Body mass index-adjusted calf circumference is associated with mortality in hospitalized older patients with excess weight.

OBJECTIVES: Given the innovative nature of the method, our study aimed to assess the prognostic significance of body mass index (BMI)-adjusted calf circumference (CC) in older patients who are hospitalized. METHODS: This was a unique analysis as part of other cohorts comprising general hospitalized patients aged 60 years or older of both sexes. Only patients with excess weight (BMI ≥ 25 kg/m2) were included. CC was adjusted by reducing 3, 7, or 12 cm for BMI (in kg/m2) within 25-29.9, 30-39.9, and ≥40 kg/m2, respectively. CC was considered low if ≤ 34 cm for males and ≤ 33 cm for females. Clinical outcomes included prolonged length of hospital stay (LOS) and mortality. RESULTS: A total of 222 patients were included. After BMI adjustments, 72.1% of the patients were reclassified from a normal CC category to a low CC category. The frequency of low CC increased from 33.8% to 81.9% following BMI adjustments. Among those reclassified to the low CC, 11 died, compared to only 2 patients in the group that maintained a normal CC classification. BMI-adjusted CC was inversely associated with mortality (HR adjusted 0.84, 95% CI 0.73 to 0.95), but not with prolonged LOS. CONCLUSIONS: Our novel study highlights the prognostic value of BMI-adjusted CC. As an anthropometric marker of muscle mass, it proved to be a predictor of mortality in older patients with high BMI. This adjustment is further important because it may help to better detect low muscle mass in these patients where such conditions might be masked.

Phase Angle but Not Psoas Muscle Predicts Nutritional Risk and Prognosis in Males with Hepatocellular Carcinoma.

Despite those with hepatocellular carcinoma (HCC) being at increased risk of malnutrition, there is a notable absence of practical approaches for nutritional assessment in clinical practice. We investigated the usefulness of phase angle (PhA) and Total Psoas Area Index (TPAI) for indicating nutritional risk and HCC prognosis. Weight, height, body mass index (BMI), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS) were assessed. The Nutritional Risk Index (NRI) was calculated. Body composition was assessed using bioimpedance spectroscopy and magnetic resonance imaging. The Child-Turcotte-Pugh (CTP) score and Barcelona-Clinic Liver Cancer (BCLC) classification determined the prognosis. Fifty-one males with HCC were enrolled (CTP C = 11.8%). PhA showed a moderate positive correlation with APMT (r = 0.450; p < 0.001) and HGS (r = 0.418; p = 0.002) and a weak positive correlation with TPAI (r = 0.332; p = 0.021). PhA had a strong positive correlation with NRI (r = 0.614; p < 0.001). Mean PhA values were significantly different according to disease severity (CTP C p = 0.001, and BCLC D p = 0.053). TPAI had no significant correlation with HGS, CTP, or BCLC. PhA was a superior approach for predicting nutritional risk and prognosis in HCC than TPAI. Lower PhA is associated with disease progression, lower muscle mass and function, greater severity of nutritional risk, and increased mortality in HCC.

Strength-to-muscle radiodensity: A potential new index for muscle quality.

BACKGROUND & AIMS: Although it is widely recognized that muscle quality significantly influences adverse outcomes in patients with cancer, the precise definition of muscle quality remains elusive. The muscle quality index (MQI), also known as muscle-specific strength, is a relatively recent functional concept of muscle quality. It is obtained through the ratio of muscle strength to muscle mass, but its predictive value in patients with cancer remains unknown. In this study, we explored the prognostic significance of MQI in patients with cancer. Furthermore, we introduce and assess the prognostic potential of a novel muscle quality metric: the strength-to-muscle-radiodensity index (SMRi). METHODS: A secondary analysis was conducted on a prospective cohort study. CT scans were opportunistically used to assess body composition parameters, including skeletal muscle mass (SM in cm2) and muscle radiodensity (SMD in HU) at the third lumbar vertebra (L3). Handgrip strength (HGS) was measured. MQICT was calculated using the ratio of HGS to SM (cm2). SMRi was calculated as the ratio of HGS to SMD (HU). For analysis purposes, low MQICT and SMRi were defined using two approaches: statistical cutoffs associated with survival, and median-based distribution data. RESULTS: A total of 250 patients were included (52.8% females, 52% adults, 20-90 years). Gastrointestinal tumors and stage III-IV were the most frequent diagnosis and stages. SMRi and MQICT were strongly positively correlated (ρ = 0.71 P < 0.001). Individual components of MQICT and SMRi were also positively correlated. Patients with both low MQICT and SMRi had shorter survival (log-rank P = 0.023 and P = 0.003, respectively). When applying median distribution cutoffs, SMRi emerged as the most accurate predictor of mortality (HR adjusted 3.18, 95% CI 1.50 to 6.75, C-index: 0.71), when compared to MQICT (HR adjusted 1.49, 95% CI 0.77 to 2.87, C-index: 0.68). CONCLUSION: This study introduces the concept and potential prognostic significance of the SMRi. The physiological and clinical implications of this new index warrant further investigation across a spectrum of diseases, including cancer.

Standardized phase angle: relationship with functionality, muscle mass and postoperative outcomes in surgical cancer patients.

To evaluate the association of standardized phase angle (SPA) with nutritional status, functional parameters, and postoperative outcomes in surgical cancer patients. This prospective study includes 59 cancer patients from Pelotas (Brazil) admitted for elective cancer surgery. We obtained the phase angle through Bioelectrical Impedance Analysis (BIA) and standardized it according to the population's reference values. We estimated the muscle mass using BIA for later calculation of the Skeletal Muscle Index (SMI) and performed handgrip strength (HGS) and gait speed (GS) tests. We used the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutritional status. Postoperative complications and duration of hospital stay were evaluated as the outcomes. The prevalence of malnutrition in the sample was 28.8%, according to ASG-PPP. SPA was statistically lower in patients with malnutrition, with lower HGS and reduced GS. For postoperative outcomes, patients with severe complications and those with prolonged hospitalization also had lower SPA values. The greater the number of functional alterations in patients, the lower the SPA value, mainly when associated with reduced muscle mass assessed by BIA, suggesting that muscle mass reduction plays an important role in the association between functional alterations and phase angle in patients with cancer. According to the parameters used in this study, low SPA value was associated with impaired nutritional and functional status and negative outcomes in the analyzed sample.

Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values.

BACKGROUND: Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). METHODS: Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). RESULTS: Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). CONCLUSION: Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.

Low Physical Performance Could Be Associated with Adverse Health Outcomes over Time: Results from a Cohort of Older Adults.

A few studies on physical performance (PP) decline among community-dwelling older adults have simultaneously evaluated various outcomes in Brazil. This longitudinal cohort study aimed to verify the association between PP and health outcomes (negative health self-perception-NHSP; consultations with health professionals; disability; falls; and hospitalization) in older Brazilians (N = 476, 68 ± 6.7 years). PP assessments included Gait Speed (GS) and Timed Up and Go (TUG) tests, and changes were evaluated over time (2014 to 2019-2020). The association between the PP and the outcomes was estimated using Poisson's regression with robust variance. The physical tests were not associated with NSPH or with the number of consultations with health professionals. However, after adjustment (economic level, diet quality, physical activity, multimorbidity, depression, polypharmacy, and BMI), low PP at baseline (TUG and GS) was associated with disability at follow-up. A low TUG performance at baseline was also associated with subsequent falls (PR = 1.57, p = 0.007). A decline in GS was associated with hospitalization (PR = 1.86, p = 0.033). PP was associated with disability, falls, and hospitalization over a five- to six-year period in older Brazilians. Regular PP assessments should be conducted and low PP should be used as an indicator of the need for preventative measures to avoid poor health outcomes.

One-Year Changes in Bioelectrical Impedance Data in Adolescent Athletes.

Raw bioelectrical impedance (BI) data and vector analysis (BIVA) have been used to evaluate fat-free mass (FFM) cross-sectionally in adolescent athletes; however, there have been no longitudinal studies about it. This study aimed to assess the magnitude of changes in raw BI data (resistance [R], reactance [Xc], and phase angle [PhA]), BIVA, and FFM in adolescent athletes (n = 137, 40% female). BI data were collected using a single-frequency device at baseline and after one year of sports practice. Baseline chronological age categorized the participants (11, 12, or 13 years [y]). In females, Xc/H increased (13 to 14 y, p = 0.04) while R/H decreased in all age groups (p = 0.001). PhA (11 to 12 y, p = 0.048) and FFM (11 to 12 y and 12 to 13 y groups p = 0.001) increased and showed the lowest magnitude of changes in the 13 to 14 y group (p = 0.05). In males, Xc/H decreased (11 to 12 and 12 to 13 y groups, p = 0.001) with a higher magnitude of changes in the 13 to 14 y group (p = 0.004); R/H decreased (p = 0.001); FFM increased in all groups (p = 0.001); however, no magnitude of changes was observed. PhA increased in the 13 to 14 y group (p = 0.004). BIVA showed no differences among ellipse distances in females. In males, a high distance was observed in the 11 to 12 y group. "Time interval" influenced PhA and Xc/H in the female group and R/H and Xc/H in the male group. "Initial age" and "time interval" influenced the increase in PhA in the male group. Raw BI data and BIVA patterns can detect the magnitude of the changes in a sex-dependent manner.

Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

Muscle mass evaluation in hospitalized patients: Comparison between doubly indirect methods.

BACKGROUND: Loss of muscle mass (MM) in hospitalized patients has been associated with negative outcomes, thus, evaluating this biomarker is important to stratify risk. Although studies have been showing that calf circumference (CC) and bioelectrical impedance analysis (BIA) are valid for estimating MM in hospitalized patients, we do not know if they are associated. The aim of this study was to evaluate the associations between CC and BIA in hospitalized patients. METHODS: A cross-sectional study, in hospitalized patients' post-acute cardiac event. We collected sociodemographic, clinical, and anthropometric data. CC measurement was adjusted according to the BMI. Spearman's correlations and associations between the methods were performed for the total sample, according to sex and stage of life (older adults or not). RESULTS: We included 177 patients, mean age of 60.5 ± 12.4 years old, the majority males (75 %). Median BMI was 26.2 kg/m2 (23.8-29.2 kg/m2), most of them overweight (41.8 %). The median of CC was lower in females and older adults, and majority of the patients had low CC (87.6 %). Higher values of fat-free mass (FFM) by BIA were observed in males and younger adults, and 5.6 % presented low FFMI. We found a positive and moderate correlation between fat-free mass index (FFMI) and CC (rho = 0.532). Males had higher correlations (rho = 0.481). An increase of 1 kg in the FFM represented an increase of 1.16 cm (crude analysis) to 1.59 cm (adjusted analysis) in CC (p < 0.001). FFM explained 37 % in the variability of CC, and together with BMI, sex and age, explained 60 % in the variability. CONCLUSIONS: Raw values of FFM obtained by BIA and CC presented a weak to moderate correlation in cardiac patients. Changes in one measure impact on the other one.

Bioelectrical impedance vector analysis is different according to the comorbidity burden in post-acute myocardial infarction.

BACKGROUND: The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post-AMI. METHODS: This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre-existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed-up until hospital discharge, and their length of stay was observed. RESULTS: A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3. CONCLUSION: Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post-AMI to improve their clinical status.

Are Overweight and Obesity Risk Factors for Developing Metabolic Syndrome or Hypertension after a Preeclamptic Event?

OBJECTIVE: To identify the determinants and risks associated with developing hypertension and metabolic syndrome in the first year postpartum in women who experienced preeclampsia. METHODS: A cohort study was conducted, involving women who had experienced preeclampsia (PE) recently. The control group was women with the same characteristics but a healthy pregnancy. The variables analyzed were somatometry, disease history, pre-pregnancy body mass index (Pre-BMI), and Third Adult Treatment Panel updated (ATP III) metabolic syndrome (MS) data (blood pressure, obesity, triglycerides, high-density lipoproteins, and fasting glucose). These variables were measured at 3, 6, and 12 months postpartum. RESULTS: Women with a history of PE exhibited higher systolic and diastolic blood pressure than women without PE. The risk of developing isolated diastolic arterial hypertension at 3 and 12 months of follow-up was two to eight times greater in women with a history of PE. Factors associated with having higher blood pressure levels were preeclampsia, insulin resistance, age, and BMI. Neither the pre-BMI index nor gestational weight gain (GWG) had any effect on blood pressure in any of the three assessments. Women with preeclampsia had a 5- to 8-fold increased risk of developing MS (which could be explained not only by the history of preeclampsia but also by the history of pre-pregnancy obesity). However, PE was not identified as a risk factor at the six-month evaluation and was only explained by pre-pregnancy obesity and overweight. CONCLUSIONS: Obesity and overweight, as well as preeclampsia, were strongly associated with the development of hypertension and metabolic syndrome during the first year following childbirth.

Validation of dysphagia perception to predict the risk for dysphagia in non-institutionalized older adults.

BACKGROUND AND AIMS: Dysphagia is a swallowing disorder that affects mainly the older adults and can compromise quality of life, and increase the risk for malnutrition and aspiration. Early diagnosis is, therefore, essential to prevent adversities. We aimed to evaluate the validity of self-perceived dysphagia in community-dwelling older adults (60 years or older) from Pelotas, Brazil, participants in the "COMO VAI?" METHODS: The Eating Assessment Tool (EAT-10) was used as the reference tool to identify the risk for dysphagia and the self-perception of dysphagia was assessed using the following question: "Do you have swallowing difficulties?" (Yes/No). The parameters of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were described with 95% confidence intervals (95% CI) and according to independent variables (sex, age, economic level, and education). RESULTS: The prevalence of dysphagia risk according to EAT-10 and self-perception was 12.9% (95% CI 10.2-16.1) and 8.8% (95% CI 6.6-11.6), respectively. Sensitivity was 34.8% (95% CI 23.5-47.6) and the highest values were observed in women and the older individuals (80 years or older). Specificity was 95.1% (95% CI 92.6-96.9). PPV was 51.1% (95% CI 35.8-66.3), NPV 90.8% (95% CI 87.8-93.2) and accuracy 87.3%. CONCLUSIONS: Considering the low sensitivity and PPV, the self-perception of dysphagia analyzed with a single question should be used with caution, as an individual at risk for dysphagia may not realize their condition.

[Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]. / Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil.

The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil / Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil

Resumo O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Abstract The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

Is there a difference in the parameters of the bioelectrical impedance obtained from devices from different manufacturers? A cross-sectional study in hospitalized cancer patients.

BACKGROUND: Cancer is a disease with high and increasing incidence rates in the world and its course tends to harm the body composition. Monitoring these body changes is very important. Therefore, it is essential to have reliable, accessible, and practical methods for evaluating body compartments. This study aims to evaluate the correlation and agreement of results for the bioelectrical impedance analysis (BIA) obtained from devices from different manufacturers. METHODS: This is a single-center cross-sectional study including hospitalized patients with cancer. Two devices from different brands used for obtaining the BIA were used; both with a tetrapolar model and a single frequency (50 kHz). The results were evaluated for resistance (R) and reactance (Xc) and used to calculate the phase angle (PhA) and fat-free mass (FFM) indicators. Pearson and Spearman correlation tests and Bland-Altman plots were performed, with results expressed as bias and limits of agreement at 95% confidence intervals (95%CI). RESULTS: We have included 116 patients, with a mean age of 60.8 ± 14.8, 51.7% were women. We have found very strong correlations between the measurements of R (rho = 0.971) and FFM (r = 0.979), and strong correlations for Xc (rho = 0.784) and PhA (rho = 0.768). However, the measurements did not agree between the methods. CONCLUSIONS: Commercial brands of devices used for the BIA influence the results generated, a factor that must be considered when choosing the most appropriate method for this analysis.

Functional dentition and edentulism associated with mortality: A cohort study of older adults in Southern Brazil.

OBJECTIVE: The aim of this study was to evaluate the association between the lack of a functional dentition and edentulism with mortality in a cohort of older adults in a Southern Brazilian city. MATERIALS AND METHODS: This is a longitudinal study carried out with community-dwelling older adults (≥60 years old) from Pelotas, Brazil, using data from the baseline (2014) and the first follow-up (2017). Main exposures were functional dentition (20+ teeth present) and edentulism (absence of all teeth), derived from self-reported number of teeth. All-causes mortality was evaluated according to the city's Epidemiological Surveillance Department. Potential confounders were age, sex, socioeconomic position, smoking, diabetes, hypertension, and body mass index (BMI). To test the association between functional dentition and edentulism with mortality, Poisson regression models with robust variance were used, to estimate Relative Risks and 95% confidence intervals. RESULTS: A total of 1289 older adults had information on all variables of interest and comprise the analytical sample (from 1451 at baseline). When analysing the presence of functional dentition, only 222 individuals (17.2%) had 20 or more teeth in their mouth, while 490 older adults were edentulous (38.0%). Crude analysis showed an association between tooth loss indicators and mortality. Models adjusted for sociodemographic variables and health conditions and behaviours revelled no association between the exposures and mortality. CONCLUSIONS: With the findings of this study, we did not identify an association between edentulism and functional dentition with mortality, after considering important shared risk factors.

Changes in Physical Performance among Community-Dwelling Older Adults in Six Years.

Changes in physical performance (PP) occur with aging, and understanding the magnitude of these changes over time is important. This study evaluated changes in Gait Speed (GS) and Timed Up and Go (TUG) performance and their association with related factors among community-dwelling older adults over a period of five to six years. A cohort study of 476 older adults with baseline assessment conducted in 2014 and reassessment in 2019-2020 was carried out. Associations between PP changes over time and sociodemographic, behavioral, and health variables were evaluated using mixed linear models. Approximately 68% of the participants declined PP; 20% had no relevant change in GS and 9% in TUG time (sustained PP); 12% increased GS, and 23% decreased TUG time (improved PP). Being male (p = 0.023), living without a partner/separated (p = 0.035), higher education (p = 0.019), and alcohol consumption in the prior month (p = 0.045) were associated with decreased GS, while older age (p < 0.001), having lower socioeconomic status (p < 0.004), physical inactivity (p = 0.017), and being overweight (p = 0.007) were associated with increased TUG time. PP declined for most participants. Factors most strongly associated with PP decline are non-modifiable. The high prevalence of PP decline over time signals the importance of including physical tests in yearly health assessments.

Impact of Chemotherapy Regimens on Body Composition of Breast Cancer Women: A Multicenter Study across Four Brazilian Regions.

This study aimed to investigate the effect of chemotherapy (CT) and its different types of regimens on the anthropometry and body composition of women with breast cancer. Three-hundred-and-four women with breast cancer were enrolled in this multicenter study. The participants were evaluated before the infusion of the first cycle of CT (pre-CT), and until two weeks after CT completion (post-CT), regarding body weight, body mass index (BMI); waist circumference (WC); waist-to-height ratio (WHtR); conicity index (C-index); fat mass index (FMI); and fat-free mass index (FFMI). CT regimens were classified as anthracycline-based (AC-doxorubicin or epirubicin); anthracyclines and taxane (ACT); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or isolated taxanes (paclitaxel or docetaxel). Women significantly increased BMI and FMI post-CT (p < 0.001 and p = 0.007, respectively). The ACT regimen increased FMI (p < 0.001), while FFMI increased after AC (p = 0.007). It is concluded that the CT negatively impacted body composition and the type of regime had a strong influence. The ACT regimen promoted an increase in FMI compared to other regimens, and the AC increased FFMI. These findings reinforce the importance of nutritional monitoring of breast cancer patients throughout the entire CT treatment.

Low calf circumference adjusted for body mass index is associated with prolonged hospital stay.

BACKGROUND: Calf circumference (CC) is of emerging importance because of its practicality, high correlation with skeletal muscle, and potential predictive value for adverse outcomes. However, the accuracy of CC is influenced by adiposity. CC adjusted for BMI (BMI-adjusted CC) has been proposed to counteract this problem. However, its accuracy to predict outcomes is unknown. OBJECTIVES: To evaluate the predictive validity of BMI-adjusted CC in hospital settings. METHODS: A secondary analysis of a prospective cohort study in hospitalized adult patients was conducted. The CC was adjusted for BMI by reducing 3, 7, or 12 cm for BMI (in kg/m2) of 25-29.9, 30-39.9, and ≥40, respectively. Low CC was defined as ≤34 cm for males and ≤33 cm for females. Primary outcomes included length of hospital stay (LOS) and in-hospital death, and secondary outcomes were hospital readmissions and mortality within 6 mo after discharge. RESULTS: We included 554 patients (55.2 ± 14.9 y, 52.9% men). Among them, 25.3% presented with low CC, whereas 60.6% had BMI-adjusted low CC. In-hospital death occurred in 13 patients (2.3%), and median LOS was 10.0 (5.0-18.0) d. Within 6 mo from discharge, 43 patients (8.2%) died, and 178 (34.0%) were readmitted to the hospital. BMI-adjusted low CC was an independent predictor of LOS ≥ 10 d (odds ratio = 1.70; 95% confidence interval: 1.18, 2.43], but it was not associated with the other outcomes. CONCLUSIONS: BMI-adjusted low CC was identified in more than 60% of hospitalized patients and was an independent predictor of longer LOS.

Muscle abnormalities in patients with liver cirrhosis and its effect on muscle function.

OBJECTIVES: The progression of chronic liver disease is associated with metabolic alterations that compromise the patient's body composition and physical function. Muscle wasting often occurs with pathologic fat accumulation in the muscle (myosteatosis). Unfavorable changes in body composition frequently arise in conjunction with a decrease in muscle strength. These conditions are associated with worse prognoses. The aim of this study was to explore the associations between computed tomography (CT)-derived measures of muscle mass and muscle radiodensity (myosteatosis) and its correlation with muscle strength in patients with advanced chronic liver disease. METHODS: This cross-sectional study was conducted between July 2016 and July 2017. CT images at the third lumbar vertebra level (L3) were analyzed, and skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were defined. Handgrip strength (HGS) was assessed by dynamometry. Correlations between CT-assessed body composition and HGS were tested. Multivariable linear regression was used to determine the factors associated with HGS. RESULTS: We evaluated 118 patients with cirrhosis, of whom 64.4% were men. Of those evaluated, the mean age was 57.5 ± 8.5 y. Both SMI and SMD showed a positive correlation with muscle strength (r = 0.46 and 0.25, respectively); and age and Model for End-Stage Liver Disease (MELD)score showed the highest negative correlations (r = -0.37 and -0.34, respectively). In multivariable analyses, the presence of comorbidities (≥1), MELD score, and SMI were significantly associated with HGS. CONCLUSIONS: Low muscle mass and clinical characteristics of disease severity may adversely affect muscle strength in patients with liver cirrhosis.