Bone mineral density and body composition in patients with ulcerative colitis

OBJECTIVE: Reduced bone mineral density (BMD) has been reported in ulcerative colitis (UC) patients, but body composition (fat and lean mass) has never been concomitantly studied. We sought to investigate BMD and body composition in a group of UC outpatients with the following characteristics: age 18-60 yr (men) and 18-45 yr (women); no intestinal resection; no immunosuppressive treatment; and regular menstruation. METHODS: Whole body and subregional BMD and body composition in 43 UC patients (21 men, 22 women; male mean age, 36.5 [21-57] yr; female mean age, 35.3 [23-45] yr) and 121 healthy volunteers were studied by means of dual X-ray photon absorptiometry. RESULTS: There were no differences in total and subregional BMD, or fat and lean mass between the patients and controls, except that the total and trunk lean mass of the UC women was lower than that in the normal controls. No correlation was found between lifetime steroid intake and BMD. CONCLUSIONS: UC outpatients do not differ from normal subjects in terms of BMD and fat mass. Mild and moderate UC does not represent a risk factor for osteopenia.     

Minor impact of juvenile arthritis on nutritional status in young adult patients

OBJECTIVE: Growth abnormalities and poor nutritional status have been reported in children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate the impact of juvenile chronic rheumatic disease on current nutritional status in adult patients in remission or with active disease. METHODS: One hundred thirty-eight women and 82 men, aged >20 years, with JIA were studied after a mean disease duration of 15.5 +/- 2.3 years. Eighty-four (61%) of the women and 49 (60%) of the men were in remission. Forty-one healthy women and 54 healthy men served as a reference group. Body composition was analyzed by dual-energy x-ray absorptiometry. RESULTS: There was no difference in height or body mass index (BMI) between patients and healthy subjects. However, female patients with systemic disease had significantly reduced BMI compared with those with pauciarticular JIA (P < 0.001), and female patients who used or had been using corticosteroids had significantly lower weight, height, and BMI compared with the patients who had never used corticosteroids (P < 0.05). Female patients in remission had significantly more lean body mass compared with healthy controls (P < 0.05) and significantly less body fat was found in both women and men (P < 0.01 for both). Patients with active disease had the same amount of lean body mass as the healthy controls, but significantly less body fat (P < 0.05 for women and P < 0.01 for men). CONCLUSION: Adult patients with JIA had attained normal height, weight, and BMI, with the exception of women with systemic JIA and those who were using or had used corticosteroids. Patients with JIA in remission seemed to have a better nutritional status than healthy subjects.     

Serum Ghrelin Levels in Inflammatory Bowel Disease with Relation to Disease Activity and Nutritional Status

Ghrelin possesses various biological activities -- it stimulates growth hormone (GH) release, plays a major role in energy metabolism, and is one of the hormones that affects body composition. It also plays a role in modulating immune response and inflammatory processes. In this study we aimed to determine whether serum ghrelin levels had correlation with markers associated with disease activation. We also investigated any probable relationship between serum ghrelin level and nutritional status. Serum levels of ghrelin and its relationship with disease activity and nutritional status were evaluated in 34 patients with ulcerative colitis (UC), 25 patients with Crohn's disease (CD), and 30 healthy controls. Serum ghrelin levels, serum IGF-1 and GH levels, and markers of disease activity (sedimentation, C-reactive protein, and fibrinogen) were measured in all subjects. Body composition and nutritional status was assessed by both direct (by anthropometry) and indirect (by bioimpedance) methods. Serum ghrelin levels were significantly higher in patients with active UC and CD than in those in remission (108 +/- 11 pg/ml vs. 71 +/- 13 pg/ml for UC patients, P < 0.001; 110 +/- 10 pg/ml vs. 75 +/- 15 pg/ml for CD patients, P < 0.001). Circulating ghrelin levels in UC and CD patients were positively correlated with sedimentation, fibrinogen and CRP and was negatively correlated with IGF-1, BMI, TSFT, MAC, fat mass (%), and fat free mass (%). This study demonstrates that patients with active IBD have higher serum ghrelin levels than patients in remission and high levels of circulating ghrelin correlate with the severity of disease and the activity markers. Ghrelin levels in inflammatory bowel disease (IBD) patients show an appositive correlation with IGF-1 and bioelectrical impedance analysis, body composition, and anthropometric assessments. Finally, we arrived at the conclusion that ghrelin level may be important in determination of the activity in IBD patients and evaluation of nutritional status.     

Bone mineral density is reduced in patients with Crohn''s disease but not in patients with ulcerative colitis: a population based study.

BACKGROUND: Patients with inflammatory bowel disease are at risk of developing metabolic bone disease. AIMS: To compare bone mineral density in patients with Crohn's disease with patients with ulcerative colitis and healthy subjects, and to evaluate possible risk factors for bone loss in inflammatory bowel disease. PATIENTS: 60 patients with Crohn's disease, 60 with ulcerative colitis, and 60 healthy subjects were investigated. Each group consisted of 24 men and 36 women. METHODS: Lumbar spine, femoral neck, and total body bone mineral density were measured by dual x ray absorptiometry (DXA), and Z scores were obtained by comparison with age and sex matched normal values. RESULTS: Mean Z scores were significantly lower in patients with Crohn's disease compared with patients with ulcerative colitis and healthy subjects. Patients with ulcerative colitis had bone mineral densities similar to healthy subjects. Use of corticosteroids, body mass index (BMI), and sex were significant predictor variables for bone mineral density in Crohn's disease. In ulcerative colitis only body mass index and sex were of significant importance. Disease localisation and small bowel resections had no influence on bone mineral density in patients with Crohn's disease. CONCLUSIONS: Patients with Crohn's disease have reduced bone mineral density. Several factors are probably involved, but the reduction is associated with corticosteroid therapy. When studying skeletal effects of inflammatory bowel disease, patients with Crohn's disease and those with ulcerative colitis should be evaluated separately.     

Body composition, lipid and lipoprotein levels in childhood-onset systemic lupus erythematosus

OBJECTIVES: Systemic inflammation, corticosteroid therapy, and reduced physical activity are risk factors for altered body composition in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess whether body composition differs between childhood-onset SLE patients and healthy controls, and to investigate the impact of disease characteristics and lifestyle factors on body fat mass, serum lipids, and lipoproteins. METHODS: Fat mass and lean tissue mass were measured in a cross-sectional study of 68 childhood-onset SLE patients and 68 matched healthy controls by dual-energy X-ray absorptiometry (DXA). The influence of disease, glucocorticosteroids, disease activity and severity, physical activity, and dietary intake on fat mass was evaluated by multiple linear regression analysis. Serum lipid and lipoprotein levels were measured. RESULTS: Patients had a significantly higher fat mass [mean (SD) 35.3 (10.8) vs. 30.9 (11.1)%; p = 0.024] and lower lean mass [39.7 (9.8) vs. 44.4 (1.5) kg; p = 0.003] than controls. Corticosteroid use and the disease itself were significant independent predictors of greater fat mass, while disease activity, physical activity, and dietary intake had only a minor influence. Mean high density lipoprotein (HDL) cholesterol and apolipoprotein A1 (apo A1) levels were significantly lower (p<0.001), and the mean apo B/apo A1 ratio significantly higher (p = 0.004), in patients than in controls. CONCLUSION: Childhood-onset SLE patients had a higher fat mass and lower lean mass than healthy controls and corticosteroid use was an independent predictor of increased fat mass. Patients had a more proatherogenic lipid profile, which will contribute to the increased risk of coronary heart disease in SLE patients.     

Abnormal body composition phenotypes in older rheumatoid arthritis patients: association with disease characteristics and pharmacotherapies

OBJECTIVE: To compare measures of body fat and lean mass and the prevalence of abnormal body composition phenotypes (sarcopenia, overfat, and sarcopenic obesity) in men and women with rheumatoid arthritis (RA) versus matched controls, and to explore the disease-related predictors of abnormal body composition in patients with RA. METHODS: A total of 189 men and women with RA and 189 age-, sex-, and race-matched non-RA controls underwent dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. Continuous and categorical measures of body composition were compared between RA and control subjects by sex and according to categories of body mass index (BMI). Within the group of RA patients, demographic, lifestyle, and RA disease and treatment characteristics were compared for RA patients with healthy body composition versus those with abnormal body composition phenotypes. RESULTS: Compared with non-RA controls, RA status was significantly associated with greater odds of sarcopenia, overfat, and sarcopenic obesity in women, but not in men. Relative differences in body composition phenotypes between RA and control subjects were greatest for patients in the normal weight BMI category (<25 kg/m(2)). Among RA characteristics, increasing joint deformity, self-reported disability scores, C-reactive protein levels, rheumatoid factor seropositivity, and a lack of current treatment with disease-modifying antirheumatic drugs were significantly associated with abnormal body composition. CONCLUSION: Abnormal body composition phenotypes are overrepresented in patients with RA, particularly in those in the normal weight BMI range. RA-associated disease and treatment characteristics contribute to this increase in abnormal body composition.     

Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass

OBJECTIVE: To explore the association of measures of body composition with disability in patients with rheumatoid arthritis (RA). METHODS: Patients with RA underwent total body dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. The associations of measures of fat and lean mass with disability, measured with the Health Assessment Questionnaire (HAQ), were explored for the total cohort and by sex, controlling for pertinent demographic, lifestyle, and RA disease and treatment covariates. RESULTS: We studied 197 subjects (118 women, 79 men). Median (interquartile range) HAQ score was 0.625 (0.125-1.25) and was significantly higher, indicating worse physical function, in women than in men. HAQ score was strongly correlated with depression, pain, RA duration, duration of morning stiffness, Disease Activity Score in 28 joints, radiographic damage scores, levels of physical and sedentary activities, and body composition, with increasing fat and decreasing lean mass associated with higher HAQ scores. Appendicular fat and lean mass demonstrated the strongest association per kilogram with HAQ. Mean HAQ score was 0.52 units higher for subjects in the highest versus the lowest quartile of appendicular fat mass (P<0.001), and 0.81 units higher for subjects in the lowest versus the highest quartile of appendicular lean mass (P<0.001). Adjusting for demographic and RA characteristics partially attenuated these associations. The joint associations of appendicular fat and lean mass on HAQ were additive without significant interaction. CONCLUSION: Body composition, particularly the amount of fat and lean mass located in the arms and legs, is strongly associated with disability in RA patients.     

Body composition and bone mass in post-menopausal women

OBJECTIVE: We aimed to assess total body composition and to study the interrelationships between fat and lean tissue mass with total and regional bone mass in healthy British post-menopausal women. DESIGN AND PATIENTS: Total body composition and regional bone mass were measured in 97 healthy post-menopausal women recruited from the general community. The mean age was 57.9 years, range 49-65. MEASUREMENTS: Total body composition (fat, lean tissue and bone mineral) and regional bone density in the lumbar spine and femur were measured by dual energy X-ray absorptiometry on a Lunar DPX. RESULTS: Significant negative correlations with age were found for total body bone mineral density (r = -0.200, P = 0.049), and lumbar spine bone mineral density (r = -0.28, P = 0.006); the calculated rate of bone loss from these two sites was 0.33 and 0.7% per annum respectively. Fat tissue mass showed a positive correlation with age (r = 0.22, P = 0.03). High correlations were observed between total body and regional bone mineral density (r = 0.755-0.829, P < 0.001). After adjustment for age and lean mass, statistically significant correlations were seen between fat tissue mass and all bone mass measurements (P < 0.01-0.001), the strongest correlations being found for total body bone mineral content and density (r = 0.477 and 0.488 respectively). Lean tissue mass showed a strong correlation with total body bone mineral content (r = 0.580, P < 0.001), after adjustment for age and fat mass; it was less strongly correlated with other bone mass measurements than fat mass, showing only weak correlations with total body, trochanteric and lumbar spine bone mineral density (r = 0.228-0.246, P < 0.05). Age-adjusted body weight showed stronger correlations with total and regional bone mass than did either body mass index or height. CONCLUSIONS: Both fat and lean tissue mass are related to total and regional bone mass in post-menopausal women, the relationship being strongest for fat mass. Body weight shows stronger correlations with bone mass than either height or body mass index. In view of the direction and magnitude of changes in fat, lean tissue and bone mineral after the menopause, adiposity and muscularity are more likely to be determinants of peak bone mass than of the rate of post-menopausal bone loss.     

Bone mineral density in patients with inflammatory bowel disease: a population-based prospective two-year follow-up study

BACKGROUND: Bone loss and osteoporosis are commonly reported in inflammatory bowel disease (IBD), especially Crohn disease (CD). The aims of the present study were to evaluate changes in bone mineral density (BMD) in IBD patients during a 2-year follow-up period, and to investigate the role played by possible contributing factors in bone loss. METHODS: Sixty patients with CD and 60 with ulcerative colitis (UC) were studied initially. Fifty-five CD and 43 UC patients were re-examined after 1 year, and 50 CD and 44 UC patients after 2 years. Lumbar spine, femoral neck and total body BMD were measured by dual X-ray absorptiometry (DXA), and Z scores were obtained by comparison with age-matched and sex-matched healthy subjects. Biochemical variables were assessed at inclusion and at the 1-year follow-up visit. RESULTS: Mean BMD values were unchanged in both CD and UC patients. In patients with repeated measurements, significant differences in Z scores (delta Z score) were found for femoral neck and total body in CD and for total body in UC. Significant bone loss occurred in 11 CD (22%) and 12 UC (27%) patients. A significant increase in BMD was found in 21 CD (42%) and 20 UC (46%) patients. In CD patients the initial BMD values for lumbar spine and femoral neck were inversely correlated to BMD changes at the same sites and the change in body mass index (BMI) was positively correlated to change in the total body BMD. C-reactive protein was significantly higher in CD patients with bone loss. Biochemical markers of bone metabolism could not be used to predict BMD changes. Although it was not significant, there was a relationship between corticosteroid therapy and bone loss in CD. CONCLUSIONS: Only minor changes in BMD were observed in both CD and UC patients during a 2-year period. The multifactorial pathogenesis of bone loss in IBD makes it difficult to assess the importance of each single contributing factor. However, our results indicate that disease activity and corticosteriod therapy are involved in bone loss in CD patients.     

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.     

Depressive symptoms, inflammatory markers and body composition in elderly with and without chronic obstructive pulmonary disease (COPD)

Our aim was to assess the relationships between cortisol, interleukin-2 (Il-2) and tumor necrosis factor-α (TNF-α) levels in elderly with and without COPD presenting with or without depressive symptoms. Forty COPD patients and 53 elderly individuals with no COPD took part in the study. Depressive symptoms (Geriatric Depression Scale=GDS-15), IL-2 and TNF-α, serum cortisol, number of comorbidities, smoking habits and body composition were evaluated. The prevalence of depressive symptoms was higher in COPD group. The number of comorbidities was higher in patients with depressive symptoms. No differences were found between IL-2, TNF-α and cortisol levels, years of smoking and smoked pack-years in the groups. The COPD group obtained lower body mass index (BMI) and fat content and higher fat free mass index as well as greater nutritional depletion. Conclusions: Depressive symptoms as well as fat and lean body composition, due to preserved BMI in those with nutritional depletion, must be investigated.     

Relationship of body composition with prevalence of osteoporosis in central south Chinese postmenopausal women

Objectives To elucidate the relationship between body composition and bone mineral density (BMD) and the prevalence of osteoporosis in central south Chinese postmenopausal women. Methods A cross‐sectional study was conducted on 954 healthy central southern Chinese postmenopausal women, aged 50–82. Total body, lumbar spine and left femur BMD and total body soft tissue composition were measured by dual X‐ray absorptiometry. Results Among the study population, 578 (60·5%) subjects were without osteoporosis and 376 (39·4%) subjects were osteoporotic. The osteoporotic women were older, shorter and thinner, had an earlier age at menopause, a lower BMD and bone mineral content (BMC) of the total body and at different sites, and had lower body mass and body mass components than the women without osteoporosis. Both fat mass and lean mass were positively correlated with age at menopause, height, weight, body mass index (BMI) and BMD at all sites. Fat mass and lean mass were also inversely correlated with age and years since menopause (P < 0·05). After controlling for age, age at menopause and height, both fat mass and lean mass were positively correlated with BMD at the lumbar_1–4 spine, the femoral neck and the total hip. Fat mass was the most significant determinant of BMD at the lumbar_1–4 spine with a higher R² change and a partial R² compared with that of lean mass, while lean mass had more impact on the total hip values. Either a fat mass below 18·4 kg or a lean mass below 33·9 kg was correlated with a higher prevalence of osteoporosis at the lumbar spine or total hip. Conclusions In central south Chinese postmenopausal women, both fat mass and lean mass are correlated with BMD at the lumbar spine and hip. Fat mass was the most significant determinant of BMD at the lumbar spine, while lean mass had more impact on the total hip value. Both lower values of fat mass and lean mass are related to a higher prevalence of osteoporosis at either the lumbar spine or the total hip. Thus, it is important to maintain a reasonable body weight to balance bone health and other metabolic disorders.     

不同性别体重指数与身体成份构成及脂肪分布的关系

目的研究不同性别人群体重指数与身体脂肪含量及分布的关系。方法采用Hologic QDR 4500W型骨密度仪对188名受检者的身体成份进行测量，计算出身体脂肪含量、肌肉含量、矿物质含量、躯干脂肪百分比及躯干脂肪占全身总量百分比。同时测量体重及身高，计算出体重指数。采用线性相关分析研究身体脂肪含量、肌肉含量、矿物质含量、躯干脂肪百分比及躯干脂肪占全身总量百分比与体重指数间的相关关系，计算回归方程系数。结果男女性间体重指数不存在差别，但身体成份构成存在明显不同。男性中体重指数与身体脂肪含量、肌肉含量和矿物质含量均呈中等相关关系，而在女性矿物质含量与体重指数不相关。回归方程中在男性身体脂肪含量、肌肉含量和矿物质含量三个指标均进入方程，而女性仅脂肪含量一个指标进入方程。结论男女两性间身体成份构成存在着明显差别。体重指数与身体脂肪含量及分布呈一般相关关系。相比男性，体重指数更适合于描述女性脂肪代谢情况。     

Assessment of sarcopenia: longitudinal versus cross sectional body composition data

BACKGROUND AND AIMS: An accurate diagnosis of sarcopenia is required. The aim of this study is to correlate the results of two methods to define sarcopenia using cross sectional body composition data, with actual loss of fat free mass. METHODS: Healthy older subjects (926 females and 381 males aged 70 years or more) and healthy young adults (425 females and 151 males aged 20 to 40 years) were studied. Body composition was assessed by double beam X ray absorptiometry (DEXA). Among older subjects, a contemporary subsample of 148 females and 45 males had two or more measurements, separated by 4.8+/-1.5 years and loss of fat free mass per year was calculated. In the whole sample, total and appendicular lean body mass index were calculated as total or appendicular lean body mass/height. Using data from young people, sex specific t scores were obtained. In older subjects residuals were derived from a regression equation, using total or appendicular fat free mass as the dependent variable and height, fat free mass and age as independent variables. RESULTS: The concordance between residuals and t scores to define sarcopenia was 68 and 72%, respectively. Among subjects with two or more measurements, men and women lost a mean of 521+/-454 and 221+/-399 g/year of fat free mass, respectively. The odds ratio of losing more than 822 g lean body mass /year among men or 514 g lean body mass /year among women was 2.63 and 2.64 for subjects classified in the two lowest quintiles of sarcopenia, using t scores or residuals, respectively. CONCLUSIONS: Cross sectional body composition data can predict loss of fat free mass among older people.     

Body composition in Chinese subjects: relationship with age and disease

Body composition measurement by dual energy absorptiometry was carried out in 160 men (age 45-87 years) and 407 women (age 20-88 years) consisting of volunteers and 25 men and 14 women with chronic obstructive airways disease (COAD) not receiving steroids from a hospital respiratory clinic. The objectives of this study were to provide normal reference values for adult Chinese including the elderly; to examine the effect of age and COAD on body composition; and to compare the use of body mass index (BMI) as a measure of obesity or malnutrition compared with body composition measurements. Values for body composition were different when compared with studies in the Caucasian population. In both sexes, height and lean mass decreased in a linear fashion with aging. In men, total body water increased till the 55-65 age group and then decreased. In women, total body water and bone mineral content also decreased with aging in a linear fashion. Changes in weight, BMI, fat mass and percentage fat with aging were also present in women and followed a quadratic trend. BMI was not a sensitive index of obesity or undernutrition, having approximately only 50-60% sensitivity in detecting high percentage fat or low standardised lean mass values. COAD was associated with low BMI only. Body composition measurements changes with aging, and should be used instead of BMI as a better indication of obesity or undernutrition. Reference values derived from the appropriate ethnic group should be used.     

Body composition in Chinese subjects: relationship with age and disease

Body composition measurement by dual energy absorptiometry was carried out in 160 men (age 45–87 years) and 407 women (age 20–88 years) consisting of volunteers and 25 men and 14 women with chronic obstructive airways disease (COAD) not receiving steroids from a hospital respiratory clinic. The objectives of this study were to provide normal reference values for adult Chinese including the elderly; to examine the effect of age and COAD on body composition; and to compare the use of body mass index (BMI) as a measure of obesity or malnutrition compared with body composition measurements. Values for body composition were different when compared with studies in the Caucasian population. In both sexes, height and lean mass decreased in a linear fashion with aging. In men, total body water increased till the 55–65 age group and then decreased. In women, total body water and bone mineral content also decreased with aging in a linear fashion. Changes in weight, BMI, fat mass and percentage fat with aging were also present in women and followed a quadratic trend. BMI was not a sensitive index of obesity or undernutrition, having approximately only 50–60% sensitivity in detecting high percentage fat or low standardised lean mass values. COAD was associated with low BMI only. Body composition measurements changes with aging, and should be used instead of BMI as a better indication of obesity or undernutrition. Reference values derived from the appropriate ethnic group should be used.     

Body composition analysis for healthy Italian vegetarians

The elementary nutritional needs of vegetarians are totally, or in great part, supplied by vegetarian food; thus the body composition of vegetarians could differ from that of omnivorous persons. The objective of the present study was to compare healthy Italian vegetarians to healthy omnivorous individuals in terms of body composition, determined using dual X-ray absorptiometry. The study population consisted of 20 vegetarians [mean age (+/-SD), 34.78+/-15.07 years; mean BMI, 22.41+/-2.15 kg/m(2)] and 10 omnivorous persons matched for age and BMI. We found no significant differences between the two groups in terms of fat mass, lean body mass, soft tissue, bone mineral content, or bone mineral density. These findings suggest that the vegetarian diet does not induce negative alterations in body composition.     

Assessment of body composition by bioelectrical impedance in adolescent patients with celiac disease

OBJECTIVE: Assessment of body composition is of primary importance in the management of celiac adolescents. We aimed to evaluate body composition by dual-energy x-ray absorptiometry and bioelectrical impedance in celiac adolescents on a gluten-free diet to investigate whether impedance may provide an alternative method to assess nutritional status in these patients. METHODS: We studied body composition in 43 adolescents affected by celiac disease on a gluten-free diet for > or = 1 yr and 30 healthy subjects. Fat, fat-free, and bone masses were assessed by dual-energy x-ray absorptiometry. Fat and fat-free masses were also assessed by bioelectrical impedance. All anthropometric measurements were performed according to standard procedures. RESULTS: All patients had a significantly lower body weight, height, fat-free mass, bone mineral density (p < 0.001), and body mass index (p < 0.01) compared with controls. In contrast, parameters predicting fat compartment (sum of skinfolds and fat mass) did not differ from those of controls. No significant difference was found between patients strictly adherent to a gluten-free diet and patients partially compliant. Compared with dual-energy x-ray absorptiometry measurements, bioelectrical impedance showed a high accuracy to estimate fat-free mass (R2 = 0.97) and limited accuracy for fat mass (R2 = 0.75). Furthermore, impedance was more reliable for estimating hydration of soft tissue underlying the fat-free mass changes. CONCLUSIONS: In adolescents with celiac disease, after a mean of 1 yr of gluten-free diet all the parameters assessing body compartments, except fat mass, were affected, compared with healthy controls. Bioelectrical impedance holds promise for routine assessment of body composition changes in celiac adolescents on a gluten-free diet.     

Bone mineral density in patients with inflammatory bowel disease: A population‐based prospective two‐year follow‐up study

Background: Bone loss and osteoporosis are commonly reported in inflammatory bowel disease (IBD), especially Crohn disease (CD). The aims of the present study were to evaluate changes in bone mineral density (BMD) in IBD patients during a 2‐year follow‐up period, and to investigate the role played by possible contributing factors in bone loss. Methods: Sixty patients with CD and 60 with ulcerative colitis (UC) were studied initially. Fifty‐five CD and 43?UC patients were re‐examined after 1 year, and 50?CD and 44?UC patients after 2 years. Lumbar spine, femoral neck and total body BMD were measured by dual X‐ray absorptiometry (DXA), and Z scores were obtained by comparison with age‐matched and sex‐matched healthy subjects. Biochemical variables were assessed at inclusion and at the 1‐year follow‐up visit. Results: Mean BMD values were unchanged in both CD and UC patients. In patients with repeated measurements, significant differences in Z scores (Δ Z score) were found for femoral neck and total body in CD and for total body in UC. Significant bone loss occurred in 11?CD (22%) and 12?UC (27%) patients. A significant increase in BMD was found in 21?CD (42%) and 20?UC (46%) patients. In CD patients the initial BMD values for lumbar spine and femoral neck were inversely correlated to BMD changes at the same sites and the change in body mass index (BMI) was positively correlated to change in the total body BMD. C‐reactive protein was significantly higher in CD patients with bone loss. Biochemical markers of bone metabolism could not be used to predict BMD changes. Although it was not significant, there was a relationship between corticosteroid therapy and bone loss in CD. Conclusions: Only minor changes in BMD were observed in both CD and UC patients during a 2‐year period. The multifactorial pathogenesis of bone loss in IBD makes it difficult to assess the importance of each single contributing factor. However, our results indicate that disease activity and corticosteriod therapy are involved in bone loss in CD patients.     

Systemic sclerosis and bone loss: the role of the disease and body composition

OBJECTIVES: Studies on body composition are not available in systemic sclerosis (SSc). As this variable may play an important role in bone loss we have analysed bone mineral density (BMD) and body composition in SSc patients and healthy controls. METHODS: Forty-three postmenopausal SSc patients and 47 healthy postmenopausal women were studied. Patients with intestinal malabsorption, renal failure, current or past history of smoking or using osteopenic drugs were excluded. BMD and body composition was evaluated by dual X-ray absorptiometry (DXA). RESULTS: A higher frequency of osteoporosis in the lumbar spine (32.5%) and femoral neck (51.1%) was observed in SSc patients when compared to controls (14.8% vs. 19.1%; p<0.01). Multiple linear regression analysis revealed an association between the presence of SSc and low BMD. Body composition showed a reduced lean mass (33.15 vs. 39.99 g; p<0.01) and fat mass (21.05 vs. 26.82 g; p<0.01) in SSc when compared to controls. Lean mass was an important factor related to BMD in the lumbar spine and femoral neck. CONCLUSION: SSc may be an independent factor for low BMD. The low lean mass in these patients emphasizes the need for appropriate additional therapeutic measures to reduce bone loss in SSc patients.