Rapid adiposity growth increases risks of new-onset asthma and airway inflammation in children.

BACKGROUND/OBJECTIVES: We aim to (1) examine the influence of long-term adiposity status/short-term adiposity changes on asthma with high or low fractional exhaled nitric oxide (FeNO), and (2) to determine the differences in long-term adiposity status/short-term adiposity changes on atopy, airway inflammation and pulmonary function. SUBJECTS/METHODS: We recruited 2450 fourth- to sixth-grade children from the nationwide Taiwan Children Health Study. Data regarding various adiposity indicators, atopic status, pulmonary function tests and asthma outcomes were collected annually. New-onset asthma was stratified by airway inflammation status using FeNO. The generalized estimating equation was used for analyzing longitudinal relationships between long-term adiposity status/short-term adiposity changes and new-onset asthma. Individual adiposity growth slopes were obtained using a hierarchical linear model to establish the relationships between short-term adiposity changes and asthma among children with high airway inflammation. RESULTS: We found long-term adiposity status predicted childhood asthma with low FeNO, whereas short-term adiposity changes may increase risks of childhood asthma with high FeNO. Long-term adiposity status reduced pulmonary function, whereas short-term adiposity increase were associated with atopic diseases and airway inflammation. CONCLUSIONS: Obesity-induced asthma could be mediated by high or low airway inflammation, depending on the velocity of increase in adiposity. Rapid adiposity growth may increase risks of childhood asthma and airway inflammation.

Effect of body mass index on knee function outcomes following continuous passive motion in patients with osteoarthritis after total knee replacement: a retrospective study.

OBJECTIVE: Obesity may influence postoperative rehabilitation outcomes after total knee replacement (TKR). The aim of this study was to evaluate the effects of body mass index (BMI) on the progression of inpatient rehabilitation using continuous passive motion (CPM) and its treatment outcomes. PARTICIPANTS AND SETTING: A retrospective study was conducted in a rehabilitation centre. In total, 354 patients undergoing primary TKR were enrolled through medical chart review. INTERVENTION: All patients commenced the CPM programme immediately after surgery and continued until hospital discharge. MAIN OUTCOME MEASURES: Knee flexion, pain score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function score. DESIGN: Patients were divided into five BMI groups: normal weight (n=59), overweight (n=95), Class I obesity (n=90), Class II obesity (n=82) and Class III obesity (n=28). All outcome measures were recorded at admission; daily during the inpatient stay; at discharge; and at 1-, 3- and 6-month follow-up assessments. RESULTS: During CPM exercises, obese patients had a smaller initial flexion angle (P<0.001) and a smaller daily increment in the CPM motion arc (P<0.001) compared with patients of normal weight. Severe obesity was associated with poor knee flexion [adjusted odds ratio (aOR) 11.9, 95% confidence interval (CI) 3.49 to 40.94, P<0.001] and WOMAC physical function score (aOR 5.09, 95% CI 1.62 to 16.03, P=0.005) at 6-month follow-up. CONCLUSIONS: Obesity had a negative effect on progress during the CPM protocol, which commenced immediately after surgery and continued until discharge. Obesity was also associated with poorer self-reported function at 6-month follow-up.

Association between body composition and median neuropathy in patients with physical disabilities.

BACKGROUND: Patients with physical disabilities more often have median neuropathies of the wrist and more than 70% of wheelchair users are overweight or obese. AIM: To explore the effects of body composition on the occurrence of distal median neuropathy and to search for the best probabilistic cutoff value of indicators to predict the likelihood of developing distal median neuropathy in patients with physical disabilities. DESIGN: A prospective study. SETTING: A 1-day annual physical checkup program for employees of a social welfare organization. POPULATION: In total, 72 patients with a physical disability (mean age ± SD, 40.0 ± 8.8 years; 40 women). METHODS: Using electrophysiologic testing to assess distal median nerve function and using a dual-energy X-ray absorptiometry examination to assess body composition. The formula for leg exercise burden index (EBI) was: leg EBI = body fat mass of both legs/lean tissue mass of both legs. RESULTS: The risk of developing a low median sensory nerve conduction velocity in the wrist-to-palm segment (< 43 m/s) was greater for patients with a higher leg EBI, yielding an adjusted odds ratio of 6.88 (P < 0.005). The body mass index (BMI) and being a wheelchair user were predictors of developing long median distal motor latency (> 4 ms). Using receiver operating characteristic analyses, we determined that patients with a physical disability were likely to develop distal median sensory neuropathy if they had a leg EBI of ≥ 0.943 and were likely to develop distal median motor neuropathy if they had a BMI of ≥ 24.5 kg/m2. CONCLUSION: The leg EBI is a predictor of having distal median sensory neuropathy among patients with a physical disability. CLINICAL REHABILITATION IMPACT: The value of the leg EBI can be useful information for identifying risk of distal median sensory neuropathy in patients with a physical disability.

Developing comprehensive and Brief ICF core sets for morbid obesity for disability assessment in Taiwan: a preliminary study.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) provides a framework for measuring functioning and disability based on a biopsychosocial model. AIM: The aim of this study was to develop comprehensive and brief ICF core sets for morbid obesity for disability assessment in Taiwan. DESIGN: Observational SETTING: Other POPULATION: Twenty-nine multidisciplinary experts of ICF METHODS: The questionnaire contained 112 obesity-relevant and second-level ICF categories. Using a 5-point Likert scale, the participants rated the significance of the effects of each category on the heath status of people with obesity. Correlation between an individual's score and the average score of the group indicated consensus. The categories were selected for the comprehensive core set for obesity if more than 50% of the experts rated them as "important" in the third round of the Delphi exercise, and for the brief core set if more than 80% of the experts rated them "very important." RESULTS: Twenty-nine experts participated in the study. These included 18 physicians, 4 dieticians, 3 physical therapists, 2 nurses, and 2 ICF experts. The comprehensive core set for morbid obesity contained 61 categories. Of these, 26 categories were from the component body function, 8 were from body structure, 18 were from activities and participation, and 9 were from environmental factors. The brief core set for obesity disability contained 29 categories. Of these, 19 categories were from the component body function, 3 were from body structure, 6 were from activities and participation, and one was from environmental factors. The comprehensive and brief ICF core sets provide comprehensive information on the health effects of morbid obesity and concise information for clinical practice. CONCLUSION: Comprehensive and brief core sets were created after three rounds of Delphi technique. Further validation study of these core sets by applying to patients with morbid obesity is needed. CLINICAL REHABILITAITON IMPACT: The comprehensive ICF core set for morbid obesity provides comprehensive information on the health effects of morbid obesity; the brief core set can provide concise information for clinical practice.

Femoral neck bone mineral density in ambulatory men with poliomyelitis.

UNLABELLED: We evaluated bilateral femoral neck bone mineral densities (FNBMDs) in 32 men with poliomyelitis and their matched controls. Men with poliomyelitis had significantly lower FNBMD in both legs, and FNBMD was lowest in their shorter legs. Knee extensor strength and regular exercise were important predictive factors associated with decreased FNBMD. INTRODUCTION: People with poliomyelitis (polio) are prone to leg fractures after mild trauma. The flaccid paralysis, asymmetric involvement, and underdeveloped growth of afflicted legs may lead to osteoporosis of either leg, characterized by different patterns. This study aimed to measure their femoral FNBMD and to explore the factors associated with changes in FNBMD in either leg. METHODS: We did a prospective study to evaluate bilateral FNBMD with dual-energy X-ray absorptiometry in 32 men with polio (age range, 41-57 years; mean, 47 years) and 32 age- and body mass index-matched controls. Measuring the difference in leg length, we classified the legs of each polio subject as "longer" or "shorter." In addition, we chose the right leg of each control as a reference leg. We then used the Mann-Whitney U test to compare FNBMD of these three groups of legs and searched for the factors associated with FNBMD using stepwise multiple regression analyses. RESULTS: Compared to the reference leg, men with polio had significantly lower FNBMD in both their longer and shorter legs, by 13% and 23%, respectively. The difference in FNBMD between the two legs of polio subjects was significant. Knee extensor strength and regular exercise were two important factors associated with bilateral FNBMD in men with polio. CONCLUSIONS: Men with polio had lower bilateral FNBMD. FNBMD of the shorter leg should be the choice for predicting the risk of hip fracture in men with polio because on average, the shorter leg has lower BMD.

Differential effects of high MUFA with high or low P/S ratio (polyunsaturated to saturated fatty acids) on improving hepatic lipolytic enzymes and mediating PPARγ related with lipoprotein lipase and hormone-sensitive lipase of white adipose tissue in diet-induced obese hamster.

OBJECTIVES: The aim of this study was to assess the relationship between high monounsaturated fatty acids (MUFAs) with different levels of polyunsaturated-to-saturated fatty acid (P/S) ratios and body fat loss in diet-induced obesity (DIO) models. DESIGN: Male Golden Syrian hamsters were randomly assigned to the control group (n=12) and obesity group (n=24) for 4 weeks of the high-fat DIO period; afterward, six hamsters from each group were killed. The remaining control hamsters were still fed a low-fat diet. For an additional 8 weeks, the remaining obesity hamsters were switched to a low-fat diet and subdivided into three subgroups (n=6/group): the obesity-control (ObC) group, high MUFA with high P/S ratio oil (HMHR) group and olive oil (OO) group. Serum insulin and leptin concentrations were measured, and hepatic fatty acid metabolic enzymes and adipose differentiation markers were determined using enzyme activities analysis, western blot and semiquantification reverse-transcription PCR. RESULTS: No difference was observed in the mean energy intake through all study periods. After the DIO period, the obesity group increased in weight gain and epididymal fat weight compared with the control group. DIO hamsters in the HMLR group had significant reductions in white adipose tissue deposition and plasma leptin levels, suppression in adipose peroxisome proliferator-activated receptor-γ (PPARγ) and lipoprotein lipase (LPL) mRNA expressions and increases in hepatic acyl-CoA oxidase and carnitine palmitoyltransferase-I activities and mRNA levels compared with those in the ObC group. The HMHR group had upregulated phosphorylation of hormone-sensitive lipase (HSL) relative to total HSL protein levels compared with the OO group. However, the OO group had significantly elevated hepatic de novo lipogenesis compared with the HMHR group. CONCLUSIONS: HMHR seemed to be beneficial in depleting white adipose tissue accumulation by decreasing adipose PPARγ and LPL mRNA expressions and mediating phosphorylation of HSL, and by improving hepatic lipolytic enzyme activities and mRNA expressions involved in ß-oxidation in DIO hamsters.

Fully automated large-scale assessment of visceral and subcutaneous abdominal adipose tissue by magnetic resonance imaging.

OBJECTIVE: To describe and evaluate a fully automated method for characterizing abdominal adipose tissue from magnetic resonance (MR) transverse body scans. METHODS: Four MR pulse sequences were applied: SE, FLAIR, STIR, and FRFSE. On 39 subjects, each abdomen was traversed by 15 contiguous transaxial images. The total abdominal adipose tissue (TAAT) was calculated from thresholds obtained by slice histogram analysis. The same thresholds were also used in the manual volume calculation of TAAT, subcutaneous abdominal adipose tissue (SAAT) and visceral abdominal adipose tissue (VAAT). Image segmentation methods, including edge detection, mathematical morphology, and knowledge-based curve fitting, were used to automatically separate SAAT from VAAT in various 'nonstandard' cases such as those with heterogeneous magnetic fields and movement artefacts. RESULTS: The percentage root mean squared errors of the method for SAAT and VAAT ranged from 1.0 to 2.7% for the four sequences. It took approximately 7 and 15 min to complete the 15-slice volume estimation of the three adipose tissue classes using automated and manual methods, respectively. CONCLUSION: The results demonstrate that the proposed method is robust and accurate. Although the separation of SAAT and VAAT is not always perfect, this method could be especially helpful in dealing with large amounts of data such as in epidemiological studies.