The ratio of autophagy activity and protein resynthesis in patients undergoing a wellness program in combination with food deprivation

Born Large for Gestational Age: Bigger Is Not Always Better

Body composition phenotypes and bone health in young adults: A cluster analysis

Body composition can substantially impact elite swimming performance. In practice, changes in fat and lean mass of elite swimmers are estimated using body mass, sum of seven skinfolds (∑7) and lean mass index (LMI). However, LMI may be insufficiently accurate to detect small changes in body composition which could meaningfully impact swimming performance. This study developed equations which estimate dual-energy x-ray absorptiometry (DXA)-derived lean and fat mass using body mass and ∑7 data. Elite Australian swimmers (n = 44; 18 male, 26 female) completed a DXA scan and standardised body mass and ∑7 measurements. Equations to estimate DXA-derived lean and fat mass based on body mass, ∑7 and sex were developed. The relationships between ∑7, body mass and DXA-derived lean and fat mass were non-linear. Fat mass (Adjusted R2 = 0.91; standard error = 1.0 kg) and lean mass (Adjusted R2 = 0.99; standard error = 1.0 kg) equations were considered sufficiently accurate. Lean mass estimates outperformed the LMI in identifying the correct direction of change in lean mass (82% correct; LMI 71%). Using the accurate estimations produced by these equations will enhance the prescription and evaluation of programmes to optimise the body composition and subsequent performance in swimmers.

Background/Introduction Primary hyperparathyroidism (PHPT) is known to have a substantial impact on bone mineral density (BMD), yet the influence of body composition remains unclear. Purpose This study aimed to explore associations between Dual-energy X-ray Absorptiometry (DXA)-derived lean and fat mass parameters and BMD at key skeletal sites in patients with PHPT. Methods We conducted an analysis of BMD at the lumbar spine, hip, and distal radius (forearm), alongside body composition indices, in a cohort of 60 adults diagnosed with PHPT. All patients were evaluated prior to any treatment. Univariate and multivariable linear regression models were employed to assess the relationships between BMD and body composition parameters, including appendicular lean mass index (AP_LMI), fat mass index (FMI), muscle mass index (MMI), total fat mass, and fat mass percentage (FM%). Results The mean BMD values of the cohort were: lumbar spine 0.938 ± 0.15 g/cm2, total hip 0.760 ± 0.14 g/cm2, femoral neck 0.662 ± 0.13 g/cm2, and forearm 0.476 ± 0.08 g/cm2. Body composition analysis showed a mean AP_LMI of 6.58 ± 1.22 kg/m2, FMI of 13.33 ± 4.48 kg/m2, MMI of 15.97 ± 2,47 kg/m2, total fat mass of 34.19 ± 11.47kg, and fat mass percentage (FM%) of 43.6 ± 7.1%. In univariate analyses, AP_LMI (p = 0.009), FMI (p = 0.019), MMI (p = 0.027), and total fat mass (p = 0.003) demonstrated significant associations with total hip BMD. In multivariable analysis, AP_LMI remained a borderline significant predictor of total hip BMD (β = 0.294, p = 0.067). For forearm BMD, univariate analysis showed significant associations with AP_LMI (p = 0.021) and FM% (p = 0.011). In the multivariable model, AP_LMI remained an independent predictor (p = 0.009), while FMI showed a borderline inverse association (p = 0.068). No significant associations were observed between body composition parameters and lumbar spine BMD. Conclusion(s) In individuals with PHPT, lean mass emerges as an independent predictor of BMD. This highlights the importance of muscle mass, advocating for the incorporation of lean mass assessment in DXA-based evaluations for PHPT and the value of interventions aimed at increasing lean mass in this population.

Associations between three diet quality indices, genetic risk and body composition: A prospective cohort study

ObjectiveOur primary objective was to determine the long-term effects of physical activity (PA) and weight loss (WL) on body composition in overweight/obese older adults. Secondarily, we evaluated the association between change in body mass and composition on change in several cardiometabolic risk factors and mobility.Design and Methods288 older (X±SD: 67.0±4.8 years), overweight/obese (BMI 32.8±3.8 kg/m2) men and women participated in this 18 month randomized, controlled trial. Treatment groups included PA+WL (n=98), PA-only (n=97), and a successful aging (SA) health education control (n=93). DXA-acquired body composition measures (total body fat and lean mass), conventional biomarkers of cardiometabolic risk, and 400-m walk time were obtained at baseline and 18 months.ResultsFat mass was significantly reduced from (X±SE) 36.5±8.9 kg to 31.7±9.0 kg in the PA+WL group (p<0.01), but remained unchanged from baseline in the PA-only (−0.8±3.8 kg) and SA (−0.0±3.9 kg) groups. Lean mass losses were three times greater in the PA+WL group compared to PA-only or SA groups (−2.5±2.8 kg vs. −0.7±2.2 kg or −0.8±2.4 kg, respectively; p<0.01); yet due to a larger decrease in fat mass, percent lean mass was significantly increased over baseline in the PA+WL group (2.1%±2.6%; p<0.01). Fat mass loss was primarily responsible for WL-associated improvements in cardiometabolic risk factors, while reduction in body weight, regardless of compartment, was significantly associated with improved mobility.ConclusionThis 18 month PA+WL program resulted in a significant reduction in percent body fat with a concomitant increase in percent body lean mass. Shifts in body weight and composition were associated with favorable changes in clinical parameters of cardiometabolic risk and mobility. Moderate PA without WL had no effect on body composition.

&lt;p dir="ltr"&gt;&lt;a href="" target="_blank"&gt;This narrative review highlights the degree to which new anti-obesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. &lt;/a&gt;Glucagon-like peptide-1 receptor agonists (GLP-1ra) induce substantial weight loss in randomised trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Therapies such as liraglutide and semaglutide (GLP-1ra), tirzepatide (GLP-1 and GIP receptor dual agonist) and retatrutide (GLP-1, GIP, and glucagon-receptor triple agonist), are peptides with incretin agonist activity that induce up to ~15-24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. &lt;a href="" target="_blank"&gt;However, these agents also cause rapid and significant loss of lean mass (~10%, ~6 kg), comparable to a decade of ageing. &lt;/a&gt;Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration over 10 weeks can elicit large increases in lean mass (~3 kg) and strength (~25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared to either alone. Retaining lean mass during incretin therapy could potentially blunt body weight (and fat) re-gain on cessation of weight loss pharmacotherapy. &lt;a href="" target="_blank"&gt;We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy, to optimise changes in body composition by preserving lean mass while achieving fat loss.&lt;/a&gt;&lt;/p&gt;

A number of studies have found an association between the increased concentration of glial fibrillar acid protein (GFAP) in blood serum in patients with various types of brain damage (ischemic stroke, traumatic brain injury, neurodegenerative and neuro-oncological diseases), as well as with a rapid decline in cognitive functions in elderly people with initially normal cognitive abilities.The objective: to identify the relationship between delayed cognitive recovery and changes in serum GFAP concentration in the perioperative period in patients operated for various oncological diseases.Subjects and Methods. The study included 30 patients who underwent surgical treatment for prostate cancer, colorectal cancer and pancreatic cancer under combined general anesthesia.The inclusion criteria were the expected duration of the operation over 300 minutes and the age over 60 years. GFAP was determined in plasma by enzyme immunoassay before anesthesia, the next day after surgery and on the 4th–5th day. Neuropsychological testing was performed before surgery and on the 4th–5th postoperative day. Delayed cognitive recovery was defined as a decrease in the composite z-score of more than one standard deviation (SD) compared to the preoperative assessment.Correlation analysis was performed between changes in the composite z-score (in absolute values) and the difference in GFAP concentration between the outcome and the first postoperative day, the outcome and the 4th–5th postoperative day and the first and 4th–5th postoperative days.Results. In five cases (16.6%), a decrease in the composite z-score &gt; 1 SD was revealed indicating a delayed cognitive recovery. In the remaining 25 (83.4%) patients, changes in the composite z-score were less than one standard deviation. The median concentration of GFAP in patients with delayed cognitive recovery was 0.13 [0.1; 0.14] before surgery, 0.12 [0.09; 0.14] the day after surgery and 0.16 [0.05; 0.19] on the 4th–5th day after surgery. In patients without cognitive impairment, the concentration of GFAP was 0.15 [0.125; 0.184] before surgery, 0.15 [0.121; 0.163] 24 hours after surgery and 0.13 [0.079; 0.151] on the 4th–5th day after surgery. The correlation values between changes in the composite z-score and the difference in GFAP concentrations were: between the outcome and the first postoperative day – rs = 0.107, p = 0.37, outcome and the 4th–5th postoperative day – rs = 0.134, p = 0.37, the first and 4th‒5th postoperative days – rs = 0.21, p = 0.37.Discussion. There was no statistically significant difference in GFAP levels between patients with delayed cognitive recovery and patients without cognitive impairment. There was also no correlation between the difference in GFAP concentrations in plasma before surgery and 24 hours after, before surgery and on the 4th–5th day of the postoperative period and the composite z-score.Conclusions. The use of GFAP to predict cognitive decline associated with surgical treatment of colorectal cancer, prostate cancer and pancreatic cancer under general anesthesia is not yet possible.

Introduction Fabry disease (FD) is an X-linked sphingolipidosis characterized by pathogenic variants in the GLA gene, which affect alpha-galactosidase A activity. Studies on body composition in FD patients have shown conflicting results. There is significant variability in weight and body mass index (BMI) among FD patients, likely due to chronic inflammatory status, gastrointestinal and renal disturbances, inactivity, exercise intolerance, and medications. However, there is no study that evaluate body composition using dual-energy X-ray absorptiometry (DXA) in FD patients compared to healthy controls. Objectives To assess body composition by DXA in Brazilian male FD patients and to compare the findings with those of healthy controls (HC). Additionally, to correlate the DXA measurements with Lyso-Gb3 concentrations, the main substrate accumulated in the disease. Method Fifteen genotype-confirmed classic male FD patients and 20 sex/age-matched HC had body composition evaluated by DXA. Lyso-Gb3 levels were obtained for FD patients. Results Mean age was 44.2 ± 12.3 years and 44.9 ± 11.8 years in FD patients and HC, respectively (p = 0.87). BMI in FD patients (22.9 ± 3.7 kg/m2) was not statistically different from HC (24.8 ± 2.4 kg/m2, p = 0.07). Appendicular lean mass was lower in FD patients (20,324 ± 2808 g) than HC (25529 ± 2535 g, p &lt; 0.0001), as well as the appendicular lean mass index (7.24 ± 0.89 vs. 8.72 ± 0.80 kg/m2, p &lt; 0.0001). There were no differences between patients and controls regarding fat mass or fat percentage. Lyso-Gb3 levels were inversely correlated with lean mass (r = - 0.63, p = 0.01), fat mass (r = - 0,68, p = 0.005) and fat percentage (r = - 0.64, p = 0.01). Conclusion Adult FD patients in this cohort had lower lean mass than controls. Lyso-Gb3 accumulation is associated with lower values of lean mass, fat mass and fat percentage in FD patients.

The use of androgen deprivation therapy (ADT) in the treatment of prostate cancer is associated with changes in body composition including increased fat and decreased lean mass. Limited information exists regarding the rate and extent of these changes. This systematic review was conducted to determine the effects of ADT on body composition in prostate cancer patients. Literature searches were conducted on MEDLINE, EMBASE and Web of Science for studies until January 2009. Only longitudinal studies that examined ADT and body composition in prostate cancer patients were included. Data were extracted on body weight, BMI, percentage of fat mass and lean body mass. Sixteen studies (14 cohorts and 2 RCTs) met the inclusion criteria. Pooled data, calculated according to a random effects model, showed that ADT increased % body fat by on average 7.7% (95% CI 4.3, 11.2, from seven studies, P < 0.0001) and decreased % lean body mass by on average -2.8% (95% CI -3.6, -2.0, from six studies, P < 0.0001) but for both there was marked heterogeneity between studies (I2 = 99% I2 = 73%, respectively). Similarly, body weight (2.1%, P < 0.0001 from nine studies) and BMI (2.2%, P < 0.0001, from eight studies) increased significantly. More extensive changes were seen with longer duration of treatment. Substantial increases in fat and declines in lean mass were observed in prostate cancer patients treated with ADT. Lifestyle changes or suitable interventions to minimize the effect of ADT on body composition need to be investigated. Prostate cancer survivors should be made aware of the side effect of treatment on body composition and further work is required to determine what interventions can minimize the impact of ADT on body composition and therefore what evidence based advice they should be provided with. In general, though recommendation of a healthy diet and moderate exercise is reasonable.

SAT0105 Adiposity and Loss of Lean Mass Are Associated with Increased Knee Pain in Older Adults

Several investigations that yielded different results in terms of net changes in body composition of weight-losing cancer patients have been reported that employed a variety of methods based on fundamentally different technology. Most of those reports were cross-sectional, whereas to the authors' knowledge there is sparse information available on longitudinal follow-up measurements in relation to other independent methods for the assessment of metabolism and performance. For the current report, the authors evaluated time course changes in body composition (dual-energy X-ray absorptiometry) with measurements of whole body and regional distribution of fat and lean tissue in relation to food and dietary intake, host metabolism (indirect calorimetry), maximum exercise capacity (walking test), and circulating hormones in cancer patients who were receiving palliative care during 4-62 months of follow-up. The entire cohort comprised 311 patients, ages 68 years +/- 3 years who were diagnosed with solid gastrointestinal tumors (84 colorectal tumors, 74 pancreatic tumors, 73 upper gastrointestinal tumors, 51 liver-biliary tumors, 3 breast tumors, 5 melanomas, and 21 other tumor types). Decreased body weight was explained by loss of body fat, preferentially from the trunk, followed by leg tissue and arm tissue, respectively. Lean tissue (fat-free mass) was lost from arm tissue, whereas trunk and leg tissue compartments increased, all concomitant with declines in serum albumin, increased systemic inflammation (C-reactive protein, erythrocyte sedimentation rate), increased serum insulin, and elevated daily caloric intake; whereas serum insulin-like growth factor 1 (IGF-1), resting energy expenditure, and maximum exercise capacity remained unchanged in the same patients. Serum albumin levels (P < 0.001), whole body fat (P < 0.02), and caloric intake (P < 0.001) predicted survival, whereas lean tissue mass did not. Daily intake of fat and carbohydrate was more important for predicting survival than protein intake. Survival also was predicted by serum IGF-1, insulin, leptin, and ghrelin levels (P < 0.02 - P < 0.001). Serum insulin, leptin, and ghrelin (total) levels predicted body fat (P < 0.001), whereas IGF-1 and thyroid hormone levels (T3, free T3) predicted lean tissue mass (P < 0.01). Systemic inflammation primarily explained variation in lean tissue and secondarily explained loss in body fat. Depletion of lean arm tissue was related most to short survival compared with the depletion of lean leg and trunk tissue. The current results demonstrated that body fat was lost more rapidly than lean tissue in progressive cancer cachexia, a phenomenon that was related highly to alterations in the levels of circulating classic hormones and food intake, including both caloric amount and diet composition. The results showed importance in the planning of efficient palliative treatment for cancer patients.

Fat-free mass has gained wide acceptance as a scaler of the maintenance dose rate in obese patients. The choice of fat-free mass as a size scaler for the maintenance dose rate is based on its relationship with drug clearance, on the basis that only lean tissue is sufficiently metabolically active to provide capacity for elimination. For xenobiotics, the majority of biotransformation occurs in the liver and hence fat-free mass is implied to scale linearly with the component of liver that is metabolically active. The liver, like the body, can be assumed to comprise two components, lean mass and fat mass. We expect the lean liver mass (or volume) to be the component that most closely relates to drug clearance. The objective of this study was to investigate the relationship of lean liver volume and fat-free mass. Total liver volume and liver fat volume were measured in 100 Indian adults by computed tomography. Lean liver volume was derived as the difference between the two measurements (as liver volume - liver fat volume). Covariate modelling to describe lean liver volume, using NONMEM version 7.3, involved testing the influence of body weight, sex, body surface area and fat-free mass with or without allometric scaling (by estimating the exponent) and the influence of clinical chemistry variables. The final model did not exclude a linear relationship between lean liver volume and fat-free mass, while allometric scaling by body weight0.75 was also supported by the data. While scaling by fat-free mass, the coefficient of proportionality (i.e. lean liver volume per kg fat-free mass) was higher in female (31.25mL) than male (25.81mL) subjects. A model to predict lean liver volume from readily available patient data was developed and evaluated. Fat-free mass plus sex was found to be the best body descriptor to scale lean liver volume. The utility of this model in scaling drug clearance and dose requirements of hepatically cleared drugs needs further exploration.

Effect of body weight and energy intake on body composition analysis of broiler breeder hens.

Increasing protein content of the diet might be an effective strategy to preserve muscle mass in older adults undergoing caloric restriction, thereby preserving muscle function. Ninety-six older adults (70.3 ± 3.7 years, 74% women, 27% African American) with obesity (35.4 ± 3.3 kg/m2; 47% total body fat) were randomized to a 6-month higher protein (providing 1.2-1.5 g/kg/d) weight loss (WL) program, utilizing the Medifast 4&2&1 Plan, or to weight stability (WS). Dual-energy x-ray absorptiometry-acquired total body mass and composition, and fast gait speed over 400 m was assessed at baseline, 3, and 6 months. At baseline, dual-energy x-ray absorptiometry-acquired total body, fat, and lean masses were 95.9 ± 14.6, 44.6 ± 7.6, and 48.7 ± 9.5 kg, respectively, and 400-m gait speed was 1.17 ± 0.20 m/s. Total body mass was significantly reduced in the WL group (-8.17 [-9.56, -6.77] kg) compared with the WS group (-1.16 [-2.59, 0.27] kg), with 87% of total mass lost as fat (WL: -7.1 [-8.1, -6.1] kg; -15.9% change from baseline). A differential treatment effect was not observed for change in lean mass (WL: -0.81 [-1.40, -0.23] kg vs WS: -0.24 [-0.85, 0.36] kg). Four-hundred-meter gait speed was also unchanged from baseline although trends suggest slightly increased gait speed in the WL group [0.01 (-0.02, 0.04) m/s] compared with the WS group [-0.02 (-0.05, 0.01) m/s]. Intentional weight loss using a high-protein diet is effective in producing significant total body mass and fat mass loss, while helping preserve lean body mass and mobility, in relatively high-functioning older adults with obesity.