Muscle mass depletion and weight loss increase mortality in hemodialysis patients independent from body mass index

Abstract BACK GROUND Primary myelofibrosis (PMF) leads to weight loss, splenomegaly and constitutional symptoms (Cancer2007;109:68–76) and hypocholesterolemia associated with decreased survival (Blood2007;110:a2548). Initial trials of JAK2 inhibitors have demonstrated improvements in these (JCO2008;26:a7004), yet little objective data exists regarding the dynamic changes in weight and spleen size during the course of PMF. METHODS We analyzed the Mayo PMF database for patients with information on disease prognosis, presentation, therapies, height and weight at diagnosis, and outcomes. Additionally, when available, we analyzed additional weights during the clinical course, the body mass index (BMI- (weight/(height*height)), spleen size, and peripheral blood studies including lipids. Results: 370 patients with PMF were identified with 193 (52%) having a weight at the time of diagnosis, the remainder had a weight obtained a median of 10.0 months (range 1.8–159) after diagnosis. Additionally, 210 patients (57%) had a weight value available from 1–3 additional time points during the course of their disease. At PMF diagnosis patients had a median BMI of 25.3 (range 17.6 to 38.4), with 53% considered overweight (USA Norms (NHANES 2004): 66% and 32.2% are considered overweight or obese). Although weight lost prior to diagnosis unclear, only 2% of patients would be deemed “underweight” at diagnosis. Serial analysis demonstrated 67% experienced a decrease in weight over time, with 23% and 6% experiencing a >10% or 20% decrease, respectively. Overall during the course of illness 65% of patients remained in the same BMI category with 27% dropping to a lower category and 8% gaining in a category (Table 1). Table 1. Distribution of Body Mass Index and Spleen Size in 370 PMF patients followed serially DX of PMF Weight 2 Weight 3 Weight 4 Underweight BMI<18.5 2% 1% 2% 2% Normal BMI=18.5–24.9 45% 41% 41% 54% Overweight BMI=25–29.9 33% 42% 41% 35% Obese BMI>30 20% 16% 16% 10% Spleen Size (cm BLCM) (median: range) 5.0 (0–30) 6 (0–33) 7 (0–33) 7.5 (0–28) Time from PMF DX (median(range) months) 0 10.3 (1.8–159) 28.3 (6–191) 57 (15–258) Major weight increases were rare <1%, and might include buildup of fluid or splenic mass. Indeed spleen sizes generally increased during the course of the illness, with 51% having “massive” splenomegaly (either >10 (45%) or >20 (20%) cm below left costal margin or requiring splenectomy (19%)). Massive splenomegaly was not associated with weight loss or weight gain, suggesting increasing splenic mass came at the expense of alternate tissue mass (muscle and or fat). Median survival for the entire cohort was 77 months and PMF prognostic scores being valid (Lille PMF score p<0.01; IWG-MRT PMF Score - Submitted separately Cervantes et. al. p<0.01), however BMI number and category was not independently predictive of survival. Additionally, neither percentage of weight loss nor changing BMI category were associated with decreased survival. Although splenomegaly was not independently associated with decreased survival, the need for splenectomy clearly was (p=0.02). Consistent with our prior observation hypocholesterolemia (total <150 (median of 151 (range 12–366) or a HDL cholesterol of <60 (median 77 (range 25–248)) were associated with decreased survival (p<0.01 and =0.05, respectively). Decreasing weight in PMF patients was most highly correlated with decreases in HDL (p=0.03). Hypocholesterolemia was highly associated with splenomegaly (p<0.001 for spleen size >10 cm at any point during disease course). Conclusions: Weight loss is common in most PMF patients, despite the confounders of edema and increasing splenomegaly which could mask the degree of loss of lean body mass. Although few PMF patients are considered “underweight” by BMI standards, the distribution compared to USA norms suggest a lower weight distribution. Additionally, patients during the course of their illness are most likely to fall from a BMI overweight category to a “normal” category which may underestimate the true degree of catabolism of muscle mass occurring. Although not independently associated with decreased survival, weight loss remains common and a sign of advancing disease in this terminal illness. More precise methodology to estimate true lean muscle mass lost or gained may yield a better understanding of the hypercatabolic state seen in PMF. Efficacious therapy (such as potentially a JAK2 inhibitor) will likely reverse the trend of weight loss in these patients.

Download Full-text

Disentangling the obesity paradox in upper gastrointestinal cancers: Weight loss matters more than body mass index

Cancer Epidemiology ◽

10.1016/j.canep.2021.101912 ◽

2021 ◽

Vol 72 ◽

pp. 101912

Author(s):

Shria Kumar ◽

Nadim Mahmud ◽

David S. Goldberg ◽

Jashodeep Datta ◽

David E. Kaplan

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Obesity Paradox ◽

Gastrointestinal Cancers ◽

Upper Gastrointestinal

Download Full-text

Enrolling Caregivers in Obesity Interventions to Improve Obesity-Related Outcomes in Children

Western Journal of Nursing Research ◽

10.1177/01939459211037057 ◽

2021 ◽

pp. 019394592110370

Author(s):

Hannah Bessette ◽

MinKyoung Song ◽

Karen S. Lyons ◽

Sydnee Stoyles ◽

Christopher S. Lee ◽

...

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Weight Loss ◽

Linear Regression ◽

Body Mass ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Weight Loss Program ◽

Weight Loss Programs ◽

Obesity Interventions

In this study, we assessed the influences of change in moderate-to-vigorous physical activity (MVPA)/sedentary time (ST) of caregivers participating in a commercial weight-loss program on their children’s change in MVPA/ST. Data from 29 caregivers and their children were collected over 8 weeks. We used multivariable linear regression to assess associations of changes in caregiver’s percent of time spent in MVPA/ST and changes in their child’s percent of time spent in MVPA/ST. For caregivers that decreased body mass index (BMI) over 8 weeks, changes in caregivers’ MVPA was strongly associated with the change in children’s MVPA (β = 2.61 [95% CI: 0.45, 4.77]) compared to caregivers who maintained/increased BMI (β = 0.24 [–2.16, 2.64]). Changes in caregivers’ ST was strongly associated with changes in children’s ST (β = 2.42 [1.02, 3.81]) compared to caregivers who maintained/increased BMI (β = 0.35 [–0.45, 1.14]). Findings reinforce encouraging caregivers to enroll in weight-loss programs for the benefit of their children as well as for themselves.

Download Full-text

Effects of a resistance training community programme in older adults

Ageing and Society ◽

10.1017/s0144686x20001786 ◽

2021 ◽

pp. 1-16

Author(s):

Majid Mufaqam Syed-Abdul ◽

Chrissa L. McClellan ◽

Elizabeth J. Parks ◽

Stephen D. Ball

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Resistance Training ◽

Muscle Mass ◽

Body Mass ◽

Fat Mass ◽

Training Programme ◽

Haemoglobin A1c ◽

Community Based ◽

Resistance Training Programme

Abstract Ageing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p < 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p < 0.001), by primarily reducing fat mass (p = 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%, p ⩽ 0.05 for all). Improvements were also observed in plasma glucose (p = 0.05), haemoglobin A1C (p = 0.06) and aldolase enzyme levels (p < 0.001). Scores for surveys on memory and sleep improved (p < 0.05). Improved QOL was associated with increased lean mass (r = −0.714, p = 0.002), decreased fat mass (r = −0.702, p = 0.003) and improved flexibility and balance (r = −0.627, p = 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.

Download Full-text

The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study

Cancers ◽

10.3390/cancers13133245 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3245

Author(s):

Emma C. Atakpa ◽

Adam R. Brentnall ◽

Susan Astley ◽

Jack Cuzick ◽

D. Gareth Evans ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Breast Density ◽

Small Sample ◽

Weight Loss Intervention ◽

Short Term ◽

Dense Area ◽

Short Term Change ◽

Term Change

We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35–45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: −0.16, 0.28). There was little association with dense area (between-women r = −0.12, 95%CI: −0.38, 0.16; within-women r = 0.01, 95%CI: −0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: −0.31 (95%CI: −0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.

Download Full-text

Five-year Outcomes of Sleeve Gastrectomy: A Prospective Multicenter study

The American Surgeon ◽

10.1177/0003134821991984 ◽

2021 ◽

pp. 000313482199198

Author(s):

Imad El Moussaoui ◽

Etienne Van Vyve ◽

Hubert Johanet ◽

André Dabrowski ◽

Arnaud Piquard ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Body Mass ◽

Excess Weight Loss ◽

Prospective Multicenter Study ◽

Weight Loss Failure ◽

Obstructive Sleep ◽

The Mean ◽

Predictors Of Weight Loss

Background Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure. Methods A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. Results Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years ( P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. Conclusions Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure.

Download Full-text

Effects of a novel mobile health intervention compared to a multi-component behaviour changing program on body mass index, physical capacities and stress parameters in adolescents with obesity: a randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02781-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

A. Stasinaki ◽

D. Büchter ◽

C.-H. I. Shih ◽

K. Heldt ◽

S. Güsewell ◽

...

Keyword(s):

Health Care ◽

Body Mass Index ◽

Muscle Mass ◽

Body Mass ◽

Body Fat ◽

Mobile Health ◽

Health Intervention ◽

Randomized Controlled ◽

Physical Capacities ◽

Stress Parameters

Abstract Background Less than 2% of overweight children and adolescents in Switzerland can participate in multi-component behaviour changing interventions (BCI), due to costs and lack of time. Stress often hinders positive health outcomes in youth with obesity. Digital health interventions, with fewer on-site visits, promise health care access in remote regions; however, evidence for their effectiveness is scarce. Methods This randomized controlled not blinded trial (1:1) was conducted in a childhood obesity center in Switzerland. Forty-one youth aged 10–18 years with body mass index (BMI) > P.90 with risk factors or co-morbidities or BMI > P.97 were recruited. During 5.5 months, the PathMate2 group (PM) received daily conversational agent counselling via mobile app, combined with standardized counselling (4 on-site visits). Controls (CON) participated in a BCI (7 on-site visits). We compared the outcomes of both groups after 5.5 (T1) and 12 (T2) months. Primary outcome was reduction in BMI-SDS (BMI standard deviation score: BMI adjusted for age and sex). Secondary outcomes were changes in body fat and muscle mass (bioelectrical impedance analysis), waist-to-height ratio, physical capacities (modified Dordel-Koch-Test), blood pressure and pulse. Additionally, we hypothesized that less stressed children would lose more weight. Thus, children performed biofeedback relaxation exercises while stress parameters (plasma cortisol, stress questionnaires) were evaluated. Results At intervention start median BMI-SDS of all patients (18 PM, 13 CON) was 2.61 (obesity > + 2SD). BMI-SDS decreased significantly in CON at T1, but not at T2, and did not decrease in PM during the study. Muscle mass, strength and agility improved significantly in both groups at T2; only PM reduced significantly their body fat at T1 and T2. Average daily PM app usage rate was 71.5%. Cortisol serum levels decreased significantly after biofeedback but with no association between stress parameters and BMI-SDS. No side effects were observed. Conclusions Equally to BCI, PathMate2 intervention resulted in significant and lasting improvements of physical capacities and body composition, but not in sustained BMI-SDS decrease. This youth-appealing mobile health intervention provides an interesting approach for youth with obesity who have limited access to health care. Biofeedback reduces acute stress and could be an innovative adjunct to usual care.

Download Full-text