Whole Body Irradiation Induces Diabetes and Adipose Insulin Resistance in Nonhuman Primates.

PURPOSE: Diabetes mellitus is a delayed effect of radiation exposure in human and nonhuman primates. Diabetes mellitus is characterized by peripheral tissue insulin resistance, and as a result, irradiation exposure may cause important changes in insulin-sensitive tissues such as muscle and adipose. METHODS AND MATERIALS: We prospectively investigated changes in response to irradiation (4 Gy whole body exposure) in 16 male rhesus macaques. We evaluated changes in body composition and glycemic control for 2 years. Insulin responsiveness, lipolysis, inflammation, and fibrosis were evaluated at study end. RESULTS: Irradiated animals accumulate less fat and significantly increased percent glycation of hemoglobin A1c over time, such that 40% of irradiated monkeys had values that define them as diabetic at 2 years. Subcutaneous (SQ) adipose tissue was insulin resistant, as evidenced by reduced phosphorylation of the insulin receptor substrate-1 in response to insulin challenge and had increased basal lipolysis despite comparable insulin exposures to control animals. Irradiated SQ adipose tissue had more macrophage infiltration and adipocytes were larger. The observed hypertrophy was associated with decreased glycemic control and macrophage infiltration correlated with decreased adiponectin, signifying that inflammation is associated with worsening health. No evidence of SQ adipose fibrosis was detected. CONCLUSIONS: Our study is the first to prospectively illustrate that sublethal irradiation exposures directly propagate metabolic disease in the absence of obesity in nonhuman primates and implicate SQ adipose dysfunction as a target tissue.

Opportunistic body composition evaluation in patients with esophageal adenocarcinoma: association of survival with 18F-FDG PET/CT muscle metrics.

OBJECTIVE: 18F-FDG PET is widely used to accurately stage numerous types of cancers. Although 18F-FDG PET/CT features of tumors aid in predicting patient prognosis, there is increasing interest in mining additional quantitative body composition data that could improve the prognostic power of 18F-FDG PET/CT, without additional examination costs or radiation exposure. The aim of this study was to determine the association between overall survival and body composition metrics derived from routine clinical 18F-FDG PET/CT examinations. METHODS: Patients who received baseline 18F-FDG PET/CT imaging during workup for newly diagnosed esophageal adenocarcinoma (EAC) were included. From these studies, psoas cross-sectional area (CSA), muscle attenuation (MA), SUVmean, and SUVmax were obtained. Correlation with overall survival was assessed using a Cox Proportional Hazards model, controlling for age, body mass index, 18F-FDG dose, glucose level, diabetes status, in-hospital status, and tumor stage. RESULTS: Among the 59 patients studied, psoas MA and SUVmax were found to be significant predictors of survival (HR 0.94, 95% CI 0.88-0.99, p = 0.04, and HR 0.37, 95% CI 0.14-0.97, p = 0.04, respectively) and remained independent predictors. Psoas CSA and SUVmean did not significantly influence survival outcomes. CONCLUSIONS: Characterization of psoas muscles as a surrogate marker for sarcopenia on baseline 18F-FDG PET/CT imaging is relatively easily obtained and may offer additional prognostic value in patients with EAC.

Effects of Melatonin on the Body Composition, Physical Performance, and Blood Erythrocyte Indexes of C57Bl/6J Mice Exposed to Continuous Illumination.

Male C57Bl/6J mice were exposed to daily 24-h illumination over 14 days and daily intragastrically received melatonin (1 mg/kg) or water (placebo). Controls were kept under standard day/night (14/10 h) conditions. Melatonin prevented the development of anemia in mice exposed to continuous illumination, which was proven by higher blood hemoglobin levels by the end of the experiment in melatonin-treated animals in comparison with the placebo group. Studies by the low-field NMR spectrometry detected lower lean body mass, total body water, and especially, fat content (by ~13%) in animals receiving placebo. Melatonin treatment led to an increase in the lean body mass and total body water on day 7 (in comparison with the placebo group) without affecting fat mass. On day 14 of continuous illumination, lean body mass increased in comparison with the corresponding parameter in the control and placebo groups. Melatonin had no effect on the physical endurance of mice exposed to continuous illumination (assessed by the grid hanging test).

Phase Angle as an Objective and Predictive Factor of Radiotherapy-induced Changes in Body Composition of Male Patients With Head and Neck Cancer.

BACKGROUND: Unfavorable changes in body composition are frequent among patients with head and neck cancer (HNC). Unfortunately, in daily clinical practice, there is a lack of reliable diagnostic tools for predicting changes in body composition in individuals following radiotherapy (RT). Among non-invasive tools, bioelectrical impedance analysis (BIA) seems to be most promising. One BIA parameter, the phase angle (PA), reflects condition of various body cells and their mass in detail. MATERIALS AND METHODS: Using BIA, the body composition was measured prior to and after RT in 52 male patients with HNC. PA derived from BIA prior to RT was tested as a predictor of body composition changes developing during RT. RESULTS: Patients with low PA had a greater than 9.3-fold higher chance of body mass index (BMI) reduction below 18.5 kg/m2 and over 5.9-fold and 4.2-fold higher chance of lean mass and fat mass reduction after therapy end compared with patients with a high PA value. PA values demonstrated significant diagnostic accuracy for detection of fat-free mass, lean mass and BMI reduction in the study group [area under the curve (AUC)=0.781, 0.774 and 0.786, respectively]. CONCLUSION: PA prior to RT is a useful marker for selection of individuals with HNC who are at a high risk of unfavorable changes in body composition.

Combined analysis of miRNA-181a with phase angle derived from bioelectrical impedance predicts radiotherapy-induced changes in body composition and survival of male patients with head and neck cancer.

BACKGROUND: Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients' quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH-induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with miRNA-181a expression. RESULTS: Patients with simultaneous presence of low PA and high miRNA expression were at a significantly higher risk of decreasing the fat-free mass index (FFMI) <14.9 kg/m2 (odds ratio [OR] = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high miRNA and low PA negatively affected patients' survival (OR = 5.12; P = .02). CONCLUSION: Evaluation of PA in combination with miRNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH-induced changes in body composition of patients with cancer.

Murine vs human tissue compositions: implications of using human tissue compositions for photon energy absorption in mice.

METHODS:: Dual energy CT (DECT) images of 9 female mice were used to extract the effective atomic number Zeff and the relative electron density ρe for each voxel in the images. To investigate the influence of the tissue compositions on the absorbed radiation dose for a typical kilovoltage photon beam, mass energy-absorption coefficients µen/ρ were calculated for 10 different tissues in each mouse. RESULTS: Differences between human and murine tissue compositions can lead to errors around 7.5 % for soft tissues and 20.1 % for bone tissues in µen/ρ values for kilovoltage photon beams. When considering the spread within tissues, these errors can increase up to 17.5 % for soft tissues and 53.9 % for bone tissues within only a single standard deviation away from the mean tissue value. CONCLUSION:: This study illustrates the need for murine reference tissue data. However, assigning only a single mean reference value to an entire tissue can still lead to large errors in dose calculations given the large spread within tissues of µen/ρ values found in this study. Therefore, new methods such as DECT and spectral CT imaging need to be explored, which can be important next steps in improving tissue assignment for dose calculations in small animal radiotherapy. ADVANCES IN KNOWLEDGE:: This is the first study that investigates the implications of using human tissue compositions for dose calculations in mice for kilovoltage photon beams.

Artificial light at night and captivity induces differential effects on leukocyte profile, body condition, and erythrocyte size of a diurnal toad.

Light pollution or artificial lighting at night (ALAN) is an emerging threat to biodiversity that can disrupt physiological processes and behaviors. Because ALAN stressful effects are little studied in diurnal amphibian species, we investigated if chronic ALAN exposure affects the leukocyte profile, body condition, and blood cell sizes of a diurnal toad. We hand-captured male toads of Melanophryniscus rubriventris in Angosto de Jaire (Jujuy, Argentina). We prepared blood smears from three groups of toads: "field" (toads processed in the field immediately after capture), "natural light" (toads kept in the laboratory under captivity with natural photoperiod), and "constant light" (toads kept in the laboratory under captivity with constant photoperiod/ALAN). We significantly observed higher neutrophil proportions and neutrophils to lymphocytes ratio in toads under constant light treatment. In addition, we observed significantly better body condition and higher erythrocyte size in field toads compared with captive toads. In summary, ALAN can trigger a leukocyte response to stress in males of the diurnal toad M. rubriventris. In addition, captivity can affect the body condition and erythrocyte size of these toads.

Análisis predictivo que evalúa la pérdida de masa magra en pacientes oncológicos expuestos a tratamiento de radioterapia / Predictive analytics assessing the lean mass loss in oncologic patients exposed to radiotherapy treatment

ANTECEDENTES: la pérdida de masa magra en el paciente oncológico produce graves consecuencias, tales como: la disminución de la calidad de vida, la peor tolerancia a los tratamientos y el aumento de los costos de la asistencia social. OBJETIVO: El objetivo del presente estudio fue establecer y desarrollar un análisis predictivo que evalúe la pérdida de masa magra experimentada en pacientes oncológicos en tratamiento de radioterapia. MÉTODOS: Se realizó un análisis prospectivo, tomando una muestra de 231 pacientes oncológicos que han sido expuestos a radioterapia. Las mediciones antropométricas se han registrado a través del instrumento TANITA TBF-300. El método hacia atrás se ha utilizado para determinar la ecuación que se desarrolla a partir de un modelo de regresión completo que incluye varias variables independientes. RESULTADOS: solo se estudiaron 197 pacientes que conformaron la muestra. La variable más representativa que contribuyó a la pérdida de masa magra se ha tomado como una variable de referencia. Esta es el tratamiento de quimioterapia (p = 0.02, IC = 95%), y a través del análisis estadístico, se ha obtenido la siguiente ecuación: % de pérdida de masa magra = -0.453 + 0.167% de contenido de agua inicial - 0.065% de masa magra + 0.246% de peso pérdida (R2 = 0.264, F = 5.375, p <0.01). CONCLUSIÓN: La ecuación obtenida para predecir el% de pérdida de masa magra, en cualquier punto o etapa durante el curso del tratamiento, es efectiva y confiable

BACKGROUND: The loss of lean mass in the oncological patient produces serious consequences such as: the decrease in the quality of life, in tolerance to treatments and increase in social healthcare costs. OBJECTIVE: The aim of the present study was to establish and develop a predictive analytics which assesses for the lean mass loss experienced in oncologic patients under radiotherapy treatment. METHODS: A prospective analysis has been undertaken, taking a sample of 231 oncologic patients which have been exposed to radiotherapy treatment. Anthropometric measurements have been recorded via TANITA TBF-300 instrument. Backward method has been used to determine the equation which develops from a complete regression model including several independent variables. RESULTS: Only 197 patients that conformed the sample were studied. The most representative variable that contributed to the lean mass loss has been taken as a reference variable. This is the chemotherapy treatment (p = 0.02, IC = 95%), and through statistical analysis, the following equation has been obtained:% lean mass loss = -0.453 + 0.167 % initial water content - 0.065 % lean mass + 0.246 % weight loss (R2 = 0.264, F = 5.375, p < 0.01). CONCLUSION: The equation obtained to predict the % lean mass loss, at any point or stage during the treatment course, is effective and reliable

Feasibility and Preliminary Efficacy of a 10-Week Resistance and Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment in Rectal Cancer Patients.

BACKGROUND: Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT. METHODS: Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m2) receiving CRT undertook supervised resistance and aerobic exercise twice weekly. Assessments were undertaken pre- and post-intervention for upper and lower body muscle strength by 1-RM, muscle endurance, physical performance tests, body composition by dual X-ray absorptiometry, quality of life, and fatigue. RESULTS: There was a significant loss in appendicular skeletal muscle (-1.1 kg, P = .012), and fat mass (-0.8 kg, P = .029) following CRT. Despite the loss in skeletal muscle, leg press ( P = .030) and leg extension ( P = .046) strength improved by 27.2% and 22.7%, respectively, and leg press endurance by 76.7% ( P = .007). Changes in strength were accompanied by improved performance ( P < .05) in 6-m fast walking speed (6.9%) and dynamic balance as determined by the 6-m backwards walk (15.5%). There was minimal change in quality of life and fatigue, and no adverse events related to training. CONCLUSIONS: Exercise during neoadjuvant CRT appears to be feasible and well tolerated in rectal cancer patients and may enhance physical function while minimizing adverse changes in body composition and cancer-related fatigue. These initial findings need to be confirmed in randomized controlled trials.

Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy.

Body composition, defined as the proportions and distribution of lean and fat tissues in the human body, is an emergent theme in clinical oncology. Severe muscle depletion (sarcopenia) is most easily overlooked in obese patients; the advent of secondary analysis of oncologic images provides a precise and specific assessment of sarcopenia. Here, we review the definitions, prevalence and clinical implications of sarcopenic obesity (SO) in medical and surgical oncology. Reported prevalence of SO varies due to the heterogeneity in the definitions and the variability in the cut points used to define low muscle mass and high fat mass. Prevalence of SO in advanced solid tumor patient populations average 9% (range 2.3%-14.6%) overall, and one in four (24.7%, range 5.9%-39.2%) patients with body mass index ≥ 30 kg/m2 are sarcopenic. SO is independently associated with higher mortality and higher rate of complications in systemic and surgical cancer treatment, across multiple cancer sites and treatment plans. These associations remain unexplained, however, it has been hypothesized that patients with sarcopenia are generally unfit and unable to tolerate stress. Another proposed mechanism relates to increased exposure to antineoplastic therapy, i.e. a large fat mass would be expected to inflate drug dose in BSA-based treatments, causing an increased rate of dose-limiting toxicity. Pharmacokinetic data are needed to confirm or refute this hypothesis. Old age, deconditioning, cancer progression, acute or chronic nonmalignant disease and drug side-effects are suggested causes of muscle loss, and it is unknown the degree to which this can be reversed. Sarcopenia can be readily detected before start of cancer treatment, however, clinical management protocols for SO patients require development. Studies of cancer treatment dose-modulation are in progress.

ASSESSMENT OF THE LATE EFFECTS ON BONES AND ON BODY COMPOSITION OF CHILDREN AND ADOLESCENTS TREATED FOR ACUTE LYMPHOCYTIC LEUKEMIA ACCORDING TO BRAZILIAN PROTOCOLS. / AVALIAÇÃO DOS EFEITOS ÓSSEOS TARDIOS E COMPOSIÇÃO CORPORAL DE CRIANÇAS E ADOLESCENTES TRATADOS DE LEUCEMIA LINFOIDE AGUDA SEGUNDO PROTOCOLOS BRASILEIROS.

OBJECTIVE: To evaluate the impact of therapy on bone mineral density (BMD) and body composition in survivors of acute lymphoblastic leukemia (ALL) treated in accordance with Brazilian protocols by the Brazilian Cooperative Group of Treatment of Lymphoblastic Leukemia in Childhood (GBTLI) LLA-93 and LLA-99. METHODS: A cross-sectional study with 101 patients was performed. BMD and body composition were evaluated using bone densitometry and were interpreted according to the age group and the reference population. Values between -1.1 and -1.9 in the group of children under 20 years were considered as risk group for low BMD z-scores. BMD values were compared to clinical characteristics, treatment received and body composition. A chi-square test, Fisher's exact test, likelihood ratio and Student's t-test were applied, with a 5% significance level. RESULTS: The patients presented a frequency of fractures of 2%, of osteonecrosis, 2%, and of low BMD, 2.9%. In the group of 79 patients under 20 years of age, three had low BMD. The 16 that presented risk for low BMD, demonstrated lower valutes in lumbar vertebrae L1-L4 (p=0.01) and whole body (p=0.005), and smaller values of lean body mass (p=0.03). In the group of 22 patients over 20 years of age, ten had osteopenia. CONCLUSIONS: The low impact of treatment on BMD of this study confirms the concept that the bone mass gain occurs with increasing age and that the treatment does not influence the process. The population at risk for low BMD values presented lower bone mass values and could benefit from a long-term monitoring for possible bone toxicity.

OBJETIVO: Avaliar o impacto da terapia sobre a densidade mineral óssea (DMO) e composição corporal em sobreviventes da leucemia linfoide aguda (LLA), tratados de acordo com os protocolos brasileiros do Grupo Cooperativo Brasileiro de Tratamento de Leucemia Linfoide Aguda na Infância (GBTLI), LLA-93 e LLA-99. MÉTODOS: Em estudo transversal com 101 pacientes, avaliaram-se a composição corporal e a DMO por meio da densitometria óssea, interpretando-a conforme a faixa etária e a população de referência. Foi considerado grupo de risco para baixa DMO valores de z-escore entre -1,1 e -1,9 no grupo dos menores de 20 anos. Compararam-se os valores da DMO com características clínicas, tratamento recebido e composição corporal. Foram utilizados os testes qui-quadrado, exato de Fisher, razão de verossimilhança e t de Student, com nível de significância de 5%. RESULTADOS: Foram encontradas 2% de fraturas, 2% de osteonecrose e 2,9% de baixa DMO. No grupo de pacientes com menos de 20 anos, três apresentaram baixa DMO. Os 16 pacientes com risco para baixa DMO exibiram menores valores em vértebras lombares L1-L4 (p=0,01), corpo total (p=0,005) e valores mais baixos de massa magra (p=0,03). No grupo de 22 pacientes com mais de 20 anos, dez demonstraram osteopenia. CONCLUSÕES: O baixo impacto do tratamento sobre a DMO neste estudo ratifica o conceito de que o ganho de massa óssea ocorre com o aumento da idade e que o tratamento não influencia tal processo. A população de risco para baixa DMO demonstrou valores menores de massa óssea, podendo beneficiar-se de um acompanhamento em longo prazo para uma possível toxicidade óssea.

Body composition of patients with autism spectrum disorder through bioelectrical impedance / Composición corporal por medio de la impedancia bioeléctrica de los pacientes con trastorno del espectro autista

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in sociability, communication, and limited repertoire of interests and behaviors. Objectives: We aimed to investigate the nutritional status through bioelectrical impedance analysis (BIA) and antrophometrics variables in 63 ASD children and adolescents (10.5 ± 4.1 years; 81% male). Materials and methods: Anthropometric variables were weight, height, and waist circumference (WC); body composition (fat mass, fat free mass) and phase angle (PA) were obtained through BIA. Results: The body mass index showed a prevalence of overweight, obesity and underweight of 38.9, 36.5 and 15.8%, respectively. According to the body fat percentual, obesity prevalence was 49.2%, and 49.2% showed WC > 80th percentile for age. Eleven patients presented lower PA values than references. Conclusion: According to the these parameters, a large percentual of ASD children and adolescents in this sample had total overweight and obesity and truncal adiposity, which causes concern, as well as the percentage of underweight participants (AU)

Introducción: el trastorno del espectro autista (TEA) es un trastorno neurológico caracterizado por deficiencias en la sociabilidad y la comunicación, y un repertorio limitado de intereses y comportamientos. Objetivos: investigar el estado nutricional por medio del análisis de impedancia bioeléctrica (BIA) y variables antropométricas en 63 niños y adolescentes con TEA (10,5 ± 4,1 años, 81% hombres). Material y métodos: las variables antropométricas fueron el peso, la altura y la circunferencia de la cintura (CC); la composición corporal (masa grasa, masa magra) y el ángulo de fase (PA) se obtuvieron por medio de BIA. Resultados: el índice de masa corporal mostró una prevalencia del sobrepeso, la obesidad y el bajo peso de 38,9, 36,5 y 15,8%, respectivamente. De acuerdo con el porcentaje de grasa corporal, la prevalencia de obesidad fue del 49,2%, y el 49,2% mostró CC > percentil 80 para la edad. Once pacientes presentaron valores de PA inferiores a las referencias. Conclusión: de acuerdo con estos parámetros, un gran porcentaje de niños y adolescentes TEA en esta muestra presentaba adiposidad total de sobrepeso y obesidad y del tronco, lo que causa preocupación, así como el porcentaje de participantes con bajo peso (AU)

AVALIAÇÃO DOS EFEITOS ÓSSEOS TARDIOS E COMPOSIÇÃO CORPORAL DE CRIANÇAS E ADOLESCENTES TRATADOS DE LEUCEMIA LINFOIDE AGUDA SEGUNDO PROTOCOLOS BRASILEIROS / ASSESSMENT OF THE LATE EFFECTS ON BONES AND ON BODY COMPOSITION OF CHILDREN AND ADOLESCENTS TREATED FOR ACUTE LYMPHOCYTIC LEUKEMIA ACCORDING TO BRAZILIAN PROTOCOLS

RESUMO Objetivo: Avaliar o impacto da terapia sobre a densidade mineral óssea (DMO) e composição corporal em sobreviventes da leucemia linfoide aguda (LLA), tratados de acordo com os protocolos brasileiros do Grupo Cooperativo Brasileiro de Tratamento de Leucemia Linfoide Aguda na Infância (GBTLI), LLA-93 e LLA-99. Métodos: Em estudo transversal com 101 pacientes, avaliaram-se a composição corporal e a DMO por meio da densitometria óssea, interpretando-a conforme a faixa etária e a população de referência. Foi considerado grupo de risco para baixa DMO valores de z-escore entre -1,1 e -1,9 no grupo dos menores de 20 anos. Compararam-se os valores da DMO com características clínicas, tratamento recebido e composição corporal. Foram utilizados os testes qui-quadrado, exato de Fisher, razão de verossimilhança e t de Student, com nível de significância de 5%. Resultados: Foram encontradas 2% de fraturas, 2% de osteonecrose e 2,9% de baixa DMO. No grupo de pacientes com menos de 20 anos, três apresentaram baixa DMO. Os 16 pacientes com risco para baixa DMO exibiram menores valores em vértebras lombares L1-L4 (p=0,01), corpo total (p=0,005) e valores mais baixos de massa magra (p=0,03). No grupo de 22 pacientes com mais de 20 anos, dez demonstraram osteopenia. Conclusões: O baixo impacto do tratamento sobre a DMO neste estudo ratifica o conceito de que o ganho de massa óssea ocorre com o aumento da idade e que o tratamento não influencia tal processo. A população de risco para baixa DMO demonstrou valores menores de massa óssea, podendo beneficiar-se de um acompanhamento em longo prazo para uma possível toxicidade óssea.

ABSTRACT Objective: To evaluate the impact of therapy on bone mineral density (BMD) and body composition in survivors of acute lymphoblastic leukemia (ALL) treated in accordance with Brazilian protocols by the Brazilian Cooperative Group of Treatment of Lymphoblastic Leukemia in Childhood (GBTLI) LLA-93 and LLA-99. Methods: A cross-sectional study with 101 patients was performed. BMD and body composition were evaluated using bone densitometry and were interpreted according to the age group and the reference population. Values between -1.1 and -1.9 in the group of children under 20 years were considered as risk group for low BMD z-scores. BMD values were compared to clinical characteristics, treatment received and body composition. A chi-square test, Fisher’s exact test, likelihood ratio and Student’s t-test were applied, with a 5% significance level. Results: The patients presented a frequency of fractures of 2%, of osteonecrosis, 2%, and of low BMD, 2.9%. In the group of 79 patients under 20 years of age, three had low BMD. The 16 that presented risk for low BMD, demonstrated lower valutes in lumbar vertebrae L1-L4 (p=0.01) and whole body (p=0.005), and smaller values of lean body mass (p=0.03). In the group of 22 patients over 20 years of age, ten had osteopenia. Conclusions: The low impact of treatment on BMD of this study confirms the concept that the bone mass gain occurs with increasing age and that the treatment does not influence the process. The population at risk for low BMD values presented lower bone mass values and could benefit from a long-term monitoring for possible bone toxicity.

Evaluación de la función cardiaca en un grupo de niños pequeños para la edad gestacional en edad escolar en tratamiento con hormona de crecimiento / Evaluation of cardiac function in a group of small for gestational age school-age children treated with growth hormone

Introducción y objetivos: Los pacientes pequeños para la edad gestacional (PEG) son población de riesgo para el desarrollo de enfermedad cardiovascular y síndrome metabólico. Nuestro objetivo es estudiar la morfología y la función cardiaca en un grupo de niños PEG en edad escolar en tratamiento con growth hormone (GH, «hormona de crecimiento»). Métodos: Se han incluido en el estudio 23 pacientes PEG y 23 controles sanos. Se valoró peso, talla, presión arterial y frecuencia cardiaca. Mediante ecocardiografía transtorácica se evaluó el tamaño de las cavidades cardiacas, el diámetro de la aorta ascendente y abdominal y parámetros de función biventricular. Resultados: Los niños PEG presentan mayores percentiles de presión arterial sistólica y diastólica (p < 0,05), sin cambios significativos en la frecuencia cardiaca. Tienen un mayor diámetro del septo interventricular (Z-score 1,57 en PEG frente a 0,89; p = 0,026) y una peor función sistólica del ventrículo derecho, con un TAPSE inferior (Z-score −0,98 en PEG frente a 0,95; p = 0,000) y una menor velocidad sanguínea en arteria pulmonar (0,85 m/s en PEG frente a 0,97 m/s; p = 0,045). No se han encontrado diferencias en la función del ventrículo izquierdo. El diámetro de la aorta ascendente es mayor en PEG (Z-score−1,09 frente a−1,93; p = 0,026), mientras que el diámetro de la aorta abdominal en sístole es menor (Z-score −0,89 frente a −0,19; p = 0,015). Conclusiones: Se han observado cambios significativos en la morfología y la función cardiaca en niños PEG en edad escolar tratados con GH. Es importante continuar en ellos un seguimiento para determinar si estas alteraciones contribuyen a un aumento de morbilidad cardiaca en la edad adulta (AU)

Introduction and objectives: Small for gestational age (SGA) patients have an increased risk of developing a cardiovascular pathology, as well as a metabolic syndrome. Our objective is to evaluate the cardiac morphology and function of SGA children treated with growth hormone (GH), identifying changes that could potentially have long-term consequences. Methods: We selected 23 SGA school-age patients and 23 healthy children. We measured their weight, height, blood pressure and heart rate. Using transthoracic echocardiography, we evaluated cardiac chamber size, ascending and abdominal aortic diameter as well as the systolic and diastolic function of both ventricles. Results: SGA children have a higher systolic and diastolic blood pressure (P < .05) without significant changes in their heart rate. They also have a thicker interventricular septum (SGA Z-score 1.57 vs. 0.89; P = .026) and a worse right ventricular systolic function, with a lower TAPSE (SGA Z-score −0.98 vs. 0.95; P = .000), as well as a lower blood flow rate in the pulmonary artery (SGA 0.85 m/s vs. 0.97 m/s; P = .045). No significant difference was observed in the patients’ left ventricular function. SGA patients’ ascending aortic diameter was greater (SGA Z-score −1.09 vs. −1.93; P = .026), whereas the systolic abdominal aortic diameter was smaller (SGA Z-score−0.89 vs. −0.19; P = .015). Conclusions: We found functional and morphological cardiac changes in SGA school-age patients treated with GH. It is important to follow-up this patient group in order to determine if these changes contribute to an increased cardiac morbidity in adulthood (AU)

Triagem nutricional por meio do MUST no paciente oncológico em radioterapia / Nutrition screening by MUST on the oncological patient in radiotherapy / Triage nutricional por médio de MUST para pacientes oncológicos en radioterapia

Introdução: a radioterapia contribui para a redução da ingestão alimentar e maior perda de peso, devido ao aparecimento de sintomas gastrointestinais, o que consequentemente leva à desnutrição. Objetivo: i dentificar o risco nutricional, por meio do Malnutrition Universal Screening Tool (Must ), em pacientes com câncer submetidos à radioterapia. Método: estudo transversal, realizado com pacientes ambulatoriais do s erviço de radioterapia do Hospital de câncer de Pernambuco, durante outubro/2014 a maio/2015. Foram avaliadas as características socioeconômicas, demográficas, estilo de vida (fumo, álcool e atividade física), variáveis antropométricas (peso habitual, atual e iMc), comorbidades (hipertensão e diabetes), tipos de neoplasias, tempo de diagnóstico e tratamento. o risco nutricional foi identificado utilizando-se o Must , que classifica o paciente com risco ou sem risco, e em baixo, médio e alto risco nutricional. Resultados: Foram estudados 150 pacientes com média de idade de 47,3 anos, a maioria mulheres (72%) e proporções semelhantes de adultos e idosos. observou-se que a maioria do grupo era procedente do interior do estado, inativos/aposentados e recebiam 1-3 salários mínimos. o risco nutricional foi significantemente maior nos idosos (62,9%), em que predominou o alto risco (45,7%), enquanto nos adultos a maioria evidenciou sem risco (61,2%). as neoplasias mais frequentes foram as ginecológicas (59,4%) com ganho de peso de 33,3%; em seguida, os tumores de cabeça e pescoço com elevada perda ponderal (p=0,007). Conclusão: o Must detectou risco nutricional em 50% dos pacientes estudados, com predominância nos idosos, a maioria com alto risco. n a neoplasia de cabeça e pescoço, predominou a perda ponderal; enquanto, no ginecológico, o ganho de peso. r essalta-se a importância da realização de triagem ambulatorial para instituir precocemente uma terapia nutricional especializada.

Introduction: radiotherapy contributes to the reduction of food intake and increased weight loss due to the appearance of gastrointestinal symptoms, which consequently leads to malnutrition. Objective: i dentify nutritional risk through the Malnutrition universal screening tool (Must ), in patients submitted to radiotherapy for the treatment of cancer. Method: c ross-sectional study with outpatients at the radiotherapy service of the cancer Hospital of Pernambuco, during o ctober 2014 until May 2015. s ocio-demographic characteristics, lifestyle (smoking, alcohol use and physical activity), anthropometric variables (habitual weight, current weight and body mass index), comorbidities (hypertension and diabetes), tumor type, time since diagnosis and duration of treatment were evaluated. n utritional risk was assessed using the Must , which classifies patients as being at low, medium or high nutritional risk. Results: 150 patients were studied with an average age of 47.3 years, with a predominance of women (72%) and similar proportions of adults and elderly individuals. The sample mainly comprised individuals from in-state regions and inactive/retired individuals who received one to three times the minimum salary. nutritional risk was significantly higher among elderly individuals (62.9%), among whom high risk predominated (45.7%), whereas most adults had no risk (61.2%). The most frequent tumors were gynecological (59.4%) with weight gain (33.3%), followed by tumors of the head and neck region with a high degree of weight loss (p = 0.007). Conclusion: The use of Must led to the detection of nutritional risk in 50% of the studied patients, with a predominance of elderly individuals, the majority of whom were at high risk. tumors of the head and neck led to weight loss, whereas gynecological tumors led to weight gain. out-patient nutritional screening is important for the early establishment of specialized nutritional counselin

Introducción: la radioterapia contribuye a la reducción de la ingesta de alimentos y el aumento de la pérdida de peso debido a la aparición de los síntomas gastrointestinales, que en consecuencia lleva a la desnutrición. Objetivo: identificar el riesgo nutricional, a través del Malnutrition Universal Screening Tool (Must ), en pacientes con cáncer sometidos a radioterapia. Método: estudio transversal con pacientes ambulatorios en el servicio de radioterapia del Hospital de cáncer de Pernambuco, realizado desde octubre/2014 hasta mayo/2015. s e evaluaron características sociodemográficas, estilo de vida (tabaco, alcohol y actividad física), variables antropométricas (peso habitual, actual e icM), comorbideces (hipertensión y diabetes), tipos de neoplasias, tiempo de diagnóstico y tratamiento. el riesgo nutricional se evaluó utilizándose el Must que clasifica al paciente en bajo, medio y alto riesgo nutricional. Resultados: se estudiaron 150 pacientes con promedio de edad de 47,3 años, en su mayoría mujeres (el 72%) y proporciones semejantes de adultos y ancianos. s e observó que la mayoría del grupo era procedente del interior del estado, inactivos/jubilados y recibían 1-3 sueldos mínimos. e l riesgo nutricional significante fue mayor en los ancianos (el 62,9%) en el que predominó el alto riesgo (el 45,7%), mientras en los ancianos la mayoría evidenció sin riesgo (el 61,2%). las neoplasias más frecuentes fueron las ginecológicas (el 59,4%) con aumento de peso del 33,3%; en seguida, los tumores de cabeza y cuello con elevada pérdida ponderal (p=0,007). Conclusión: e l Must detectó riesgo nutricional en el 50% de los pacientes estudiados, con predominancia en los ancianos, la mayoría con alto riesgo. e n la neoplasia de cabeza y cuello predominó la pérdida ponderal, mientras que en el ginecológico el aumento de peso. s e resalta la importancia de la realización de selección ambulatorio para instituir precozmente una terapia nutricional especializad

Impact of a ketogenic diet intervention during radiotherapy on body composition: II. Protocol of a randomised phase I study (KETOCOMP).

BACKGROUND: We have found that a ketogenic diet (KD) during the course of radiotherapy (RT) was feasible and led to a preservation or favorable changes of body composition. Based on these observations and theoretical considerations, we initiated a study to investigate the impact of a KD or a ketogenic breakfast intervention in patients undergoing RT. METHODS: All patients presenting for curative RT with age between 18 and 75, body mass index between 18 and 34 kg/m2 and a histologically confirmed cancer of the breast, colorectum or head and neck region are considered for inclusion. Exclusion criteria are Karnofsky index <70, pregnancy, metallic body parts that interfere with bioimpedance analysis (BIA), type I diabetes, known enzyme defects that contradict a KD and renal insufficiency. Randomization is achieved by all consecutive patients first entering the control group and then an intervention group 1 until both groups contain 15 breast, 15 colorectal and 5 head and neck cancer patients. Intervention group 1 will receive each radiotherapy fraction after an overnight fast and subsequently ingest a ketogenic breakfast consisting of (i) 50-250 ml of a medium-chain triglyceride drink (betaquick®, vitaflo, Bad Homburg, Germany) plus (ii) 5-15 g amino acids (MAP, dr. reinwald healthcare gmbh+co kg, Schwarzenbruck, Germany). If willing to undertake a complete KD for the duration of RT, patients are entered into intervention group 2. Intervention group 2 does not have to fast prior to RT fractions but will be supplemented with MAP analogous to intervention group 1. The control group will not receive dietary advice to follow a KD or reduce carbohydrate intake. The objective is twofold: (i) to test whether the ketogenic interventions are feasibly, as measured by the number of dropouts; (ii) to see whether intervention groups 1 and 2 attain a better preservation of BIA phase angle than the control group. ENDPOINTS: Primary endpoints are the feasibility of the interventions (measured through dropout rates), and changes in body weight and composition (measured through BIA). Secondary endpoints are changes in quality of life (EORTC questionnaires) and blood parameters as well as the occurrence and grade of toxicities and grade of regression after surgery in case of colorectal carcinomas.

Métodos de evaluación de la composición corporal: una revisión actualizada de descripción, aplicación, ventajas y desventajas / Methods of assessment of body composition: an updated review of description, application, advantages and disadvantages

El estudio de la composición corporal es un tema de interés creciente que puede ser utilizado tanto para la investigación como para fines clínicos. Para los profesionales de las ciencias de la salud es importante conocer las características de los diferentes métodos de evaluación y análisis de la composición corporal, ya que cambios en esta guardan relación directa con la salud y el riesgo de enfermedades. Actualmente, los métodos de análisis de la composición corporal son divididos en tres grupos, donde están el directo, los indirectos y los doblemente indirectos. El método directo es la disección de cadáveres. Entre los indirectos encontramos la tomografía axial computarizada, la resonancia magnética nuclear (RMN), la absorciometría dual de rayos X y la plestimografía; y en lo referente a los métodos doblemente indirectos destacan la antropometría y la impedancia bioelectrica. Asi, este trabajo tiene como objetivo revisar los métodos mas utilizados para el análisis de la composición corporal, describiéndoles, analizando sus aplicaciones, ventajas y desventajas. Se llevo a cabo una búsqueda de artículos en las bases de datos PubMed, Web of Science, Scopus, SportDiscus y Google Academico. Las palabras usadas fueron, body composition, body mass, body fat, muscle mass, fat mass, measurement, assessment y evaluation, aisladas o combinadas, y sus respectivos sinónimos en castellano y portugués. Fueron encontrados 221 artículos, de los cuales fueron seleccionados 59 para esta revisión. Se concluye que los diferentes métodos para evaluar la composición corporal presentan ventajas y desventajas, que deben ser analizados cuando se elige el método a ser empleado, para intentar minimizar sus desventajas y potencializar sus ventajas (AU)

The study of body composition is a topic of growing interest that can be used both for research and for clinical purposes. For professionals of health sciences is important to know the characteristics of the different methods of evaluation and analysis of body composition because, it changes are directly related to health and disease risk. Currently, methods of analysis of body composition are divided into three groups, which are direct, indirect and double indirect. The direct method is the dissection of cadavers. Indirect find computed tomography, magnetic resonance imaging, dual X-ray absorptiometry and plethysmography and in terms of the doubly indirect methods include anthropometry and bioelectrical impedance. Thus, this paper is aimed to review the most used for analysis of body composition by describing, analyzing their applications, advantages and disadvantages methods. Was conducted a search of article in databases PubMed, Web of Science, Scopus, SportDiscus and Google Scholar. The words used were, body composition, body mass, body fat, muscle mass, fat mass, measurement, assessment and evaluation, isolated or combined and their alternatives in Castilian and Portuguese. Were selected articles that were in English, Castilian and portuguese. They were found 221 articles, of which 59 were selected for this review. It is concluded that the different methods for assessing body composition have advantages and disadvantages, which should be analyzed when choosing the method to be used to try to minimize the disadvantages and empower its advantages (AU)

Grasa epicárdica y factores de riesgo cardiometabólico en la posmenopausia / Epicardial fat and cardiometabolic risk in postmenopausal women

Objetivo. El riesgo cardiovascular aumenta en la etapa posmenopáusica. El tejido adiposo epicárdico ha mostrado utilidad para la identificación del riesgo cardiovascular, sin embargo, la información es aún escasa en la mujer posmenopáusica. El objetivo de este estudio fue analizar la relación entre el tejido adiposo epicárdico y los componentes del síndrome metabólico en mujeres posmenopáusicas. Sujetos y métodos. Estudio transversal comparativo en 50 mujeres posmenopáusicas, se midieron los factores de riesgo cardiometabólico, se les realizó ecocardiograma transtorácico y análisis de composición corporal. Resultados. La grasa epicárdica es más elevada en mujeres con síndrome metabólico en comparación a aquellas sin síndrome metabólico (515,6 ± 130,9 vs. 358,0 ± 138,7, p < 0,001) y presenta un incremento proporcional con el número de componentes del síndrome metabólico (p < 0,001). Conclusiones. El tejido adiposo epicárdico tiene relación con los componentes del síndrome metabólico en la posmenopausia, etapa que se caracteriza por mayor vulnerabilidad a la trombosis (AU)

Objective. Postmenopausal women have an increased risk of cardiovascular disease. Epicardial adipose tissue has been shown to be useful in identifying cardiovascular risk but there is little information in postmenopausal women. The objective of this study was to examine the association between epicardial fat and components of metabolic syndrome in postmenopausal women. Subjects and methods. A cross sectional study was conducted in 50 postmenopausal women. All participants underwent transthoracic echocardiography and body composition analysis. Results. A greater amount of epicardial adipose tissue was found in postmenopausal women with metabolic syndrome than in those without this syndrome (515.6 ± 130.9 vs 358.0 ± 138.7, p < 0.001). The amount of epicardial adipose tissue increased with a greater number of metabolic components (p < 0.001). Conclusions. There is a direct relationship between epicardial fat and cardiometabolic risk after menopause, a period when there is a higher risk of thrombosis (AU)

”Valoración de la grasa corporal: ultrasonidos frente a sistemas de bioimpedancia y antropometría. Estudio piloto". Respuesta / No disponible

No disponible

Acuracidade de diferentes tipos de impedância bioelétrica na estimativa da gordura corporal de homens / Accuracy of different types of bioelectrical impedance to estimate body fat in men

Introdução: A impedância bioelétrica (IB) é uma técnica rápida, não invasiva e relativamente barata, podendo ser aplicada em situações de campo ou em clínicas. Seu custo é cada vez mais baixo, tornando assim um equipamento de fácil aquisição, porém a acuracidade de alguns equipamentos ainda é questionável devido ao fornecimento de informações referentes apenas a gordura relativa e/ou absoluta, deixando de informar valores de resistência e/ou reatância. Objetivo: Analisar a validade da estimativa do percentual de gordura corporal (%GC) obtido por meio de equipamentos de IB tetrapolar e bipolares (mão-mão e pé-pé) utilizando a pesagem hidrostática (PH) como uma técnica de referência. Métodos: O %GC foi mensurado em 102 homens (18 - 30 anos), com 3 equipamentos de IB: Maltron BF-906 (tetrapolar); Omron 306BL [bipolar (mãomão)] e Plena Ice [bipolar (pé-pé)] e pela PH. A acuracidade foi verificada por teste t pareado, correlação, erro padrão de estimativa, erro constante, erro total e análise de resíduos. Resultados: A IB mão-mão subestimou e a IB pé- pé superestimou significativamente (p< 0,05) os valores de %GC. Já a IB tetrapolar não apresentou diferença significativa, bem como demonstrou o maior valor de correlação, menor erro constante e erro total e o maior percentual de concordância com a PH. Conclusão: Os equipamentos de IB bipolares empregados neste estudo não apresentaram acuracidade para a estimativa da gordura corporal relativa. Somente a IB tetrapolar da marca Maltron BF-906 apresentou validade na determinação do %GC na amostra estudada (AU)

Introduction: The bioelectrical impedance (BI) is a fast, non-invasive and relatively inexpensive technique that can be applied in field situations or clinics. Its cost is ever lower, thus making equipment easy to purchase, but the accuracy of some equipment is still questionable due to the provision of information relating only to fat relative and/or absolute, failing to report values of resistance and/or reactance. Objective: Evaluate the validity of the estimate of the percentage of body fat (%BF) obtained through BI analyzers tetrapolar and bipolar (hand to hand and foot to foot) using the hydrostatic weighing (HW) with a reference technique. Methods: The %BF was measured in 102 men (18 - 30 years), with three equipment BI: Maltron BF-906 (tetrapolar); Omron 306BL (bipolar hand to hand) and Plena Ice (foot to foot) and HW. The accuracy was verified by paired t-test, correlation, standard error of estimate, constant error, total error and residue analysis. Results: The BI hand to hand underestimated and BI foot to foot overestimated significantly (p< 0.05) values of %BF. Already tetrapolar BI showed no significant difference, and showed the highest correlation value, lower constant error and total error and the highest percentage of agreement with the HW. Conclusion: The equipment used in this study bipolar BI showed no accuracy to estimate relative body fat. Only IB tetrapolar brand Maltron BF-906 showed validity in determining %BF in the sample (AU)