Carers of patients receiving palliative care. Specialized psychosocial care may be needed for carers.
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Caregivers↗
Biomedical subjects
D Gallagher
Publications and source records attributed to D Gallagher.
Epidemiology of sarcopenia among the elderly in New Mexico.
Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.
Adult↗
Body mass index as a measure of adiposity among children and adolescents: a validation study.
OBJECTIVES: To test the hypothesis that in a healthy pediatric population body mass index (BMI) (kilograms per meter square) is a valid measure of fatness that is independent of age for both sexes. METHODS: Total body fat (TBF) (in kilograms) and percent of body weight as fat (PBF) were estimated by dual energy x-ray absorptiometry (DXA) in 198 healthy Italian children and adolescents between 5 and 19 years of age. We developed multiple regression analysis models with TBF and percent body fat as dependent variables and BMI, age, and interaction terms as independent variables. Separate analyses were conducted for boys and girls. RESULTS: BMI was strongly associated with TBF (R2 = 0.85 and 0.89 for boys and girls, respectively) and PBF (R2 =0.63 and 0.69 for boys and girls, respectively). Confidence limits on BMI-fatness association were wide, with individuals of similar BMI showing large differences in TBF and in PBF. Age was a significant covariate in all regression models. Addition of nonlinear terms for BMI did not substantially increase the R2 for TBF and PBF models in boys and girls. CONCLUSION: Our results support the use of BMI as a fatness measure in groups of children and adolescents, although interpretation should be cautious when comparing BMI across groups that differ in age or when predicting a specific individual's TBF or PBF.
Absorptiometry, Photon↗
Stroke prevention trial in sickle cell anemia.
Stroke occurs in 7-8% of children with Sickle Cell Disease (Hb SS) and is a major cause of morbidity. Rates of recurrence have been reduced from 46-90% to less than 10% through chronic blood transfusions. Prevention of first stroke, however, would be preferable because even one stroke can cause irreversible brain injury. Transcranial Doppler (TCD) ultrasound can detect arterial blood flow rates associated with subsequent stroke risk. By combining TCD screening and a potentially effective treatment, first stroke may be prevented. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) is the first stroke prevention trial in Hb SS and the first randomized, controlled use of transfusion in Hb SS. This multi-center trial is designed to test whether reducing sickle hemoglobin to 30% or less with periodic blood transfusions will reduce first-time stroke by at least 70% compared to standard care. Primary endpoints will be clinically evident symptoms of cerebral infarction with consistent findings on Magnetic Resonance Imaging and Angiography (MRI/MRA) or symptomatic intracranial hemorrhage. Secondary endpoints will be asymptomatic brain lesions detected by MRI in brain areas not involved in primary endpoints. The design calls for a 6-month start-up interval, 18 months of TCD screening and randomization, and observation for stroke from entry through month 54. Key features of the trial are standardized TCD and MRI/MRA protocols interpreted blindly, and blinded adjudication of endpoints. The sample size (60 per treatment group) is based on prospective data relating TCD velocity to risk of stroke. A time-averaged mean velocity of > or = 200 cm/sec is associated with a 46% risk of cerebral infarction over 39 months. The sample size is sufficient to detect 70% reduction in the primary endpoint at 90% power. This trial will determine if transfusion is effective in the primary prevention of stroke. Secondary aims may further the understanding of the effects of transfusion on the brain and guide future research into cerebrovascular disease in Hb SS.
Adolescent↗
Dolphin interleukin-8 receptor. Map position 18q25-26.
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Animals↗
Dolphin beta-glucocerebrosidase, map position 1q22.
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Animals↗
Organ-tissue mass measurement allows modeling of REE and metabolically active tissue mass.
Investigators have expressed interest in the associations between resting energy expenditure (REE) and body mass for over a century. Traditionally, descriptive models using regression analysis are applied, linking REE with metabolically active compartments such as body cell mass (BCM) and fat-free body mass (FFM). Recently developed whole body magnetic resonance imaging (MRI) and echocardiography methods now allow estimation of all major organs and tissue volumes in vivo. Because measured values are available for REE, BCM, and FFM content of individual organs and tissues, it should now be possible to develop energy expenditure-body composition estimation models based on MRI-measured organ-tissue volumes. Specifically, the present investigation tested the hypothesis that in vivo estimation of whole body REE, BCM, and FFM is possible using MRI- and echocardiography-derived organ volumes combined with previously reported organ-tissue metabolic rates and chemical composition. Thirteen subjects (5 females, 8 males) had REE, BCM, and FFM measured by indirect calorimetry, whole body 40K counting, and dual-energy X-ray absorptiometry, respectively. Models developed from estimated and measured variables were highly correlated, with no significant differences between those estimated and measured [e.g., calculated vs. measured REE: r = 0.92, P < 0. 001; (mean +/- SD) 6,962 +/- 1,455 and 7,045 +/- 1,450 kJ/day, respectively (P = not significant)]. Strong associations were observed between REE, individual or combined organ weights, BCM, and FFM that provide new insights into earlier observed metabolic phenomona. The present approach, the first to establish an energy expenditure-body composition link with a mechanistic model in vivo, has the potential to greatly expand our knowledge of energy expenditure-body size relationships in humans.
Adolescent↗
Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography.
Magnetic resonance imaging (MRI) and computerized tomography (CT) are promising reference methods for quantifying whole body and regional skeletal muscle mass. Earlier MRI and CT validation studies used data-acquisition techniques and data-analysis procedures now outdated, evaluated anatomic rather than adipose tissue-free skeletal muscle (ATFSM), studied only the relatively large thigh, or found unduly large estimation errors. The aim of the present study was to compare arm and leg ATFSM cross-sectional area estimates (cm2) by using standard MRI and CT acquisition and image-analysis methods with corresponding cadaver estimates. A second objective was to validate MRI and CT measurements of adipose tissue embedded within muscle (interstitial adipose tissue) and surrounding muscle (subcutaneous adipose tissue). ATFSM area (n = 119) by MRI [38.9 +/- 22.3 (SD) cm2], CT (39.7 +/- 22.8 cm2), and cadaver (39.5 +/- 23.0 cm2) were not different (P > 0.001), and both MRI and CT estimates of ATFSM were highly correlated with corresponding cadaver values [MRI: r = 0.99, SE of estimate (SEE) 3.9 cm2, P < 0.001; and CT: r = 0.99, SEE = 3.8 cm2, P < 0.001]. Similarly good results were observed between MRI- and CT-measured vs. cadaver-measured interstitial and subcutaneous adipose tissue. For MRI-ATFSM the intraobserver correlation for duplicate measurements in vivo was 0. 99 [SEE = 8.7 cm2 (2.9%), P < 0.001]. These findings strongly support the use of MRI and CT as reference methods for appendicular skeletal muscle, interstitial and subcutaneous adipose tissue measurement in vivo.
Adipose Tissue↗
QTc interval (cardiac repolarization): lengthening after meals.
Weight reduction, either by dietary or surgical means, is associated with prolongation of the heart rate corrected QT interval (QTc = QT/R-R0.5) and, on occasion, sudden death. Screening subjects with obesity before weight loss for prolonged QTc intervals is an accepted practice, although at present, there are no guidelines for whether subjects should be fasting before electrocardiogram (EKG) evaluation. The aim of this study was to test the hypothesis that EKG QTc interval duration is independent of meal ingestion. The hypothesis was tested in 11 healthy subjects who ingested a 500-kcal formula meal. A small decrease in absolute QT interval and a steady decline in R-R interval were observed for up to 60 minutes after formula ingestion. The QTc interval increased above baseline at 15 minutes (p < 0.007) after meal, a change that persisted for the 1-hour postmeal observation period. Spectral analysis of EKG R-R intervals (low-/high-frequency amplitude ratio) indicated a change in cardiac autonomic flow after meal ingestion. The QTc interval did not lengthen and R-R low-/high-frequency amplitude ratio remained unchanged in eight subjects evaluated in a similar manner but in whom isovolumic amounts of water replaced the meal. These observations suggest that (1) cardiac repolarization changes with fasting and feeding, (2) the QTc interval is influenced by meal intake, and (3) the autonomic nervous system may play a role in meal-related QTc changes. These findings have implications for the evaluation of patients with obesity before starting and during weight loss treatment.
Adult↗
Body fat distribution before and after weight gain in anorexia nervosa.
OBJECTIVE: To study abdominal fat distribution in anorexia nervosa subjects and to assess the effects of initial weight regain on abdominal fat distribution. DESIGN: Longitudinal, clinical study. The baseline measurement was acquired within four days of admission to the eating disorders clinic. All patients were treated by re-feeding, reinforced by psychotherapy. Following weight regain of at least 5 kg, a second body fat distribution evaluation was performed. Of the 21 subjects evaluated at baseline, 14 achieved the goal of body weight regain and were retested. PATIENTS: Fourteen subjects (age: 18-38 y; body mass index: 11.5-18.3; relative body weight: 54.9-88.3%). MEASUREMENTS: Total, subcutaneous and visceral abdominal adipose tissue areas at the L4-L5 level were evaluated by computed tomography. RESULTS: At baseline the subjects showed a higher proportion of visceral adipose tissue (% visceral adipose tissue = 55.3 +/- 26.1). A significant association was observed between body weight and both subcutaneous adipose tissue and total adipose tissue. A regain of body weight of 7.3 +/- 1.6 kg was accompanied by a significant increase in total adipose tissue, comprising both subcutaneous and visceral adipose tissue. The increase observed in subcutaneous adipose tissue, however, was significantly greater than for visceral adipose tissue (212.6% vs 116.8%, respectively, P < 0.01). CONCLUSION: The results of the current study show a higher proportion of visceral adipose tissue than subcutaneous adipose tissue in anorexia nervosa subjects. With regain of body weight there is a preferential regain of subcutaneous adipose tissue. These data demonstrate a redistribution of abdominal adipose tissue with weight regain in anorexia nervosa subjects.
Abdomen↗
Electrocardiographic QTC interval: short-term weight loss effects.
OBJECTIVE: Prolongation of the QTc interval is a risk-factor for ventricular arrhythmias and sudden death. There is a correlation between body mass index (BMI) and QTc, with longer intervals observed in obese subjects. Dieting and weight loss on selected diets are also associated with prolongation of the QTc interval, although the mechanisms and risk factors of this syndrome are not clearly established. The aim of the current investigation was to determine if short-term weight loss over seven days while living on a metabolic ward influences cardiac repolarization as indicated by QT interval duration. DESIGN AND SUBJECTS: The electrocardiogram QT, RR, and QTc (QT/RR(0.5)) intervals were assessed in 30 healthy obese (BMI > 27 kg/m2) men and women ingesting a balanced 1120 kcal/d formula diet (23% kcal as fat and 52 g protein/d). RESULTS: Weight loss (3.9 +/- 1.7 kg) over seven days had no measurable effect on the RR interval and there was a significant (P = 0.02) shortening of the QT interval (mean +/- s.d., 0.395 +/- 0.028-0.386 +/- 0.027 s) and borderline significant (P = 0.11) shortening of the QTc (0.411 +/- 0.028-0.404 +/- 0.025 s) interval. The QTc interval normalized in three subjects with prolonged baseline QTc (> 0.44 s). A statistically significant (P = 0.007) reduction in systolic blood pressure early in the course of weight loss (day 2) accompanied the electrocardiographic changes. CONCLUSION: These results fail to support the development of cardiac repolarization abnormalities in obese patients who ingest a nutritionally balanced low calorie diet over seven days. A significant reduction in QT interval duration and amelioration of abnormally prolonged baseline QTc intervals suggest improved cardiac repolarization with early weight loss.
Adult↗
Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging.
OBJECTIVES: To assess the relationship between body mass index (BMI; kg/m2) and mortality in a large nationally representative sample of US adults over age 70 years. DESIGN: Prospective longitudinal cohort study, the Longitudinal Study of Aging (LSOA). Subjects were all those 7260 black and white people (2769 men, 4491 women) initially interviewed in 1984 for whom height and weight were available. These subjects were followed through to 1990. MEASUREMENTS: Measurements included self-reported height and weight, date of death if subjects died, sex, age, race, measures of socio-economic status, number of living first degree relatives, and responses to questions asking whether the subject had retired due to poor health, had difficulty eating, worried about their health, and felt their health was worse than during the prior year. Smoking status was not assessed. RESULTS: When analyzed via Cox proportional hazard regression, the relationship between BMI and mortality, represented by means of hazard ratio, was clearly U-shaped for both men and women. The base of the curves was fairly wide suggesting that a broad range of BMIs are well tolerated by older adults. The minimum mortality (estimated from the fitted proportional hazard models) occurred at a BMI of approximately 31.7 for women and 28.8 for men. The results were essentially unchanged, if analyses were weighted, if various disease states were controlled for, and if apparently unhealthy subjects were excluded. CONCLUSIONS: The finding of the relatively high BMI (27-30 for men, 30-35 for women) associated with minimum hazard in persons older than seventy years supports some previously documented findings and opposes others and, if confirmed in future research, has implications for public health and clinical recommendations.
Aged↗
Bioimpedance analysis: evaluation of leg-to-leg system based on pressure contact footpad electrodes.
Conventional single frequency bioimpedance analysis (BIA) systems require technician placement of arm and leg gel electrodes, a suitable location for recumbent measurements, and a separate measurement of body weight. The aim of this study was to evaluate a new single frequency 50 KHz leg-to-leg bioimpedance analysis (BIA) system combined with a digital scale that employs stainless steel pressure-contact foot pad electrodes for standing impedance and body weight measurements. Healthy adults were evaluated for 1) electrode validity and 2) potential for body component estimation. Pressure-contact foot-pad electrode measured impedance was highly correlated with (N = 9, r = 0.99, P < 0.001) impedance measured using conventional gel electrodes applied to the plantar surface of both lower extremities; mean (+/-SD) impedance was systematically higher by about 15 ohms for pressure contact electrodes (526 +/- 56 ohms vs 511 +/- 59 ohms; P < 0.001). Second, the relationship between stature-adjusted leg-to-leg impedance (H2/Z) measured by the new system and two body composition components (total body water by 3H2O dilution (N = 144); and fat-free body mass, by underwater weighing and dual x-ray absorptiometry (N = 231)) was modeled using multiple regression analysis. Correlation coefficients for H2/Z alone versus body composition components were lower for leg-to-leg BIA than for arm-to-leg BIA; correlation coefficients and SEEs became similar for the leg-to-leg and arm-to-leg BIA systems with addition of three covariates (age, gender, and waist/hip circumference ratio) to regression models. The leg-to-leg pressure contact electrode BIA system has overall performance characteristics for impedance measurement and body composition analysis similar to conventional arm-to-leg gel electrode BIA and offers the advantage of increased speed and ease of measurement.
Absorptiometry, Photon↗
Density of fat-free body mass: relationship with race, age, and level of body fatness.
The two-compartment body composition method assumes that fat-free body mass (FFM) has a density of 1.100 kg/l. This study tested the hypothesis that FFM density is independent of race, age, and body fatness. Subjects were 703 black and white subjects, ages 20-94 yr, with body mass index (BMI) 17-35 kg/m2. Body composition was assessed using a four-compartment model based on tritium dilution volume, body density by underwater weighing, bone mineral by dual-energy X-ray absorptiometry, and body weight. No relationship was observed between FFM density and race or BMI. A tendency was observed for a lower FFM density only in older white women. The difference in percent body fat (delta fat) between the four-compartment model and underwater weighing was < 2% for all groups. Race, age, and BMI explained only 2.3 (women) and 1.4% (men) of the variance in delta fat, whereas the total body water fraction of FFM explained 77%. In contrast to current thinking, these results show that the assumption of constant FFM density is valid in black, elderly, and obese subjects.
Adipose Tissue↗
Appendicular skeletal muscle mass: effects of age, gender, and ethnicity.
This study tested the hypothesis that skeletal muscle mass is reduced in elderly women and men after adjustment first for stature and body weight. The hypothesis was evaluated by estimating appendicular skeletal muscle mass with dual-energy X-ray absorptiometry in a healthy adult cohort. A second purpose was to test the hypothesis that whole body 40K counting-derived total body potassium (TBK) is a reliable indirect measure of skeletal muscle mass. The independent effects on both appendicular skeletal muscle and TBK of gender (n = 148 women and 136 men) and ethnicity (n = 152 African-Americans and 132 Caucasians) were also explored. Main findings were 1) for both appendicular skeletal muscle mass (total, leg, and arm) and TBK, age was an independent determinant after adjustment first by stepwise multiple regression for stature and weight (multiple regression model r2 = approximately 0.60); absolute decrease with greater age in men was almost double that in women; significantly larger absolute amounts were observed in men and African-Americans after adjustment first for stature, weight, and age; and >80% of within-gender or -ethnic group between-individual component variation was explained by stature, weight, age, gender, and ethnicity differences; and 2) most of between-individual TBK variation could be explained by total appendicular skeletal muscle (r2 = 0.865), whereas age, gender, and ethnicity were small but significant additional covariates (total r2 = 0.903). Our study supports the hypotheses that skeletal muscle is reduced in the elderly and that TBK provides a reasonable indirect assessment of skeletal muscle mass. These findings provide a foundation for investigating skeletal muscle mass in a wide range of health-related conditions.
Absorptiometry, Photon↗
Diagnosis and management of migraine. Care needs to be taken with treatment.
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Adrenergic beta-Agonists↗
How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?
This study tested the hypothesis that body mass index (BMI) is representative of body fatness independent of age, sex, and ethnicity. Between 1986 and 1992, the authors studied a total of 202 black and 504 white men and women who resided in or near New York City, were ages 20-94 years, and had BMIs of 18-35 kg/m2. Total body fat, expressed as a percentage of body weight (BF%), was assessed using a four-compartment body composition model that does not rely on assumptions known to be age, sex, or ethnicity dependent. Statistically significant age dependencies were observed in the BF%-BMI relations in all four sex and ethnic groups (p values < 0.05-0.001) with older persons showing a higher BF% compared with younger persons with comparable BMIs. Statistically significant sex effects were also observed in BF%-BMI relations within each ethnic group (p values < 0.001) after controlling first for age. For an equivalent BMI, women have significantly greater amounts of total body fat than do men throughout the entire adult life span. Ethnicity did not significantly influence the BF%-BMI relation after controlling first for age and sex even though both black women and men had longer appendicular bone lengths relative to stature (p values < 0.001 and 0.02, respectively) compared with white women and men. Body mass index alone accounted for 25% of between-individual differences in body fat percentage for the 706 total subjects; adding age and sex as independent variables to the regression model increased the variance (r2) to 67%. These results suggest that BMI is age and sex dependent when used as an indicator of body fatness, but that it is ethnicity independent in black and white adults.
Adipose Tissue↗
Metabolically active component of fat-free body mass: influences of age, adiposity, and gender.
Fat-free body mass (FFM) is often considered the metabolically active compartment and is widely used to adjust between-subject differences in resting energy expenditure for body composition. The use of FFM as the metabolically active portion of body weight makes the assumption that the body cell mass (BCM) component which is more difficult to measure, maintains a relatively constant relationship to FFM within and between subjects. The aim of this study was to test the hypothesis that BCM and FFM are associated independently of age, adiposity (as represented by body density), and gender in healthy white women and men. BCM and FFM were estimated by whole-body 40K-counting and dual-energy x-ray absorptiometry (DXA), respectively. Multiple regression analysis was used to model the relationships between BCM as the dependent variable and FFM, age, body density, and gender as potential independent variables. FFM alone explained 51% and 63% of between-individual BCM differences in women (n = 269) and men (n = 204) (both P = .0001), respectively. Age contributed significantly (P = .0001) to BCM prediction after adjusting first for FFM in both women and men. Body density also added significantly (P = .004 and P = .0001) to FFM and age prediction of BCM in women and men, respectively. Lastly, gender contributed significantly to the composite model, with 91% of between-individual differences in BCM explained by FFM, age, body density, and gender. Hence, BCM does not maintain a fixed relationship to FFM, as often assumed, but varies significantly and independently of FFM with age, adiposity, and gender. These findings have implications for the study of metabolic indices such as resting energy expenditure.
Absorptiometry, Photon↗