivariate correlates were entered into a logistic regression analysis using backward and forward selection methods to identify predictors of healthy nutritional behaviors (i.e., endorsing 4 out of 5 questions about frequently making good food choices, limiting fat intake, consuming 5 servings of fruits and vegetables, reading food labels, and eating regularly).ResultsSex, nutritional self-efficacy, optimism/pessimism, body mass index, physical activity, emotional self-management, and communication with physician were used in the logistic analysis. Nutritional self-efficacy (β = 0.69, p < 0.001) was the strongest predictor of nutritional behaviors, followed by physician communication (β = 0.08, p = 0.029) and physical activity (β = 0.01, p = 0.035). Neither impairments nor activity limitations were significantly associated with nutritional behaviors.ConclusionsThis study provides preliminary evidence that self-efficacy and self-management activities are correlates of nutritional behaviors in individuals with MS. Supporting the development of self-management skills and increasing self-efficacy might be methods for improving engagement in healthy nutritional behaviors among adults with MS.     

Obesity misclassification and the metabolic syndrome in adults with functional mobility impairments: Nutrition Examination Survey 2003–2006

ObjectivesThe purpose of this study was to estimate the degree of obesity misclassification between body mass index (BMI) and body fat percentage in adults with functional mobility impairment, and to determine cardiometabolic risk profiles.MethodsData from the combined 2003–2006 National Health and Nutrition Examination Survey (NHANES) were incorporated. The representative sample included 852 individuals, aged 20–85 years, reporting at least one major physical limitation related to mobility or lower body function, and 4724 individuals reporting no impairments. Body mass index, percent body fat (%BF) as determined by dual energy X-ray absorptiometry (DXA), objectively measured sedentary behavior and activity, and markers of cardiometabolic risk were compared between adults with and without functional mobility impairments. Among functional mobility impaired individuals, sensitivity, specificity, and receiver operating characteristic curves were used to evaluate the performance of BMI as a continuous variable, as well as various BMI thresholds to detect obesity defined by sex-specific %BF cutoffs.ResultsAdults with functional mobility impairments were older, had larger waist circumferences (WC), had greater prevalence of obesity according to BMI and %BF, were more sedentary, had less physical activity, and had higher overall cardiometabolic risk. The standard BMI cutoff for obesity had excellent specificity in both men (100%) and women (98.4%) with functional mobility impairment, but sensitivity was poor (< 55%). Whereas approximately 36% and 43% of impaired men and women fell into the obese BMI category, over 80% of men and women were obese according to %BF. Individuals with high %BF who were misclassified as not obese, according to BMI, had a significantly higher prevalence of the metabolic syndrome (17.6%) compared to subjects with normal BMI and low %BF (2.1%).ConclusionsObesity misclassification and cardiometabolic risk are prevalent among individuals with functional mobility impairments, and thus diagnostic screening for obesity should be modified to account for %BF and/or waist circumference. Behavioral interventions to decrease sedentary behavior, increase activity, and reduce abdominal obesity are warranted.     

Understanding Disparities in Lipid Management Among Patients with Type 2 Diabetes: Gender Differences in Medication Nonadherence after Treatment Intensification

BackgroundGender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity.MethodsSecondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol.FindingsWomen had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048).ConclusionsDespite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.     

Validity of segmental multiple-frequency bioelectrical impedance analysis to estimate body composition of adults across a range of body mass indexes

ObjectiveWe compared body composition estimates using an eight-electrode, segmental, multiple-frequency bioelectrical impedance analysis (segmental MF-BIA) and dual x-ray absorptiometry (DXA) in a group of healthy adults with a range of body mass indexes (BMIs).MethodsPercentage of body fat (%BF), fat-free mass, and fat mass assessed by DXA and segmental MF-BIA in 132 healthy adults were classified by normal (N; 18.5–24.9 kg/m²), overweight (OW; 25–29.9 kg/m²), and obese (OB; 30–39.9 kg/m²) BMI.ResultsCompared with DXA, segmental MF-BIA overestimated %BF in the OB BMI group (3.4%; P < 0.0001). MF-BIA overestimated %BF among men (0.75%; P < 0.006) and women (0.87%; P < 0.006) and underestimated it in the N BMI group (?1.56%; P < 0.0001); %BF was not different between methods in the OW BMI group. Error in %BF determined by segmental MF-BIA and DXA increased as %BF increased (r = 0.42, P < 0.0001). Waist circumference was the only significant predictor of systematic error in %BF between MF-BIA and DXA (r = 0.60, P < 0.0001).ConclusionEight-electrode, segmental MF-BIA is a valid method to estimate %BF in adults with BMI classified as N and OW, but not as OB. Estimation of trunk resistance with current segmental MF-BIA devices may explain the underestimation of %BF in the adults with OB BMI. Further examination of the effect of waist circumference and body fat distribution on the accuracy of BIA measurements is warranted.     

Urinary bisphenol-A,phthalate metabolites and body composition in US adults,NHANES 1999–2006

Background: Exposure to bisphenol-A (BPA) and phthalates is highly prevalent. Prior studies have not assessed associations between urinary levels of BPA and phthalate metabolites and body composition. Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006 on adults aged ≥20 were analyzed by linear regression for associations between urinary BPA, monoethyl phthalate, monobutyl phthalate (MBP), monoethylhexyl phthalate (MEHP), and monobenzyl phthalate (MBzP) and lean mass, fat mass, and percent body fat. Results: BPA and phthalate metabolites were not independently associated with fat mass or percent body fat. Significant inverse associations were observed with lean mass, with the strongest association observed for BPA in men (mean lean mass 1.39 kg lower for quartile 4 vs. quartile 1, p trend = 0.02). Conclusions: BPA and some phthalates could have important, negative effects on muscle and may affect conditions related to deficits in lean mass, though additional research is needed.     

Percentage Body Fat by Dual-Energy X-Ray Absorptiometry Is Associated With Menstrual Recovery in Adolescents With Anorexia Nervosa

PurposeTo evaluate mediators of resumption of menses (ROM) in adolescents with anorexia nervosa (AN).MethodsAnthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies, and responses to mental health screens were obtained at 6-month intervals for 18 months in 37 adolescents with AN randomized to the placebo arm of a double-blind treatment trial. Outcomes were compared between subjects with menstrual recovery and those without.ResultsTwenty-four subjects (65%) had ROM. Higher percentage body fat was associated with ROM (odds ratio, 1.19; 95% confidence interval, 1.06, 1.33; p < .01), as was body mass index and percent median body weight. Estradiol ≥30 ng/mL alone did not predict menses (p = .08) but was associated with ROM when coupled with percent mean body weight (odds ratio, 2.49; 95% confidence interval, 1.09, 5.65; p = .03). Changes in leptin, cortisol, and mental health were not associated with return of menses.ConclusionsPercentage body fat may be an additional, useful clinical assessment to follow in caring for adolescents with AN.     

Visceral adipose tissue and body fat mass: Predictive values for and role of gender in cardiometabolic risk among Turks

ObjectiveWe investigated the predictive values of visceral adipose tissue area (VAT) and body fat mass for a composite endpoint consisting of type 2 diabetes and coronary heart disease and for incident metabolic syndrome.MethodsWe analyzed at 4-y follow-up 157 middle-aged men and women in whom body composition analyzer and single-scan computerized tomography had been used.ResultsSex- and age-adjusted mean areas of visceral fat were 1.5-fold greater in individuals with than without the composite endpoint (P < 0.001), whereas abdominal subcutaneous fat was similar. Analysis of receiver operating characteristics for the optimal criterion regarding the composite endpoint (in 37 participants) indicated a VAT of 130 cm² and accuracies of 60% in men and 85% in women. Whereas age-adjusted VAT alone significantly predicted the composite endpoint in men, body fat mass or VAT predicted it in women (with 2.2- to 2.6-fold relative risks for 1-SD increment). Age-adjusted incident metabolic syndrome was significantly predicted by each parameter in men but only by fat mass in women.ConclusionVisceral adiposity in men and body fat mass in women seem to be of greater relevance in cardiometabolic risk for the prediction of which 130 cm² of VAT in both sexes and/or 27 kg of fat mass in women are useful cutoffs. Sex differences may reflect the predominating role of visceral adiposity in men and of insulin resistance in women in this risk.     

Circumference Method Estimates Percent Body Fat in Male US Service Members with Lower Limb Loss

BackgroundThe Department of Defense circumference method (CM) is used to estimate percent body fat (%BF) in evaluation of health, physical fitness, appearance, and military readiness; however, the CM has not been validated in individuals with lower limb loss.ObjectiveTo evaluate the agreement between CM and dual-energy X-ray absorptiometry (DXA) for measuring %BF in individuals with lower limb loss.DesignThis study is part of a larger cross-sectional comparison study, and this analysis was included as a secondary objective. Two methods of measuring %BF included CM and DXA, with DXA as the reference standard for this study.Participants/settingThis study was conducted at Walter Reed Army Medical Center. Data were collected from summer 2010 to summer 2011. One hundred individuals, 50 with and 50 without lower limb loss, were screened for this study; three individuals with limb loss and two without limb loss had incomplete data, and one individual (female, without limb loss) lacked a comparison participant. All participants were recruited from a military medical center, and data were collected in a clinic research laboratory.Main outcome measuresMeasurements of %BF were compared between methods for each group.Statistical analyses performedMeasurements of %BF were compared using paired t-tests and intraclass correlation coefficient. Agreement and bias were assessed with Bland-Altman analysis. Receiver operating characteristic analysis was used to determine the diagnostic accuracy of the CM to identify participants with %BF levels in the obese category (≥25%).ResultsA statistically significant difference was found between %BF methods in the group with limb loss (1.7%; P = 0.001) and the group without limb loss (1.4%; P = 0.005), with DXA consistently higher than CM. However, the intraclass correlation coefficient estimates for the agreement between %BF by CM and DXA were 0.848 (95% confidence interval [CI]: 0.683–0.922; P < 0.001) and 0.828 (CI: 0.679–0.906; P < 0.001), for the groups with and without limb loss, respectively, suggesting that CM has good to near excellent agreement with DXA for estimating %BF in these groups. Receiver operating characteristic analysis indicated that the area under the curve supported predictive ability to detect obesity-based %BF in males with and without limb loss.ConclusionsAlthough a statistically significant difference was found between methods for individuals with limb loss, there was also good agreement between the methods, suggesting that CM may be a useful tool for estimating %BF in individuals with lower limb loss. The CM may be a useful and field expedient method for assessing %BF in a clinical setting when DXA is not available.     

High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease

ObjectiveBoth high-intensity interval training (HIIT) and resistance exercises (R) are used in cardiac rehabilitation in patients with coronary artery disease (CAD). However, the combined effect of an HIIT + R exercise program in older adults with CAD is not well investigated. The study's purpose was to assess the changes in anthropometric parameters, physical activity, functional capacity, physiological parameters, and quality of life (QoL) in this population following a combined HIIT + R program.DesignThe study was a 2-group (n = 45 each) randomized controlled single-blinded trial.Setting and ParticipantsThe study was done at a treatment clinic of a tertiary hospital. The mean age of participants was 69.23 ± 4.9 years. The HIIT + R group performed 8 sessions (1/wk) of HIIT + R training. The 30 minutes of the active exercise phase consisted of ten 3-minute bouts. Each bout comprised of 1 minute of high-intensity treadmill walking at 85% to 90% maximum heart rate (MHR), followed by a low-intensity walking at 60%-70% MHR, followed by low-to moderate-intensity resistance training. The Usual Care group underwent conventional medical treatment.MeasuresAnthropometric measurements [weight, body mass index (BMI), waist circumference, body fat percentage, lean body mass], physical activity (International Physical Activity Questionnaire), functional capacity (Incremental Shuttle Walking Test), physiologic measurements (blood pressure, heart rate), and QoL (36-Item Short Form Health Survey) were measured pre- and postintervention.ResultsSignificant group and time interaction were found for the participants in the HIIT + R Group for BMI (P = .001), body fat percentage (P = .001), waist circumference (P < .001), physical activity (P < .001), functional capacity (P < .001), and QoL (P = .001) compared with the UC Group. Significant improvement in systolic blood pressure (P = .001) was seen in the HIIT + R group.Conclusions and ImplicationsA combined HIIT + R training protocol in older adults with CAD can be useful in producing desired health outcomes. Further evaluation of longer duration exercise programs with more frequent dosing needs to be evaluated for their benefits and sustainability.     

Accuracy of anthropometric measurements in estimating fat mass in individuals with 21-hydroxylase deficiency

ObjectiveThe use of anthropometric measurements to estimate the percentage of body fat (%BF) is easy and inexpensive. However, the accuracy of these methods in patients with 21-hydroxylase deficiency (21OHD) has not been explored. The objective of this study was to evaluate the accuracy of skinfold-based models, body mass index (BMI), and waist circumference (WC) in estimations of %BF using dual-energy X-ray absorptiometry (DXA) as the reference method in individuals with 21OHD.MethodsFifty-four 21OHD patients (32 women and 22 men), aged 7 to 20 y, were recruited for the study. DXA was used to determine %BF; four predictive skinfold equations, BMI, and WC were assessed for accuracy in determining %BF.ResultsAll predictive skinfold equations were highly associated (R, range: 0.82-0.89) with DXA %BF values. In women, BMI and WC showed moderate correlations (R = 0.69 for both BMI and WC) with DXA values. In contrast, among men there was a low explanatory power for BMI (13%) and WC (4%) and high errors (BMI, 6.9%; WC, 7.4%). All predictive equations significantly underestimated %BF (range of differences, ?4.1 to ?8.9) compared with DXA (women, 31.3 ± 6.1; men, 24.4 ± 7.3), and large limits of agreement were observed (range, ?15.3 to 1.7 and ?15.5 to 4.2 for women and men, respectively).ConclusionIn children and adolescents with 21OHD, %BF as estimated by skinfold measurements was associated more strongly with DXA-assessed %BF than both BMI and WC. However, still, the skinfold-based assessment underestimated DXA %BF and showed moderate agreement.     

Prognostic value of changes in lean and fat mass in alcoholics

Background & aims

The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes.

Methods

From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25–53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment).

Results

Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ² = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ² = 4.68; p = 0.03) and right leg lean mass (χ² = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan–Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality.

Conclusions

Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass.     

Muscle Strength Rather Than Muscle Mass Is Associated With Standing Balance in Elderly Outpatients

ObjectivesAssessment of the association of muscle characteristics with standing balance is of special interest, as muscles are a target for potential intervention (ie, by strength training).DesignCross-sectional study.SettingGeriatric outpatient clinic.ParticipantsThe study included 197 community-dwelling elderly outpatients (78 men, 119 women; mean age 82 years).MeasurementsMuscle characteristics included handgrip and knee extension strength, appendicular lean mass divided by height squared (ALM/height²), and lean mass as percentage of body mass. Two aspects of standing balance were assessed: the ability to maintain balance, and the quality of balance measured by Center of Pressure (CoP) movement during 10 seconds of side-by-side, semitandem, and tandem stance, with both eyes open and eyes closed. Logistic and linear regression models were adjusted for age, and additionally for height, body mass, cognitive function, and multimorbidity.ResultsHandgrip and knee extension strength, adjusted for age, were positively related to the ability to maintain balance with eyes open in side-by-side (P = .011; P = .043), semitandem (P = .005; P = .021), and tandem stance (P = .012; P = .014), and with eyes closed in side-by-side (P = .004; P = .004) and semitandem stance (not significant; P = .046). Additional adjustments affected the results only slightly. ALM/height² and lean mass percentage were not associated with the ability to maintain standing balance, except for an association between ALM/height² and tandem stance with eyes open (P = .033) that disappeared after additional adjustments. Muscle characteristics were not associated with CoP movement.ConclusionMuscle strength rather than muscle mass was positively associated with the ability to maintain standing balance in elderly outpatients. Assessment of CoP movement was not of additional value.     

The Influence of Habitual Protein Intake on Body Composition and Muscular Strength in Career Firefighters

Objective: The aim of this research was to determine the relationship among protein (PRO) intake, body composition, and muscle strength in overweight and obese firefighters. A secondary objective was to evaluate differences in body composition and muscle strength among overweight and obese firefighters with low (L; < 0.8 g·kg^?1), moderate (M; 0.8–1.0 g·kg^?1), and high (H; > 1.0 g·kg^?1) PRO intake.

Methods: Relative PRO intake [r_PRO] was evaluated from 3-day dietary logs, self-reported by 43 overweight and obese male career firefighters (mean ± standard deviation; age = 37.3 ± 7.2 years; body mass index = 33.2 ± 5.0 kg·m^?2; percent body fat [%BF] = 28.9 ± 4.0%). Body composition (fat mass [FM], %BF, lean mass [LM], percent LM [%LM]) and muscle strength (peak torque [PT], relative peak torque [r_PT] of the leg extensors) were measured using dual-energy x-ray absorptiometry and isokinetic dynamometry, respectively.

Results: Greater r_PRO was associated with less FM, %BF, LM (r = ?0.498 to ?0.363) and greater %LM (r = 0.363), but not muscle strength (p > 0.05). Fat mass (r = ?0.373) and %BF (r = ?0.369) were associated with lower r_PT; %LM was associated with greater r_PT (r = 0.373). Individuals with L r_PRO had greater FM (mean difference ± standard error: L–H = 10.08 ± 3.18 kg), %BF (L–H = 3.8% ± 1.4%) and lower %LM (L–H = ?3.7% ± 1.3%) than those with H r_PRO (p < 0.05) but no significant differences in muscle strength (p > 0.05).

Conclusions: Protein intake > 0.8 g·kg^?1 was associated with more favorable body composition in male career firefighters.     

Cardiometabolic efficacy of multidisciplinary weight loss interventions is not altered in adolescents with obesity initially diagnosed or with a persistent metabolic syndrome

The efficacy of weight loss interventions might be affected by the metabolic profile of adolescents with obesity. In this study, we hypothesized that the initial diagnosis of the MS, or its persistence after an intervention, will not reduce the efficacy of a 16-week multidisciplinary weight loss program. Ninety two adolescents (12-15 years; 62 girls) with obesity completed baseline anthropometric and body composition evaluation (DXA). Lipid profile, insulinemia, glycaemia and blood pressure were measured and metabolic syndrome (MS) diagnosed. The adolescents then followed a 4-month inpatient multidisciplinary weight-management program. All measurements were performed before (T0) and after 4 months of intervention (T1). Body weight, body mass index (BMI) and percentage of fat mass (%FM) decreased significantly between T0 and T1 (P< .001), with no difference in fat-free mass (kg). All metabolic variables (except blood pressure) were improved. 47.6% of the whole sample presented with MS at baseline against 35.7% at T1. Body weight (P = 0.006), BMI (P = 0.0261), %FM (P = 0.0211), hip circumference (= 0.0131), BMI percentile (P = 0.0319), and diastolic blood pressure (P = 0.0365) showed a time x group interaction and their deltas (variations between T0 and T1) were significantly different between adolescents with and without MS at baseline. There was no significant difference between adolescents with persistent and nonpersistent MS except for ΔBMI percentile that deceased significantly more in the nonpersistent group (P = 0.0115). According to our results, the efficacy of weight loss interventions is not reduced in adolescents initially diagnosed with MS or different between those who present a persistent or nonpersistent MS after the intervention.