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2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 672-681, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197680

RESUMO

La obesidad sarcopénica se ha asociado con mayor discapacidad y morbimortalidad. Sin embargo, todavía existen pocos estudios sobre el papel de la sarcopenia en las comorbilidades asociadas a la obesidad en individuos con edad inferior a 65 años. La etiopatogenia es multifactorial pero parece que los mediadores inflamatorios y la resistencia a la insulina desempeñan un papel relevante. Aunque no existe un consenso claro sobre su definición y métodos diagnósticos, hay un creciente interés por disponer de biomarcadores que ayuden a su detección y seguimiento. Respecto al tratamiento, se postula el abordaje multimodal, que básicamente se fundamenta en recomendaciones dietéticas, ejercicio y eventualmente cirugía bariátrica


Sarcopenic obesity has been associated with greater disability, morbidity and mortality. However, at present, there are few studies regarding the role of sarcopenia in the evolution of the comorbidities associated with obesity in individuals less than 65 years of age. The pathogenesis is multifactorial and uncompletely ilucidated, but it seems that inflammatory mediators and insulin resistance play an important role. Although there is no clear consensus on its definition and diagnostic methods, there is a growing interest in finding biomarkers useful for the detection and monitoring. Regarding the treatment, a multimodal approach is recomended, based on dietary recommendations, exercise and eventually bariatric surgery


Assuntos
Humanos , Obesidade/complicações , Sarcopenia/patologia , Obesidade/diagnóstico , Obesidade/fisiopatologia , Sarcopenia/fisiopatologia , Inquéritos e Questionários , Antropometria , Absorciometria de Fóton/métodos , Tomografia Computadorizada por Raios X , Diabetes Mellitus Tipo 2 , Disfunção Cognitiva , Qualidade de Vida , Exercício Físico
3.
Arch Osteoporos ; 15(1): 154, 2020 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-33009959

RESUMO

The purpose was to determine if increasing serum 25(OH)D and calcium in postmenopausal women increased skeletal muscle size, strength, balance, and functional task performance while decreasing muscle fatigue. PCSA of the vastus lateralis increased and ascent of stairs time decreased after 6 months of increased serum 25(OH)D. PURPOSE: The Institute of Medicine recommends ≥ 20 ng/ml of serum 25-hydroxyvitamin D [25(OH)D] for bone and overall health. Serum 25(OH)D levels have been associated with physical performance, postural sway, and falls. The purpose of this study was to determine if increasing postmenopausal women's serum 25(OH)D levels from 20-30 ng/ml to 40-50 ng/ml improved skeletal muscle size, strength, balance, and functional performance while decreasing skeletal muscle fatigue. METHODS: Twenty-six post-menopausal women (60-85 years old) with baseline serum 25(OH)D levels between 20 and 30 ng/ml were recruited. Oral over-the-counter (OTC) vitamin D3 and calcium citrate were prescribed to increase subjects' serum 25(OH)D to levels between 40 and 50 ng/ml, serum calcium levels above 9.2 mg/dl, and PTH levels below 60 pg/ml, which were confirmed at 6 and 12 weeks. Outcome measures assessed at baseline and 6 months included muscle physiological cross-sectional area (PCSA), muscle strength, postural balance, time to perform functional tasks, and muscle fatigue. Repeated measures comparisons between baseline and follow-up were performed. RESULTS: Nineteen subjects completed the study. One individual could not afford the time commitment for the repeated measures. Three individuals did not take their vitamin D as recommended. Two subjects were lost to follow-up (lack of interest), and one did not achieve targeted serum 25(OH)D. Vastus lateralis PCSA increased (p = 0.007) and ascent of stair time decreased (p = 0.042) after 6 months of increasing serum 25(OH)D levels from 20-30 ng/ml to 40-50 ng/ml. Isometric strength was unchanged. Anterior-posterior center of pressure (COP) excursion and COP path length decreased (p < 0.1) albeit non-significantly, suggesting balance may improve from increased serum 25(OH)D and calcium citrate levels. CONCLUSIONS: Several measures of muscle structure and function were sensitive to elevated serum 25(OH)D and calcium levels indicating that further investigation of this phenomenon in post-menopausal women is warranted.


Assuntos
Citrato de Cálcio/administração & dosagem , Cálcio/sangue , Colecalciferol/administração & dosagem , Fadiga Muscular/efeitos dos fármacos , Força Muscular/efeitos dos fármacos , Pós-Menopausa/sangue , Deficiência de Vitamina D/prevenção & controle , Vitamina D/análogos & derivados , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Citrato de Cálcio/uso terapêutico , Colecalciferol/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Humanos , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Projetos Piloto , Análise e Desempenho de Tarefas , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/administração & dosagem , Vitaminas/uso terapêutico
4.
Arch Osteoporos ; 15(1): 151, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33005974

RESUMO

This is the first study to examine the potential association of adherence to the healthy eating index-2015 (HEI-2015) and bone health. Findings suggest that better diet quality (i.e., a higher HEI-2015 score) is significantly associated with a small but clinically important increase in bone mineral density among adult Iranian women. PURPOSE: The HEI-2015 is a multidimensional measure of diet quality used to assess how well people's dietary behaviors align with key recommendations of the 2015-2020 Dietary Guidelines for Americans for achieving a healthy dietary pattern. We examined the potential association of the HEI-2015 and bone mineral density (BMD) among adult Iranian women, hypothesizing that a higher HEI-2015 score is associated with greater BMD. METHODS: Four-hundred sixteen participants (mean age 48.0 years; 64.7% premenopausal) participated in this cross-sectional study. Lumbar spine and femoral neck BMDs were measured via dual-energy X-ray absorptiometry. Dietary intakes were assessed using a valid and reliable food frequency questionnaire. The HEI-2015 score was calculated based on dietary intakes of 13 components emphasized or minimized in the HEI-2015. The higher the HEI-2015 score, the better the diet quality. RESULTS: After adjusting for potential covariates in the multiple linear regression analysis, higher HEI-2015 scores were associated with greater lumbar spine and femoral neck BMDs (lumbar spine: standardized beta-coefficient [ß] = 0.292; femoral neck: ß = 0.192; both P < 0.001). Similar significant associations were found among premenopausal (lumbar spine: ß = 0.337; femoral neck: ß = 0.262; both P < 0.001) and postmenopausal women (lumbar spine: ß = 0.198; femoral neck: ß = 0.287; both P < 0.050). Overall, every 10-unit increase in the HEI-2015 score was associated with a 0.03 g/cm2 higher multivariable-adjusted BMD at both lumbar spine and femoral neck (both P < 0.001). CONCLUSION: Findings suggest that better diet quality, as indicated by a higher HEI-2015 score, is significantly associated with a small but clinically important increase in BMD among adult Iranian women.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Dieta Saudável/etnologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa , Inquéritos e Questionários
5.
Arch Osteoporos ; 15(1): 166, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079259

RESUMO

In our study investigating the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and possible factors responsible for falls, we have found that prevalence of OSO is 10.7%. OSO does not significantly increase the odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. PURPOSES: The purposes of the study were (a) to determine the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and (b) to investigate the association between falls and possible factors in individuals with and without OSO. METHODS: Medical records of patients aged ≥ 65 years were retrospectively reviewed. Individuals were diagnosed with OSO based on their T-score assessed by dual x-ray absorptiometry, handgrip strength, appendicular lean mass index (ALMi), gait speed and body fat percentile. Comorbidities, history of falls, depressive state, medications and anthropometric measures were also noted. RESULTS: A sample of 460 individuals were assessed (337 females; 123 males) and 49 patients were diagnosed with OSO. There was no statistically significant difference in falls between the two groups (OR: 0.768, 95% CI: 0.409-1.440, p: 0.41) and the presence of OSO was not significantly associated with increased odds of falling (OR: 1.755, 95% CI: 0.547-5.628, p: 0.344). Handgrip strength (OR: 0.931, 95% CI: 0.893-0.971, p: 0.001), ALMi (OR: 0.799, 95% CI: 0.708-0.901, p < 0.0001) and gait speed (OR: 0.529, 95% CI: 0.283-0.988, p: 0.046) were independently associated with falls in overall group, whereas interaction analysis did not reveal any significant moderator effect of OSO vs. non-OSO in the associations between risk factors and falls. CONCLUSION: The prevalence of OSO was 10.7%. OSO was not associated with elevated odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. Further prospective research is needed to clarify the effect of OSO on odds of falling, in consideration with possible risk factors. TRIAL REGISTRATION NUMBER AND DATE: NCT04288401 /26.02.2020.


Assuntos
Fragilidade/fisiopatologia , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Obesidade/epidemiologia , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/epidemiologia , Absorciometria de Fóton/métodos , Idoso , Antropometria/métodos , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Obesidade/fisiopatologia , Osteoporose/fisiopatologia , Equilíbrio Postural/fisiologia , Prevalência , Estudos Retrospectivos , Sarcopenia/fisiopatologia
6.
Arch Osteoporos ; 15(1): 142, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918631

RESUMO

T-score discordance between hip and spine is a common problem in the diagnosis of osteoporosis based on dual-energy X-ray absorptiometry. Not much information on the prevalence and risk factors of this problem is available in Malaysia. Our study found that factors like age, height, physical activity and menopausal status should be taken into account in the diagnosis of osteoporosis. INTRODUCTION AND OBJECTIVE: T-score discordance between hip and spine is a common problem in bone mineral density assessment. A difference ≥ 1 standard deviation (SD) (regardless of diagnostic class) is considered minor, and a difference more than one diagnostic class is considered major discordance. This study aimed to determine the prevalence and factors of hip and spine T-score discordance in a population aged ≥ 40 years in Klang Valley, Malaysia. SUBJECTS AND METHODS: In this cross-sectional study, subjects answered a demographic questionnaire and underwent body composition and bone health assessment using dual-energy X-ray absorptiometry. Chi-square and binary logistic regression analysis were used to assess the prevalence of T-score discordance among the subjects. RESULTS: A total of 786 Malaysians (382 men, 404 women) subjects were recruited. The prevalence of minor and major discordance was 30.3% and 2.3%, respectively. Overall, factors related to T-score discordance were advanced age, decreased height, and being physically active. Sub-analysis showed that decreased height and being physically active predicted T-score discordance in men, being menopausal and Indian (vs Chinese) were predictors in women. CONCLUSIONS: T-score discordance between hip and spine is common among Malaysian middle-aged and elderly population. Diagnosis of osteopenia/osteoporosis should be based on the T-score of more than one skeletal site as per the current recommendations.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Osteoporose/diagnóstico , Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Prevalência
7.
Arch Osteoporos ; 15(1): 135, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32833113

RESUMO

A guide to the clinician on the use of dual-energy x-ray absorptiometry bone densitometry for the management of osteoporosis and the importance of recognizing its pitfalls. PURPOSE: Osteoporosis is a major risk factor for severe fractures in the aging population worldwide, posing a serious public health issue. Dual-energy X-ray absorptiometry (DXA) is and remains the main tool for screening of osteoporosis and monitoring of osteoporosis treatment through quantitative measurement of bone mineral density (BMD). Employing DXA to measure BMD is not without pitfalls. We set out to analyze and classify the potential pitfalls of DXA acquisitions and BMD measurements encountered in clinical practice in our institution. METHODS: Technical inaccuracies and discrepancies in BMD interpretation in the history of our department were analyzed and classified into different categories of pitfalls. RESULTS: We found that major pitfalls of BMD acquisition and interpretation using DXA can be classified into technical, patient, and interpretive factors. These are illustrated with case examples. CONCLUSION: Good technical understanding of BMD measurements using DXA and recognition of potential pitfalls allow for greater technical and interpretive accuracy, which together hopefully increases the precision of osteoporosis management when practiced in accordance with established clinical guidelines.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Osteoporose/diagnóstico por imagem , Idoso , Competência Clínica , Erros de Diagnóstico , Fraturas Ósseas/diagnóstico por imagem , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Valor Preditivo dos Testes , Medição de Risco
8.
Arch Osteoporos ; 15(1): 129, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32804253

RESUMO

This study examined the association between healthy lifestyle score (HLS), which contained 7 items (smoking, BMI, physical activity, diet, alcohol, sleep and anxiety) and BMD. Results showed HLS was positively associated with BMD at all studied sites, suggesting that healthier lifestyle patterns might be beneficial to bone health. PURPOSE: Previous studies have reported favourable associations of individual healthy lifestyle factors with bone mineral density (BMD), but limited evidence showed the relationship of a combined healthy lifestyle score (HLS) with BMD. This study examined the association between the HLS and BMD. METHODS: This community-based cross-sectional study included 3051 participants aged 40-75 years. The HLS contained 7 items (smoking, BMI, physical activity, diet quality, alcohol intake, sleep and anxiety). BMD values of whole body (WB), lumbar spine 1-4 (L1-4), total hip (TH) and femur neck (FN) were measured using dual-energy X-ray absorptiometry. RESULTS: After adjusting for potential covariates, HLS was positively associated with BMD at all studied sites (P-trend < 0.01). The mean BMDs were 2.69% (WB), 5.62% (L1-4), 6.13% (TH) and 5.71% (FN) higher in participants with HLS of 6-7 points than in those with HLS of 0-2 points. The per 1 of 7 unit increase in the HLS was associated with increases of 7.63 (WB)-13.4 (TH) mg/cm2 BMD levels at all sites. These favourable associations tended to be more pronounced in men than in women. Among the 7 items, physical activity contributed most to the favourable associations, followed by BMI, non-smoking and diet; the other three items played little roles. Sensitivity analyses showed that the significant associations remained after excluding any one of the 7 components or excluding fracture subjects at all sites. CONCLUSION: Higher HLS was associated with greater BMD in middle-aged and elderly Chinese, suggesting that healthier lifestyle patterns might be beneficial to bone health.


Assuntos
Absorciometria de Fóton/métodos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Densidade Óssea , Colo do Fêmur/diagnóstico por imagem , Estilo de Vida Saudável , Vértebras Lombares/diagnóstico por imagem , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Arch Osteoporos ; 15(1): 132, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32812073

RESUMO

The osteoporosis self-assessment tool was more accurate than hand grip strength, gait speed, and calf circumference in predicting osteoporosis in women. Hand grip strength was more accurate than the osteoporosis self-assessment tool, gait speed, and calf circumference in predicting osteoporosis in men. PURPOSE: The osteoporosis self-assessment tool, functional assessment, and anthropometric measurement are different techniques to identify those at risk of osteoporosis. This study aimed to compare the performance of these techniques in predicting osteoporosis. METHODS: In this cross-sectional, hospital-based study including 1109 participants, the bone mineral density of the spine and hips was evaluated using the dual-energy X-ray absorptiometry. The Osteoporosis Self-Assessment Tool was used as a simple clinical risk assessment tool to screen for osteoporosis. Gait speed and hand grip strength were used as functional assessments to predict osteoporosis. Calf circumference was used as an anthropometric measurement to predict osteoporosis risk. RESULTS: In women, the Osteoporosis Self-Assessment Tool was better than hand grip strength, gait speed, and calf circumference in predicting osteoporosis. In contrast, in men, hand grip strength was better than the Osteoporosis Self-Assessment Tool, gait speed, and calf circumference. CONCLUSION: The application of simple, cost-effective techniques for the identification of osteoporosis risk will be beneficial for both screening and patient care when dual-energy X-ray absorptiometry is not available. We suggest that the Osteoporosis Self-Assessment Tool can be used to identify the risk of osteoporosis in women and hand grip strength measurement can be used for men.


Assuntos
Absorciometria de Fóton/métodos , Antropometria , Densidade Óssea/fisiologia , Força da Mão , Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Marcha/fisiologia , Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Autoavaliação , Coluna Vertebral/diagnóstico por imagem , Velocidade de Caminhada
10.
Medicine (Baltimore) ; 99(28): e20906, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664083

RESUMO

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Contagem de Células Sanguíneas/métodos , Densidade Óssea/fisiologia , Hemoglobinas/análise , Pós-Menopausa/sangue , Absorciometria de Fóton/métodos , Idoso , Contagem de Células Sanguíneas/tendências , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Feminino , Hematopoese/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos
11.
PLoS One ; 15(7): e0236323, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706814

RESUMO

Obesity and regional adiposity are important risk factors for cardiometabolic disorders. The aim of this study is to compare 7-site skinfold (SF) measurement to dual-energy x-ray absorptiometry (DXA) as the reference method for estimating body fat percentage (BF%) and regional adiposity in diabetic outpatients. A total of 59 diabetic patients (36 females and 23 males) aged 28.5-78 years (median 67.7 years) with BMI 18.8-40.6 kg/m2 (median: 25.5 kg/m2) were enrolled. 7-site skinfold measurement and DXA were performed at the same visit day and biochemistry data were collected. Our results demonstrate the BF% calculated via Jackson & Pollock 7-site skinfold equation presents a strong correlation (r = 0.672, p < 0.001 in females; r = 0.885, p < 0.001 in males) with that measured by DXA, but the means of BF% between these two methods are significantly different in both sexes (paired t-test, p < 0.001). The Bland-Altman analysis showed the mean differences (DXA-SF) of BF% were positive for female (8.74%) and male (7.22%), suggesting Jackson & Pollock 7-site skinfold equation tends to underestimate the BF%. Besides, regional SF thicknesses of 7-site skinfold measurement were significantly correlated with the matched regional adiposity quantified by DXA. Furthermore, truncal and android SF thicknesses were notably positively correlated with several cardiometabolic risk factors in gender-specific manner. Our data indicate the 7-site skinfold measurement is not an interchangeable method for precisely measuring BF%, but might be practical for evaluating the cardiometabolic risks in Taiwanese diabetic outpatients.


Assuntos
Absorciometria de Fóton/métodos , Tecido Adiposo/diagnóstico por imagem , Adiposidade , Obesidade/diagnóstico por imagem , Pregas Cutâneas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
12.
Lancet Diabetes Endocrinol ; 8(8): 672-682, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32707115

RESUMO

BACKGROUND: The validation of bone mineral density (BMD) as a surrogate outcome for fracture would allow the size of future randomised controlled osteoporosis registration trials to be reduced. We aimed to determine the association between treatment-related changes in BMD, assessed by dual-energy x-ray absorptiometry, and fracture outcomes, including the proportion of treatment effect explained by BMD changes. METHODS: We did a pooled analysis of individual patient data from multiple randomised placebo-controlled clinical trials. We included data from multicentre, randomised, placebo-controlled, double-blind trials of osteoporosis medications that included women and men at increased osteoporotic fracture risk. Using individual patient data for each trial we calculated mean 24-month BMD percent change together with fracture reductions and did a meta-regression of the association between treatment-related differences in BMD changes (percentage difference, active minus placebo) and fracture risk reduction. We also used individual patient data to determine the proportion of anti-fracture treatment effect explained by BMD changes and the BMD change needed in future trials to ensure fracture reduction efficacy. FINDINGS: Individual patient data from 91 779 participants of 23 randomised, placebo-controlled trials were included. The trials had 1-9 years of follow-up and included 12 trials of bisphosphonate, one of odanacatib, two of hormone therapy (one of conjugated equine oestrogen and one of conjugated equine oestrogen plus medroxyprogesterone acetate), three of PTH receptor agonists, one of denosumab, and four of selective oestrogen receptor modulator trials. The meta-regression revealed significant associations between treatment-related changes in hip, femoral neck, and spine BMD and reductions in vertebral (r2 0·73, p<0·0001; 0·59, p=0·0005; 0·61, p=0·0003), hip (0·41, p=0·014; 0·41, p=0·0074; 0·34, p=0·023) and non-vertebral fractures (0·53, p=0·0021; 0·65, p<0·0001; 0·51, p=0·0019). Minimum 24-month percentage changes in total hip BMD providing almost certain fracture reductions in future trials ranged from 1·42% to 3·18%, depending on fracture site. Hip BMD changes explained substantial proportions (44-67%) of treatment-related fracture risk reduction. INTERPRETATION: Treatment-related BMD changes are strongly associated with fracture reductions across randomised trials of osteoporosis therapies with differing mechanisms of action. These analyses support BMD as a surrogate outcome for fracture outcomes in future randomised trials of new osteoporosis therapies and provide an important demonstration of the value of public access to individual patient data from multiple trials. FUNDING: Foundation for National Institutes of Health.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Interpretação Estatística de Dados , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Absorciometria de Fóton/métodos , Biomarcadores/metabolismo , Densidade Óssea/fisiologia , Humanos , Fraturas por Osteoporose/metabolismo , Análise de Regressão , Comportamento de Redução do Risco , Resultado do Tratamento
13.
PLoS One ; 15(6): e0235174, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574226

RESUMO

AIM: To investigate markers of systemic inflammation in pre- and postmenopausal women and identify possible predictors of systemic inflammation with menopause. METHODS: Cross-sectional study of 69 healthy women between 45- and 60 years. Blood samples were collected to assess leukocyte subsets and plasma cytokines. MRI and DXA scans were performed to assess body composition. Through uni- and multivariate analyses, follicle-stimulating hormone (FSH), visceral fat mass and age were evaluated as predictors of systemic inflammation in relation to menopause. RESULTS: Postmenopausal women tended to have higher leukocyte counts (5.4 x109 vs. 4.9 x109 cells/l, p = 0.05) reflected in increased total lymphocytes (1.8 x109 vs. 1.6 x109 cells/l, p = 0.01) and monocytes (0.5 x109 vs. 0.4 x109 cells/l, p = 0.02), compared to premenopausal women. Increased visceral fat mass was a strong predictor of high leukocyte subsets. Postmenopausal women had higher plasma TNF-α (2.24 vs. 1.91 pg/ml, p = 0.01) and IL-6 (0.45 vs. 0.33 pg/ml, p = 0.004) compared to premenopausal women and high FSH was a significant predictor of increased plasma TNF-α, IL-1ß and IL-6. Menopause was further associated with increased T-cells (1,336 vs. 1,128 cells/µl, p = 0.04) reflected in significantly higher counts of exhausted-, senescent-, and memory CD4+ T-cell subsets. CONCLUSIONS: Menopause is associated with increased systemic inflammation as well as exhausted- and senescent T-cells. We suggest, that both increased visceral fat mass and declining sex hormone levels might contribute to postmenopausal systemic inflammation and calls for further large-scale studies to confirm these findings.


Assuntos
Citocinas/imunologia , Inflamação/imunologia , Pós-Menopausa/imunologia , Subpopulações de Linfócitos T/imunologia , Absorciometria de Fóton/métodos , Composição Corporal , Citocinas/sangue , Citocinas/metabolismo , Feminino , Hormônio Foliculoestimulante/sangue , Hormônio Foliculoestimulante/imunologia , Hormônios Esteroides Gonadais/sangue , Hormônios Esteroides Gonadais/imunologia , Humanos , Inflamação/sangue , Inflamação/metabolismo , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/imunologia , Gordura Intra-Abdominal/metabolismo , Linfócitos/citologia , Linfócitos/imunologia , Linfócitos/metabolismo , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/imunologia , Monócitos/metabolismo , Análise Multivariada , Pós-Menopausa/sangue , Pós-Menopausa/metabolismo , Subpopulações de Linfócitos T/citologia , Subpopulações de Linfócitos T/metabolismo
14.
Arch Osteoporos ; 15(1): 85, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32514615

RESUMO

In 50,330 women undergoing bone mineral density (BMD) testing, adjusting FRAX® major osteoporotic fracture (MOF) probability for T-score differences between lumbar spine and femoral neck had a small impact on treatment qualification, with only 1.1% reclassified from below to above the 20% MOF intervention threshold. PURPOSE: Discordance between lumbar spine and femoral neck T-score measurements are frequently encountered in clinical practice. The FRAX tool accepts femoral neck BMD as an optional input but does not consider lumbar spine BMD, though adjustments based upon T-score difference have been proposed. This analysis was undertaken to examine change in treatment qualification using the lumbar spine T-score adjustment to FRAX assuming an intervention threshold of 20% MOF. METHODS: Women aged > 50 years with baseline FRAX MOF probability computed with femoral neck BMD of ≥ 20% but without previous high-risk fracture or high-risk medication use were identified in the province of Manitoba BMD registry. If lumbar spine T-score was lower than the femoral neck T-score, MOF probability was recalculated, and treatment qualification, reassessed. RESULTS: The study population consisted of 50,300 women (mean age 64.2 ± 8.6 years). During mean follow-up of 9.5 years, 4550 sustained incident MOF. The baseline mean T-score difference (femoral neck minus lumbar spine) was - 0.2 ± 1.1. Recalculated MOF probability using the T-score difference significantly improved overall net reclassification index for incident MOF prediction (+ 0.017, p < 0.001). A total of 561 (1.1%) of these women were reclassified from below to above 20% MOF probability based upon the T-score difference. No individuals with MOF probability less than 15% were reclassified to the higher risk category. Risk reclassification increased with lower lumbar spine T-score (15.6% reclassification for lumbar spine T-score of - 3.5 or lower, 4.0% of the study population) and larger T-score differences (9.7% reclassification for T-score difference of 2.5 or more, < 1% of the study population). CONCLUSIONS: Very few women showed risk reclassification based upon adjusting FRAX MOF probability for lumbar spine T-score. Reclassification occurred only in those with baseline MOF probability > 15%.


Assuntos
Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Medição de Risco/métodos , Absorciometria de Fóton/métodos , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Humanos , Incidência , Manitoba , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Guias de Prática Clínica como Assunto , Sistema de Registros , Fatores de Risco
15.
Rev. esp. nutr. comunitaria ; 26(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194453

RESUMO

FUNDAMENTOS: la contextualización y caracterización de las técnicas utilizadas para valorar la composición corporal (CC), brinda información sobre las regiones más investigadas en determinadas poblaciones específicas. Los objetivos fueron: a) contextualizar las investigaciones en niños y adolescentes chilenos según variables demográficas, b) verificar las técnicas de evaluación utilizadas para medir la CC y c) identificar las investigaciones efectuadas según región geográfica en Chile. MÉTODOS: Se efectuó una revisión sistemática sobre la CC en niños y adolescentes de Chile. Se consideraron estudios publicados la base de datos PubMed entre los años 2010-2017. Se utilizó una ficha de observación para registrar la información y para sistematizar el proceso de la revisión se utilizó el diagrama de flujo PRISMA. RESULTADOS: Se evidenció, entre los años 2010 y 2017, un total de 30 investigaciones, donde el tamaño de la muestra osciló desde 27 a 3.593 sujetos, desde los cero meses hasta los 18 años. La técnica de evaluación que más utilizada fue la absorciometría de rayos X de doble energía (DXA) (33%), seguido de la antropométrica de los pliegues cutáneos (28%), ecuaciones de regresión (15%) y dilución isotópica y bio-impedancia (12%). En la región metropolitana se efectuaron más estudios (67%), seguido de la región de la Araucanía (14%), Maule (10%), Valparaíso y Bio-Bio (3%) y un 3% no especifica la región. CONCLUSIONES: Los resultados sugieren que es necesario ampliar las investigaciones de CC en el norte y sur de Chile y poner mayor énfasis en las variables demográficas, puesto que hasta donde se sistematizó son muy limitados


BACKGROUND: Contextualization and characterization in relation to the techniques most used to assess body composition (CC), provides information on the most researched regions in certain specific populations. The objectives were: a) contextualize the research carried out in Chilean children and adolescents according to demographic variables, b) verify the evaluation techniques that have been used to measure the CC, and c) identify the investigations that have been carried out according to geographical region in Chile. METHODS: A systematic review study on CC in children and adolescents in Chile was carried out. Studies published in the Pub Med database between the years 2010-2017 was considered. An observation sheet was used to record the information and to systematize the review process the PRISMA flow chart was used. RESULTS: A total of 30 investigations have been carried out between 2010 and 2017. The sample size varied from 27 to 3593 subjects, from zero months to 18 years. The most commonly used evaluation technique was double energy X-ray absorptiometry (DXA) (33%), followed by the anthropometric of skin folds (28%), regression equations (15%) and isotopic dilution and Bio impedance (12%). More studies (67%) have been carried out in the metropolitan region, followed by the Araucanía region (14%), Maule (10%), Valparaíso and Bio-Bio (3%) and 3% do not specify the region where was carried out. CONCLUSIONS: The results suggest that it is necessary to expand CC research in the north and south of Chile and place greater emphasis on demographic variables, since as far as it was systematized they are very limited


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Composição Corporal/fisiologia , Fenômenos Fisiológicos Musculoesqueléticos , Exercício Físico/fisiologia , Chile , Absorciometria de Fóton/métodos , Absorciometria de Fóton/estatística & dados numéricos , Antropometria
16.
J Sports Med Phys Fitness ; 60(5): 733-742, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32438789

RESUMO

BACKGROUND: This study investigated the comparability between air displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance analysis (BIA) methods for body composition assessment and their correlations with physical performance in rugby players. METHODS: Nineteen male elite players participated in the study. ADP, DXA, and BIA were used to assess fat-mass and fat-free mass. Physical performance was assessed by means of Carminatti's test of peak velocity (PVTCAR), countermovement jump (CMJ), sprint speed (10 and 30-m), and match performance analyses (sprinting, distance covered, and high-intensity running). RESULTS: BIA overestimated fat-mass (13±41%; r2=0.60) and underestimated fat-free mass (-1±7%; r2=0.66) compared to ADP (P=0.001). BIA underestimated fat-mass (-28±3%; r2=0.92) and overestimated fat-free mass (10±5%; r2=0.87) compared to DXA (P<0.001). ADP underestimated fat-mass (-36±37%; r2=0.69) and overestimated fat-free mass (11±8%; r2=0.52) compared to DXA (P<0.001). Fat-mass measured by ADP, DXA, and BIA negatively correlated with PVTCAR (r2≥0.49), height and peak power from CMJ (r2≥0.30), sprinting ability (r2≥0.65), and match performance variables (r2≥0.30). CONCLUSIONS: As long as one considers that ADP and BIA underestimated fat-mass and overestimated fat-free mass compared to DXA, the methods can be used to estimate body composition, particularly to track body fat-mass changes, which negatively influence several physical capacities determinant to rugby performance. The limitations of the methods should be borne in mind when assessing the body composition of rugby athletes.


Assuntos
Absorciometria de Fóton/métodos , Composição Corporal/fisiologia , Futebol Americano/fisiologia , Pletismografia de Impedância/métodos , Tecido Adiposo/metabolismo , Adolescente , Adulto , Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Impedância Elétrica , Humanos , Masculino , Corrida/fisiologia , Adulto Jovem
17.
Arch Osteoporos ; 15(1): 64, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32335776

RESUMO

This study investigated the impact and non-impact sports on bone mineral density accrual in adolescents over 18 months. The impact sports were beneficial for bone health (accrual of bone density). In contrast, swimmers had similar or lower bone mineral density compared with the control group depending on the skeletal site. PURPOSE: To investigate the impact and non-impact sports on bone mineral density (BMD) accrual in adolescents over a period of 18 months METHODS: The sample was composed of 71 adolescents, avarage age of 12.7 (± 1.7) years old at baseline. Bone outcomes were compared according to the loading of the sports practiced (impact sports, n = 33 [basketball, karate, and judo], non-impact sport, n = 18 [swimming], and control group, n = 20). Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (DXA) and bone mineral apparent density (BMAD) estimated through equation. The results were compared between the groups using analysis of variance and analysis of covariance. RESULTS: Adjusted aBMD at lower limbs, whole body less head (WBLH), and adjusted WBLH BMAD were significantly greater in the impact sport group than the non-impact sport group at all time points. Adjusted upper limbs aBMD was significantly higher at the impact sports group compared to the non-impact sport group at 9 months and 18 months, besides compared to the control group at baseline and 18 months. Non-impact sport group presented a significant lower adjusted aBMD compared with control group at lower limbs and WBLH at 9 months, and at 9 months and 18 months in WBLH BMAD. There was a significant interaction (time × sport group) at upper limbs (p = 0.042) and WBLH aBMD (p = 0.006), and WBLH BMAD (p < 0.001). CONCLUSION: Impact sports were more beneficial on accumulating aBMD and BMAD over a period of 18 months, while non-impact group (swimmers) had similar and lower aBMD and BMAD compared with the control group.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Basquetebol/fisiologia , Desenvolvimento Ósseo/fisiologia , Artes Marciais/fisiologia , Natação/fisiologia , Absorciometria de Fóton/métodos , Adolescente , Análise de Variância , Densidade Óssea , Criança , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Fatores de Tempo , Extremidade Superior/diagnóstico por imagem
18.
Acta Orthop Traumatol Turc ; 54(1): 27-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175894

RESUMO

OBJECTIVE: The study aimed to identify the prevalence of sarcopenia in patients with osteoporotic hip fractures, investigate the anthropometric differences between sarcopenic and non-sarcopenic patients, and evaluate and compare the surgical outcomes between the two groups. METHODS: The study included 135 patients (35 men and 100 women; mean age: 74.1 years (range; 25-96)) who received surgical treatment for hip fracture between March 2014 and October 2016 and underwent whole-body dual-energy X-ray absorptiometry (DEXA). The skeletal muscle mass index (SMI) for diagnosis of sarcopenia was measured using whole-body DEXA. The following data were collected to compare the preoperative details of the sarcopenic and non-sarcopenic groups: SMI, age, sex, type of fracture, type of operation, BMI, obesity, American society of Anesthesiologists (ASA) class, pre-injury mobility score, BMD, and follow-up period. We compared clinical outcomes, including Harris Hip Score (HSS) and the walking ability at the last follow-up visit and radiologic outcomes, including non-union and the time to union. RESULTS: The average HHS and Parker's mobility score at the last follow-up were 81.7 and 6.9 in the sarcopenic group, and 77.6 and 6.3 in the non-sarcopenic group, respectively (p=0.149 and 0.122). Non-union was identified 0 (0%) in sarcopenic group and 4 (10%) in non-sarcopenic group (p=0.288). The mean union timer of the patients in the sarcopenia group was 4.0 months and that of patients in the non-sarcopenic group was 4.4 months (p=0.210). Multiple regression analysis did not show any significant association between sarcopenia and postoperative surgical outcomes, including HHS, mobility score at the last follow up, non-union, and time to union. CONCLUSION: Although the present study showed that the prevalence of sarcopenia in hip fracture patients was 45.9% (62/135), there was no clinical association between sarcopenia and postoperative. Based on these results, the clinical impact of sarcopenia may be confined to increased risk of hip fracture occurrence and surgical outcomes of hip fracture may not be affected by sarcopenia. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Sarcopenia , Absorciometria de Fóton/métodos , Absorciometria de Fóton/estatística & dados numéricos , Idoso , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Prevalência , Estudos Retrospectivos , Medição de Risco , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia
19.
Medicine (Baltimore) ; 99(11): e19251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176049

RESUMO

Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ±â€Š0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/patologia , Neoplasias Colorretais/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton/métodos , Adenocarcinoma Mucinoso/cirurgia , Adulto , Idoso , Estudos de Coortes , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Modelos Logísticos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Biomed Res Int ; 2020: 4154290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32185203

RESUMO

Background: Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods: A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results: There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion: The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.


Assuntos
Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Durapatita/administração & dosagem , Fluoretos/administração & dosagem , Radioisótopos de Flúor/administração & dosagem , Absorciometria de Fóton/métodos , Idoso , Artroplastia de Quadril/métodos , Feminino , Prótese de Quadril , Humanos , Masculino , Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos
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