Abnormal bone mineral density and content in girls with early-onset anorexia nervosa

Background Early-onset anorexia nervosa (EO-AN) represents a significant clinical burden to paediatric and mental health services. The impact of EO-AN on bone mineral abnormalities has not been thoroughly investigated due to inadequate control for pubertal status. In this study, we investigated bone mineral abnormalities in girls with EO-AN regardless of pubertal development stage. Method We conducted a cross-sectional study of 67 girls with EO-AN (median age = 12.4 [10.9–13.7 years]) after a median duration of disease of 1.3 [0.6–2.0] years, and 67 healthy age-, sex-, pubertal status- matched control subjects. We compared relevant bone mineral parameters between groups: the total body bone mineral density [TB-BMD], the lumbar spine BMD [LS-BMD], the total body bone mineral content [TB-BMC] and the ratio of the TB-BMC to lean body mass [TB-BMC/LBM]. Results TB-BMD, TB-BMC, LS-BMD and TB-BMC/LBM were all significantly lower in patients with AN compared to controls. In the EO-AN group, older age, later pubertal stages and higher lean body mass were associated with higher TB-BMC, TB-BMD, and LS-BMD values. Discussion Girls with EO-AN displayed deficits in bone mineral content and density after adjustment for pubertal maturation. Age, higher pubertal stage and lean body mass were identified as determinants of bone maturation in the clinical population of patients with EO-AN. Bone health should be promoted in patients, specifically in those with an onset of disorder before 14 years old and with a delayed puberty.

Factors associated with measures of sarcopenia in pre and postmenopausal women

Background Menopause associated low serum estradiol marks varieties of derangements in muscle mass and functions leading to sarcopenia. This cross-sectional study was carried out to examine the factors associated with measures of sarcopenia; skeletal muscle mass (SMM), muscle strength and physical performance (PP) in a group of premenopausal (PrMW) and postmenopausal women (PMW) selected from Sri Lanka. Methods Randomly selected 184 PrMW and 166 PMW from Galle district, Sri Lanka were studied. SMM was measured with duel energy X ray absorptiometry and relative appendicular SMM index (RSMI; kg/m2) was calculated. Other measurements made include handgrip strength (HGS; kg) and gait speed (GS; m/s), anthropometric indices, consumption of macro and micronutrients, and pattern of physical activities (PA). A serum sample was analyzed for fasting insulin, serum estradiol and vitamin D. Variables which significantly correlated with RSMI, HGS and GS of PrMW and PMW were separately entered into multiple linear regression models to extract the associated factors. Results Mean (SD) age of PrMW and PMW were 42.4 (6.0) and 55.8 (3.8) years respectively. In the regression analysis, RSMI in PrMW showed significant associations with body mass index (BMI), HGS, total-body-fat-mass (TBFM) and weight (adjusted R2 = 0.85) and in PMW with BMI, weight, TBFM, hip-circumference and fasting insulin (adjusted R2 = 0.80). BMI showed the strongest association with RSMI in both PrMW (r = 0.87, R2 = 0.76) and in PMW (r = 0.87, R2 = 0.76). HGS in PrMW showed significant associations with appendicular SMM (ASMM), total-body-bone-mineral-content, vigorous PA score, age and weight (adjusted R2 = 0.33) and in PMW with ASMM and height (adjusted R2 = 0.23). ASMM showed the strongest association with HGS in both PrMW (r = 0.44, R2 = 0.20) and PMW (r = 0.44, R2 = 0.20). GS in PrMW showed significant associations with height, BMI and energy consumption (adjusted R2 = 0.13) while in PMW, with carbohydrate consumption and total-body-bone-mineral-density (adjusted R2 = 0.09). While in PrMW, height showed the strongest association with GS (r = 0.28, R2 = 0.08) in PMW, it was carbohydrate consumption (r = 0.24, R2 = 0.06). Conclusions Factors that are associated with different measures of sarcopenia are not uniform and vary widely from anthropometry to nutrient intake indicating that these measures are somewhat independent and are governed by different factors.

108 Factors Associated with Hand Grip Strength of a Group of Pre and Postmenopausal Women from Sri Lanka

Hand grip strength (HGS) is a component of sarcopenia and provides an estimate on muscle strength and overall health status. This cross-sectional study examined the factors associated with HGS in community dwelling healthy premenopausal women (PrMW) and postmenopausal women (PMW). Randomly selected 184 PrMW (42.4±6.0years) and 166 PMW (55.8±3.8years) from Galle, Sri Lanka were studied. HGS (kg) of dominant side was evaluated using a hand-held-dynamometer. Body composition; Appendicular-skeletal-muscle-mass (ASMM, kg), total-body-fat-mass (TBFM, kg), total body bone-mineral-density (TBBMD, g/cm3) and total-body-bone mineral-content (TBBMC, g) were measured with DXA. Anthropometry indices; weight (kg), height (m), waist-circumference (WC, cm) and hip-circumference (HC, cm) were measured. Body-mass-index (BMI, kg/m2) and waist-to-hip-ratio (WHR) were calculated. Gait speed (GS, m/s) was evaluated. Consumption of nutrients; carbohydrate, protein, fats and total energy and physical activity (PA) pattern; walking, moderate, vigorous and total PA score were evaluated. Serum sample was analyzed for 25-hydroxy-vitamin-D (n/mol), estradiol (mlU/L), fasting insulin (μU/mL). Variables significantly correlated with HGS of PrMW and PMW were separately entered in to multiple linear regression models to extract the associated factors. Mean±SD HGS of PrMW and PMW were 19.06±6.06 kg and 15.27±4.86 kg (p<0.001) respectively. In multiple regression analysis, factors that showed significant association with HGS in PrMW were ASMM (β=0.57), TBBMC (β=0.31), vigorous PA score (β=0.12), age (β=-0.19) and weight (β=0.42) (R=0.58, adjusted R2=0.33). In the same analysis, the factors associated with HGS in PMW were ASMM (β=0.31) and height (β=0.22) (R=0.48, adjusted R2=0.22). The most significant factor associated with HGS was ASMM in both PrMW (R=0.44, R2=0.20) and PMW (R=0.44, R2=0.19). Age, anthropometry indices, PA and ASMM showed significant associations with HGS among middle-aged women, while ASMM was the main predictor of HGS irrespective of menopausal status.

Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Background. Disturbed bone turnover, osteoporosis, and increased fracture risk are late complications of insulin-dependent diabetes mellitus. Little is known about how far and to what extent can glycaemic control of type 1 diabetes mellitus (T1DM) prevent disturbances of bone health and body composition during the growth and maturation period. Objective. The aim of this cross-sectional study was to compare the skeletal status outcomes and body composition between patients stratified by glycaemic control (1-year HbA1c levels) into well- and poorly-controlled subgroups in a population of T1DM adolescents, that is, <8% and ≥8%, respectively. Subjects and Methods. Skeletal status and body composition were evaluated in 60 adolescents with T1DM (53.3% female; mean aged: 15.1 ± 1.9 years; disease duration: 5.1 ± 3.9 years) using dual energy X-ray absorptiometry (GE Prodigy). The results were compared to age- and sex-adjusted reference values for healthy controls. The calculated Z-scores of different metabolic control subgroups were compared. Clinical data was also assessed. Results. As evidenced by Z-scores, patients with T1DM revealed a significantly lower TBBMD (total body bone mineral density), TBBMC (total body bone mineral content), S24BMD (bone mineral density of lumbar spine L2–L4), and TBBMC/LBM ratio (total body bone mineral content/lean body mass), but higher FM (fat mass) and FM/LBM ratio (fat mass/lean body mass) values compared to an age- and sex-adjusted general population. The subset (43.3% patients) with poor metabolic control (HbA1c ≥ 8%) had lower TBBMD, TBBMC, and LBM compared to respective values noted in the HbA1c < 8% group, after adjusting for confounders (mean Z-scores: −0.74 vs. −0.10, p=0.037; −0.67 vs. +0.01, p=0.026; and −0.45 vs. +0.20, p=0.043, respectively). Additionally, we found a significant difference in the TBBMC/LBM ratio (relative bone strength index) between the metabolic groups (−0.58 vs. −0.07; p=0.021). A statistically significant negative correlation between 1-year HbA1c levels and Z-scores of TBBMD, TBBMC, and LBM was also observed. In patients with longer disease duration, a significant negative correlation was established only for TBBMD, after adjusting for confounders. The relationships between densitometric values and age at onset of T1DM and sex were not significant and showed no relation to any of the analysed parameters of the disease course. Conclusion. Findings from this study of adolescents with T1DM indicate that the lower Z-scores of TBBMD, TBBMC, and LBM as well as the TBBMC/LBM ratio are associated with increased HbA1c levels. Their recognition can be crucial in directing strategies to optimise metabolic control and improve diabetes management for bone development and maintenance in adolescents with T1DM.

Body Composition and Bone Mineral Density in Patients With Heart Failure

The purpose of this study was to examine associations among bone mineral density, osteopenia/osteoporosis, body mass index (BMI), and body composition in patients with heart failure (HF). A total of 119 patients (age = 61 ± 12 years, 65% male) underwent dual-energy X-ray absorptiometry scans to determine bone mineral density and body composition. In multivariable linear regressions, BMI, relative skeletal muscle index (RSMI), and mineral-free lean mass were positively associated with total body bone mineral density. Mineral-free lean mass was most strongly associated with bone mineral density (β = .398). In multivariable logistic regressions, higher BMI, RSMI, and mineral-free lean mass were associated with lower odds for osteopenia/osteoporosis. Fat mass was not associated with total body bone mineral density or osteopenia/osteoporosis. These results suggest that muscle mass may be the important component of body mass associated with bone mineral density in patients with HF.