Measurement of body composition by DXA, BIA, Leg-to-leg BIA and near-infrared spectroscopy in breast cancer patients - comparison of the four methods.

BACKGROUND & AIMS: Body composition plays a crucial role in therapy adherence and the prognosis of cancer patients. The aim of this work was to compare four measurement methods for determining body composition regarding their validity, reliability and practicability in order to be able to draft a practical recommendation as to which method is most suitable as a standard measurement method in oncology. METHODS: Fat mass (FM) and fat-free mass (FFM) was estimated for 100 breast cancer patients with ages of 18-70 years during a defined 20-week inpatient and outpatient rehabilitation process after primary therapy or follow-up rehabilitation. The four methods used were dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), leg-to-leg BIA and near-infrared spectroscopy (NIRS). At baseline (t0) and after 20 weeks (t20) the agreement between the four body composition analysis methods was quantified by pairwise method comparisons using Bland-Altman bias and limits of agreement estimates, t-tests and Lin's concordance correlation coefficients (CCCs). RESULTS: CCCs and Bland-Altman plots indicated that DXA and BIA, DXA and NIRS as well as BIA and NIRS showed an excellent agreement concerning FM estimation at both time points (CCC>0.9). In contrast, no methods agreed with a CCC higher than 0.9 with respect to FFM estimation. However, most estimates were also significantly different between two methods, except for BIA and NIRS which yielded comparable FFM and FM estimates at both time points, albeit with large 95% limits of agreement intervals. The agreement between DXA and BIA was best in the lowest BMI tertile and worsened as BMI increased. Significant differences were also found for FFM changes measured with DXA versus BIA (mean difference -0.4 kg, p = 0.0049), DXA versus to Leg-to-leg BIA (-0.6 kg, p = 0.00073) and for FM changes measured with DXA versus Leg-to-leg BIA (0.5 kg, p = 0.0011). CONCLUSIONS: For accurate and valid body composition estimates, Leg-to-leg BIA cannot be recommended due to its significant underestimation of FM or significant overestimation of FFM, respectively. BIA and NIRS results showed good agreement with the gold standard DXA. Therefore both measurement methods appear to be very well suitable to assess body composition of oncological patients and should be used more frequently on a routine basis to monitor the body composition of breast cancer patients.

Hidden gout- Ultrasound findings in patients with musculo-skeletal problems and hyperuricemia.

The goal of this study was to investigate the frequency of gout-specific ultrasonography findings in a cohort of hyperuricemic patients with various musculo-skeletal complaints. A blinded examiner regarding the patients' clinical and laboratory assessment performed standardized ultrasound examinations of 12 joints in 74 individuals with diverse musculo-skeletal complaints. Gout-specific changes were assessed and combined with the patients' medical history (diagnosis gout vs. non-gout) and laboratory values of hyperuricemia. Of 74 patients, 58 (mean age 55 yrs) had hyperuricemia (serum uric acid levels > 7 mg/dl/420 µmol/L). Of those, 27 (47%) had a history of gout attacks. In total, 888 joints were examined by ultrasound. With 44/324 joints (14%) the pathological finding most often found in joints of gout patients was the double contour sign compared to 29/372 joints (8%) in patients with asymptomatic hyperuricemia and 2/192 joints (1%) in normouricemic controls. In patients with gout, the ultrasound showed pathological findings in 67/324 joints (21%). In 26/39 (67%) previously affected joints, gout-specific sonographic indications were found. With regard to the first metatarsophalangeal joint, sonographic pathologies were detectable in 16/22 (73%) so far asymptomatic joints on the contralateral. Ultrasonographic gout-specific signs are not only found in joints affected by gout attacks, but often also in the corresponding contralateral, asymptomatic joint. Patients with asymptomatic hyperuricemia already showed sonographic features implicating an as yet "silent" precipitation of urate crystals. As the examined cohort represents patients at high risk, further research for gout-specific findings is indicated, especially for hyperuricemic patients.

[Improvement of health-related quality of life in breast cancer patients by inpatient rehabilitation]. / Verbesserung der gesundheitsbezogenen Lebensqualität bei Brustkrebspatientinnen durch stationäre Rehabilitation.

PURPOSE: Improvement of health-related quality of life in women with breast cancer after primary therapy by standardized inpatient rehabilitation. PATIENTS AND METHODS: 129 women with breast cancer, 25-75 years old, and 42 healthy women were interviewed about their health-related quality of life by using the EORTC-QLQ-C30. This questionnaire assesses different aspects of quality of life as well as overall quality of life. Quality of life of breast cancer patients was assessed before and after inpatient rehabilitation, considering especially their age and the interval between diagnosis and rehabilitation. RESULTS: Compared with healthy women, the breast cancer patients had distinctly reduced values in the beginning of rehabilitation. By specific therapy, the overall quality of life as well as physical, emotional and role function could be improved significantly (p < 0.0001). Concerning cognitive and social function, there were also significant changes after rehabilitation (p < 0.0001), but only in 50% of the women an improvement could be shown. There was no evidence of correlation between quality of life after the end of primary therapy and the patients' age or the interval between diagnosis and rehabilitation. CONCLUSION: Up to 3 years after the end of primary therapy, the health-related quality of life is noticeably reduced in breast cancer patients, without showing a tendency toward spontaneous improvement. By an intensive therapy with psychooncologic measures and activating physiotherapy, the quality of life can be improved in these patients. Whether this improvement leads to a long-term effect must be shown by a presently conducted randomized, prospective study.