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The ageing process in men is marked by changes in body composition (loss of fat-free mass (FFM) and skeletal muscle, and gain in fat mass (FM)) and is associated with a decline in serum testosterone. Correlations between these aspects of ageing and the acknowledged role of exogenous testosterone in reversing the loss of FFM and gain in FM seen in adult men with congenital or acquired hypoandrogenism have led to the hypothesis that testosterone therapy in ageing men will result in favourable changes in body composition and may improve metabolic status and/or cardiovascular risk. Data from randomized controlled trials of testosterone therapy in ageing men addressing the endpoints of body composition and components of the metabolic syndrome and cardiovascular risk factors are reviewed, and the impact of the increasing prevalence of obesity on these relationships is considered.

OBJECTIVES: Conflicting reports of the effect of physical activity on knee cartilage may be due to the heterogeneity of populations examined and, in particular, the underlying health of the knee joint. This study examined the influence of recreational and occupational physical activity on cartilage volume loss. METHODS: A total of 250 participants with no significant musculoskeletal disease were recruited. A gender-specific median cartilage volume split was used to define people in the lowest and highest 50% of baseline cartilage volume. Baseline recreational and occupational activity was examined by questionnaire, while cartilage volume was assessed by MRI at baseline and 2.4 : years later. RESULTS: Significant interactions were demonstrable between physical activity and cartilage volume loss based on stratification of baseline cartilage volume (all P ⩽ 0.03). There was a dose-response relationship between frequently performed baseline occupational activities and medial cartilage volume loss in both the low (B = 0.2% per annum, 95% CI: 0.0, 0.04% per annum) and high (B = -0.2% per annum, 95% CI: -0.4, 0.0% per annum) baseline cartilage volume groups (P = 0.001 for interaction). Individuals with low baseline cartilage volume who were active in their occupation and/or recreational activity had greater medial cartilage volume loss than their more inactive counterparts (2.4% per annumvs1.5% per annum, P = 0.02). CONCLUSION: Whereas people with less baseline cartilage volume are more at risk of structural knee damage with either heavy occupational or recreational workloads or both, individuals with high baseline cartilage volume may advantageously modify their risk for knee OA by participating in more frequent occupational physical activities.

Process Initially, two systematic reviews were undertaken to assess: (i) the relationship between body mass index with musculoskeletal foot disorders, and (ii) the relationship between body composition and foot structure and function. Following this, we undertook a longitudinal and cross-sectional study of fat mass and foot pain to determine any association. Finally, a cross-sectional study of foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals was undertaken.

cope Polycystic ovary syndrome (PCOS) is underpinned by insulin resistance (IR). In PCOS, the relationships between vitamin D, adiposity, and IR are unclear. We aim to explore these relationships in lean and overweight women with PCOS. Methods and results This is a cross-sectional study conducted in a tertiary medical center. Participants included 42 women with PCOS and 34 controls without PCOS. Vitamin D and metabolic markers were measured. Detailed body composition and gold standard hyperinsulinemic euglycemic clamps were performed. The main outcome measures were plasma levels of vitamin D, adiposity measures, and glucose infusion rate. Vitamin D levels were lower in overweight women with PCOS compared with overweight controls (31.6 and 46.1 nmol/L, respectively, p = 0.01). Vitamin D was not associated with IR after adjustment for confounders; however, there was a significant interaction between PCOS and percentage body fat. Further analysis by PCOS status revealed that vitamin D was associated with IR in the PCOS group (β coefficient 2.1, 95% CI 0.2–4.0, p = 0.03), but not in the non-PCOS group. Conclusion Vitamin D is associated with IR in women with PCOS, but not in controls. Large intervention studies are needed to determine if vitamin D supplementation can improve IR in PCOS.

Background It is estimated there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high quality information on body composition including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans indetermining the influence of reduced muscle mass on clinical outcome in abdominal cancer. Methodology A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal was undertaken. Results Ten cohort studies met the inclusion criteria. Seven demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3-66.7%) were identified as sarcopenic using CT scans compared to numbers identified as malnourished using Body Mass Index (BMI). Conclusion CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective.

Background Marked weight loss reduces lean body mass and quadriceps thickness. It is unclear whether muscle loss varies according to the method of weight loss. Objective This study compared the association of surgical versus nonsurgical weight loss with change in vastus medialis (VM) properties in obese adults. Methods Twenty obese patients (body mass index≥30 kg/m 2 ) who lost weight via laparoscopic gastric banding were matched for weight loss with obese patients who lost weight nonsurgically. The thickness and fat infiltration of VM were assessed at baseline and a mean of 2.4 years later. Results After adjusting for confounders, the annual change in VM thickness was –2.9% in the surgical group and –.5% for the nonsurgical group ( P = .02). There was also a tendency toward an increased risk for VM fat infiltration to be reduced when weight loss occurred nonsurgically (OR 5.1, 95% CI .8–32.8; P = .09). Conclusions Compared with nonsurgical weight loss, laparoscopic gastric banding was associated with greater VM muscle thickness loss. Relative to laparoscopic gastric banding, there was also a tendency toward an increased risk for VM fat infiltration to be reduced with nonsurgical weight loss. Close attention to preserving muscle properties at the knee when significant amounts of weight loss have occurred is required. Physical therapy may be important in the management of patients after laparoscopic gastric banding in an attempt to preserve skeletal muscle mass.

In Australia, 25.5% of men aged 55-64 years and 19.9% of men aged 65-74 years are obese, as defined by body mass index (BMI: ratio of body weight in kilograms to height in metres squared) � 30 kg/m 2 ; this represents a 2.5-fold increase over the past 20 years. 7 More than one in three men aged 55 years or older has a waist circumference (WC) in the obese range (� 102 cm) — a ABSTRACT Objective: To determine the influence of obesity on the diagnosis of age-related androgen deficiency (AD) in symptomatic men according to current Australian guidelines. Design, setting and participants: A community-based cohort of healthy ageing men with symptoms suggestive of AD was studied between May 2001 and February 2003. Men were classified as obese or non-obese according to body mass index (BMI) or waist circumference (WC). Main outcome measure: Diagnosis of AD according to Endocrine Society of Australia (ESA) guidelines. Results: 223 men aged 54-86 years with mean BMI 27.3 ±0.2 kg/m 2 (range 20.5-36.2 kg/ m 2 ) were recruited; 99 men were obese (BMI � 30.0 kg/m 2 or WC � 102 cm) and 124 men were non-obese. Obese men had lower total testosterone (TT) (12.7 ±0.4 v 15.0 ±0.4 nmol/L); P < 0.001) and calculated free testosterone (275.7 ±7.8 v 299.3 ±7.4 pmol/L); P = 0.03) levels than non-obese men. TT levels < 8 nmol/L were recorded in 12% of obese men and 1% of non-obese men. Applying the ESA guidelines for the diagnosis of age-related AD, 15 obese men (15%) and 4 non-obese men (3%) were classified as being eligible for androgen therapy supported by the Pharmaceutical Benefits Scheme (PBS); the relative risk in obese men was 1.92 (95% CI, 1.44-2.55; P < 0.001). Conclusion: Obesity is an important determinant of serum TT levels in ageing men. Almost one in seven obese men but only one in 30 non-obese men in our study were eligible for PBS-supported androgen therapy according to Australian guidelines. Although obese men are more likely to have biochemical hypoandrogenism, the clinical implications of this remain uncertain. Studies of testosterone therapy in this group of

BACKGROUND A very-low-energy diet (VLED) can result in substantial, rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity. Despite its growing popularity, a VLED in this setting has received little attention. OBJECTIVE The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED. DESIGN In a prospective observational study, 32 subjects (n = 19 men and 13 women) with a mean (+/-SD) age of 47.5 +/- 8.3 y and a body mass index (in kg/m(2)) of 47.3 +/- 5.3 consumed a VLED for 12 wk. Primary outcomes included changes in liver volume (LV) and in visceral and subcutaneous adipose tissue (VAT/SAT). Changes in body weight, anthropometric measures, and biochemical variables were also recorded, and compliance with, acceptability of, and side effects of treatment were assessed. Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2, 4, 8, and 12. RESULTS Mean (+/-SD) LV, VAT/SAT, and body weight decreased significantly (P < 0.001 for all). The degree of LV reduction was directly related to the reduction in relative body weight (r = 0.54, P = 0.001) and initial LV (r = 0.43, P = 0.015). Eighty percent of the reduction in LV occurred between weeks 0 and 2 (P < 0.001). Reductions in body weight and VAT were uniform over the 12-wk period. Attrition was 14%. Acceptability was adequate but waned over time, and mild transitory side effects occurred. CONCLUSIONS Given the observed early reduction in LV and the progressive reduction in VAT, we suggest that the minimum duration for a preoperative VLED be 2 wk. Ideally, the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability.

Liver cirrhosis is a condition in which overnutrition, edema, and undernutrition can coexist simultaneously, or successively, over a period of time, giving rise to alterations in body composition, as well as systemic and multiorgan manifestations. We undertook a cross-sectional study of body composition in 198 adult patients with liver cirrhosis (140 males, mean age 53.6, range 31-85 years; and 58 females, mean age 58.4, range 36-79 years). The patients had cirrhosis of differing etiology and different stages of severity. They were gathered from seven different hospital clinics in the city of Melbourne, Australia, but all the body composition measurements were performed in one body composition laboratory. A variety of body composition techniques were used to identify which commonly available ones could best assess both fat-free mass and fat mass relative to a criterion "gold-standard" method available in a specialist laboratory. A gold-standard fat-free mass (FFMGS) was defined as the sum of total body protein, measured by in vivo neutron activation analysis (IVNA), plus total body water, measured by D2O dilution, plus bone mineral content, measured by dual X-ray absorptiometry (DXA). A gold-standard fat mass (FATGS) was defined as the difference between body weight and FFMGS. "Usual" fat mass and fat-free mass were defined by different techniques including DXA, anthropometry (ANT), single-frequency bioelectrical impedance (SFBIA), multiple-frequency bioelectrical impedance spectroscopy (MFBIA), and whole body gamma counting (TBK). The FFMGS was overhydrated in both sexes, relative to the usual value of 0.73, but women were significantly overhydrated compared to men. Relative to the gold-standard deuterium oxide dilution method for measuring total body water, SFBIA slightly overestimated TBW, whereas MFBIA slightly underestimated TBW, with both methods having wide limits of agreement for any single estimate. In comparing FFM to FFMGS, only DXA showed a small negative bias, in both males and females, with modest limits of agreement for any single estimate. All other methods showed a large negative bias (ANT, SFBIA, and MFBIA) or a large positive bias (TBK) relative to FFMGS, with wide limits of agreement. In comparing FAT with the FATGS, only DXA showed a small positive bias, in both males and females, with modest limits of agreement for any single estimate. All other methods showed a large positive bias (ANT, SFBIA, and MFBIA) or a large negative bias (TBK) relative to FATGS, with wide limits of agreement. In cirrhosis, DXA is a good and widely available method to assess both fat mass and fat-free mass. However, it cannot give information about the quality of the FFM, particularly its water content. The bedside methods of anthropometry and bioelectrical impedance, both SFBIA and MFBIA, are poor methods of measuring body composition in patients with liver cirrhosis, whereas whole body gamma counting, although not widely available, also significantly differs from the gold-standard method of assessment of fat-free mass and fat mass in liver cirrhosis.

The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10-year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors treated for 12 months, in conjunction with a fat-reduced, but otherwise ad libitum, diet.A double-blind, randomized, placebo-controlled, parallel study was performed in conjunction with a fat-reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean +/- s.d. age = 52.0 +/- 7.5 years, body mass index (BMI) = 37.6 +/- 5.1 kg/m(2)) or placebo three times daily (n = 89 women, 80 men; age = 52.5 +/- 7.4 years, BMI = 38.0 +/- 4.9 kg/m(2)). The primary efficacy criterion was the 10-year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life.There was no difference in the change in 10-year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL-cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF-36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids.Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low-risk group (approximately 10% of risk of a CVD event over 10 years).

Objective Although obesity is widely accepted as a risk factor for knee osteoarthritis, it is not clear whether individual components of body composition, such as the mass and distribution of muscle and fat, are associated with development of the disease. This study examined the effect of measures of body composition on the longitudinal change in tibial cartilage volume. Methods Body composition, assessed via dual x-ray absorptiometry, and tibial cartilage volume, assessed via magnetic resonance imaging, were measured in 86 healthy men and women who were mid-life in age. Change in tibial cartilage volume was assessed by imaging each knee 2 years after the baseline measurement and determining the difference from baseline in tibial cartilage volume. Correlations were determined between the muscle and fat mass of the arm, leg, and total body and the volume of the lateral- and medial-tibial cartilage, as well as the change in tibial cartilage volume over 2 years, after adjusting for confounders. Results There was a significant association between muscle mass and the medial-tibial cartilage volume, independent of age, sex, body mass index, tibial bone area, and level of physical activity. Although there was a positive association between muscle mass and the lateral-tibial cartilage volume, this did not persist after adjustment for confounders. Loss of muscle mass was associated with an increased loss of medial- and lateral-tibial cartilage over 2 years, after adjusting for confounders. No relationship was apparent between fat mass and either medial- or lateral-tibial cartilage volume, or between fat mass and change in either medial- or lateral-tibial cartilage volume over 2 years, after adjusting for confounders. Conclusion Muscle mass is an independent predictor of medial-tibial cartilage volume in healthy people in mid-life and is associated with a reduction in the rate of loss of tibial cartilage. This suggests that increased muscle mass may be protective against the onset of osteoarthritis.

AIMTo examine early factors in bone mineral accretion in cystic fibrosis (CF).METHODSIn 22 prepubertal children with CF and mild lung disease, the relation between total body bone mineral density (BMD) and measures of body composition, biochemistry, lung function, and physical activity was studied.RESULTSThere was a non-significant mild reduction in mean total body BMD. No relation was found between BMD and anthropometric indices, fat free soft tissue, degree of lung disease, degree of fat malabsorption, dietary energy intake, or level of physical activity. Significant impairments in physical growth were apparent in this population and were found to correlate with degree of lung disease.CONCLUSIONA CF specific factor appears unlikely to be associated with the osteopenia commonly found in CF. Careful attention to general aspects of lifestyle and nutrition is recommended to maximise bone mineral accretion in this population.

OBJECTIVE To examine whether bone mass is reduced in prepubertal, asthmatics receiving high doses of inhaled corticosteroids. METHODOLOGY A cross-sectional comparison of lumbar spine-bone mineral density (LS-BMD) was undertaken in 76 subjects after stratifying them according to dosage and administration route of corticosteroid. RESULTS Weight was the only independent predictor of LS-BMD (r(2) = 0.38). Children receiving greater than 800 microg/day of inhaled corticosteroid plus intermittent oral corticosteroid had a significantly lower weight-adjusted LS-BMD than children treated with 400-800 microg/day of inhaled corticosteroid (mean difference: 0.06 g/cm(2), 95% confidence interval (CI): - 0.02 to - 0.10). A significant difference in weight-adjusted LS-BMD persisted when all children receiving greater than 800 microg/day of inhaled corticosteroid, irrespective of additional oral corticosteroid treatment, were compared with children receiving 400-800 microg/day of inhaled corticosteroid (mean difference: - 0.05 g/cm(2), 95%CI interval: -0.02 to - 0.09). Bone mass was similar in children not receiving any inhaled corticosteroid and those treated with 400-800 microg/day of inhaled corticosteroid. CONCLUSIONS A reduced bone mass in prepubertal asthmatic children receiving high doses of inhaled corticosteroids may predetermine a compromised peak bone mass and increase osteoporotic fracture risk in adulthood.

Objective To illustrate common psychogenic factors involved in undereating and undernutrition in the elderly Method Two cases are described. Results In the context of age-related physical and social factors, obsessional, phobic, and hypochondriacal anxieties can lead to significant food restrictions and undernutrition. Discussion Psychogenic factors need to be considered in undernutrition of the elderly and the phenomena considered in the spectrum of eating disorders. © by John Wiley & Sons, Inc. Int J Eat Disord 25: 345–348, 1999.

Recognition of the biological and health importance of abdominal fatness has stimulated researchers, clinicians and public health workers. Most work and interest so far has focussed on how it might account for health outcomes, with increasing attention to its preferred measurement. Its aetiology and pathogenesis is thought to reflect gender, age and energy balance which, if positive, leads to increased total body fatness, including abdominal fatness. But these contributors themselves, when considered mechanistically, raise possibilities about other potentially important modulators of abdominal fatness, such as adipocyte differentiation and apoptosis, the kinetics of cell fat content, its hormonal and neural control, along with underlying genetic predisposition and expression. In turn, the ways in which environmental factors may influence fat distribution come into focus; these include nutritional factors, which may be as broad as the food cultural (given ethnic differences in abdominal fatness) or as located as specific food factors like those which are thermogenic (eg. capsaicin-like), hormone-like (notably the candidate phyto-estrogens) or essentiall fatty acids which affect receptor function (like omega-3 fatty acids). There is a prima facie case for food intake, aside from its energy value, in its own right, or in conjunction with early life events and/or physical activity and/or substance abuse having a determinant role in the development of abdominal fatness. To what extent, and how, it is now opportune to ask.

Objectives. To measure the change in body composition in a pre-menopausal female systemic lupus erythematosus (SLE) population over 3 yr, and to identify predictors of change in body composition including the eVects of disease-, corticosteroid (CS)- and patientrelated variables. Methods. All 55 pre-menopausal females with SLE who participated in a cross-sectional study of body composition in 1994 were invited to undergo interview, examination, medical record review, and body composition assessment by dual-energy X-ray absorptiometry (DXA). Results. Twenty-eight subjects participated with a mean (s.e.m.) age of 34.4 (1.6) yr, duration of SLE of 6.8 (0.8) yr and mean (range) time to follow-up of 3.2 (2.9‐3.4) yr. Seventeen subjects were exposed to CS during the study period with a mean (range) daily dose of prednisolone of 12.0 (2.8‐22.9) mg. There was a significant increase in body mass index (BMI ) (24.53± 0.83 vs 25.37± 1.04, P= 0.03) and fat-free mass (41.04± 0.83 vs 41.53± 0.92, P= 0.05) over the 3 yr period. Univariate analysis revealed that change in fatfree mass was significantly associated with change in total body bone mineral density (BMD) (P= 0.03). Stepwise multiple linear regression analysis revealed a significant independent association of disease activity with increases in both BMI (r2 = 0.41, P= 0.006) and fat mass (r2 = 0.39, P= 0.007), and of exercise and Modified Health Assessment Questionnaire with an increase in fat-free mass (r2 = 0.51, P= 0.007). Age at SLE diagnosis and smoking were significant independent predictors for loss of total body BMD, while CS duration was predictive of an increase in total body BMD (r2 = 0.80, P< 0.0001). Conclusion. In this SLE population, disease activity was predictive of deleterious changes in body composition, including increases in BMI and fat mass. Patient-related variables were also important predictors of body composition change with exercise independently predicting an increase in fat-free mass, and smoking predictive of loss of total body BMD. In contrast, CS-related variables were not found to have harmful eVects on body composition. Change in fat-free mass, and not fat mass, was predictive of change in total body BMD.

To compare percentage total body fat (%BF) estimated by the four skinfold thickness measurement (SKF) and single-frequency bioelectrical impedance analysis (BIA) methods using three different sets of equations, to that assessed by the dual energy X-ray absorptiometric (DEXA) method using a Lunar DPX densitometer.Cross-sectional study.An Anglo-Celtic Australian population of 66 males and 130 females (age: 26-86 y).%BF by anthropometry, BIA using three different sets of equations and DEXA.Mean %BF assessed by DEXA (%BF(DEXA)) was similar to that estimated by SKF (%BF(SKF)) in males, while %BF(DEXA) was slightly higher in females. %BF estimated by BIA (%BF(BIA)) was significantly lower than %BF(DEXA) in females, regardless of equations used for calculation, while the level of agreement between BIA and DEXA in estimating %BF in males was dependent on prediction equations used for calculation of %BF(BIA). A better agreement was obtained from the use on the prediction equations of Segal et al (1988), compared to other two sets of equations. The agreement between SKF or BIA and DEXA declined with increasing %BF.There was a good agreement between DEXA and SKF, and slightly less so between DEXA and BIA, in estimating %BF in an Anglo-Celtic adult population. The agreement in most cases, however, was dependent on the degree of body fatness. In comparison to DEXA, both SKF and BIA, with the use of the equations of Segal et al (1988), are applicable to estimate %BF in an Anglo-Celtic Australian population.

The aim of this study was to test the hypothesis that increased dietary intake of phytoestrogens reduces the health impact of the menopause. To test this hypothesis, a double-blind, randomized, entry-exit, cross-over study was conducted to assess the effects of three dietary manipulations--soy and linseed diets (high in phytoestrogens) and a wheat diet (low in phytoestrogens). Postmenopausal women were recruited and randomly assigned to one of the three dietary regimens. Urinary phytoestrogen concentrations, hot flush rate, vaginal smears, bone mineral density and bone mineral content were assessed for two 12-week periods. Comparative analysis showed no significant differences, but, when analyzed separately, groups consuming high phytoestrogen diets had between 10 and 30 times higher urinary excretion of phytoestrogens compared to those consuming the low phytoestrogen diet (p < 0.01). Study participants consuming soy, linseed and wheat diets had a 22% (not significant, n.s.), 41% (p < 0.009) and 51% (p < 0.001) reduction in hot flush rate; a 103% (p < 0.04), 5.5% (n.s.) and 11% (n.s.) increase in vaginal cytology maturation index; and a 5.2% (p < 0.04), 5.2% (n.s.) and 3.8% (n.s.) increase in bone mineral content, respectively. No changes were detected in bone mineral density. The differential effects of high phytoestrogen dietary manipulations on outcomes may represent tissue-specific responses to isoflavones and lignans contained in soy and linseed, respectively. Whilst health outcome measures were not significantly different between groups, the data obtained from separate analysis suggest that phytoestrogens in soy and linseed may be of use in ameliorating some of the symptoms of menopause. Furthermore, the significant decrease in hot flush rate in the wheat group cannot be attributable to phytoestrogens measured in this study. Due to subject variability, larger studies are still needed to evaluate population benefit.

Introduction Meniscal tears are commonly found on MRI and increase the risk for radiographic knee osteoarthritis (OA). While meniscectomy is recommended when knee pain is severe or functionally disabling, it is unclear how to best treat meniscal tears without these symptoms. The aim of this longitudinal study was to examine the effect of weight change on knee cartilage and pain in a cohort of community-based adults with and without meniscal tears detected by MRI. Methods 250 adults with no history of knee OA or knee injury were recruited from the general community and weight-loss clinics. MRI of the knee, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), weight and height were measured at baseline and again at follow-up approximately 2 years later. Results Medial meniscal tears were present in 36 (18%) of the cohort. In those with medial meniscal tears, after adjustment for confounders, percentage weight change was significantly associated with percentage change in medial tibial cartilage volume (β 0.2% 95% CI 0.08% to 0.3% p=0.002) and knee pain (β 11.6% 95% CI 2.1% to 21.1% p=0.02). That is, for every 1% gain in weight, there was an associated 0.2% increased loss of medial tibial cartilage volume and 11.6% increase in pain. In those with no medial meniscal tear, neither change in medial tibial cartilage volume (β 0.02% 95% CI −0.01% to 0.10% p=0.53) or pain (β 1.9% 95% CI −2.2% to 6.1% p=0.36) were significantly associated with change in weight. Conclusions This study demonstrated that among adults with medial meniscal tears, weight gain is associated with increased cartilage loss and pain, while weight loss is associated with the converse. This suggests attention to weight is particularly important in the management of people with medial meniscal tears.

Patients with transfusion-dependent thalassemia have abnormal growth, hormonal deficits, and increased bone loss. We investigated the relationship between skeletal muscle mass, fat mass, and bone mineral density in adult subjects with transfusion-dependent thalassemia based on their gonadal status. Our findings show that hypogonadism attenuates the strength of the muscle–bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. Transfusion-dependent thalassemia is associated with a high prevalence of fractures. Multiple hormonal complications, in particular hypogonadism, can lead to changes in body composition and bone mineral density (BMD). We investigated for the first time the relationship between skeletal muscle mass (SMM), fat mass, and BMD in adult subjects with transfusion-dependent thalassemia based on their gonadal status. A retrospective cohort study of 186 adults with transfusion-dependent thalassemia was analyzed. Body composition and BMD were measured using dual energy X-ray absorptiometry. The association between skeletal muscle, fat, and BMD was investigated through uni-, multi-, and stepwise regression analyses after adjusting for multicollinearity. SMM was derived using the formula, SMM = 1.19 × ALST−1.65, where ALST is equivalent to the sum of both arm and leg lean tissue mass. There were 186 subjects, males (43.5 %) and females (56.5 %), with a median age of 36.5. Hypogonadism was reported in 44.4 % of males and 44.7 % of females. SMM and BMD were positively correlated and strongest in eugonadal males (0.36 ≤ R 2 ≤ 0.59), but the association was attenuated in hypogonadal males. SMM (0.27 ≤ R 2 ≤ 0.69) and total fat mass (0.26 ≤ R 2 ≤ 0.55) were positively correlated with BMD in hypogonadal females, but the correlation was less pronounced in eugonadal females. Leg lean tissue mass and arm lean tissue mass in males and females, respectively, were most highly correlated to BMD in the stepwise regression analysis. Hypogonadism attenuates the strength of the muscle–bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. This study supports the notion that exercise is important for maintaining BMD and the need to optimize treatment of hypogonadism in patients with transfusion-dependent thalassemia.

Background: Muscle wasting is a consequence of many primary conditions including sarcopenia, cachexia, osteoporosis, HIV/AIDS, and chronic kidney disease. Unfortunately, there is not a clinically accessible method to measure total body protein, which is the functional mass of muscle. Objective: We sought to derive a simple method to measure total body protein by using dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA). Design: We retrospectively analyzed a clinical convenience sample of individuals with numerous metabolic conditions from the Monash Medical Centre, Melbourne, Australia, who had a concurrent protein measure by using neutron activation analysis-derived protein (NAA-TBPro), water measure by using BIA, and whole-body DXA scan. The study was split into calibration and validation data sets by using simple random sampling stratified by sex, BMI category, and age decade. We generated a protein estimate directcalibration protein (DC-TBPro) derived from BIAwater, bone mass, and body volume. We compared NAA-TBPro with DC-TBPro and 2 protein estimates from the literature, one that used the DC-TBPro equation with fixed coefficients [4-compartment Lohman method for analysis of total body protein (4CL-TBPro)] and another that used fat-free mass, age, and sex [Wang equation‐derived protein (W-TBPro)]. Results: A total of 187 participants [119 women; mean (6SD) age: 37.0 6 15.4 y; mean (6SD) BMI (in kg/m 2 ) 24.5 6 7.7] were included. When plotted against NAA-TBPro, DC-TBPro had the highest correlation [coefficient of determination (R 2 ) = 0.87], lowest root mean squared error (RMSE; 0.87 kg), and fewest outliers compared with 4CL-TBPro (R 2 = 0.75; RMSE = 1.22 kg) and W-TBPro (R 2 = 0.80; RMSE = 1.10 kg). Conclusions: A simple method to measure total body protein by using a DXA system and BIA unit was developed and compared with NAA as proof of principle. With additional validation, this method could provide a clinically useful way to monitor musclewasting conditions. Am J Clin Nutr doi: 10.3945/ajcn.112. 048074.

There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations.Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years).The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p0.001), but all equations were highly correlated.The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation.

PRECIS: The aim of this study was to evaluate the safety and tolerance of a soybean/MCT/olive/fish oil emulsion in intestinal failure patients on long-term parenteral nutrition. 73 patients took part in a randomized, double-blind, multi-centre study. The study demonstrates that the lipid emulsion containing four different types of oils is safe and well tolerated in long-term PN.BACKGROUND & AIM: Long-term safety and efficacy of a lipid emulsion containing soybean oil, medium-chain triglycerides (MCT), olive oil and fish oil and enriched in vitamin E have not yet been evaluated in adult patients requiring long-term parenteral nutrition (PN).METHODS: Randomised, controlled, double-blind, multicentre study in 73 patients with stable intestinal failure, requiring PN with either soybean/MCT/olive/fish emulsion (SMOFlipid, n = 34) or soybean emulsion (Intralipid, control n = 39) for 4 weeks. Safety and tolerance were monitored with standard clinical laboratory parameters, adverse events (AEs, according to the Common Terminology Criteria for Adverse Events (CTCAE) classification v 3.0) and vital signs. Fatty acid pattern in red blood cell phospholipids and plasma lipoproteins, serum Vitamin E, Interleukin (IL)-6, and soluble tumour necrosis (s-TNF)-receptor(R)II were also evaluated.RESULTS: Mean concentrations of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin, whilst remaining within the reference range, were significantly lower with soybean/MCT/olive/fish (SMOF) oil emulsion after the treatment period compared to control. Eicosapentaenoic acid, docosahexaenoic acid and n-3/n-6 fatty acid ratio increased in the SMOF group, while they remained unchanged in the control in plasma and RBC. Serum α-tocopherol concentrations significantly increased in the study group compared to control (p = 0.0004). IL-6 and sTNF-RII levels did not change during the study period. Grade 4 (serious) adverse events occurred in 2 SMOF patients and in 8 control patients (p = 0.03).CONCLUSIONS: Soybean/MCT/olive/fish emulsion was safe and well tolerated over 4 weeks and leads to positive change in fatty acids profile.

Advances in body composition measurement, evaluation, and analysis have contributed vastly to our knowledge of human biology. These advances can be organized into three distinct, interconnected areas: body composition paradigms, body composition methodology, and body composition response to external influences. The first research area describes the architecture of human body composition identifying proportions of various compartments and their steady-state associations among the atomic, molecular, cellular, tissue system, and whole-body levels; the second research area investigates the merits of different body composition measurement methods for in vivo; and the third investigates the response of body composition to factors such as growth and aging. The five-level model proposed by Z. Wang et al. in 1992 was an important advancement towards building an appropriate structure for body composition research by organizing components into five distinct levels of increasing complexity: atomic, molecular, cellular, tissue system, and whole-body. The eight articles that appear in this special issue are categorized with some overlap into these three main research areas. The review paper proposed by A. M. Silva et al. provides the relationship between body composition architecture and methodology research. The authors discuss the assumptions of hydrometric and densitometric two-component models, namely, 73.2% and 1.1 g/cc for the fat-free mass (FFM) hydration and density, correspondingly. These averages do not include interindividual variability in FFM, particularly in the pediatric population. The review highlights the need for multicomponent models for more accurate body composition assessment in children. To meet this need, the authors reviewed skinfolds and bioelectrical impedance-based predictive equations developed using multicomponent models for use as a reference method. In general, development of methodology, methodology evaluation, and methodology validation was the main focus of one review and three original papers. These articles develop mathematical formulae derived from statistical analysis of experimental observations. At the whole-body level of analysis, A. F. Casey reviewed assessment validity and reliability in individuals with intellectual disability. D. Machado et al. proposed new anthropometric-based equations to assess bone mineral, lean soft tissue, and fat mass for a male pediatric population. E. Forsum et al. analyzed the relationship between body mass index and body fat assessed by air displacement plethysmography in 4-year-old children. At the tissue level of analysis, W. Shen et al. compared bone marrow fat measurements among T1-weighed magnetic resonance imaging (MRI) and magnetic resonance spectroscopy. E. L. Rolfe et al. analyzed the validity of ultrasound visceral and subcutaneous abdominal depth as a proxy for MRI measured internal abdominal and subcutaneous fat in infants. Finally, in the last research category, two original papers investigated body composition response to aging and ethnicity. M. F. Almeida et al. examined longitudinal anthropometric changes in Brazilian older adults from 2000 to 2006. C. L. Carpenter et al. evaluated the efficacy of the body mass index (BMI) as a proxy for adiposity across different ethnic groups by comparing to measured percent body fat. The research field investigating body composition responses also includes responses to growth, development, nutrition, exercise, hormonal changes, and medication. In this regard, the study of the dynamic relations between body components and its associate's functions has been recently explored. A large body of research evaluating body composition responses to these factors at both the experimental and theoretical levels is now available. In fact, the concept of functional body composition has been proposed, providing more sophisticated view of nutritional status, metabolism, endocrinology, and diseases. More than just the assessment of the compartments in any of these five levels, functional body composition addresses the quantitative and biological interactions of these compartments with energy balance status, metabolic features, healthy and unhealthy biomarkers, sports performance markers, and many other measurable physiological expressions of a living organism. In conclusion, the original research and reviews contained in this special issue identify gaps and provide potential alternatives to more accurate routine body composition assessment in basic science and clinical settings. From a clinician's perspective, these papers mostly tell us about body composition models, techniques, and assessment in health across the age span, with the underlying assumption of steady state. However, these papers do not address how robust these techniques are in a nonsteady state (i.e. clinical illness). This is important in an obesodiabetogenic environment that appears to hit all corners of the world. This aspect is also intimately linked to the functional aspects of body composition where a key question is the nature and the extent of pathophysiological influences on body composition changes, on the one hand, and the effect of those body composition changes on pathophysiology on the other hand. What these papers do is to help in setting a modern scene for interpreting clinical findings, though more research is needed to capture the longitudinal body composition response and related energy regulation during clinical illness, growth, and aging, as well as the effect of diet and exercise interventions. Analiza M. Silva David A. Fields Diana Thomas Boyd J. Strauss

We describe the management and outcomes of pregnancy in two women affected with Maple syrup urine disease (MSUD). Both patients had classical disease diagnosed in the newborn period and were managed with low-protein diets and supplements, although compliance was moderately poor throughout life. Both pregnancies were complicated by poor compliance and one patient had a metabolic decompensation, which included seizures and profound encephalopathy, at the end of the first trimester. Peri-partum management required a coordinated team approach including a high-calorie and low-protein diet. Both patients had elevated leucine levels in the post-partum period – one due to mastitis and the other due to poor dietary and supplement compliance combined with uterine involution. On later review, leucine had returned to pre-pregnancy levels. Both infants were unaffected and have made normal developmental progress in the subsequent 1 to 2 years.

Summary: Dialysate based assessment of the delivered dose of dialysis offers several advantages over blood sampling methods as it remains accurate in the face of fistula recirculation, urea rebound, variable blood flow and incorrect treatment time. Kr/V is calculated from the slope of the decline in urea concentration in the dialysate over the course of the treatment. By equilibrating dialysate with blood at the initiation of the treatment an estimate of pre-dialysis blood urea and the volume of distribution for urea (V) can be obtained. We performed Kt/V assessments on 20 in-centre haemodialysis patients using the Baxter Biostat 1000® dialysate urea monitor and compared the results with urea reduction ratios and Kt/V calculated by the formula of Basile. In addition, in 11 of these patients, V and pre-dialysis urea was derived and compared to total body water estimates using D2O. the mean Kt/V by Biostat was 1.11 ± 0.23 and by formula was 1.23 ± 0.16 (P < 0.005, Student's paired t-test). the lab pre-dialysis urea was 24.4 ± 6.2 mmol/L compared to the Biostat result of 23.9 ± 5.9 (when corrected for plasma water), with the mean difference of the techniques being −0.53 mmol/L. (95% CI −0.36–1.42). For V, the D2O result was 36.7 ± 9.7 litres, compared to the Biostat result of 37.9 ± 9.6. the mean difference of the techniques by Bland and Altman analysis (or bias of the Biostat) was 1.2 L (95% CI −0.9–3.3) and the limits of agreement were −5.2–7.6L. Thus the Biostat provides easy access to dialysis adequacy data and gives a reasonable assessment of V, tending to overestimate this value.

To investigate the role of androgens in increasing bone density and improving low libido in postmenopausal women, we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospective, 2 year, single-blind randomised trial. Thirty-four postmenopausal volunteers were randomised to treatment with either estradiol implants 50 mg alone (E) or estradiol 50 mg plus testosterone 50 mg (E&T), administered 3-monthly for 2 years. Cyclical oral progestins were taken by those women with an intact uterus. Thirty-two women completed the study. BMD (DEXA) of total body, lumbar vertebrae (L1-L4) and hip area increased significantly in both treatment groups. BMD increased more rapidly in the testosterone treated group at all sites. A substantially greater increase in BMD occurred in the E&T group for total body (P < 0.008), vertebral L1-L4 (P < 0.001) and trochanteric (P < 0.005) measurements. All sexual parameters (Sabbatsberg sexual self-rating scale) improved significantly in both groups. Addition of testosterone resulted in a significantly greater improvement compared to E for sexual activity (P < 0.03), satisfaction (P < 0.03), pleasure (P < 0.01), orgasm (P < 0.035) and relevancy (P < 0.05). Total cholesterol and LDL-cholesterol fell in both groups as did total body fat. Total body fat-free mass (DEXA, anthropometry, impedance) increased in the E&T group only. We concluded that in postmenopausal women, treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone. Significantly greater improvement in sexuality was observed with combined therapy, verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women. The favourable estrogenic effects on lipids were preserved in women treated with T, in association with beneficial changes in body composition.

OBJECTIVES: Conflicting reports of the effect of physical activity on knee cartilage may be due to the heterogeneity of populations examined and, in particular, the underlying health of the knee joint. This study examined the influence of recreational and occupational physical activity on cartilage volume loss. METHODS: A total of 250 participants with no significant musculoskeletal disease were recruited. A gender-specific median cartilage volume split was used to define people in the lowest and highest 50% of baseline cartilage volume. Baseline recreational and occupational activity was examined by questionnaire, while cartilage volume was assessed by MRI at baseline and 2.4 : years later. RESULTS: Significant interactions were demonstrable between physical activity and cartilage volume loss based on stratification of baseline cartilage volume (all P ⩽ 0.03). There was a dose-response relationship between frequently performed baseline occupational activities and medial cartilage volume loss in both the low (B = 0.2% per annum, 95% CI: 0.0, 0.04% per annum) and high (B = -0.2% per annum, 95% CI: -0.4, 0.0% per annum) baseline cartilage volume groups (P = 0.001 for interaction). Individuals with low baseline cartilage volume who were active in their occupation and/or recreational activity had greater medial cartilage volume loss than their more inactive counterparts (2.4% per annumvs1.5% per annum, P = 0.02). CONCLUSION: Whereas people with less baseline cartilage volume are more at risk of structural knee damage with either heavy occupational or recreational workloads or both, individuals with high baseline cartilage volume may advantageously modify their risk for knee OA by participating in more frequent occupational physical activities.

Pigment epithelium-derived factor (PEDF) is upregulated in obese rodents and is involved in the development of insulin resistance (IR). We aim to explore the relationships between PEDF, adiposity, insulin sensitivity, and cardiovascular risk factors in obese women with polycystic ovary syndrome (PCOS) and weight-matched controls and to examine the impact of endurance exercise training on PEDF. This prospective cohort intervention study was based at a tertiary medical center. Twenty obese PCOS women and 14 non-PCOS weight-matched women were studied at baseline. PEDF, cardiometabolic markers, detailed body composition, and euglycemic-hyperinsulinemic clamps were performed and measures were repeated in 10 PCOS and 8 non-PCOS women following 12 weeks of intensified aerobic exercise. Mean glucose infusion rate (GIR) was 31.7% lower (P = 0.02) in PCOS compared to controls (175.6 ± 96.3 and 257.2 ± 64.3 mg.m(-2).min(-1)) at baseline, yet both PEDF and BMI were similar between groups. PEDF negatively correlated to GIR (r = -0.41, P = 0.03) and high-density lipoprotein (HDL) (r = -0.46, P = 0.01), and positively to cardiovascular risk factors, systolic (r = 0.41, P = 0.02) and diastolic blood pressure (r = 0.47, P = 0.01) and triglycerides (r = 0.49, P = 0.004). The correlation with GIR was not significant after adjusting for fat mass (P = 0.07). Exercise training maintained BMI and increased GIR in both groups; however, plasma PEDF was unchanged. In summary, PEDF is not elevated in PCOS, is not associated with IR when adjusted for fat mass, and is not reduced by endurance exercise training despite improved insulin sensitivity. PEDF was associated with cardiovascular risk factors, suggesting PEDF may be a marker of cardiovascular risk status.

Single-slice abdominal computed tomography or magnetic resonance imaging (MRI) performed to measure visceral adipose tissue in individuals with obesity and diabetes mellitus can also image skeletal muscle. The aim of this study was to validate a method developed in cancer patients using a single abdominal cross-sectional image to estimate fat-free mass (FFM) and appendicular lean tissue mass index (LTMI), a total body skeletal muscle mass surrogate, in an obese cohort of subjects with and without type 2 diabetes.In total, 49 obese subjects (22 with diabetes) recruited into a weight loss study underwent dual-energy X-ray absorptiometry (DXA) and abdominal MRI at baseline. DXA-derived FFM and LTMI were compared with skeletal muscle area at the level of the third lumbar vertebra (L3) on MRI.L3 skeletal muscle area correlated with FFM (R (adj) (2)=0.825; P0.001) and LTMI (R (adj) (2)=0.6; P0.001). A simple formula, previously shown to predict LTMI in cancer patients, produced a good estimation of LTMI from L3 skeletal muscle area (95% confidence interval -3.70, 2.56%) in our obese cohort. Equations incorporating age, sex, height, weight and diabetic status improved the relationship between L3 skeletal muscle area and estimated FFM (r=0.976, P0.001) and LTMI (r=0.879, P0.001).A single-axial slice at the L3 level can be used to estimate FFM and LTMI in obese diabetic and non-diabetic subjects, allowing precise analysis of body composition using a single imaging modality in clinical research and practice.

Objective To examine the longitudinal association between significant weight change and change in knee symptoms (pain, stiffness, and function), and to determine whether the effects differ in those who are obese and those with osteoarthritis (OA). Methods Two hundred fifty subjects ranging from normal weight to obese (body mass index range 16.9-59.1 kg/m2) and no significant musculoskeletal disease were recruited from the general community and weight loss clinics and organizations. Seventy-eight percent were followed at ∼2 years. Weight, height, and knee symptoms (using the Western Ontario and McMaster Universities Osteoarthritis Index) were assessed at baseline and followup. Any weight loss methods were recorded. Results Thirty percent of subjects lost ≥5% of baseline weight, 56% of subjects' weight remained stable (loss or gain of

Polycystic ovary syndrome (PCOS) is a common condition in women associated with menstrual irregularity and anovulation. While obesity worsens and weight loss or exercise improves reproduction function in PCOS, the mechanism for this is unclear. The aim of this study was to examine the effect of exercise on ovarian hormones [anti-Müllerian hormone (AMH)] and menstrual and ovulatory function in women with and without PCOS. Overweight women with (n=7) and without (n=8) PCOS of comparable age, weight and BMI undertook a 12-week intensified endurance exercise training program (1 h 3 times/week) with no structured energy restriction. Primary outcomes were AMH, ovulation (weekly urinary pregnanediol) and menstrual regularity. Secondary outcomes were insulin resistance (euglycemic hyperinsulinemic clamp) and body composition (computed tomography and dual X-ray absorptiometry). Exercise decreased BMI, total and android fat mass and improved insulin sensitivity for all women. AMH was significantly higher in women with PCOS compared to controls before (p0.001) and after exercise (p=0.001). There was a significant interaction between AMH changes with exercise and PCOS status (p=0.007) such that women without PCOS had no change in AMH (+1.4±5.2 pmol/l, p=0.48) while women with PCOS had a decrease in AMH (- 13.2±11.7 pmol/l, p=0.025). Exercise is associated with improvements in ovarian hormones in women with abnormal ovarian function. This suggests that mechanisms associated with ovarian dysfunction can be improved by exercise in PCOS.

Objective: To examine the relationship between obesity, body composition, and foot pain as assessed by the Manchester Foot Pain and Disability Index (MFPDI). Methods: Subjects 25–62 years of age ( n = 136) were recruited as part of a study examining the relationship between obesity and musculoskeletal health. Foot pain was defined as current foot pain and pain in the last month, and an MFPDI score of ≥ 1. Body composition (tissue mass and fat distribution) was measured using dual x-ray absorptiometry. Results: The body mass index (BMI) in this population was normally distributed around a mean of 32.1 kg/m 2 . The prevalence of foot pain was 55.1%. There was a positive association between BMI and foot pain (odds ratio [OR] 1.11, 95% confidence interval [95% CI] 1.06–1.17). Foot pain was also positively associated with fat mass (OR 1.05, 95% CI 1.02–1.09) and fat mass index (FMI; OR 1.16, 95% CI 1.06–1.28) when adjusted for age, sex, and skeletal muscle mass and age, sex, and fat-free mass index (FFMI), respectively. When examining fat distribution, positive associations were observed for android/total body fat ratio (OR 1.42, 95% CI 1.11–1.83) and android/gynoid fat ratio (OR 35.15, 95% CI 2.60–475.47), although gynoid/total body fat ratio was inversely related to foot pain (OR 0.83, 95% CI 0.73–0.93). Skeletal muscle mass and FFMI were not associated with foot pain when adjusted for fat mass or FMI, respectively. Conclusion: Increasing BMI, specifically android fat mass, is strongly associated with foot pain and disability. This may imply both biomechanical and metabolic mechanisms.

The objective was to compare weight loss and change in body composition in obese subjects with and without type 2 diabetes mellitus during a very-low-calorie diet (VLCD) program. Seventy weight-matched subjects with diabetes or normal fasting glucose (controls) participated in a 24-week VLCD study. Primary end points were changes in anthropometry, body composition, and fasting plasma insulin and β-hydroxybutyrate concentrations. Fifty-one subjects (24 with diabetes) completed the study. No difference in weight loss between the 2 groups at 24 weeks was found by intention-to-treat analysis. Both groups completing the study per protocol had near-identical weight change during the program, with similar weight loss at 24 weeks (diabetes: 8.5 ± 1.3 kg vs control: 9.4 ± 1.2 kg, P = .64). Change in fat mass index correlated with change in body mass index (BMI) in both groups (diabetes: r = 0.878, control: r = 0.920, both P < .001); but change in fat mass index per unit change in BMI was less in the diabetic group compared with controls (0.574 vs 0.905 decrease, P = .003), which persisted after adjusting for age, sex, and baseline BMI (P = .008). Insulin concentrations remained higher and peak β-hydroxybutyrate concentrations were lower in the diabetic compared with the control group. While following a 24-week VLCD program, obese subjects with and without diabetes achieved comparable weight loss; but the decrease in adiposity per unit weight loss was attenuated in diabetic subjects. Hyperinsulinemia may have inhibited lipolysis in the diabetic group; however, further investigation into other factors is needed.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To determine whether body composition is associated with low back pain intensity and/or disability. SUMMARY OF BACKGROUND DATA: The relationship between obesity and low back pain and disability is unclear. No study has examined the role of body composition in low back pain and disability. METHODS: A total of 135 participants (25-62 years), with a range of body mass indices (18-55 kg/m), were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed the Chronic Back Pain Grade Questionnaire, which examines individuals' levels of low back pain intensity and disability. Body composition was assessed using dual radiograph absorptiometry. RESULTS: Body mass index was associated with higher levels of back pain intensity (Odds ratio [OR] = 1.35; 95% confidence interval [CI] = 1.09, 1.67) and disability (OR = 1.66; 95% CI = 1.31, 2.09). Higher levels of pain intensity were positively associated with total body (OR = 1.19; 95% CI = 1.04, 1.38) and lower limb fat mass (OR = 1.51; 95% CI = 1.04, 2.20), independent of lean tissue mass. There were also positive associations between higher levels of low back disability and total body (OR = 1.41; 95% CI = 1.20, 1.67) and upper (OR = 1.67; 95% CI = 1.27, 2.19) and lower (OR = 2.29; 95% CI = 1.51, 3.49) limbs fat mass. Similar relationships were observed with trunk, android, and gynoid fat mass. After adjusting for confounders, no measures of lean tissue mass were associated with higher pain intensity or disability (P > 0.10). CONCLUSION: Greater fat, but not lean tissue mass, was associated with high levels of low back pain intensity and disability. Longitudinal investigation is needed to determine whether fat mass is predictive of low back pain and disability, as this may have important implications for further prevention strategies. Understanding the mechanism for these relationships may provide novel approaches to managing low back pain.

Malnutrition can lead to poor outcome in patientswith colorectal cancer (CRC). Body composition, particularlysarcopenia, may be directly pertinent to clinical outcome [1].However, there are minimal data on the roles of computedtomography (CT) and bioelectrical impedance analysis (BIA)in determining body composition in this group.

Objective. Although there is a well-established sex difference in the prevalence and severity of OA, the mechanism for this is not clear. The aim of this study was to examine the potential role of BMD and BMC in explaining gender differences in knee cartilage volume. Methods. A total of 153 subjects aged 25 60 years, 81% female, were recruited. MRI was performed of the dominant knee. Cartilage volume was measured using validated methods. Total body BMD and content was measured using DXA. Results. Total body BMC and BMD was significantly associated with medial cartilage volume in both sexes. However, the associations were stronger in men for BMC (B= 0.52; 95% CI 0.21, 0.83; P for difference = 0.001) and BMD (B= 2242; 95% CI 443, 4041; P for difference = 0.05). Similar results were obtained in the lateral tibial compartment. No significant association was obtained between total body BMD and BMC and patella cartilage volume in either men or women. Conclusions. In this relatively healthy population, we found a positive relationship between total body BMD and BMC and tibial cartilage volume in the medial and lateral compartments. These relationships were stronger in men than women. Thus, the results of this study may provide some insight into the sex differences in knee cartilage volume, which may in turn facilitate our understanding of the pathogenesis of OA.

Objective. Obesity is an important risk factor for knee OA. Evidence suggests that fat and muscle have differential effects on the pathogenesis of disease. The aim of this study was to examine the relationship between body composition and knee structure, including knee cartilage volume, defects and bone marrow lesions (BMLs). Methods. A total of 153 subjects aged 25 60 years, 81% females, were recruited across a range of BMI(18 55 kg/m2) for a study examining the relationship between obesity and musculoskeletal disease. MRI was performed of the dominant knee. Cartilage volume, defects and BMLs were measured using validated methods. Body composition was measured using dual X-ray absorptiometry. Results. There was an 81 (95% CI: 69, 94) mm3 increase in cartilage volume for every 1 kg increase in skeletal muscle mass. Fat mass was not significantly associated with cartilage volume. Fat mass, but not skeletal muscle mass, was a risk factor for cartilage defects and BMLs. For every 1 kg increase in total body fat there was an increased risk of cartilage defects (OR = 1.31, 95% CI: 1.04, 1.64) and BMLs (OR = 1.09, 95% CI: 1.01, 1.18). Conclusions. In this relatively healthy population, fat mass was associated with increased cartilage defects and BMLs, which are features of early knee OA. In contrast, skeletal muscle mass was positively associated with cartilage volume, which may be due to coinheritance, a commonality of environmental factors associated with cartilage accrual or a protective effect of increased muscle.

Background The Forbes equation relating fat-free mass (FFM) to fat mass (FM) has been used to predict longitudinal changes in FFM during weight change but has important limitations when paired with a one dimensional energy balance differential equation. Direct use of the Forbes model within a one dimensional energy balance differential equation requires calibration of a translate parameter for the specific population under study. Comparison of translates to a representative sample of the US population indicate that this parameter is a reflection of age, height, race and gender effects. Results We developed a class of fourth order polynomial equations relating FFM to FM that consider age, height, race and gender as covariates eliminating the need to calibrate a parameter to baseline subject data while providing meaningful individual estimates of FFM. Moreover, the intercepts of these polynomial equations are nonnegative and are consistent with observations of very low FM measured during a severe Somali famine. The models preserve the predictive power of the Forbes model for changes in body composition when compared to results from several longitudinal weight change studies. Conclusions The newly developed FFM-FM models provide new opportunities to compare individuals undergoing weight change to subjects in energy balance, analyze body composition for individual parameters, and predict body composition during weight change when pairing with energy balance differential equations.

Most studies reporting malnutrition in the elderly relate to high-level care. However, one third of Australians in aged care reside in low-level care facilities. Data is limited on their nutritional status.To investigate the nutritional status of elderly in low-level care facilities.A cross sectional study design.14 low-level aged care facilities in metropolitan Melbourne.Convenience sample of 103 ambulatory elderly (86 +/- 6.6 years (mean +/- SD), 76% female, comprising 15% of the hostel population) able to perform daily functions of living.Nutritional intake assessed by three-day weighed food records, and nutritional status by haematological and biochemical markers and body composition (dual energy X-ray absorptiometry).FOOD served did not supply the estimated average requirements (EAR) for 5 of the 14 nutrients analysed. Compared with EAR, 34% of participants were protein malnourished and 62% had energy intake deficits. Micronutrient intake was low for calcium, magnesium, folate, zinc (for men) and dietary fibre. Vitamin D deficiency (serum 25OH Vitamin D50 nmol/L) was present in 58% of residents. More men than women had low haemoglobin (P0.000), low red blood cells (P0.000), and a raised white blood cell count (P = 0.004). Forty three percent of men and 21% women had sarcopenia, 28% of men and 44% women had excess body fat (28% and40%, respectively) and 14% of men and 12 % of women were sarcopenic-obese. Only 12% showed no sign of undernutrition using seven different nutritional indicators. Around 65% had two or more indicators of undernutrition.These findings highlight the need for the supply of more, better quality, nutrient dense food to residents and better detection of undernutrition in aged care facilities. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care.

Background Vascular calcification contributes to cardiovascular disease in patients with chronic kidney disease (CKD). Few studies have addressed interventions to decrease vascular calcification; however, experimental studies report benefits of bisphosphonates. Recent studies of hemodialysis patients also suggest benefits of bisphosphonates on vascular calcification; however, no study exists in nondialysis patients with CKD. Study Design We conducted a randomized controlled trial to determine the effect of bisphosphonates on vascular calcification in patients with CKD. Setting & Participants 51 patients with CKD stages 3-4 were recruited from a hospital outpatient setting; 50 were treated with study medication. Interventions Patients were randomly assigned to either alendronate, 70 mg (n = 25), or matching placebo (n = 25), administered weekly. Outcomes The primary outcome was change in aortic vascular calcification after 18 months. Secondary outcomes included superficial femoral artery vascular calcification, arterial compliance, bone mineral density (BMD), renal function, and serum markers of mineral metabolism. Measurements At baseline and 12 and 18 months, computed tomography, pulse wave velocity using SphygmoCor (AtCor Medical, PWV Inc, www.atcormedical.com), and dual-energy x-ray absorptiometry were performed to measure vascular calcification, arterial compliance, and BMD, respectively. Analysis was by intention to treat, with a random-effect linear regression model to assess differences. Results 46 patients completed the study (24 alendronate, 22 placebo); baseline mean age was 63.1 ± 1.8 years, estimated glomerular filtration rate was 34.5 ± 1.4 mL/min/1.73 m 2 , 59% had diabetes, and 65% were men. 91% had aortic vascular calcification at the start and 78% showed progression. At 18 months, there was no difference in vascular calcification progression with alendronate compared with placebo (adjusted difference, −24.2 Hounsfield units [95% CI, −77.0 to 28.6]; P = 0.4). There was an increase in lumbar spine BMD (T score difference, +0.3 [95% CI, 0.03-0.6]; P = 0.04) and a trend toward better pulse wave velocity (−1 m/s [95% CI, −2.1 to 0.1]; P = 0.07) with alendronate. Femoral BMD was similar between groups. There was a nonsignificant decrease in kidney function in patients on alendronate therapy compared with placebo (−1.2 mL/min/1.73 m 2 [95% CI, −4.0 to 1.7]). Limitations Small sample size and baseline differences, especially with aortic vascular calcification, may have diminished any potential difference between groups. Conclusions Unlike previous studies of hemodialysis patients, alendronate did not decrease the progression of vascular calcification compared with placebo in patients with CKD during 18 months.

Plants contain compounds with oestrogen--like action called phytoestrogens. Soy contains daidzin, a potent phytoestrogen, and wheat flour contains less potent enterolactones. We aimed to show in 58 postmenopausal women (age 54, range 30-70 years) with at least 14 hot flushes per week, that their daily diet supplemented with soy flour (n = 28) could reduce flushes compared with wheat flour (n = 30) over 12 weeks when randomised and double blind. Hot flushes significantly decreased in the soy and wheat flour groups (40% and 25% reduction, respectively < 0.001 for both) with a significant rapid response in the soy flour group in 6 weeks (P < 0.001) that continued. Menopausal symptom score decreased significantly in both groups (P < 0.05). Urinary daidzein excretion confirmed compliance. Vaginal cell maturation, plasma lipids and urinary calcium remained unchanged. Serum FSH decreased and urinary hydroxyproline increased in the wheat flour group.

Background and objective: Mortality and morbidity in COPD have been related to reduced FEV1 as well as indices of body composition. Different techniques used to evaluate body composition may vary in accuracy, particularly in conditions with altered fluid balance such as COPD. We hypothesized that direct measurement of fat-free mass index (FFMI) by dual-energy X-ray absorptiometry (DEXA) would provide superior assessment of body composition in COPD. Methods: We measured body composition in 31 patients with COPD randomly selected from a teaching hospital clinic. To estimate total body water (TBW) and FFMI, skin-fold anthropometry, bioelectrical impedance analysis (BIA) with Schols and Lukaski equations as well as DEXA, total body potassium by whole-body γ-counting (TBK) and in vivo neutron activation analysis were used. Combined body composition methods providing precise estimations of TBW were used for comparisons. Bland–Altman analyses, ANOVA and χ2-testing were used to examine data. Results: Mean BMI was 27.6 ± 5.34 kg/m2 (mean ± SD). Estimations of TBW were similar using Schols BIA or by using combined body composition methods. FFMI did not vary significantly between grades of COPD severity but was significantly different when assessed using DEXA and other methods. Calculated FFM hydration was significantly different from the fixed hydration factor used to calculate FFMI from BIA TBW (P

Malnutrition in cystic fibrosis (CF) is associated with poorer survival, but the determinants of fat-free mass (FFM) depletion are not well-characterized. It is unknown whether routine nutritional indicators, including body mass index (BMI), are adequate for detecting FFM depletion. This study aimed to determine the prevalence of FFM depletion in adults with CF, to compare fat-free mass index (FFMI) with BMI, and to identify predictors of FFM depletion.This was a prospective cross-sectional study of 86 adults with CF (19-59 y old). Body composition was assessed using dual-energy X-ray absorptiometry to determine FFMI and BMI. FFMI percentiles and Z-scores were derived from a reference population of 156 healthy adults. FFM depletion was defined as an FFMI below the fifth percentile for age and gender and low BMI as18.5 kg/m(2). Univariate and multivariate analyses identified predictors of FFMI and FFMI Z-score.Mean FFMIs were 18.3+/-1.9 kg/m(2) in men with CF and 15.8+/-1.1 kg/m(2) in women with CF (P0.0005). FFM depletion was found in 14% of adults with CF, and low BMI was found in 18.6%. The sensitivity of BMI for detecting FFM depletion was 42%. Forced expiratory volume in 1 s as a percentage of predicted was independently associated with FFMI in women (r=0.62, P0.0001) and men (r=0.28, P=0.045) and FFMI Z-score (r=0.41, P0.0001).FFM depletion was found in 14% of adults with CF, but was undetectable by BMI in 58% of these patients. These findings, together with the association of FFMI with forced expiratory volume in 1 s predicted, suggest a role for body composition assessment in adult CF care.

Objective Evidence based guidelines for home parenteral nutrition (HPN) were commissioned by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) and developed by a multidisciplinary group. The guidelines make recommendations in four domains: patient selection, patient training, formulation and monitoring regimens, and preventing and managing complications. Methods The Appraisal of Guidelines Research and Evaluation guideline process was used to focus questions and identify evidence by systematic literature reviews of meta-analyses and randomized control trials in the Cochrane Library, Medline, Embase, and Cinahl to mid-2007. Where no randomized control trial evidence was found, the search was broadened to observational studies and expert opinion from related national and international guidelines as assessed by a validated appraisal process. Results Selection of patients must assess individual risk/benefit and medical ethics. Patient training should be undertaken within a structured framework. Access devices should be selected for lowest risk of complications, including occlusion, sepsis, and breakage and be managed by early diagnosis and treatment. HPN should be formulated according to individual patient requirements by professionals with relevant skills and training. Pumps and ancillary products should conform to quality standards. Other intravenous medications may be prescribed provided these are reviewed for compatibility and effects on metabolic status. Conclusion Overall there is a lack of randomized control trials to provide high-quality evidence-based guidance but graded recommendations can be made. Multidisciplinary teams in centers with HPN management expertise are required for optimal care. This guideline should improve outcomes and quality of life for HPN patients in Australia and New Zealand.