In Hemodialysis Patients, Intradialytic Resistance Exercise Improves Osteoblast Function: A Pilot Study.

OBJECTIVE: Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients. Physical exercise can improve many indicators of physical functioning, and recent studies showed beneficial effects on bone mineral density in the general population. The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis (HD) patients. DESIGN: This was a randomized controlled trial. SUBJECTS: The study included 13 HD patients (46.2% men). INTERVENTION: Patients were divided into a control group and an exercise group, which performed 8 weeks of intradialytic resistance exercise. Serum sclerostin, bone alkaline phosphatase (BAP), insulin, leptin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and body composition were measured before and after the exercise period. RESULTS: In the exercise group, BAP levels increased from 11.4 ± 6.5 to 14.6 ± 6.4 U/L (P < .05) and serum 1,25-dihydroxyvitamin D levels from 46.0 ± 23.5 to 87.2 ± 31.8 ng/mL (P < .05). After exercise, serum BAP levels were inversely correlated with serum sclerostin (r = -0.96, P < .05). There was no change in body composition in either group. CONCLUSION: Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation.

Resistance exercise: a strategy to attenuate inflammation and protein-energy wasting in hemodialysis patients?

PURPOSE: Patients undergoing hemodialysis (HD) present persistent inflammation and protein-energy wasting (PEW), which contributes to high rates of mortality. This study aimed to assess the effects of a resistance exercise training program (RETP) on inflammation and PEW in HD patients. METHODS: Thirty-seven patients (56.7 % men, 45.9 ± 14.1 years, 23.5 ± 3.9 kg/m(2)) performed 6 months of intradialytic RETP. Plasma adhesion molecules levels (ICAM-1 and VCAM-1) were measured using the enzyme immunometric assay, and interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor-alpha by ELISA. Anthropometric, physical capacity, and PEW (simultaneously presence of: BMI <23 kg/m(2), serum albumin <3.8 g/dL, and reduced arm muscle area) were analyzed. RESULTS: There was a reduction of ICAM-1 [(1,934.1 pg/mL (1,031.8-2,875.0) vs. 1,571.1 pg/mL (447.1-2,985.5), p < 0.05], VCAM-1 [5,259.51 pg/mL (3,967.4-6,682.4) vs. 3,062.11 pg/mL (2,034.0-5,034.4), p < 0.05], and CRP levels (2.3 ± 0.9 to 1.6 ± 0.6 pg/mL, p < 0.001) after 6 months of RETP. Body composition improved, albumin increased (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05), and the number of patients presenting PEW was decreased (p = 0.005). CONCLUSIONS: Resistance exercise program for 6 months seems to be effective in reducing inflammation and PEW of HD patients. The universal trial number of this study is U1111-1139-1326.

[Crosstalk between bone and adipose tissue in chronic kidney disease]. / Crosstalk entre osso e tecido adiposo na doença renal crônica.

Within the concept that hormones are regulated by a cycle of reciprocity, the fact that osteoblasts and adipocytes are developed from mesenchymal stem cells and that bone remodeling is regulated by leptin brings up the idea of possible bone participation in energy metabolism and vice-versa. Recent studies have shown that the differentiation and function of these bone cells are regulated by leptin, which seems to trigger a bimodal response, via sympathetic nervous system, and a local response, in which leptin acts on the bone. In fact, studies have shown complex interactions between bone, adipose tissue and brain. However, there are few studies on crosstalk in patients with chronic kidney disease (CKD). These patients have a tendency to decreased bone mineral density and high levels of leptin. Then, this article presented a review of potential involvement of adipose tissue and bone mass in patients with CKD.

Crosstalk entre osso e tecido adiposo na doença renal crônica / Crosstalk between bone and adipose tissue in chronic kidney disease

Dentro do conceito de que os hormônios são regulados por um ciclo de reciprocidade, o fato de osteoblastos e adipócitos serem desenvolvidos a partir de células-tronco mesenquimais e da remodelação óssea ser regulada pela leptina, traz a ideia de possíveis participações do osso no metabolismo energético e vice-versa. Estudos recentes têm demonstrado que a diferenciação e as funções das células ósseas são reguladas pela leptina, que parece desencadear uma resposta bimodal central, via sistema nervoso simpático, e uma local, na qual a leptina agiria sobre o osso. De fato, estudos têm revelado complexa interação entre osso, tecido adiposo e cérebro; no entanto, existem poucos estudos sobre esse crosstalk em pacientes com doença renal crônica (DRC). Como tais pacientes têm tendência à diminuição da densidade mineral óssea e elevados níveis de leptina, o presente artigo apresentou uma revisão sobre o possível envolvimento entre tecido adiposo e massa óssea, em pacientes com DRC.

Within the concept that hormones are regulated by a cycle of reciprocity, the fact that osteoblasts and adipocytes are developed from mesenchymal stem cells and that bone remodeling is regulated by leptin brings up the idea of possible bone participation in energy metabolism and vice-versa. Recent studies have shown that the differentiation and function of these bone cells are regulated by leptin, which seems to trigger a bimodal response, via sympathetic nervous system, and a local response, in which leptin acts on the bone. In fact, studies have shown complex interactions between bone, adipose tissue and brain. However, there are few studies on crosstalk in patients with chronic kidney disease (CKD). These patients have a tendency to decreased bone mineral density and high levels of leptin. Then, this article presented a review of potential involvement of adipose tissue and bone mass in patients with CKD.

[Development, adaptation and validation of silhouette scales for self-assessment of nutritional status: a systematic review]. / Construção, adaptação e validação de escalas de silhuetas para autoavaliação do estado nutricional: uma revisão sistemática da literatura.

Self-assessment of body image is a multidimensional construction by which individuals describe the internal representations of their body structure and physical appearance in relation to themselves and others. Silhouette scales have been used to for self-assessment of nutritional status, due to their low cost and ease of administration, especially in field surveys. This study aimed to identify the various silhouette scales that have been developed or adapted since 1983 and to conduct a systematic review of the validation of such scales against objective measures of nutritional status. A total of 33 publications were found and showed moderate to good correlation between nutritional status and both adapted (0.66 to 0.87) and developed silhouette scales (0.59 to 0.94) in adults, but much lower correlation in children and adolescents. Most of the studies used inappropriate statistical analysis. The data indicated that silhouette scales should be used with caution to predict nutritional status with or without anthropometric measures.

Construção, adaptação e validação de escalas de silhuetas para autoavaliação do estado nutricional: uma revisão sistemática da literatura / Development, adaptation and validation of silhouette scales for self-assessment of nutritional status: a systematic review

A autoavaliação da imagem corporal é uma construção multidimensional por meio da qual os indivíduos descrevem as representações internas da estrutura corporal e da aparência física, em relação a si próprio e aos outros. As Escalas de Silhuetas são testes que viabilizam a autoavaliação, especialmente em pesquisas de campo, devido ao baixo custo e facilidade na administração do método. O objetivo deste trabalho foi resgatar as Escalas de Silhuetas construídas ou adaptadas desde 1983 e realizar uma revisão sistemática sobre a validação destas frente a medidas objetivas do estado nutricional. Foram identificados 33 estudos com grande variação na correlação com o estado nutricional de adultos, tanto para as Escalas de Silhuetas adaptadas (coeficientes de correlação de 0,66 a 0,87) quanto para as construídas (0,59 a 0,94). Já em crianças e adolescentes, as correlações entre as Escalas de Silhuetas e o estado nutricional não resultaram em valores satisfatórios em vários dos estudos. Muitos trabalhos utilizaram estatística inapropriada. Os dados da presente revisão indicam que deve-se ter cuidado no uso de Escalas de Silhuetas para estimar o estado nutricional com ou sem a medição antropométrica.

Self-assessment of body image is a multidimensional construction by which individuals describe the internal representations of their body structure and physical appearance in relation to themselves and others. Silhouette scales have been used to for self-assessment of nutritional status, due to their low cost and ease of administration, especially in field surveys. This study aimed to identify the various silhouette scales that have been developed or adapted since 1983 and to conduct a systematic review of the validation of such scales against objective measures of nutritional status. A total of 33 publications were found and showed moderate to good correlation between nutritional status and both adapted (0.66 to 0.87) and developed silhouette scales (0.59 to 0.94) in adults, but much lower correlation in children and adolescents. Most of the studies used inappropriate statistical analysis. The data indicated that silhouette scales should be used with caution to predict nutritional status with or without anthropometric measures.