Protein intake and muscle mass maintenance in patients with cancer types with high prevalence of sarcopenia: a systematic review.

RATIONALE: Cancer is associated with muscle wasting. However, optimal protein intake has not been determined, limiting the efficacy of nutritional interventions. This systematic review aims to assess the effect of protein intake on muscle mass of patients with cancer types with high prevalence of sarcopenia during treatment, in longitudinal studies. METHODS: MEDLINE, CINAHL, and Scopus databases were searched following PRISMA guidelines. Longitudinal studies written in English, including adults with high sarcopenia prevalence cancer diagnosis, submitted to (chemo)radiotherapy, with assessment of protein intake and muscle changes during treatment, published until 4 October 2020 were included. Studies including supplementation with substances, such as n-3 fatty acids, specific amino acids, or proteins, were excluded. Study appraisal was independently conducted by two reviewers, and a qualitative research synthesis was performed. RESULTS: Overall, 575 records were identified, of which, eight studies were included (one randomized clinical trial and seven uncontrolled before and after studies). Patients with head and neck (n = 5), lung (n = 2), and esophageal cancer (n = 1) were included, comprising a total of 554 participants. The studies presented heterogeneous methodologies, objectives, and methods to assess body composition. Overall, participant groups with a mean protein intake below 1.2 g/kg presented muscle wasting, with one exception, while those reporting a mean intake above 1.4 g/kg, maintained muscle during treatment. CONCLUSIONS: Our findings show that protein intakes below 1.2 g/kg, even when within the recommendations, have been associated with muscle wasting during treatment. Only intakes above 1.4 g/kg have been associated with muscle maintenance. High-quality research is needed to establish an optimal dose response.

The acute effect of maximal exercise on central and peripheral arterial stiffness indices and hemodynamics in children and adults.

This study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and ß (echo-tracking), contralateral carotid blood pressure, and upper and lower limb and central/aortic PWV (applanation tonometry) were taken at rest and 10 min after a bout of maximal treadmill running in 34 children (7.38 ± 0.38 years) and 45 young adults (25.22 ± 0.91 years) having similar aerobic potential. Two-by-two repeated measures analysis of variance and analysis of covariance were used to detect differences with exercise between groups. Carotid pulse pressure (PP; η(2) = 0.394) increased more in adults after exercise (p < 0.05). Compliance (η(2) = 0.385) decreased in particular in adults and in those with high changes in distending pressure, similarly to stiffness index α and ß. Carotid PWV increased more in adults and was related to local changes in PP but not mean arterial pressure (MAP). Stiffness in the lower limbs decreased (η(2) = 0.115) but apparently only in those with small MAP changes (η(2) = 0.111). No significant exercise or group interaction effects were found when variables were adjusted to height. An acute bout of maximal exercise can alter arterial stiffness and hemodynamics in the carotid artery and within the active muscle beds. Arterial stiffness and hemodynamic response to metabolic demands during exercise in children simply reflect their smaller body size and may not indicate a particular physiological difference compared with adults.

Waist-to-Hip Ratio is Related to Body Fat Content and Distribution Regardless of the Waist Circumference Measurement Protocol in Nonalcoholic Fatty Liver Disease Patients.

Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in nonalcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 years, and 9 females, 47 ± 13 years). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r = .47 for WHR1; r = .59 for WHR2 and WHR3; r = .58 for WHR4) and BF distribution (r = .45 for WHR1; r = .56 for WHR2 and WHR3; r = .51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.

Finding the Best Waist Circumference Measurement Protocol in Patients With Nonalcoholic Fatty Liver Disease.

BACKGROUND: Central fat accumulation is important in nonalcoholic fatty liver disease (NAFLD) etiology. It is unknown whether any commonly used waist circumference measurement protocol (WCmp), as a whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WCmp to be used in patients with NAFLD, based on 3-fold criteria. METHODS: Body fat (BF) was assessed through dual-energy x-ray absorptiometry in 28 patients with NAFLD (19 men, 51 ± 13 years; 9 women, 47 ± 13 years). WC was measured with 4 types of WCmp: WC1, narrowest torso; WC2, just above iliac crest; WC3, middistance between iliac crest and last rib; WC4, at the umbilicus. RESULTS: All WC measurements were highly correlated with central BF depots, including trunk BF (r = 0.78, r = 0.82, r = 0.82, r = 0.84 for WC1, WC2, WC3, and WC4, respectively), abdominal BF (r = 0.78, r = 0.78, r = 0.80, r = 0.72 for WC1, WC2, WC3, and WC4, respectively), and central abdominal BF (r = 0.76, r = 0.77, r = 0.78, r = 0.68 for WC1, WC2, WC3, and WC4, respectively), controlling for age, sex, and body mass index. There were no differences between the correlation coefficients obtained between all studied waist circumference measurements and each whole and central analyzed BF variable. CONCLUSIONS: All studied WCmps seem suitable for use in patients with NAFLD, particularly as a central BF clinical assessment tool, though not interchangeably. Hence, biological and precision criteria alone did not sanction the superiority of any WCmp. Practical criteria may endorse WC measured at the iliac crest.

Linking cardiorespiratory fitness classification criteria to early subclinical atherosclerosis in children.

It is unclear if cardiorespiratory fitness (CRF) can be used as a screening tool for premature changes in carotid intima-media thickness (cIMT) in paediatric populations. The purpose of this cross-sectional study was 3-fold: (i) to determine if CRF can be used to screen increased cIMT; (ii) to determine an optimal CRF cut-off to predict increased cIMT; and (iii) to evaluate its ability to predict increased cIMT among children in comparison with existent CRF cut-offs. cIMT was assessed with high-resolution ultrasonography and CRF was determined using a maximal cycle test. Receiver operating characteristic analyses were conducted in boys (n = 211) and girls (n = 202) aged 11-12 years to define the optimal sex-specific CRF cut-off to classify increased cIMT (≥75th percentile). Logistic regression was used to examine the association between the CRF cut-offs with the risk of having an increased cIMT. The optimal CRF cut-offs to predict increased cIMT were 45.81 and 34.46 mL·kg(-1)·min(-1) for boys and girls, respectively. The odds-ratios for having increased cIMT among children who were unfit was up to 2.8 times the odds among those who were fit (95% confidence interval: 1.40-5.53). Considering current CRF cut-offs, only those suggested by Adegboye et al. 2011. (Br. J. Sports Med. 45(9): 722-728) and Boddy et al. 2012 (PLoS One, 7(9): e45755) were significant in predicting increased cIMT. In conclusion, CRF cut-offs (boys: ≤ 45.8; girls: ≤ 34.5 mL·kg(-1)·min(-1)) are associated with thickening of the arterial wall in 11- to 12-year-old children. Low CRF is an important cardiovascular risk factor in children and our data highlight the importance of obtaining an adequate CRF.

Intima-Media Thickness in 11- to 13-Year-Old Children: Variation Attributed to Sedentary Behavior, Physical Activity, Cardiorespiratory Fitness, and Waist Circumference.

BACKGROUND: It is unclear how sedentary behavior (SED), physical activity (PA), and cardiorespiratory fitness (CRF) influence vascular structure in children of varying body size. This study examined whether associations between SED, PA, and CRF with intima-media thickness (IMT) added to that of abdominal fatness and IMT. Differences in physiological measures among waist circumference (WC) percentiles were tested. METHODS: We assessed IMT of the carotid artery in 265 children aged 11 to 13 years (135 girls). Measures included IMT assessed with high-resolution ultrasonography, WC, body fat mass (BFM) from DXA, and CRF determined using a maximal cycle test. SED and PA were assessed by accelerometry. Association between IMT and CRF adjusted for PA variables, and body composition phenotypes were tested with multiple linear regression analysis. RESULTS: CRF was related to IMT independently of moderate to vigorous PA (MVPA) and SED (P < .05). When WC was added to the model CRF was no longer associated with IMT (P > .05). Children in the higher WC group had increased mean values of BMI, BFM, WC, and IMT and lower MVPA and CRF (P < .05). CONCLUSION: Full modeling of SED, MVPA, CRF, and WC revealed that regional adiposity appears to have the biggest role in arterial structure of children.

Body composition phenotypes and carotid intima-media thickness in 11-13-year-old children.

UNLABELLED: Early detection of impairment in vascular structure is an important clinical pursuit. However, it is unknown which measure of body composition best predicts vascular wall changes. We assess the differences in body composition among intima-media thickness (IMT) tertiles and determined which measures of body composition are associated with IMT in 385 children aged 11-13 years (196 girls). In this cross-sectional study, body mass index (BMI), waist circumference (WC), body fat mass (BFM), and trunk fat mass (TFM) from dual-energy radiographic absorptiometry and IMT through high-resolution ultrasonography were collected. Differences in body composition measures among IMT tertiles [low IMT (LIMT), ≤ 0.46 mm; middle IMT, 0.46-0.53 mm; higher IMT (HIMT), ≥0.53 mm] were assessed with ANOVA/ANCOVA after categorization. Regression analysis was used to assess the relationships between body composition and IMT. The groups were similar for sex, age, and maturity (p > 0.05). As compared with LIMT group, subjects with HIMT had higher mean values of BMI, BFM, TFM, and WC (p < 0.05). Significant differences were found for WC even when controlling for BMI (p < 0.05). Combining all subjects, IMT was significantly correlated to BMI, BFM, TFM, and WC (p < 0.05). In multiple regression, WC was the only predictor of IMT (ß = 0.22, p < 0.001). CONCLUSION: Differences exist in body composition variables among IMT tertiles. In the overall model, WC was the only obesity-related predictor of increased IMT in 11-13-year-old children.

Body fat responses to a 1-year combined exercise training program in male coronary artery disease patients.

OBJECTIVE: To analyze the body fat (BF) content and distribution modifications in coronary artery disease (CAD) patients in response to a 1-year combined aerobic and resistance exercise training (CET) program. DESIGN AND METHODS: We followed two groups of CAD male patients for 12 months. One group consisted of 17 subjects (57 ± 12 years) who engaged in a CET program (CET group) and the other was a age-matched control group of 10 subjects (58 ± 11 years). BF content and distribution were measured through dual energy X-ray absorptiometry (DXA) at baseline and follow-up. RESULTS: We found no differences on body mass and BMI between baseline and end of follow-up in both groups but, in CET group, we found significant reductions in all analyzed BF depots, including total BF (21.60 ± 6.00 vs. 20.32 ± 5.89 kg, P < 0.01), % total BF (27.8 ± 5.5 vs. 26.4 ± 5.4%, P < 0.05), trunk fat (12.54 ± 3.99 vs. 11.77 ± 4.01 kg, P < 0.05), % trunk fat (31.1 ± 6.9 and 29.2 ± 7.1%, P < 0.05), appendicular fat (8.22 ± 2.08 vs. 7.72 ± 2.037 kg, P < 0.01), % appendicular fat (25.7 ± 4.9 and 24.5 ± 4.9%, P < 0.05), and abdominal fat (2.95 ± 1.06 vs. 2.75 ± 1.10 kg, P < 0.05). Control group showed significant increase in appendicular fat (7.63 ± 1.92 vs. 8.10 ± 2.12 kg, P < 0.05). CONCLUSIONS: These results confirm the positive effect of CET on body composition of CAD patients, despite no changes in body mass or BMI. In this study, we observed no alterations on BF distribution meaning similar rate of fat loss in all analyzed BF depots. These results also alert for the limitations of BMI for tracking body composition changes.