Assessment of osteoporosis by quantitative ultrasound versus dual energy X-ray absorptiometry in children with chronic rheumatic diseases

OBJECTIVE: To evaluate the validity of quantitative ultrasound bone sonometry (QUBS) as a screening tool for the diagnosis of osteoporosis in children with chronic rheumatic diseases (CRD), compared to the conventional dual energy x-ray absorptiometry (DEXA). METHODS: Forty children with CRD [32 with juvenile idiopathic arthritis (JIA), 6 with systemic lupus erythematosus, and 2 with dermatomyositis] aged 9.9 +/- 4.3 years, were evaluated by QUBS of radius and tibia and DEXA of the lumbar spine. Twenty-five (62.5%) patients were treated with corticosteroids. Measurements of the velocity of the ultrasound wave, expressed as speed of sound (SOS) in m/s, and the results of the bone mineral density (BMD) assessed by DEXA were compared to reference data from healthy age and sex matched Israeli children. RESULTS: Compared to controls, patients with CRD had significantly lower values by QUBS and DEXA alike. BMD and SOS z scores < -1 SD were found in 45% and 38% of the patients, respectively. Reduced BMD and SOS values correlated with age at disease onset and corticosteroid treatment. BMD alone correlated negatively with disease duration and methotrexate therapy. BMD was significantly lower in patients with polyarticular JIA compared to patients with oligoarticular disease (p < 0.03). SOS values did not differ between subtypes of JIA. A significant positive correlation was found between the lumbar DEXA and radius SOS. CONCLUSION: QUBS evaluation of radius and tibia yielded results comparable to DEXA and may therefore be used for screening patients with CRD for osteoporosis. QUBS might represent a promising means of evaluating bone quality in at-risk children.     

The role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry

The aim of this study was to establish whether quantitative ultrasound (QUS) parameters could identify patients classified as osteoporotic and osteopenic on the basis of dual energy X-ray absorptiometry (DEXA). One hundred and twenty-three patients (39 male, 84 female) with osteoporosis and suspected of having osteoporosis were included in this study. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured and bone mineral densities (BMD) of the lumbar spine and left hip was measured by DEXA. Subjects were classified into three groups (normal, osteopenic and osteoporotic) on the basis of BMD T-scores measured by DEXA. QUS parameters of the osteoporotic group were significantly lower than those of osteopenic and normal groups; there was no difference in QUS parameters between the normal and osteopenic groups. Correlations of both right and left SOS and BUA with the spine and femoral neck BMD were moderate (r = 0.343-0.539, P < 0.001). There was also reasonable correlation between DEXA and QUS T-scores (r = 0.364-0.510, P < 0.001). QUS had a sensitivity of 21% and a specificity of 95% for diagnosing osteoporosis. We concluded that, although DEXA and QUS parameters were significantly correlated, QUS parameters can not predict osteopenia as defined by DEXA, and sensitivities and specificities of QUS parameters were not sufficiently high for QUS to be used as an alternative to DEXA.     

Performance of calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry in the discrimination of prevalent asymptomatic osteoporotic fractures in postmenopausal women

Due to its low cost, portability, and nonionizing radiation, quantitative ultrasound (QUS) of the heel is an alternative to the measurement with dual X-ray absorptiometry (DXA) in the evaluation of bone status. The objective of the study is to compare in asymptomatic postmenopausal women the ability of QUS and DXA to discriminate between those with and without prevalent vertebral fractures (VFs). The study cohort consists of a population of 295 postmenopausal women aged between 60 and 84 (mean age, weight and BMI of 66.3 years, 72.0 kg and 29.4 kg/m², respectively). Lateral VFA images and scans of the lumbar spine and proximal femur were obtained by two technologists using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. All women had a calcaneous QUS examination. The mean age of the women in our sample was 66.3 (±5.3) years, ranging from 60 to 84 years. Eighty-seven (29.3%) women had VFs Genant grade 2 and 3. Patients with VFs had an age and a number of years of menopause higher to those without VFs, but showed lower height, weight, and BMI. All densitometric and ultrasonometric measurements were significantly reduced in women with VFs. The intercorrelations of BMD at different sites were high, and the correlations of BUA with BMD were lower. BUA correlated weakly with total hip BMD (r = 0.36), lumbar spine BMD (r = 0.32), and much less with femur BMD (r = 0.30); all correlations were significant (P < 0.01). Analysis of the AUC for the ROC curves showed lumbar spine T-score below −2.5 to provide consistently the highest AUC (0.64). Age-adjusted ORs after correction for confounding variables (years of menopause, weight, height, and BMI) for QUS and BMD measurements showed that only lumbar spine T-score below −2.5 could predict significantly the presence of VFs (OR, 1.94; 95%CI, 1.02–3.41). Lumbar spine BMD (and not QUS) was able to discriminate asymptomatic postmenopausal women with prevalent VFs from women without VFs and independently contributed to determining the association with fracture. The combination of QUS and BMD did not improve the diagnostic ability of either individual technique.     

Poor correlations between measurements of bone quality by quantitative ultrasound sonography and dual energy X-ray absorptiometry in patients with beta-thalassaemia major

Objectives: Osteopenia/osteoporosis is a major component of morbidity even in young patients with β‐thalassaemia major. Dual energy X‐ray absorptiometry (DXA) is the reference method for determining bone mineral density (BMD). Quantitative ultrasound sonography (QUS) for bone measurement is a relatively new, inexpensive and radiation‐free method that could serve as an alternative to DXA. Our aim was to assess bone status in thalassaemic patients both with QUS and DXA and, consequently, to investigate the degree of correlation between the two methods. Methods: Thirty‐three patients (15 male and 18 female) with β‐thalassaemia major, regularly transfused and systematically iron‐chelated, participated in the study. Mean age was 22.0 ± 8.0 yr (range: 6.5–41.0 yr). All patients were evaluated with QUS at radius and tibia and had DXA scan at lumbar spine vertebrae (L2–L4), whereas 20 patients were additionally assessed with DXA at the left hip (femoral neck, trochanter region and Ward’s triangle). Results: Results were expressed as Z‐scores compared with sex‐ and age‐matched population. Lowest mean Z‐scores measured with DXA were recorded at lumbar spine and Ward’s triangle (?1.1 ± 1.13 and ?0.95 ± 1.07, respectively). Lowest mean QUS‐derived Z‐scores were measured at radius, statistically significant compared with Z‐scores measured at tibia (?0.6 ± 1.1 vs. 0.4 ± 1.1, P < 0.001). QUS measurements at radius were significantly correlated to QUS measurements at tibia (r = 0.51, P = 0.002). The latter were correlated to BMD measured at lumbar spine (r = 0.516, P = 0.002) and at trochanter region (r = 0.646, P = 0.003). All BMD measurements at hip were significantly correlated to each other. Lumbar spine BMD was correlated to BMD at femoral neck (r = 0.607, P = 0.003) and to BMD at Ward’s triangle (r = 0.438, P = 0.027). Finally, no agreement was recorded between the two methods in identifying thalassaemic patients at risk for osteoporosis (κ = 0.203, P = 0.04). Conclusion: Quantitative ultrasound sonography could not serve as an alternate to DXA.     

Differences between measurements of bone mineral densities by quantitative ultrasound and dual-energy X-ray absorptiometry in type 2 diabetic postmenopausal women

CONTEXT: Quantitative ultrasound (QUS) may be more helpful than dual-energy X-ray absorptiometry (DXA) in detecting bone deficits in patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: The objective of the study was to compare differences in bone mass measurement by DXA and QUS in T2DM and nondiabetic postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: This clinical investigation was a cross-sectional study in 76 patients with T2DM and 86 nondiabetic postmenopausal women. MAIN OUTCOME MEASURES: The primary outcomes were speed of sound (SOS) at the radius, phalanx, and tibia measured by QUS and bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) measured by DXA. RESULTS: BMDs in T2DM patients were higher (LS, 1.06 +/- 0.12 vs. 0.90 +/- 0.23 g/cm(2); FN, 0.80 +/- 0.13 vs. 0.74 +/- 0.12 g/cm(2); TH, 0.87 +/- 0.14 vs. 0.80 +/- 0.13 g/cm(2), respectively, P < 0.001), whereas SOSs were lower than those in nondiabetics (radius, 4044 +/- 178 vs. 4129 +/- 182 m/sec; phalanx, 3902 +/- 207 vs. 3999 +/- 214 m/sec, respectively, P < 0.001). The positive relationships between SOS and BMD (r = 0.26-0.75, P < 0.05) in nondiabetics were not observed in women with T2DM. T2DM impacted negatively on SOSs (radius, beta= -0.223, P <0.01; phalanx, beta= -0.219, P <0.01) but positively on BMDs (LS, beta = 0.314, P < 0.001; FN, beta = 0.173, P < 0.05; TH, beta = 0.203, P <0.01). CONCLUSIONS: Differences in bone mass as measured by DXA and QUS in postmenopausal T2DM and nondiabetic women do not change in parallel. QUS can provide useful information in the skeletal assessment of patients with T2DM.     

Bone mineral density, quantitative ultrasound parameters and bone metabolism in postmenopausal women with depression

Low bone mineral density, which increases the risk of stress fragility fractures, is a frequent, often persistent finding in patients with major depressive disorder (MDD). The clinical association between major depressive disorder and osteopenia is still unclear, although several factors are associated with a loss of bone mass. The aim of our study, therefore, was to evaluate bone mineral density and bone metabolism in patients with MDD. Bone mineral density was evaluated in fifty postmenopausal women with MDD, and in 50 matched postmenopausal control women by dual-energy X-ray absorptiometry of the lumbar spine and femur, and by ultrasonography of the calcaneus and phalanges. Serum levels of 25-hydroxivitamin D, parathyroid hormone, Osteoprotegerin/Receptor Activator for Nuclear Factor κB Ligand ratio, bone turnover markers, serum and urinary cortisol were examined. Bone mineral density of the lumbar spine (BMD: 0.72 ± 0.06 vs. 0.82 ± 0.09 g/cm², p < 0.001), femoral neck (BMD: 0.58 ± 0.04 vs. 0.71 ± 0.07 g/cm², p < 0.001) and total femur (BMD 0.66 ± 0.09 vs. 0.54 ± 0.06 g/cm², p < 0.001); and ultrasound parameters at calcaneus (SI: 81.30 ± 6.10 vs. 93.80 ± 7.10, p < 0.001) and phalanges (AD-SOS: 1915.00 ± 37.70 vs. 2020.88 ± 39.46, p < 0.001; BTT : 1.30 ± 0.8 vs. 1.45 ± 0.9, p < 0.001) are significantly lower in patients with MDD compared with controls. Moreover bone turnover markers, parathyroid hormone levels and Receptor Activator for Nuclear Factor κB Ligand are significantly higher in MDD patients compared with controls, while serum levels of 25-hydroxivitamin D and osteoprotegerin are significantly lower. There are no differences in urinary excretion and serum cortisol between groups. Postmenopausal women with depressive disorder have an elevated risk for osteoporosis. Our data suggest that a high level of parathyroid hormone may play a role in the pathogenetic process underlying osteopenia in these patients.     

Bone quality and bone mass as assessed by quantitative ultrasound and dual energy x ray absorptiometry in women with rheumatoid arthritis: relationship with quadriceps strength

OBJECTIVE: To examine relationships of bone quality as assessed by quantitative ultrasound (QUS) and bone mineral density (BMD, g/cm(2)) with quadriceps strength (QS) in women with rheumatoid arthritis (RA). METHODS: Sixty seven women with RA according to the 1987 American College of Rheumatology (ACR) criteria were examined. Mean (SD) age was 62 (13) years, mean disease duration 15 years. Most were or had been receiving glucocorticoid treatment. Calcaneal bone quality expressed as speed of sound (SOS, m/s), broadband ultrasound attenuation (BUA, dB/MHz), and stiffness was measured by QUS. BMD of the femoral neck, spine, and distal forearm was measured by dual energy x ray absorptiometry (DXA). Maximal voluntary isokinetic quadriceps strength (Nm) was assessed by isokinetic dynamometry. Pain was recorded on a visual analogue scale (VAS), disability was scored by the Stanford Health Assessment Questionnaire (HAQ), and the degree of physical impairment was expressed by the Steinbrocker index (SI). RESULTS: In multiple regression analyses, QS predicted SOS, BUA, and stiffness (r(partial) ranging from 0.36 to 0.45, p<0.005) and femoral neck BMD (r(partial)=0.30, p<0.05) independently of age, height, weight, disease duration, HAQ, VAS, SI, and cumulative steroid dose. BMD of the spine and distal forearm was not associated with QS. After adjustment for covariates, women with subnormal BMD of the femoral neck (T score <-1), had a 20% lower QS than those with normal BMD (p<0.0001). CONCLUSIONS: Calcaneal bone quality and femoral neck BMD were associated with QS in women with RA. This finding indicates that physical activity including muscle strengthening exercises may play a part in the prevention of bone loss in these patients.     

Multi-site quantitative ultrasound compared to dual energy X-ray absorptiometry in rheumatoid arthritis: effects of body mass index and inflamed soft tissue on reproducibility

The objective of the study is to evaluate multi-site quantitative ultrasound (QUS) in comparison to dual energy X-ray absorptiometry (DXA) considering the effects of body mass index (BMI) and disease activity on measurements in patients suffering from rheumatoid arthritis (RA). Sixty-eight patients underwent a cross-sectional analysis of bone mineral density measured by DXA (lumbar spine, total femur) and speed of sound estimated by QUS (phalanx III, distal radius). The short-term precision of QUS was investigated with regard to BMI of healthy individuals and with regard to the level of disease activity in patients suffering from RA. The patients with RA were divided into two BMI groups as well as into low and advanced disease activity groups. The short-term precision of QUS–SOS ranged from 0.90 to 2.55% (healthy controls) and from 0.64 to 1.89% (patients with RA). The association between DXA and QUS parameters were limited in the case of advanced disease activity and pronounced BMI. Low QUS–SOS was observed for advanced disease activity group (QUS–SOS phalanx: −2.5%; QUS–SOS distal radius: −2.1%) in comparison to low disease activity group, whereas only a slight change of DXA parameters was observed. DXA–BMD and QUS parameters revealed higher values with pronounced BMI. The system shows only a short-term precision with limitations in healthy controls with accentuated BMI, as well as in patients with active RA. The application of multi-site QUS seems to be restricted for patients with active inflammation based on soft tissue alteration in RA and for healthy individuals with pronounced body mass.     

Bone mineral density in patients with hyperthyroidism measured by dual energy X-ray absorptiometry

OBJECTIVE We assessed the changes of bone mass in patients with hyperthyroidism by measuring bone mineral density using a new method, dual energy X-ray absorptiometry. DESIGN The values of bone mineral density in patients with hyperthyroidism were compared with data obtained from the controls, and we assessed the correlation analysis between bone mineral density and several metabolic parameters. PATIENTS We studied 52 Japanese patients with hyperthyroidism (20 males, 32 females). Healthy normal subjects served to establish the mean bone mineral density In the healthy Japanese population (Shiraki et al. 1991). MEASUREMENT Bone mineral density was assessed by the measurement of lumbar vertebrae and femur by dual energy X-ray absorptiometry. The bone mineral density of vertebrae for each patient was calculated as the percentage of the mean value (% bone mineral density) obtained from an age and sex-matched control group. Blood was drawn to measure the levels of serum calcium, phosphorus, creatinine, alkaline phosphatase, free T3, free T4, TSH, TSH receptor antibody, parathyroid hormone, and serum osteocalcin. RESULTS The percentage bone mineral density of vertebrae in patients was 92.6 as compared with that of normal controls, and was inversely correlated with serum TSH receptor antibody, osteocalcin, and alkaline phosphatase. CONCLUSIONS These findings suggest that bone mineral density is decreased in patients with hyperthyroidism and that TSH receptor antibody, osteocalcin, and alkaline phosphatase are sensitive markers of bone metabolism alterations in hyperthyroidism.     

Relationship between absorptiometry and ultrasound measurements of abdominal subcutaneous fat tissue in postmenopausal women

The purpose of this study was to describe the association of abdominal subcutaneous adipose tissue (SAT) as assessed by ultrasound with fat tissue in the abdomen, trunk, and other areas as measured by DXA in 101 postmenopausal Caucasian women (62.5 years; 27.3 kg/m(2); 43.0% body fat). Ultrasound SAT thickness was calculated with electronic calipers positioned at the skin-fat and fat-muscle computer screen interface, at the suprailiac (SUPT) and abdominal (ABDT) sites. Pearson correlation showed significant ( p<0.001) coefficients between SAT by DXA at both ABDT ( r=0.644) and SUPT ( r=0.537). Other DXA measurements were also associated ( p<0.001) with SAT assessed by DXA and ultrasound. In postmenopausal women, DXA estimates of subcutaneous and total adiposity are moderately associated with ultrasound measures of fat in the abdomen. Future research at our and other laboratories should clarify the clinical and practical significance of these findings.     

Prediction of fractures in perimenopausal women: a comparison of dual energy x ray absorptiometry and broadband ultrasound attenuation.

OBJECTIVE: To consider whether bone mineral density (BMD) measurements can predict traumatic fractures occurring in perimenopausal women. METHODS: One thousand perimenopausal women called up for screening underwent both dual energy x ray absorptiometry (DXA) of the spine and hip, and broadband ultrasound attenuation (BUA) of the heel. Two years later, they were sent a questionnaire to discover those who had since had a fracture, and compare them with those who had not. RESULTS: About 2% of the women had sustained a fracture in the two years since attendance for screening. Fractures in this age group can be predicted weakly, but significantly, by bone mass measurements using DXA and BUA (odds ratios from 1.4 to 2.1). The lumbar spine appeared to be one of the best predictive sites (odds ratio for 1 SD reduction in BMD 2.1 (95% confidence interval 1.2 to 3.8)), but no significant differences were found between the areas under the curve in receiver operator characteristic (ROC) analysis. CONCLUSION: In this preliminary study it appeared that bone mass measurements are predictive of perimenopausal traumatic fractures in addition to postmenopausal fractures related to osteoporosis. DXA of the lumbar spine did not perform significantly better than BUA. The number of fractures occurring was low, however, and further long term follow up is required to confirm the finding.     

Body composition analysis by dual energy X-ray absorptiometry and exercise performance in underweight patients with COPD

STUDY OBJECTIVES: The aim of this study was to examine the effect of body composition on maximal exercise performance in patients with COPD. METHODS: The study was carried out on 27 patients with COPD and was confirmed by pulmonary function testing. Body composition was measured by dual energy x-ray absorptiometry (DXA). Exercise performance was conducted on a cycle ergometer and was measured as maximal work rate (WRmax) and maximal oxygen uptake (VO2max). Bone mineral content (BMC), lean mass (LEAN), and fat mass (FAT) were assessed by DXA and were expressed as a percentage of ideal body weight, BMC, LEAN, and FAT. RESULTS: LEAN% correlated significantly with VO2max (r = 0.66, p = 0.0002) and WRmax (r = 0.70, p < 0.0001). No significant correlation was found between FAT% and exercise performance. By stepwise regression analysis, variables significantly contributing to WRmax and VO2max were LEAN% and the maximal voluntary ventilation. Total variance explained in these models was 81% for WRmax aid 82% for VO2max. CONCLUSION: Lean mass was an important determinant of maximal exercise performance in patients with COPD.     

Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD.

The measurement of body composition is of value in the nutritional assessment of patients with chronic obstructive pulmonary disease (COPD). The purpose of the present study was to compare two bedside methods for the measurement of body composition using dual energy X-ray absorptiometry (DEXA) as a reference method. Fat-free mass (FFM) was measured using DEXA, bioelectric impedance analysis (BIA) and skinfold anthropometry (SFA) in a cohort of 85 COPD patients accepted for pulmonary rehabilitation. Patients whose body mass index was >30 were excluded. Relative to DEXA, BIA underestimated FFM, whereas it was overestimated by SFA. There was a systematic increase in bias with mean FFM for both DEXA versus BIA and DEXA versus SFA, but this was almost eliminated when results were expressed as FFM index. Significant sex differences in the bias of BIA and SFA measurements of FFM were found. Forty-two (49.4%) patients were identified as nutritionally depleted using DEXA. Compared to DEXA, the sensitivity for detecting nutritional depletion was 86 and 74% for BIA and SFA, respectively, and the specificity 88 and 98%, respectively. There are significant intermethod differences in the measurement of body composition in chronic obstructive pulmonary disease patients. The choice of measurement method will have implications for nutritional assessment in chronic obstructive pulmonary disease.     

Validation of dual energy X-ray absorptiometry (DXA) by comparison with chemical analysis of dogs and cats

BACKGROUND: Dual-energy X-ray absorptiometry (DXA) has been used extensively to measure body composition, but has been validated by comparison to chemical analysis on relatively few occasions. Moreover, these previous validation studies have ground up entire carcasses prior to chemical analysis, thus potentially obscuring sources of error in the DXA analysis. OBJECTIVE: The purpose of this study was to validate DXA by comparison to chemical analysis in dogs and cats, performing chemical analysis on dissected rather than ground carcasses to reveal sources of discrepancy between the two methods. DESIGN: Sixteen animals (10 cats and 6 dogs weighing between 1.8 and 22.1 kg) were scanned by DXA post-mortem using a Hologic QDR-1000 W pencil beam machine and then dissected into 22 separate components. Individual tissues were dried and then sub-sampled for analysis of fat content by Soxholet extraction, or ashing in a muffle furnace. Body composition by DXA was compared to body composition by chemical analysis and discrepancies between the two correlated with chemical composition of individual tissues. We also explored the capability of the machine to establish the fat contents of mixtures of ground beef, lard and water. RESULTS: DXA estimates were strongly correlated with estimates derived from chemical analysis: total body mass (r=1.00), lean tissue mass (r=0.999), body water content (r=0.992) and fat mass (r=0.982). Across individuals the absolute and percentage discrepancies were also small: total body mass (13.2 g, 1.02%), lean tissue mass (119.4 g, 2.64%), water content (101 g, 1.57%) and fat content (28.5 g, 2.04%), where the percentage error is expressed relative to the average mass of that component across all individuals. Although on average DXA compared very well to chemical analysis, individual errors were much greater. Individual errors in the lean tissue and fat tissue components were strongly correlated with the fat content of skeletal muscle and the lean content of mesenteric fat. The error in the DXA estimate of total fat content was related to skeletal muscle hydration. Experimental studies using mixtures of lean ground beef, water and lard indicated that tissue hydration may have important effects on the perception of tissue fat content by DXA. Bone mineral content by DXA was approximately 30% lower than whole body ash content but only 7.7% lower than ash content of the bones. CONCLUSIONS: On average pencil beam DXA analysis using the Hologic QDR-1000 W machine provides an accurate estimate of body composition in subjects weighing between 1.8 and 22.1 kg. Individual discrepancies, however, can be large and appear to be related to lean tissue hydration.     

Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents

OBJECTIVE: To compare estimates of adiposity by dual emission X-ray absorptiometry (DXA), skinfolds and body mass index (BMI); and to evaluate the relation of these measures to cardiovascular risk in adolescents. DESIGN: In a cohort of adolescents participating in a longitudinal study of insulin resistance, Slaughter formulas were used to estimate adiposity from skinfolds and DXA was used to estimate adiposity as % body fat (%BF) and fat mass (FBM). BMI, blood pressure, lipids and insulin resistance were measured. SUBJECTS: Male and female, 11-17 y old (n=130). MEASUREMENTS: To compare DXA with two office-based methods of assessing fatness and cardiovascular risk. RESULTS: Slaughter estimates were highly correlated with DXA (%BF r=0.92, P=0.0001; FBM r=0.96, P=0.0001). Correlations were similar in heavy and thin children. BMI was also highly correlated with DXA (%BF r=0.85, P=0.0001; FBM r=0.95, P=0.0001), and these relations were stronger in heavy than thin children. BMI and the Slaughter formulas were similar to DXA in their relations to cardiovascular risk factors. CONCLUSIONS: Adiposity by BMI and Slaughter formulas are highly correlated with DXA and similarly related to cardiovascular risk factors. BMI is easy to obtain and is an acceptable method for initial office estimation of body fatness. BMI and skinfolds compare well with DXA in predicting adverse cardiovascular risk profile.     

Body composition changes induced by chronic ethanol abuse: evaluation by dual energy X-ray absorptiometry

OBJECTIVE: Nutritional disorders in alcoholics remain one of the most relevant medical problems in Western societies. As ethanol can supply >50% of the dietary energy in alcoholics, body composition alterations may easily occur. The aim of the present study was to evaluate the influence of chronic alcohol consumption on body composition in alcoholics compared to healthy social drinkers. METHODS: A total of 34 alcoholics defined according to DSM III R criteria, aged 41.6 +/- 9.3 yr and with a body mass index (BMI) 23.8 +/- 3.2 kg/m2, were consecutively enrolled in the study. In addition, 43 healthy male social drinkers were used as controls. Body composition was assessed using dual energy x-ray absorptiometry (DXA), and dietary habits were determined by a 3-day food diary. RESULTS: Mean daily alcohol intake was 194 +/- 62.4 g/day in alcoholics and 35.7 +/- 5.2 in healthy subjects (p < 0.0001). Body weight did not differ between alcoholics and controls (70.1 +/- 9.9 vs 71.8 +/- 6.4 kg). Alcoholics had a lower percent body fat (PBF) than control subjects (18.7 +/- 3.7 vs 23.9 +/- 3.9%; p < 0.01), as well as a lower fat mass content (13.4 +/- 3.8 vs 17.0 +/- 3.7 kg; p < 0.01). BMI was highly correlated with PBF in the patient population studied (R = 0.79; p < 0.0001). Significantly higher waist-to-hip ratios were found in alcoholics than in healthy subjects (p < 0.01). No correlation was found between dose of ethanol or duration of alcohol abuse and any of the variables examined. CONCLUSIONS: Alcoholics showed a reduced fat mass and a good preservation of lean body mass with respect to control subjects, and duration of alcohol use and alcohol dose did not seem to influence body composition. These data suggest that, unlike control subjects, alcoholics cannot store the calories provided by ethanol as fat deposits.