Association between Dietary Practice and Gait Speed in Community-Dwelling Older Adults with Overweight and Obesity: A Cross-Sectional Study.

Slow gait speed is associated with poorer clinical outcomes and higher rates of functional limitation and mortality in older adults, especially when combined with overweight or obesity. Aging is also associated with nutritional deficits. The aim of our study was to assess the potential association between dietary practice and gait speed performance in community-dwelling older adults with overweight and obesity. Participants underwent body composition measurement with the Tanita MC-780MA Bioimpedance Analyzer (BIA). Dietary patterns were assessed with the Mini Nutritional Assessment (MNA) questionnaire, and a dietary adequacy (DA) score system was constructed. The four-meter gait speed test was performed in order to assess gait speed. Of 222 participants, aged 67.6 ± 6.6 years, with a body mass index (BMI) of 31.9 ± 4.5 kg/m2, 34.7% had reduced gait speed and lower DA compared to those with normal gait speed (2.99 ± 1.12 vs. 3.37 ± 1.07; p < 0.05). The DA score of participants with slower gait speed was more likely to fall below the median than that of participants with normal gait speed (70.1% vs. 51.7%; p < 0.05). Participants with slower gait speed were more likely to be nutritionally at risk of low DA (22.1% vs. 10.3%; p < 0.05). Logistic regression analysis, after adjustment for confounders, showed that the risk of having a slow gait speed was 75% lower among those with a higher DA score (OR = 0.25; 95% CI = 0.11-0.53). Older adults with overweight or obesity in community dwellings might need to be supported with nutritional interventions that can improve their gait speed.

The Association between Obesity and Reduced Weight-Adjusted Bone Mineral Content in Older Adults: A New Paradigm That Contrasts with the Obesity Paradox.

The relationship between body weight and bone mass in the elderly remains unclear, and whether obesity is a protective factor is still a matter of debate. For this reason, the aim of this study is to assess the association between body mass index (BMI) and bone mineral content adjusted by body weight, expressed as a percentage (w-BMC%), and to test the validity of the obesity paradox in this context. A cohort of 1404 older adults was categorized according to the World Health Organization's BMI cut-off points and completed a total and segmental body composition measurement by means of a dual X-ray absorptiometry scan. Individuals with obesity displayed a lower mean w-BMC% (3.06 ± 0.44%; 2.60 ± 0.37%) compared to those who were normal-weight (3.95 ± 0.54%; 3.38 ± 0.48%) and overweight (3.06 ± 0.44%; 3.04 ± 0.37%) in both genders. Linear regression analysis also showed a negative association between BMI and w-BMC% in males (ß = -0.09; p < 0.001) and females (ß = -0.06; p < 0.001). Finally, among individuals with obesity, and after adjusting for age, the linear regression models revealed a significant decrease of 0.75% and 0.28% in w-BMC% for every one-unit increase in the trunk fat/appendicular lean mass ratio in both males (ß = -0.749; p < 0.0001) and females (ß = -0.281; p < 0.001). In conclusion, we suggest a new paradigm regarding the impact of obesity on bone mass, in which the former does not appear to be a protective factor of the latter, especially in individuals with central obesity and low muscle mass.

Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach.

Physical activity (PA) plays a vital role in knee osteoarthritis (KOA) management. However, engaging individuals with KOA in regular exercise is challenging, especially when they are affected by obesity. The aim of the current review is to elucidate how to increase adherence to exercise in this population. When implementing a PA program with patients with KOA and obesity, a specific multi-step approach can be adopted. In phase I (the baseline assessment), the patients' eligibility for exercise is ascertained and a physical fitness assessment, sarcopenic obesity screening and quantification of the pain experienced are undertaken. Phase II adopts a patient-centered approach in implementing a PA program that combines an active lifestyle (>6000 steps/day) with land- or water-based exercise programs performed over eight to twelve weeks, with a frequency of three to five sessions per week, each lasting 60 min. In phase III, several strategies can be used to increase the patients' adherence to higher levels of PA, including the following: (i) personalizing PA goal-setting and real-time monitoring; (ii) enhancing physical fitness and the management of sarcopenic obesity; (iii) building a sustainable environment and a supportive social network for an active lifestyle; and (iv) reducing pain, which can ameliorate the clinical severity of KOA and help with weight management in this population.

Personalized Nutritional Strategies to Reduce Knee Osteoarthritis Severity and Ameliorate Sarcopenic Obesity Indices: A Practical Guide in an Orthopedic Setting.

Knee osteoarthritis (KOA) is one of the most common joint diseases, especially in individuals with obesity. Another condition within this population, and which presents frequently, is sarcopenic obesity (SO), defined as an increase in body fat and a decrease in muscle mass and strength. The current paper aims to describe recent nutritional strategies which can generally improve KOA clinical severity and, at the same time, ameliorate SO indices. Searches were carried out in the PubMed and Science Direct databases and data were summarized using a narrative approach. Certain key findings have been revealed. Firstly, the screening and identification of SO in patients with KOA is important, and to this end, simple physical performance tests and anthropometric measures are available in the literature. Secondly, adherence to a Mediterranean diet and the achievement of significant body weight loss by means of low-calorie diets (LCDs) remain the cornerstone nutritional treatment in this population. Thirdly, supplementation with certain micronutrients such as vitamin D, essential and non-essential amino acids, as well as whey protein, also appear to be beneficial. In conclusion, in the current review, we presented a detailed flowchart of three different nutritional tracks that can be adopted to improve both KOA and SO based on joint disease clinical severity.

Beyond Weight Loss: Added Benefits Could Guide the Choice of Anti-Obesity Medications.

PURPOSE OF REVIEW: To highlight the added benefits of approved and upcoming, centrally-acting, anti-obesity drugs, focusing not only on the most common metabolic and cardiovascular effects but also on their less explored clinical benefits and drawbacks, in order to provide clinicians with a tool for more comprehensive, pharmacological management of obesity. RECENT FINDINGS: Obesity is increasingly prevalent worldwide and has become a challenge for healthcare systems and societies. Reduced life expectancy and cardiometabolic complications are some of the consequences of this complex disease. Recent insights into the pathophysiology of obesity have led to the development of several promising pharmacologic targets, so that even more effective drugs are on the horizon. The perspective of having a wider range of treatments increases the chance to personalize therapy. This primarily has the potential to take advantage of the long-term use of anti-obesity medication for safe, effective and sustainable weight loss, and to concomitantly address obesity complications/comorbidities when already established. The evolving scenario of the availability of anti-obesity drugs and the increasing knowledge of their added effects on obesity complications will allow clinicians to move into a new era of precision medicine.

Association between metabolic syndrome, insulin resistance, and IGF-1 in breast cancer survivors of DIANA-5 study.

PURPOSE: Circulating insulin-like growth factor-1 (IGF-1) is positively associated with the risk of BC recurrence, and is more frequently dysregulated in older people, especially in those with metabolic syndrome (MetS) and obesity. This study aimed to analyze the association between IGF-1 levels and indices of MetS and insulin resistance in BC survivors. METHODS: Baseline data of 563 BC survivors enrolled in the DIet and ANdrogen-5 (DIANA-5; NCT05019989) study were analyzed. RESULTS: Lower circulating IGF-1 levels in subjects with MetS than in those without MetS were found. After stratification of the patients according to the diagnosis of MetS, we highlighted that the insulin was the main predictor of elevated IGF-1 levels only in subjects without MetS. Moreover, we found an interaction between high-density lipoprotein cholesterol (HDL-C), glycemia, and IGF-1 levels, showing a positive correlation between HDL-C and IGF-1, especially in subjects with higher values of glycemia and without a diagnosis of MetS. CONCLUSIONS: While IGF-1 levels appear to be much more impaired in subjects diagnosed with MetS, in non-MetS subjects, IGF-1 levels may respond better to metabolic parameters and lifestyle changes. Further studies are needed to analyze the role of physical activity and/or dietary intervention in modulating IGF-1 concentrations in BC survivors. IMPLICATIONS FOR CANCER SURVIVORS: These results could have important clinical implications for planning customized strategies aimed at modulating IGF-1 levels in BC survivors. In fact, while the IGF-1 system seems to be much more compromised in subjects with a diagnosis of MetS, in noMetS subjects, IGF-1 levels could better respond to lifestyle changes.

Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study.

The aim of this study was to evaluate the association of adipose tissue characteristics with survival in rectal cancer patients. All consecutive patients, diagnosed with stage II-IV rectal cancer between 2010-2016 using baseline unenhanced Computed Tomography (CT), were included. Baseline total, subcutaneous and visceral adipose tissue areas (TAT, SAT, VAT) and densities (TATd, SATd, VATd) at third lumbar vertebra (L3) were retrospectively measured. The association of these tissues with cancer-specific and progression-free survival (CCS, PFS) was assessed by using competitive risk models adjusted by age, sex and stage. Among the 274 included patients (median age 70 years, 41.2% females), the protective effect of increasing adipose tissue area on survival could be due to random fluctuations (e.g., sub-distribution hazard ratio-SHR for one cm2 increase in SAT = 0.997; 95%confidence interval-CI = 0.994-1.000; p = 0.057, for CSS), while increasing density was associated with poorer survival (e.g., SHR for one Hounsfield Unit-HU increase in SATd = 1.03, 95% CI = 1.01-1.05, p = 0.002, for CSS). In models considering each adipose tissue area and respective density, the association with CSS tended to disappear for areas, while it did not change for TATd and SATd. No association was found with PFS. In conclusion, adipose tissue density influenced survival in rectal cancer patients, raising awareness on a routinely measurable variable that requires more research efforts.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study.

RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Association between Sarcopenia and Reduced Bone Mass: Is Osteosarcopenic Obesity a New Phenotype to Consider in Weight Management Settings?

Sarcopenic obesity (SO) is a frequent phenotype in people with obesity; however, it is unclear whether this links with an impaired bone status. In this study, we aimed to investigate the association between SO and low bone mass, and to assess the prevalence of a new entity that combines excessive fat deposition, reduced muscle mass and strength, and low bone mass defined as osteosarcopenic obesity (OSO). Body composition was completed by a DXA scan in 2604 participants with obesity that were categorized as with or without SO, and with low or normal bone mineral content (BMC). Participants with both SO and low BMC were defined as OSO. Among the entire sample, 901 (34.6%) participants met the criteria for SO. This group showed a reduced mean BMC (2.56 ± 0.46 vs. 2.85 ± 0.57, p < 0.01) and displayed a higher prevalence of individuals with low BMC with respect to those without SO (47.3% vs. 25.9%, p < 0.01). Logistic regression analysis showed that the presence of SO increases the odds of having low BMC by 92% [OR = 1.92; 95% CI: (1.60-2.31), p < 0.05] after adjusting for age, body weight, and body fat percentage. Finally, 426 (16.4%) out of the total sample were affected by OSO. Our findings revealed a strong association between SO and reduced bone mass in adults with obesity, and this introduces a new phenotype that combines body fat, muscle, and bone (i.e., OSO) and appears to affect 16% of this population.

The Risk of Sarcopenia among Adults with Normal-Weight Obesity in a Nutritional Management Setting.

Normal-weight obesity (NWO) is a phenotype characterized by excessive body fat (BF) despite normal body weight. We aimed to assess the association between NWO and the risk of sarcopenia. Two groups of patients with a normal body mass index [BMI (20-24.9 kg/m2)] were selected from a large cohort of participants. Body composition was measured using dual-energy X-ray absorptiometry (DXA), and 748 participants were categorized as NWO or normal-weight without obesity (NWNO) and were classed according to whether or not they were at risk of sarcopenia. The "NWO group" included 374 participants (cases), compared to 374 participants (controls) in the "NWNO group", all of a similar BMI, age and gender. The participants in the "NWO group" displayed a higher prevalence of the risk of sarcopenia than the control group across both genders (0.6% vs. 14.1% in males; 1.4% vs. 36.5% in females). Regression analysis showed that being in the NWO category increased the risk of sarcopenia 22-fold in males (RR = 22.27; 95%CI: 3.35-147.98) and 25-fold in females (RR = 25.22; 95%CI: 8.12-78.36), compared to those in the NWNO category. In a "real-world" nutritional setting, the assessment of body composition to identify NWO syndrome is vital since it is also associated with a higher risk of sarcopenia.

Impact of low skeletal muscle mass and quality on clinical outcomes in patients with head and neck cancer undergoing (chemo)radiation.

The study aimed to explore the impact of low skeletal muscle mass and quality on survival outcomes and treatment tolerance in patients undergoing radical chemo-radiation therapy for head and neck cancer (HNC). This is significant given the growing interest in sarcopenia as a possible negative predictive/prognostic factor of disease progression and survival. From 2010 to 2017, 225 patients were included in the study. Pre-treatment computed tomography (CT) scans of HNC patients undergoing (chemo)radiation therapy were retrospectively reviewed. The skeletal muscle area, normalized for height to obtain the skeletal muscle index (SMI), the skeletal muscle density (SMD) and the intramuscular adipose tissue area (IMAT) were measured at the level of the L3 vertebra. Low SMD and low SMI were defined according to previously reported thresholds, while high IMAT was defined using population-specific cut-point analysis. SMI, SMD, and IMAT were also measured at the proximal thigh (PT) level and tested as continuous variables. Clinical morpho-functional parameters, baseline nutritional markers with a known or suspected impact on HNC treatment, clinical outcomes and sarcopenia were also collected. In multivariate analyses, adjusted by age, sex, stage, diabetes, body mass index (BMI), and weight loss, L3-SMI was not significantly associated with survival, while poor muscle quality was negatively associated with overall survival (OS) (HR = 1.88, 95% CI = 1.09-3.23, p = 0.022 and HR = 2.04, 95% CI = 1.27-3.27, p = 0.003, for low L3-SMD and high L3-IMAT, respectively), progression-free survival (PFS) (HR = 2.26, 95% CI = 1.39-3.66, p = 0.001 and HR = 1.97, 95% CI = 1.30-2.97, p = 0.001, for low L3-SMD and high L3-IMAT, respectively) and cancer-specific survival (CSS) (HR = 2.40, 95% CI = 1.28-4.51, p = 0.006 and HR = 1.81, 95% CI = 1.04-3.13, p = 0.034, for low L3-SMD and high L3-IMAT, respectively). Indices at the PT level, tested as continuous variables, showed that increasing PT-SMI and PT-SMD were significant protective factors for all survival outcomes (for OS: HR for one cm2/m2 increase in PT-SMI 0.96; 95% CI = 0.94-0.98; p = 0.001 and HR for one HU increase in PT-SMD 0.90; 95% CI = 0.85-0.94; p < 0.001, respectively). PT-IMAT was a significant risk factor only in the case of CSS (HR for one cm2 increase 1.02; 95% CI = 1.00-1.03; p = 0.046). In conclusion, pre-treatment low muscle quality is a strong prognostic indicator of death risk in patients affected by HNC and undergoing (chemo)radiotherapy with curative intent.

New BMI Cut-Off Points for Obesity in Middle-Aged and Older Adults in Clinical Nutrition Settings in Italy: A Cross-Sectional Study.

Obesity is a major health problem defined as an excess accumulation of body fat (BF). The World Health Organization (WHO) usually relies on a body mass index (BMI) ≥ 30 kg/m2 as an indicator of obesity. Due to changes in body composition that occur across the lifespan, with an increase in BF and a decrease in lean mass, we aimed to test the validity of this BMI cut-off point for adiposity in middle-aged and older adults. This cross-sectional study, composed of 4800 adults of mixed gender aged between 40 and 80 years, included (according to the WHO BMI classification) 1087 normal-weight, 1826 overweight, and 1887 obese individuals who were referred to the Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy. The sample was then categorized by adiposity status based on the total BF% as measured by dual-energy X-ray absorptiometry (DXA), and the best sensitivity and specificity were attained for predicting obesity according to the receiver operating characteristic curve (ROC) analysis. In a real-world clinical setting, a new BMI cut-off point (BMI = 27.27 kg/m2) has been identified for predicting obesity in middle-aged and older adults. Obesity guidelines in Italy therefore need to be revised accordingly.

Approaching Sarcopenic Obesity in Young and Middle-Aged Female Adults in Weight Management Settings: A Narrative Review.

This paper presents a review of the available literature on sarcopenic obesity (SO) in young and middle-aged female adults with obesity in weight management settings. A literature review using the PubMed/Medline and Science Direct databases was conducted, and the data were summarized through a narrative approach. Firstly, some physical performance tests and questionnaires are available for screening young and middle-aged female adults with a high risk of SO. Secondly, these patients can undergo instrumental measurements such as dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to confirm or reject a diagnosis of SO, applying definitions that account for body mass. Thirdly, SO is a prevalent phenotype in females seeking weight management treatment, as well as being strongly associated (vs. non-SO) with obesity-related comorbidities that need to be promptly managed, initially with nutritional programs or/and in combination with medications. Finally, patients with SO have a reduced baseline resting energy expenditure and more sedentary behaviors, which seem to account for the relationship between SO and poorer weight management outcomes, such as a higher early dropout rate and major later difficulties in weight loss maintenance. Therefore, specific strategies for personalized weight management programs for patients with SO should be incorporated to determine a successful management of this phenotype.

The Role of Obesity, Body Composition, and Nutrition in COVID-19 Pandemia: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, infecting nearly 500 million people, with more than 6 million deaths recorded globally. Obesity leads people to be more vulnerable, developing worse outcomes that can require hospitalization in intensive care units (ICU). This review focused on the available findings that investigated the link between COVID-19, body composition, and nutritional status. Most studies showed that not only body fat quantity but also its distribution seems to play a crucial role in COVID-19 severity. Compared to the body mass index (BMI), visceral adipose tissue and intrathoracic fat are better predictors of COVID-19 severity and indicate the need for hospitalization in ICU and invasive mechanical ventilation. High volumes of epicardial adipose tissue and its thickness can cause an infection located in the myocardial tissue, thereby enhancing severe COVID-related myocardial damage with impairments in coronary flow reserve and thromboembolism. Other important components such as sarcopenia and intermuscular fat augment the vulnerability in contracting COVID-19 and increase mortality, inflammation, and muscle damage. Malnutrition is prevalent in this population, but a lack of knowledge remains regarding the beneficial effects aimed at optimizing nutritional status to limit catabolism and preserve muscle mass. Finally, with the increase in patients recovering from COVID-19, evaluation and treatment in those with Long COVID syndrome may become highly relevant.

Do Lifestyle Interventions before Gastric Bypass Prevent Weight Regain after Surgery? A Five-Year Longitudinal Study.

It is unclear whether weight loss (WL) achieved by means of lifestyle interventions (LSIs) before bariatric surgery (BS) can improve long-term WL outcomes after surgery. We aimed to assess the impact of a structured LSI on WL% after gastric bypass (GBP). Two groups of patients were selected from a large cohort of participants with obesity who underwent GBP surgery at Santa Maria Nuova Hospital (Reggio Emilia, Italy). The groups were categorized as those who have or have not received LSI prior to GBP. The LSI group included 91 participants (cases) compared to 123 participants (controls) in the non-LSI group. WL% was measured at follow-up times of 1, 3, 6, 12, 24, 36, 48, and 60 months. The LSI group achieved a clinically significant WL% (-7.5%) before BS, and at the time of surgery, the two groups had similar body weights and demographic statuses. At all points, until the 24-month follow-up, the two groups displayed similar WLs%. With regard to the longer follow-ups, the LSI group maintained weight loss until the last timepoint (60 months), whereas the non-LSI group experienced weight regain at 36, 48, and 60 months. In a real-world context, a structured behavioral LSI prior to GBP seems to prevent longer-term weight regain.

Modifications of Chest CT Body Composition Parameters at Three and Six Months after Severe COVID-19 Pneumonia: A Retrospective Cohort Study.

We aimed to describe body composition changes up to 6-7 months after severe COVID-19 and to evaluate their association with COVID-19 inflammatory burden, described by the integral of the C-reactive protein (CRP) curve. The pectoral muscle area (PMA) and density (PMD), liver-to-spleen (L/S) ratio, and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, and IMAT) were measured at baseline (T0), 2-3 months (T1), and 6-7 months (T2) follow-up CT scans of severe COVID-19 pneumonia survivors. Among the 208 included patients (mean age 65.6 ± 11 years, 31.3% females), decreases in PMA [mean (95%CI) -1.11 (-1.72; -0.51) cm2] and in body fat areas were observed [-3.13 (-10.79; +4.52) cm2 for TAT], larger from T0 to T1 than from T1 to T2. PMD increased only from T1 to T2 [+3.07 (+2.08; +4.06) HU]. Mean decreases were more evident for VAT [-3.55 (-4.94; -2.17) cm2] and steatosis [L/S ratio increase +0.17 (+0.13; +0.20)] than for TAT. In multivariable models adjusted by age, sex, and baseline TAT, increasing the CRP interval was associated with greater PMA reductions, smaller PMD increases, and greater VAT and steatosis decreases, but it was not associated with TAT decreases. In conclusion, muscle loss and fat loss (more apparent in visceral compartments) continue until 6-7 months after COVID-19. The inflammatory burden is associated with skeletal muscle loss and visceral/liver fat loss.

Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients.

Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17-18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26-4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10-11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03-1.7; p = 0.03, and HR = 1.30; CI = 1.04-1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients.

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

Strength and Performance Tests for Screening Reduced Muscle Mass in Elderly Lebanese Males with Obesity in Community Dwellings.

The reduction in skeletal muscle mass (SMM) is a common phenomenon in older adults. It is associated with several diseases, a reduction in physical fitness, longer periods of hospitalization and high rates of mortality. We aimed to identify the reliability of simple tools for screening for reduced SMM among older adult males in Lebanon. The Tanita MC-780MA bioimpedance analyzer (BIA) was used to assess body composition in a population of 102 community-dwelling elderly males with overweight or obesity, in order to be then categorized as with or without reduced SMM. Participants also performed the handgrip strength test and the 4 m gait speed test. Of the total sample of 102 participants (mean age 67.4 ± 6.96 years; BMI 30.8 6 ± 4.04 kg/m2), 32 (31.4%) met the criteria for reduced SMM. Partial correlation analysis showed that handgrip strength (ρ = 0.308, p = 0.002) and 4 m gait speed (ρ = 0.284, p = 0.004) were both associated with low SMM. Receiver operating characteristic (ROC) curve analysis identified discriminating cut-off points of 1.1 m/s for the 4 m gait speed test and 32.0 kg for the handgrip strength test. Our study showed that participants displayed a substantial prevalence of reduced SMM. Reduced 4 m gait speed and handgrip strength were associated with low SMM. Clear cut-off points for strength and functional tests for screening for this condition in Lebanese older men were identified.