Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.

Effects of Exergames and Protein Supplementation on Body Composition and Musculoskeletal Function of Prefrail Community-Dwelling Older Women: A Randomized, Controlled Clinical Trial

This study aimed to investigate the effects of exergames and protein supplementation on the body composition and musculoskeletal function of pre-frail older women. Methods: A randomized controlled clinical trial was conducted with 90 pre-frail older women (71.2 ± 4.5 years old) divided into five groups: control (CG); exergames training (ETG); protein supplementation (PSG); exergames combined with protein supplementation (ETPSG); exergames combined with isoenergetic supplementation (ETISG). The primary outcomes were pre-frailty status, body composition (appendicular muscle mass (ASM); appendicular muscle mass index (ASMI)) assessed by dual energy X-ray absorptiometry and gastrocnemius muscle architecture via ultrasound. Secondary outcomes were protein intake, plasma levels of interleukin (IL)-6, plantar and dorsiflexion isokinetic peak torque, and handgrip strength (HS). Data were analyzed using an ANOVA mixed model test and Bonferroni post hoc test (p < 0.05). The ETG showed a reduction of ASM (16.7 ± 3.4 vs. 16.1 ± 3.3 kg; Δ = −0.5; p = 0.02; d = 0.26) and ASMI (6.8 ± 0.9 vs. 6.5 ± 0.9 kg; Δ = −0.2; p = 0.03; d = 0.35), without changing ASM in other groups. The average protein intake in the supplemented groups (PSG and ETPSG) was 1.1 ± 0.2 g/kg/day. The dorsiflexion peak torque increased 11.4% in ETPSG (16.3 ± 2.5 vs. 18.4 ± 4.2 Nm; p = 0.021; d = −0.58). The HS increased by 13.7% in ETG (20.1 ± 7.2 vs. 23.3 ± 6.2 kg, Δ = 3.2 ± 4.9, p = 0.004, d = −0.48). The fatigue/exhaustion reduced by 100% in ETG, 75% in PSG, and 100% in ETPSG. Physical training with exergames associated with protein supplementation reversed pre-frailty status, improved the ankle dorsiflexors torque, and ameliorated fatigue/exhaustion in pre-frail older women.

Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure

Background: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. Methods: We prospectively enrolled adults with class I–IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. Results: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81–11.84], P =0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non–physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non–physically frail men. Conclusions: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.

Prevalence of sarcopenia in idiopathic dropped head syndrome patients is similar to healthy volunteers

Dropped head syndrome (DHS) exhibits cervical deformity due to weakness of the cervical extensor group, and sarcopenia is characterized by progressive and systemic reduction in skeletal muscle mass. These clinical finding are associated with reduced activity of daily living, reduced quality of life, and increased risk of mortality. We collected and reviewed prospective registry data for 16 patients with idiopathic DHS continuously collected without dropping out and 32 healthy individuals who matched their gender and age. The prevalence of sarcopenia and body composition data were compared. There were no differences in the prevalence of sarcopenia, appendicular muscle mass, and leg muscle mass between DHS patients and the healthy elderly. Trunk muscle mass in DHS patients was significantly lower than that in healthy individuals. A significant correlation was found between appendicular muscle mass and trunk muscle mass in healthy subjects but not in DHS patients. Sarcopenia was not associated with the onset of idiopathic DHS. The prevalence of sarcopenia was not high in patients with idiopathic DHS due to the preservation of their appendicular skeletal muscle mass. Patients with DHS were characterized by a significant loss of trunk muscle mass that may be related to the disease but not aging.

Relationships of Bone Mineral Variables with Body Composition, Blood Hormones and Training Volume in Adolescent Female Athletes with Different Loading Patterns

The aim of this investigation was to determine the relationships of areal bone mineral density (aBMD) and content (BMC) with body composition, blood hormone and training load variables in adolescent female athletes with different loading patterns. The participants were 73 healthy adolescent females (14–18 years), who were divided into three groups: rhythmic gymnasts (RG; n = 33), swimmers (SW; n = 20) and untrained controls (UC; n = 20). Bone mineral and body compositional variables were measured by dual-energy X-ray absorptiometry, and insulin-like growth factor-1 (IGF-1), estradiol and leptin were analyzed from blood samples. In addition, aerobic performance was assessed by a peak oxygen consumption test. No differences (p > 0.05) in weekly training volume were observed between rhythmic gymnasts (17.6 ± 5.3 h/week) and swimmers (16.1 ± 6.9 h/week). Measured areal bone mineral density and bone mineral content values were higher in rhythmic gymnasts compared with other groups (p < 0.05), while no differences (p > 0.05) in measured bone mineral values were seen between swimmers and untrained control groups. Multiple regression models indicated that IGF-1 alone explained 14% of the total variance (R2 × 100) in lumbar spine aBMD, while appendicular muscle mass and training volume together explained 37% of the total variance in femoral neck BMC in the rhythmic gymnast group only. In swimmers, age at menarche, estradiol and appendicular muscle mass together explained 68% of the total variance in lumbar spine BMC, while appendicular muscle mass was the only predictor and explained 19 to 53% of the total variance in measured bone mineral values in untrained controls. In conclusion, adolescent rhythmic gymnasts with specific weight-bearing athletic activity present higher areal bone mineral values in comparison with swimmers and untrained controls. Specific training volume together with appendicular muscle mass influenced cortical bone development at the femoral neck site of the skeleton in rhythmic gymnasts, while hormonal values influenced trabecular bone development at the lumbar spine site in both athletic groups with different loading patterns.

AB0176 PATHOLOGICAL PHENOTYPES OF BODY COMPOSITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Inflammation, decreased physical activity, hormonal disorders, and the use of glucocorticoids lead to changes in the composition of the body in rheumatoid arthritis (RA). Various combinations of decreased muscle and bone mass and increased adipose tissue have led to the release of various pathological phenotypes of the composition of the body.Objectives:To determine the frequency of pathological phenotypes of body composition in patients with RA.Methods:The study included 79 women with RA, with a median age of 60 y.o. [55; 65]. 92% of the women were postmenopausal. The median duration of the disease was 9 years [3; 11]. Basic anti-inflammatory therapy was received by 81% of patients. Methotrexate was used most often as the basic therapy – in 52% of cases. 49% of patients were treated with glucocorticoid drugs. All patients underwent dual-energy X-ray absorptiometry. The mineral density of the tissues was determined in the standard measurement areas - the spine and the proximal thigh, and the content of muscle and adipose tissue was analyzed. We calculated appendicular muscle mass (AMM), which is the sum of upper and lower limb muscle mass and appendicular muscle index (AMI), the ratio of appendicular muscle mass to the square of height. AMM< 15 kg, AMI < 6 kg / m2 corresponds to sarcopenia.Results:The average AMM was 17.8±3.0 kg. 18% patients had AMM <15 kg / m2. The average AMI was 6.8±1.0 kg / m2. 25% patients had AMI < 6 kg/m2. The average body mass index (BMI) was 27.6±4.8 kg/m2. 37% patients were overweight (25≤ BMI <29.9 kg/m2), 28% of women had a BMI corresponding to obesity. The average fat content was 28.2 kg. 71% of women had an obesity, according to X-ray absorptiometry, which is 2.5 times higher than the number of cases of obesity detected by BMI. A decrease a bone mineral density (BMD) was found in 73% of women, including osteoporosis in 25%. The most frequent phenotype was osteopenic obesity (Table 1), which was detected in almost 40% of patients. Isolated osteoporosis (16.5%) and obesity (17.7%) and osteosarcopenic obesity (16.5%) were found with approximately the same frequency. Osteosarcopenia was found in 9% of patients. In 4%, no changes in the compositional composition of the human body were detected.Table 1.Pathological phenotypes of body compositionPathological phenotypes of body compositionn=79Osteoporosis, n (%)13 (16,5)Obesity, n (%)14 (17,7)Osteosarcopenia, n (%)7 (8,9)Osteopenic obesity, n (%)29 (36,7)Osteosarcopenic obesity, n (%)13 (16,5)Conclusion:The overall frequency of pathological phenotypes of body composition was high and amounted to 96.2% in women with RA. The most common pathological phenotype was an osteopenic obesity characterized by a decrease in BMD and an increase in fat mass.Disclosure of Interests:None declared

Prevalence of Sarcopenia in Idiopathic Dropped Head Syndrome Patients is Similar to Healthy Volunteers

Dropped head syndrome (DHS) exhibits cervical deformity due to weakness of the cervical extensor group, and sarcopenia is characterized by progressive and systemic reduction in skeletal muscle mass. These clinical finding are associated with reduced activity of daily living, reduced quality of life, and increased risk of mortality. We collected and reviewed prospective registry data for 16 consecutive female patients with idiopathic DHS and 32 healthy individuals who matched their gender and age. The prevalence of sarcopenia and body composition data were compared. There were no differences in the prevalence of sarcopenia, appendicular muscle mass, and leg muscle mass between DHS patients and the healthy elderly. Trunk muscle mass in DHS patients was significantly lower than that in healthy individuals. A significant correlation was found between appendicular muscle mass and trunk muscle mass in healthy subjects but not in DHS patients. Sarcopenia was not associated with the onset of idiopathic DHS. The prevalence of sarcopenia was not high in patients with idiopathic DHS due to the preservation of their appendicular skeletal muscle mass. Patients with DHS were characterized by a significant loss of trunk muscle mass that may be related to the disease but not aging.

Appendicular Muscle Mass, Thigh Intermuscular Fat Infiltration, and Risk of Fall in Postmenopausal Osteoporotic Elder Women

Background: The association between the quantity and composition of skeletal muscle and the decline in physical function in elderly is poorly understood. Therefore, the primary aim of this cross-over study was to investigate the association between thigh intermuscular adipose tissue (IMAT) infiltration, appendicular muscle mass, and risk of fall in postmenopausal osteoporotic elder women. Second, we examined the differences in muscle mass, IMAT, and risk of fall in the same sample of older subjects after being classified as sarcopenic or nonsarcopenic on the basis of the dual-energy X-ray absorptiometry (DXA)-based Appendicular Skeletal Muscle Mass Index (ASMMI). Methods: Twenty-nine subjects (age: 72.4 ± 6.8; BMI: 23.0 ± 3.3; and T-score: −2.7 ± 0.2) completed the following clinical evaluations: (1) whole-body DXA to assess the ASMMI; (2) magnetic resonance to determine the cross-sectional muscle area (CSA) and IMAT of thigh muscles, expressed both in absolute (IMATabs) and relative (IMATrel) values; and (3) risk of fall assessment through the OAK system (Khymeia, Noventa Padovana, Italy). The existence of a correlation between the risk of fall (OAK scores, an automated version of the Brief-BESTest) and the clinical parameters (ASMMI, CSA, IMATrel, and IMATabs) was tested by the Pearson’s correlation index while data homogeneity between sarcopenic and nonsarcopenic subjects was tested through unpaired Student t tests or with the Mann-Whitney rank test. Effect sizes (ES) were used to determine the magnitude of the effect for all significant outcomes. Results: Eleven subjects were classified as sarcopenic and 18 as nonsarcopenic based on their ASMMI (cutoff value: 5.5 kg/m2). A positive correlation between OAK and CSA was observed (r2 = 0.19; p = 0.033), whereas a negative correlation between OAK and IMATrel was detected (r2 = 0.27; p = 0.009). No correlations were observed between OAK and ASMMI and between ASMMI and IMATrel. Sarcopenic subjects showed significantly lower weight (p = 0.002; ES = 1.30, large), BMI (p = 0.0003; ES = 1.82, large), CSA (p = 0.010; ES = 1.17, moderate), and IMATabs (p = 0.022; ES = 1.63, large) than nonsarcopenic individuals, whereas OAK scores and IMATrel were similar between groups. Discussion/Conclusion: Increased IMAT and lower CSA in the thigh muscles are associated with higher risk of fall while ASMMI, a value of appendicular muscle mass, was not associated with physical performance in older adults.