Sarcopenia in patients with diabetes mellitus.

INTRODUCTION: Diseases such as diabetes mellitus may be associated with adverse changes in body composition. Sarcopenia is characterized by a progressive and generalized loss of skeletal muscle mass and functionality. AIM: To investigate the relationship between type 2 diabetes mellitus (T2DM) and sarcopenia. MATERIALS AND METHODS: In a retrospective, non-randomized study, 35 T2DM patients, aged 20-80 years, were assessed for sarcopenia prevalence compared to controls (n=16). Appendicular skeletal mass (ASM) (kg) was measured, and sarcopenia was defined as SMI <7.0 and <5.7 kg/m2, in males and females, respectively, using the European Working Group on Sarcopenia in Elderly (EWGOSP) definition. Low physical performance was defined as a walking speed of <0.8 m/s. RESULTS: Incidence of sarcopenia was significantly higher in T2DM patients vs. controls (27% vs. 20%, p=0.01) and elderly vs. young participants (40% vs. 12%, p<0.001), respectively. Walking velocity was significantly lower in T2DM patients compared to male and female controls (1.08±0.22 vs. 1.23±0.18 and 1.07±0.26 vs. 1.26±0.16, respectively, p<0.001,). CONCLUSIONS: A moderate prevalence of sarcopenia in patients with type 2 diabetes mellitus was observed, which appeared to increase significantly in older men. Finally, incidence of T2DM displayed decreased physical performance in both genders.

The Combyn™ ECG: Adding haemodynamic and fluid leads for the ECG. Part II: Prediction of total body water (TBW), extracellular fluid (ECF), ECF overload, fat mass (FM) and "dry" appendicular muscle mass (AppMM).

Simultaneous with a 12 channel ECG, body composition was analysed by segmental multi-frequency impedance analysis in 101 healthy subjects and in 118 patients with chronic heart failure (CHF, n= 40), chronic renal failure with haemodialysis (HD, n= 20), and miscellaneous internal diseases (n= 58). Whole body DXA and sodium bromide dilution were used as reference methods for total body water (TBW), extracellular fluid (ECF), appendicular muscle mass (AppMM) and fat mass (FM). Empirical prediction equations were developed in a randomized evaluation sample and then evaluated in unknowns. TBW, ECF, AppMM and FM could be predicted with regression coefficients of 0.96, 0.90, 0.95 and 0.93, respectively, all with p< 0.001. Only segmental impedances and height, but not age, sex, weight and BMI contributed to the prediction of water compartments. About half the patients with CHF and half of those on HD showed increased ECF/ICF ratio in relation to % FM at the legs but not at the thorax. The predicted AppMM was additionally corrected for increased ECF to determine "dry AppMM", which is markedly lower than the misleading reference DXA. This methodology shows promise as a combination of routine ECG with measurement of body composition, assessment of sarcopenia and detection of overhydration.

Dual X-Ray Absorptiometry Whole Body Composition of Bone Tissue in Rheumatoid Arthritis - a Cross-Sectional Study.

OBJECTIVES: Previous studies of bone tissue in rheumatoid arthritis (RA) using dual X-ray absorptiometry (DXA) concentrated on regions of interest that were used to diagnose osteoporosis. This study aimed to compare the whole body bone tissue (wbBT) of RA patients with healthy subjects and to identify the RA variables which significantly predict wbBT. METHODS: The study was cross-sectionally designed to include postmenopausal RA patients and age-matched healthy female controls. All 107 RA patients and all 104 controls underwent clinical examination, laboratory tests and whole body DXA composition, which recorded total and regional bone indices. Non-parametric standard statistical test and regression models after data normalization were used to assess correlations, associations and differences. RESULTS: Compared to controls, RA patients had significantly lower whole body and regional bone mass (14.9 kg compared to 15.5 kg; p = 0.031). Disease duration (r = -0.402 ; p < 0.001), C-reactive protein (r = -0.279; p = 0.015) and inflammation (2.5% wbBT compared to 2.9%; p = 0.043), radiographic damage (14.3 kg compared to 16.2 kg; p < 0.001), disease activity scores (r = -0.275 ; p = 0.018 for HAQ) are significantly correlated/associated with lower wbBT. Clinical structural damage is associated with lower wbBT and it can significantly predict them (R2 = 0.014; p = 0.001), while glucocorticoid treatment, even in low doses, was associated with lower wbBT percent (2.6% compared to 2.8%; p = 0.045). Treatment with biologics was associated with a lower rate of whole body osteoporosis (0% compared to 22.2%; p = 0.013). CONCLUSIONS: The main associated factors with the generalized bone loss in female RA patients are disease duration and disease activity. Clinical structural damage is the most powerful predictor of the whole body bone loss. These results suggest a general disturbance of skeletal bone metabolism in RA and could explain a greater risk of fragility fractures of non-central sites (e.g. ribs, tibia, ankles etc.) compared to post-menopause osteoporosis.

National Health and Nutrition Examination Survey whole-body dual-energy X-ray absorptiometry reference data for GE Lunar systems.

The National Health and Nutrition Examination Survey (NHANES 1999-2004) includes adult and pediatric comparisons for total body bone and body composition results. Because dual-energy x-ray absorptiometry (DXA) measurements from different manufacturers are not standardized, NHANES reference values currently are applicable only to a single make and model of Hologic DXA system. The purpose of this study was to derive body composition reference curves for GE Healthcare Lunar DXA systems. Published values from the NHANES 1999-2004 survey were acquired from the Centers for Disease Control and Prevention website. Using previously reported cross-calibration equations between Hologic and GE-Lunar, we converted the total body and regional bone and soft-tissue measurements from NHANES 1999-2004 to GE-Lunar values. The LMS (LmsChartMaker Pro Version 3.5) curve fitting method was used to generate GE-Lunar reference curves. Separate curves were generated for each sex and ethnicity. The reference curves were also divided into pediatric (≤20 years old) and adult (>20 years old) groups. Adult reference curves were derived as a function of age. Additional relationships of pediatric DXA values were derived as a function of height, lean mass, and bone area. Robustness was tested between Hologic and GE-Lunar Z-score values. The NHANES 1999-2004 survey included a sample of 20,672 participants' (9630 female) DXA scans. A total of 8056 participants were younger than 20 yr and were included in the pediatric reference data set. Participants enrolled in the study who weighed more than 136 kg (over scanner table limit) were excluded. The average Z-scores comparing the new GE-Lunar reference curves are close to zero, and the standard deviation of the Z-scores are close to one for all variables. As expected, all measurements on the GE-Lunar reference curves for participants younger than 20 yr increase monotonically with age. In the adult population, most of the curves are constant at younger age and drop moderately as age increases. We have presented NHANES reference curves applicable to DXA whole-body scans acquired on GE Healthcare Lunar systems by age, sex and ethnicity. Users of GE Healthcare GE-Lunar DXA systems can now benefit from the large body composition reference data set collected in the NHANES 1999-2004 study.