Effects of body size and body composition on survival in hemodialysis patients

It is unclear whether increased muscle mass or body fat confer the survival advantage in hemodialysis patients with high body-mass index (BMI). Twenty-four-hour urinary creatinine (UCr) excretion was used as a measure of muscle mass. The outcomes of hemodialysis patients with high BMI and normal or high muscle mass (inferred low body fat) and high BMI and low muscle mass (inferred high body fat) were studied to study the effects of body composition on outcomes. In 70,028 patients who initiated hemodialysis in the United States from January 1995 to December 1999 with measured creatinine clearances reported in the Medical Evidence form, all-cause and cardiovascular mortality were examined in Cox and parametric survival models. When compared with normal BMI (18.5 to 24.9 kg/m(2)) group, patients with high BMI (> or = 25 kg/m(2)) had lower hazard of death (hazard ratio [HR], 0.85; P < 0.001). However, when compared with normal BMI patients with UCr >25th percentile (0.55 g/d), high BMI patients with UCr >0.55 g/d had lower hazard of all-cause (HR, 0.85; P < 0.001) and cardiovascular death (HR, 0.89; P < 0.001), and high BMI patients with UCr < or =0.55 g/d had higher hazard of all-cause death (HR, 1.14; P<0.001) and cardiovascular death (HR, 1.19; P <0.001). Both BMI and body composition are strong predictors of death. The protective effect conferred by high BMI is limited to those patients with normal or high muscle mass. High BMI patients with inferred high body fat have increased and not decreased mortality.     

Nutritional assessment of the lung transplant patient: body mass index as a predictor of 90-day mortality following transplantation.

BACKGROUND: It is well documented that malnourished and/or obese surgical patients have increased morbidity and mortality post-operatively. Only a few studies investigating the effect of nutritional status on mortality are available pertaining to the transplant population. Since limited data are available on the nutritional status and its effects on mortality in the lung transplant population, we sought to ascertain whether there is an association between mortality and preoperative nutritional status. METHODS: We examined mortality during the first 3 months after transplantation. Patients were grouped by body mass index (BMI) categories as < 17 kg/m(2), 17 to < 20 kg/m(2), 20 to 25 kg/m(2) (reference group), > 25 to 27 kg/m(2), and > 27 kg/m(2). Additional risk factors retrieved from the pre-transplant records included age, gender, diagnosis, energy requirements, protein requirements, protein and caloric intake, and weight history. Logistic regression for univariate and multivariate analysis for mortality used recipient age, gender, disease category, pre-transplant cytomegalovirus (CMV) serology, transplant type (single or bilateral), and donor age, gender, and CMV serology. RESULTS: The likelihood estimates or odds ratios (ORs) of the risk of death within 90 days of lung transplantation for the BMI categories compared to the reference group were 3.7 for BMI < 17 kg/m(2) (p = 0.085), 1.6 for BMI < 17 to 20 kg/m(2) (p = 0.455), 3.5 for BMI > 25 to 27 kg/m(2) (p = 0.069), and 5.0 for BMI > 27 kg/m(2) (p = 0.003). CONCLUSIONS: In patients with a pre-transplant BMI < 17 kg/m(2) or > 25 kg/m(2) the risk of dying within 90 days post-transplant was increased. In patients with a pre-transplant BMI of > 27 kg/m(2) the risk was significantly higher in than the reference group.     

Correlation of serum leptin concentrations with body composition and gender in Taiwanese hemodialysis patients without diabetes

OBJECTIVE: (1) To evaluate the impact of body composition and gender on serum leptin concentration in hemodialysis patients. (2) To study which marker of adiposity is most appropriate in Taiwanese hemodialysis patients without diabetes. (3) To compare the nutrition status between nonlean and lean subjects. PATIENTS AND METHODS: Serum leptin concentrations were measured by radioimmunoassay collected in 88 hemodialysis patients without diabetes. Bioimpedance analysis was performed to determine percent fat mass (%FM), lean body mass (LM), and total body water (TBW). Body mass index (BMI) was calculated as weight/height2. Albumin and transferrin were measured by standard laboratory methods. RESULTS: Serum leptin levels were more correlated with percent fat mass (r = 0.697; P < 0.001) than with body fat mass (r = 0.672; P < 0.001) or with BMI (r = 0.594; P < 0.001) in the group as a whole and in each subgroup when analyzed separately by gender. The mean (+/- SD) serum leptin levels were 32.5 +/- 34.3 ng mL(-1) in women subjects and 13.6 +/- 15.5 ng mL(-1) in men subjects (P < 0.001). Multiple regression analysis in all subjects revealed that serum leptin levels were independently affected by percent fat mass and gender. Adiposity corrected serum leptin, such as leptin/BMI, leptin/percent fat mass, and leptin/body fat mass was significantly different between sexes (P < 0.001). The significantly higher serum leptin concentrations in women than in men were observed in obese subjects with BMI > 25 kg/m2 (P < 0.001) as well as nonobese subjects with BMI < 25 kg/m2 (P < 0.05). There were no differences in lean mass and albumin between nonlean and lean subjects. CONCLUSION: Gender and adiposity had impact on serum leptin levels in hemodialysis patients without diabetes. In terms of adiposity, serum leptin levels had stronger correlation with percent fat mass than with body fat mass (FM) or BMI in Taiwanese hemodialysis patients. Steady-state serum leptin levels could serve as valuable clinical markers for the body adiposity in stable hemodialysis patients without diabetes. Protein malnutrition markers and lean mass should be checked in lean subjects for the evaluation of the protein stores of hemodialysis patients.     

Effect of body weight on testosterone/estradiol ratio in oligozoospermic patients

To evaluate the effect of body mass on the hormonal and semen profiles of subfertile men with oligozoospemia, sperm concentration and reproductive hormone levels were compared in two body mass index (BMI) groups: underweight or normal weight patients (BMI = 25 kg/m2) vs. overweight or obese patients (BMI > 25 kg/m2). The mean BMI was 27 +/- 4.6 kg/m2. The testosterone/estradiol ratio was significantly reduced in the high BMI group as compared to the low BMI group (17 +/- 4 vs. 12 +/- 3; p < 0.05). A similar difference was found in the sperm concentration (11.2 +/- 3.16 x 10(6)/ml vs. 8.1 +/- 2.6 x 10(6)/ml). A nonsignificant difference was found in the LH/FSH ratio (1.41 +/- 0.64 vs. 1.63 +/- 0.72). We concluded that obesity and the consequent estrogen excess decrease the sperm concentration by influencing the hypothalamo-pituitary system.     

The Effect of Body Build and BMI on Aerobic Test Performance in School Children (10-15 Years)

Body Mass Index (BMI) has often questionably been used to define body build. In the present study body build was defined more specifically using fat free mass index (FFMI = fat free mass normalised to the stature) and fat mass index (FMI = fat mass normalised to stature). The body build of an individual is ‘solid’ in individuals with a high FFMI for their FMI and is ‘slender’ in individuals with a low FFMI relative to their FMI. The aim of the present study was to investigate the association between aerobic test performance and body build defined as solid, average or slender in 10 to 15 year old children. Five-hundred-and-two children (53% boys) aged 10 to 15 years of age were included in the study. Aerobic test performance was estimated with an incremental cycle ergometer protocol and a shuttle run test. BMI and percentage fat (by skin folds) were determined to calculate FMI and FFMI. After adjustment for differences in age, gender and body mass the solid group achieved a significantly higher maximal power output (W) and power output relative to body mass (W/kg) during the cycle test (p < 0.05) and a higher shuttle-run score (p < 0.05) compared to the slender group. The power output relative to FFM (W/kg FFM) was comparable (p > 0.05) between different body build groups. This study showed that body build is an important determinant of the aerobic test performance. In contrast, there were no differences in aerobic test performance per kilogramme FFM over the body build groups. This suggests that the body build may be determined by genetic predisposition.

Key Points

• Children with a solid body build perform better in aerobic exercise tests than slender children.
• The power output relative to fat free mass was comparable in the solid, slender and average group.
• Besides body composition, body build should be considered related to other performance measurements.

Key words: Shuttle run test, cycle test, BMI, percentage fat, solid body build, slender body build     

Body composition in paraplegic men.

To investigate alterations in the body composition of paraplegic men, 31 complete paraplegic men thoracic (T)4-T 12 neurological level of injury, 16 with paraplegia above (high), and 15 below (low) thoracic 7, were compared with 33 able-bodied men. Whole body dual X-ray absorptiometry was used to estimate regional (arms, legs) and total body bone mineral density (g/cm(2)), lean, and fat mass (g).The influence of the neurological level of injury and the duration of paralysis in relation with the above parameters were also investigated. Body mass index, bone mineral density, and lean mass were significantly decreased (p < 0.0005) and fat mass was increased (p < 0.05) in the legs and total body composition in paraplegics. Bone mineral density was significantly lower in high paraplegics' arms compared with low paraplegics (p = 0.028). The correlation of body mass index with fat mass was statistically significant in all paraplegics and controls (r = 0.57, p = 0.001 and r = 0.73, p = 0.0001, respectively) and in low paraplegics (r = 0.72, p = 0.004). Legs' bone mineral density and arms' fat mass were correlated with the duration of paralysis in all paraplegics (r = -0.46, p = 0.009 and r = 0.43, p = 0.020, respectively) and in high paraplegics (r = 0.73, p = 0.001 and r = 0.55, p = 0.042, respectively). Total fat mass was correlated with the duration of paralysis in high paraplegics (r = 0.5, p = 0.05). These results suggest body composition changes in paraplegics.     

El índice de masa corporal y la dieta afectan el desarrollo del cáncer de próstata

IntroductionProstate cancer (CaP) is one of the most important causes of morbidity and mortality in the world. There is evidence that obesity and inadequate eating habits may promote CaP development.ObjectiveTo analyze and compare the body mass index (BMI) and the food intake, especially fats and antioxidants, among subjects with CaP and those free of disease as a control group.Material and MethodsA sample of 40 men between 50 and 80 years old were selected for the study: 20 with CaP and 20 healthy men as control group. All volunteers underwent a digital rectal examination, prostate specific antigen level, ultrasound and transrectal prostate biopsy, and a nutritional interview where a dietary history and different anthropometric measurements were made. Statistical analysis was performed using the Student T test for independent samples (p <0.05).ResultsBMI in the subjects with CaP was higher than in controls (29.8 kg/m2 vs. 27.96 kg/m2, p = 0.13) but not statistically significant. However, there was a direct correlation between BMI and tumor aggressiveness (r = 0.79, P <0.001). Total, saturated, monounsaturated and polyunsaturated fat intake was significantly higher in subjects with CaP; while ?3 fatty acids, vitamin C and lycopene intake was significantly lower than in controls (p <0.05).ConclusionsA healthy weight and a diet low in total fat, saturated, monounsaturated and polyunsaturated fat and rich in ?3 fatty acids, vitamin C and lycopene is associated with a lower risk of CaP.     

BMI和SMI在类风湿关节炎继发骨质疏松中的临床研究

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者的体质量指数(body mass index,BMI)、脂肪质量指数(fat mass index,FMI)和骨骼肌质量指数(skeletal muscle mass index,SMI)与RA患者继发骨质疏松(osteoporosis,OP)的相关性。方法选择RA患者418例,同时选择同期健康体检的158名正常人作为对照组。采用双能X线骨密度仪测量研究对象股骨颈(Neck)、大转子(G.T)、总髋部(Hip)、腰椎1～4(L1、L2、L3、L4)部位的骨密度(bone mineral density,BMD)并参照OP诊断标准进行分级,采用直接节段多频率生物电阻抗测试法测定研究对象的骨骼肌含量、体脂肪、矿物质含量,并计算BMI、FMI和SMI。结果①RA患者各测定部位的BMD均明显低于正常对照组(P0.0001),其OP发生率(42.6%)明显高于对照组(13.9%)(χ~2=41.551,P0.0001)。②RA患者肌少症发生率(54.5%)明显高于对照组(9.0%)(χ~2=96.747,P0.0001)。③不同BMI组RA患者间各部位的BMD、SMI、FMI、矿物质含量、体脂百分比和骨骼肌含量是明显不同的(P0.0001),且随着BMI的增高,上述各指标均呈线性增高趋势(P0.0001)。④在BMI为消瘦的RA患者中,肌少症组中OP发生率与无肌少症组中相近(48.1%vs 45.5%,χ~2=0.027,P=0.870),在BMI为正常、超重或肥胖组中,肌少症组中OP发生率均明显高于无肌少症组(56.6%vs 33.0%,χ~2=12.238,P0.0001;52.6%vs 22.7%,χ~2=10.953,P=0.001)。在有或无肌少症的RA患者中,不同BMI组间RA患者OP发生率无明显差别(P=0.563、0.148)。⑤线性相关分析显示,SMI与各部位的BMD和BMI均呈正直线相关(P0.0001),而与体脂百分比呈负直线相关(P0.0001)。⑥多元Logistic回归分析显示,SMI(OR=0.696,P=0.001,95%CI:0.565～0.857)为RA患者发生OP的保护因素,年龄(OR=1.091,P0.0001,95%CI:1.065～1.117)和性别(OR=5.259,P0.0001,95%CI:2.543～10.876)均为RA患者发生OP的危险因素。结论 BMI、SMI和FMI均与RA患者OP的发生有关,但SMI是RA患者发生OP最重要的保护因素。     

Relation of forearm's bone and soft tissues to infant's body composition.

Small portable units using the dual X-ray absorptiometry method (pDEXA) are becoming available to evaluate a localized region of the body such as the forearm. The purpose of this study was to evaluate the relationship between infant's forearm measurements of bone mineral, lean, and fat mass and total body composition. Twenty-two infants participated in this study. Mean age of the infants was 21 d with a weight range of 1-3.6 kg. All infants were stable and had their forearm and total body scanned on the same day. The long-term precision error for the pDEXA was 0.4%. The infant's total body was scanned by the XR-26 (Norland Medical Systems, Fort Atkinson,WI). Forearm bone mineral content, bone mineral density (BMD), fat mass, and lean mass correlated to total body mineral content (BMC) (r = 0.84, p < 0.001), total body BMD (r = 0.73, p < 0.001), total fat mass (r = 0.53, p < 0.05), and total body lean mass (r = 0.80, p < 0.001). Forearm BMC, lean, and fat mass correlated significantly with body weight and length (r = 0.73-0.94). In conclusion, forearm measurements of bone mineral, fat, and lean mass reflect total body bone mineral, fat, and lean mass in small infants.     

Relationship between BMI, total testosterone, sex hormone-binding-globulin, leptin, insulin and insulin resistance in obese men

The objective of this work was to evaluate the relationship between sex steroid hormones, sex hormone-binding-globulin, leptin, insulin and insulin resistance in obese men. Anthropometrical indexes, total testosterone (Tt), free testosterone (fT), estradiol (E), sex hormone-binding-globulin (SHBG), glucemia, insulin and leptin were measured in 77 men, with ages between 20 and 60 years. According to their body mass index (BMI), subjects were grouped into three categories: normal body weight (< 24.9 kg/m2), overweight (25-29.9 kg/m2) and obese group (> 30 kg/m2). Insulin resistance index was obtained by the homeostasis assessment model for insulin resistance (HOMA-IR). Total testosterone and SHBG concentrations were lower in the obese group compared with normal and overweight subjects (p < 0.05). The mean insulin concentration was significantly higher in the obese group compared with the other groups (p < 0.05). T was negatively correlated with the BMI (r = -0.447; p < .01), WC (r = -0.464); p < .01, leptin (r = -0.382; p < .01), insulin (r = -0.391; p < 0.01) and also with the HOMA-IR (r = -0.416; p < 0.01). The SHBG negatively and significantly correlated with BMI (r = -0.334; p < 0.01) and WC index (= -0.322; p < 0.01), as well with insulin levels (r = -0.313; p < 0.01) and insulin resistance (= -0.266; p < 0.05). Our results shows that in a sample of men, Tt and SHBG concentrations proportionally diminished with both the increase of BMI and insulin resistance index.     

Obesity is Associated with Worsening Cardiovascular Risk Factor Profiles and Proteinuria Progression in Renal Transplant Recipients

Obesity is associated with adverse cardiovascular (CV) parameters and may be involved in the pathogenesis of allograft dysfunction in renal transplant recipients (RTR). We sought the spectrum of body mass index (BMI) and the relationships between BMI, CV parameters and allograft function in prevalent RTR. Data were collected at baseline and 2 years on 90 RTR (mean age 51 years, 53% male, median transplant duration 7 years), categorized by BMI (normal, BMI < or = 24.9 kg/m2; pre-obese, BMI 25-29.9 kg/m2; obese, BMI > or = 30 kg/m2). Proteinuria and glomerular filtration rate (eGFR(MDRD)) were determined. Nine percent RTR were obese pre-transplantation compared to 30% at baseline (p < 0.001) and follow-up (25 +/- 2 months). As BMI increased, prevalence of metabolic syndrome and central obesity increased (12 vs 48 vs 85%, p < 0.001 and 3 vs 42 vs 96%, p < 0.001, respectively). Systolic blood pressure, fasting blood glucose and lipid parameters changed significantly with BMI category and over time. Proteinuria progression occurred in 65% obese RTR (23 (13-59 g/mol creatinine) to 59 (25-120 g/mol creatinine)). BMI was independently associated with proteinuria progression (beta 0.01, p = 0.008) but not with changing eGFR(MDRD.) In conclusion, obesity is common in RTR and is associated with worsening CV parameters and proteinuria progression.     

Obesity as a predictor of biochemical recurrence and survival after radiation therapy for prostate cancer

OBJECTIVE: Obesity has been demonstrated to predict biochemical progression in men undergoing radical prostatectomy for prostate adenocarcinoma, and is associated with a higher risk of biochemical and clinical relapse after radiation therapy (RT). We evaluated if obesity, determined by body mass index (BMI), is associated with adverse disease characteristics, pre-treatment serum testosterone, biochemical disease free survival (bDFS), disease-specific survival (DSS), or overall survival (OS) in patients undergoing radical external beam radiation therapy for prostate cancer. PATIENTS AND METHODS: A cohort of 706 patients with localized prostate adenocarcinoma treated with RT between 1993 and 2001 were categorized as obese (BMI > or = 30 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)) or normal (BMI < 25 kg/m(2)). The association between BMI, disease characteristics, and progression were evaluated by Chi-square and ANOVA tests, Kaplan-Meier survival analysis, and Cox regression analysis. RESULTS: 195 patients (27.6%) were normal weight, 358 (50.7%) were overweight and 153 (21.7%) were obese. Obese men had lower serum testosterone levels than overweight and normal-weight men (means 12.8, 14.1, and 15.7 nmol/L, respectively; p < 0.001). The BMI groups did not differ in Gleason score, pretreatment PSA, or stage. On multivariate analysis, BMI group was predictive of reduced bDFS (p = 0.02) and DSS (p = 0.008), with a trend toward reduced OS (p = 0.062). CONCLUSION: Obesity was associated with lower serum testosterone levels but not with adverse pretreatment pathological features. Obese men have a higher risk of biochemical recurrence and prostate-cancer specific death after RT.     

Benefits of laparoscopic renal surgery are more pronounced in patients with a high body mass index

PURPOSE: Aim of this prospective study was to determine whether patients with a higher body mass index (BMI) will benefit more from laparoscopic procedures in respect to postoperative morbidity and pain as compared to regular patients. PATIENTS AND METHODS: Between September 1999 and October 2001, we performed 36 laparoscopic radical nephrectomies and 18 nephron sparing partial nephrectomies for renal cell carcinoma and 6 nephrectomies for benign disease (group 1, n=60). In addition, we performed 24 open radical nephrectomies and 18 nephron spearing interventions for renal cell carcinoma (group 2, n=42). Mean age was 59+/-17.9 years and average BMI was 27.1+/-3.3 kg/m(2) in the entire group. All techniques were evaluated for intraoperative results and complications. Postoperative morbidity was assessed in all patients by quantifying pain medication and by daily evaluation of Visual Analogue Scale (VAS). RESULTS: Mean hospitalisation time in group 1 as compared to group 2 was 10.1 days versus 5.4 days, average operating time was 273 minutes versus 187 minutes, mean length of skin incision was 7.2 cm versus 30.8 cm. Overall analgesic consumption was lower in the laparoscopic group (190 mg versus 590 mg, p<0.001), in patients with a BMI >28 kg/m(2) the difference was even more pronounced (160 mg versus 210 mg, p=0.032). In group 1, patients with a BMI >28 kg/m(2) had significantly less pain on the first and fourth postoperative day in a linear regression analysis (VAS1=10.714-0.218 BMI; r=0.688 (p<0.001) and VAS4=3.98-0.09 BMI, r=0.519 (p<0.001), respectively). In group 1, 3/60 (5.0%) and in group 2, 5/42 (11.9%) complications occurred, no difference was found in respect to a high BMI (p=0.411). CONCLUSION: Patients with a higher BMI (cut-off >28 kg/m(2)) benefit more from laparoscopy than slim patients in respect to postoperative pain and morbidity but do not experience more complications. Consequently, reluctance to perform laparoscopic procedures in patients with a higher BMI is no longer justified.     

Metabolic and Nutritional Status Changes After 10% WeightLoss in Severely Obese Patients Treated with Laparoscopic Surgery vs Integrated Medical Treatment

BACKGROUND: Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI] > 40 kg/m(2)). METHODS: Twenty patients (9 males, 11 females; 37.6 +/- 8 years; BMI = 50.1 +/- 8 kg/m(2)) treated with dietary therapy and lifestyle correction (group 1) have been compared with 20 matched patients (41.8 +/- 6 years; BMI = 50.4 +/- 6 kg/m(2)) treated with laparoscopic gastric bypass (LGBP; group 2). Patients have been evaluated before treatment and after >10% WL obtained on average 6 weeks after LGBP and 30 weeks after integrated medical treatment. Metabolic syndrome (MS) was evaluated using the Adult Treatment Panel III/America Heart Association (ATP III/AHA) criteria. Resting metabolic rate (RMR) and respiratory quotient (RQ) was assessed with indirect calorimetry; body composition with bioimpedance analysis. RESULTS: At entry, RMR/fat-free mass (FFM) was 34.2 +/- 7 kcal/24 h.kg in group 1 and 35.1 +/- 8 kcal/24 h.kg in group 2 and did not decrease in both groups after 10% WL (31.8 +/- 6 vs 34.0 +/- 6). Percent FFM and fat mass (FM) was 50.7 +/- 7% and 49.3 +/- 7% in group 1 and 52.1 +/- 6% and 47.9 +/- 6% in group 2, respectively (p = n.s.). After WL, body composition significantly changed only in group 1 (% FFM increased to 55.9 +/- 6 and % FM decreased to 44.1 +/- 6; p = 0.002). CONCLUSION: After >10% WL, MS prevalence decreases precociously in surgically treated patients; some improvements in body composition are observed in nonsurgically treated patients only. Further investigations are needed to evaluate long-term effects of bariatric surgery on body composition and RMR after stable WL.     

Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group.

Thinness (low percentage of body fat, low body mass index [BMI], or low body weight) was evaluated as a risk factor for low bone mineral density (BMD) or increased bone loss in a randomized trial of alendronate for prevention of osteoporosis in recently postmenopausal women with normal bone mass (n = 1609). The 2-year data from the placebo group were used (n = 417). Percentage of body fat, BMI, and body weight were correlated with baseline BMD (r = -0. 13 to -0.43, p < 0.01) and 2-year bone loss (r = -0.14 to -0.19, p < 0.01). Women in the lowest tertiles of percentage of body fat or BMI had up to 12% lower BMD at baseline and a more than 2-fold higher 2-year bone loss as compared with women in the highest tertiles (p 相似文献   

Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index.

Dietary calcium intake and physical activity are considered practical measures for prevention of osteoporosis. However, their associations with bone mineral density (BMD) in the elderly are not clear. The present study examined the association between osteoporosis and these two factors in relation to body mass index (BMI) in a cross-sectional, epidemiological study involving 1075 women and 690 men, aged 69 +/- 6.7 years (mean +/- SD). Dietary calcium intake (median of 580 mg/day) was inversely related to age (p = 0.01), positively related to physical activity index (PAI) (p = 0.01), femoral neck BMD (p = 0.01) in women, and higher lumbar spine (p = 0.003) and femoral neck BMD (p = 0.03) in men. Quadriceps strength was negatively associated with age (p < 0.0001) and positively related to BMI (p < 0.0001) and BMD (p < 0.0001) in both men and women. The PAI was associated with quadriceps strength (p < 0.0001) and femoral neck and lumbar spine BMD in women (p < 0.001) and with femoral neck BMD in men (p = 0.04); however, these associations were not significant after adjusting for age, BMI, quadriceps strength, and dietary calcium. Women in the top tertile of quadriceps strength (> or =23 kg) and dietary calcium intake (> or =710 mg/day) had 15% higher BMD than those in the lowest tertiles (< or =15 kg and < or =465 mg/day); the difference was comparable in men (11%). Among subjects with the lowest tertiles of BMI (< or =23 kg/m2 for women and < or =24 kg/m2 for men), quadriceps strength (< or =15 kg for women and < or =28 kg for men), and dietary calcium intake (< or =465 mg/day), 64% and 40% of women and men, respectively, were classified as having osteoporosis (based on a 2.5-SD reduction from the young-normal mean). The prevalence was only 12% in women and 1.5% in men among those in the highest tertiles of the three factors. Adequate dietary calcium intake and maintaining a physically active lifestyle in late decades of life could potentially translate into a reduction in the risk of osteoporosis and hence improve the quality and perhaps quantity of life in the elderly population.     

Obesity increases precision errors in dual-energy X-ray absorptiometry measurements

The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (<25 kg/m(2)) (n=48), overweight (25-30 kg/m(2)) (n=26), and obese (>30 kg/m(2)) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.     

BioEnterics Intragastric Balloon: Clinical Outcomes of the First 100 Patients—A Turkish Experience

BACKGROUND: The BioEnterics Intragrastric Balloon (BIB(R)) together with restricted diet has been used for the treatment of obesity and morbid obesity. METHODS: A prospective study was conducted on 100 patients who had undergone the BIB procedure between February 2005 and February 2007. RESULTS: Mean age, mean weight, and mean BMI of the patients were 35.35 +/- 9.25 years, 113.23 +/- 24.76 kg (range 73-200 kg), and 39.28 +/- 6.98 kg/m(2) (range 30-69.2 kg/m(2)), respectively. Six months after the BIB procedure, mean weight and mean BMI were reduced to 100.46 +/- 26.05 kg (range 58-178 kg) and 34.70 +/- 11 kg/m(2) (range 21.83-61.59 kg/m(2)), respectively. There was a statistically significant reduction in weight and BMI at 6 months after the BIB procedure (p < 0.01). Excess weight loss (EWL) at 6 months ranged between 0 and 28 kg, with a mean value of 12.68 +/- 7.70 kg. The subjects had 0 to 99.2% %EWL (mean 28.63 +/- 19.29). Reduction in BMI at 6 months ranged between 0 and 12.3 kg/m(2), with a mean value of 4.51 +/- 2.85 kg/m(2), and percent excess body mass index loss (%EBMIL) was 38.20 +/- 28.78% (range 0-158%). At 6 months, there was a significant reduction in body weight and BMI (p < 0.01) in both groups. The reduction in BMI of the morbidly obese group was significantly greater than that of the obese group (p = 0.035), and both the %EWL and %EBMIL of the morbidly obese patients were significantly lower than those of the obese patients at 6 months (p = 0.001). CONCLUSIONS: BIB application is a reasonable weight loss method with few complications.     

Post-parathyroidectomy serum phosphate kinetics is peculiar to female hemodialysis patients with a high body mass index

BACKGROUND: Persistent hyperphosphatemia is one of the most important factors in the development of secondary hyperparathyroidism (sHPTH). Recently, we demonstrated that a higher body mass index (BMI) and female gender could predispose to a larger phosphate (P) body burden, thereby influencing the severity of sHPTH. METHODS: This prospective study aimed to verify if these two risk factors, i.e. BMI and female gender, also influenced calcium (Ca) and P kinetics in the immediate post-parathyroidectomy (PTx) period in 42 consecutive adult Caucasian anuric hemodialysis (HD) patients referred for first PTx. Serum Ca and P were measured pre-PTx and on the 5 consecutive post-PTx days; serum immunoreactive parathyroid hormone (iPTH) and alkaline phosphatase (ALP) levels were measured pre-PTx and 3 days post-PTx. RESULTS: Ablation of parathyroid tissue determined a significant reduction in serum iPTH, ALP, Ca and P (p = 0.001). The stratification of the cohort into four groups according to the cut-off value of BMI = 25 kg/m(2) and according to gender showed the following: males and females with BMI >25 kg/m(2) (analyzed both separately and as a subgroup including males and females) had significantly higher pre-PTx serum P levels, when compared with the respective sub-groups with BMI <25 kg/m(2) (p < 0.01); a significantly higher mean area under the concentration curve (AUC) of serum P was observed in the high BMI group (males and females), when compared with the low/normal BMI group (p = 0.03); the serum P kinetics in the 5 post-PTx days did not differ between the two groups of male patients (low/normal BMI males vs. high BMI males), whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the low/normal BMI female patients (p = 0.003); finally, the serum P kinetics in the 5 post-PTx days did not differ between the two groups of low/normal male and female patients, whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the high BMI male patients (p = 0.006). A linear multiple regression analysis with the serum P AUC of each patient as a dependent variable and BMI, gender, age and dialysis duration as independent variables showed that BMI (p = 0.0001) and female gender (p = 0.001) were independent predictors of the serum P AUC. CONCLUSIONS: High BMI and female gender are associated with peculiar serum P kinetics in the immediate post-PTx period, suggesting the existence of a larger P body burden in high BMI female HD patients. The existence of a larger P pool exclusively based on serum P kinetics prompts the need for further studies to better understand such intriguing aspects of bone pathophysiology in response to parathyroid gland removal in chronically uremic patients.