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Biomedical subjects

Laurence Genton

Publications and source records attributed to Laurence Genton.

At least 19 recordsLinked to original sources
PubMed2006

Hospitalized mechanically ventilated patients are at higher risk of enteral underfeeding than non-ventilated patients.

BACKGROUND & AIMS: Enteral nutrition (EN) is the preferred method of nutrition support in hospitalized patients but only 50-90% of the required calories are actually delivered. In order to identify where our nutrition support team (NST) should focus its activity, we prospectively evaluated the level of coverage of energy and protein needs during the first 5 days of EN in intensive care unit (ICU) and non-ICU patients and the relationship of energy and protein coverage with serum albumin, transthryretin, insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP). METHODS: Subjects (n=183) who required nutrition support and received EN were prospectively recruited. Calorie prescription was 20 and 25, 25 and 30 kcal/kg BW for women and men 60 years and <60 years, respectively. Protein needs were estimated as 1.2g protein/kg BW. Logistic regression analysis was used to estimate odds ratios (OR) for energy and protein delivery 66.6% and <66.6% and albumin, transthryretin, IGF-1 (low vs. normal) and CRP (high vs. normal) in ventilated vs. non-ventilated patients. RESULTS: Significantly more mechanically ventilated than non-ventilated patients received <66.6% of energy (71% vs. 48%) and protein (96% vs. 65%). The ventilated patients were more likely to be energy (OR 2.1, CI 1.1-4.0) and protein (OR 15.7, CI 4.9-50.8) underfed than non-ventilated patients. There was a significant association on day 5 between low protein delivery and low albumin (OR 2.9, CI 1.3-6.5), low transthyretin (OR 3.0, CI 1.4-6.5), low IGF-1 (OR 2.8, CI 1.2-6.7) and high CRP (OR 3.5, CI 1.6-7.8). CONCLUSIONS: The energy and protein needs of hospitalized patients are not met during the first 5 days of EN. Ventilated patients are more likely to be energy and protein underfed than non-ventilated patients and to have low plasma protein level. These findings support our decision to intensify EN monitoring by our NST in ventilated patients to optimize their nutritional coverage.

Aged↗
PubMed2006

Ergonomic and economic aspects of total parenteral nutrition.

PURPOSE OF REVIEW: Ergonomics in total parenteral nutrition include the work performed in the (hospital) pharmacy and on the medical ward. This article reviews the developments in total parenteral nutrition ergonomics and the related cost-savings. RECENT FINDINGS: Research focuses on the ergonomic advantages of multi-compartment total parenteral nutrition bags compared with the multi-bottle system, of multi versus single-layered total parenteral nutrition bags and of the presence of a nutritional team and training in clinical nutrition to improve regimen prescription and delivery. SUMMARY: Three-compartment bags are safe, economic and ergonomic. It is important, however, to keep the knowledge of pharmacies to compound total parenteral nutrition for children and (adult) patients with specific pathologies. Research is ongoing in the development of bags with more than three compartments, to include for instance vitamins. This necessitates improvements in bag materials and wrapping. Progress can be made regarding total parenteral nutrition prescription and delivery, as well as in the incidence of related infections by promoting training in clinical nutrition and the implementation of a multidisciplinary nutritional support team.

Critical Illness↗
PubMed2005

Comparison of body weight and composition measured by two different dual energy X-ray absorptiometry devices and three acquisition modes in obese women.

BACKGROUND AND AIMS: Weight measured by dual-energy X-ray (DXA) was shown to be increasingly underestimated in subjects over 75 kg compared to an electronic scale. This study compares body weight and composition measured by balance beam scale and three DXA acquisition modes in obese subjects. METHODS: In 39 obese, body weight was measured by balance beam scale, and body weight and composition by DXA Hologic QDR4500A in normal (NPM) and high power mode (HPM) (Enhanced v8.26 and v8.26* software) and DXA GE-Lunar Prodigy (v6.5 software). To ensure linearity of body weight and composition measured by the different DXA acquisitions, we also measured 13 women with a body mass index (BMI) of 25-30 kg/m(2). RESULTS: While QDR4500A HPM overestimates scale weight by about 2 kg over the whole BMI spectrum, QDR4500A NPM underestimates scale weight as a weight-dependent response (-1.7+/-1.8 kg overall, -4.1+/-1.6 kg in morbidly obese women). These results suggest switching from one mode to the other at a specific threshold, i.e. in our study a weight of 90 kg or a BMI of 34 kg/m(2). Prodigy gives weight about similar to scale (+0.5+/-0.8 kg). Both Hologic acquisition modes underestimate fat mass but overestimate lean body mass compared to Prodigy. CONCLUSIONS: The QDR4500A NPM is inappropriate in women over 90 kg. Unfortunately, the QDR4500A HPM overestimates body weight in the range of 90-150 kg. The difference between scale and Prodigy weight remains stable throughout weight ranges. To better assess their accuracies in terms of body composition, QDR4500A NPM, HPM and Prodigy should be tested against phantoms or in vivo multi-compartment models.

Absorptiometry, Photon↗
PubMed2005

A 3-year longitudinal study on body composition changes in the elderly: role of physical exercise.

BACKGROUND: Cross-sectional data have shown that sarcopenia and fat accumulation are associated with aging and can be limited by structured physical training. However, it is often difficult to maintain a long-term compliance to training programs. It is not clear whether leisure-time physical activity is effective in preventing sarcopenia and fat accumulation. OBJECTIVES: (i) To investigate longitudinal body composition changes in a population of elderly people in good apparent health. (ii) To evaluate the impact of leisure-time physical activity on muscle mass and characteristic as reflected by total body potassium per fat-free soft tissue (TBK/FFST), and on fat accumulation. DESIGN: Longitudinal evaluation over 3 years, of body composition changes in 74 healthy men and 66 women, over 65 years old. Body fat and FFST were analyzed by dual-energy X-ray absorptiometry and TBK by whole-body (40)K counter. Physical activity was analyzed by a specific questionnaire. RESULTS: Despite a stable total body weight, FFST and appendicular skeletal muscle mass slightly decreased (-0.3+/-1.4 and -0.2+/-2.2 kg, P<0.01, respectively) as well as the TBK/FFST (-4.1+/-6.3 mmol/kg, P<0.001), over the 3-year period. Body fat increased significantly (0.6+/-2.2 kg, P<0.0001), and it accumulated mainly in the abdomen (0.4+/-1.5 kg, P<0.01). Multiple regression analysis showed that body composition changes were related mainly to body weight changes. Nevertheless, positive linear correlations were observed between the degree of engagement in leisure-time physical activity and FFST (P<0.01), appendicular skeletal muscle mass (P<0.05), TBK/FFST (P<0.05), whereas negative correlation was observed with total and truncal fat (P<0.01). CONCLUSIONS: Mild but significant decline in muscle mass and its TBK content, and body fat accumulation were observed over a 3-year period in healthy elderly subject: leisure-time physical activity does not seem to prevent them. However, a higher level of physical activity is associated with higher muscle mass and TBK content, and less total and truncal fat.

Absorptiometry, Photon↗
PubMed2005

Clinical evaluation of hormonal stress state in medical ICU patients: a prospective blinded observational study.

OBJECTIVE: To evaluate whether classification of patients as having low, moderate, or high stress based on clinical parameters is associated with plasma levels of stress hormone. DESIGN AND SETTING: Prospective, blinded, observational study in an 18-bed medical ICU. PATIENTS: Eighty-eight consecutive patients. INTERVENTIONS: Patients were classified as low (n=28), moderate (n=33) or high stress (n=27) on days 0 and 3 of ICU stay, based on 1 point for each abnormal parameter: body temperature, heart rate, systemic arterial pressure, respiratory rate, physical agitation, presence of infection and catecholamine administration. The stress categories were: high: 4 points or more, moderate 2-3 points, low 1 point. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin, glucagon, cortisol were measured on days 0 and 3. MEASUREMENTS AND RESULTS: Plasma cortisol and glucagon were significantly higher and IGF-1 lower in high vs. low stress patients on days 0 and 3. High stress patients were more likely to have high cortisol levels (odds ratio 5.8, confidence interval 1.8-18.9), high glucagon (8.7, 2.1-36.1), and low IGF-1 levels (5.9, 1.8-19.0) than low stress patients on day 0. Moderate stress patients were also more likely to have high cortisol and glucagon levels than low stress patients. Insulin and GH did not differ significantly. Results were similar for day 3. CONCLUSIONS: Moderate and severe stress was significantly associated with high catabolic (cortisol, glucagon) and low anabolic (IGF-1) hormone levels. The hormonal stress level in ICU patients can be estimated from simple clinical parameters during routine clinical evaluation.

Adolescent↗
PubMed2005

Comparison of fat-free mass and body fat in Swiss and American adults.

OBJECTIVE: No current studies have compared North American with European body composition parameters, i.e., fat-free mass (FFM), body fat (BF), and percentage of BF (%BF) in large populations. This study compared FFM, BF, and %BF values derived from two bioelectrical impedance analysis (BIA) equations (Geneva and National Health and Nutrition Examination Survey [NHANES]) in Swiss subjects and compared FFM, BF, and %BF values of white Swiss with those of white North American adults with the same BIA equations. METHODS: Healthy adults (3714 men and 3199 women), ages 20 to 79 y, in Switzerland were measured by single-frequency BIA and compared with means and standard deviations for body mass index and body composition parameters obtained from the NHANES III study (United States; n = 2538 men, 2862 women). FFM was calculated with the Geneva and NHANES equations. RESULTS: Mean FFMGENEVA values did not differ from FFMNHANES values in men but was significantly lower (-1.5 kg) in women. FFM and BF values in American men, who weighed 4.2 to 12.0 kg more than the Swiss men, were significantly higher (+2.1 to +6.0 kg and +1.5 to +6.4 kg, respectively) than those in the Swiss men. FFM and BF values in American women, who weighed 2.3 to 12.1 kg more than the Swiss women, were significantly higher (+1.3 to +2.1 kg and +4.8 to +11.8 kg, respectively, except FFM in subjects ages 20 to 29 y and BF in those ages 70 to 79 y) than FFMGENEVA values in Swiss women. FFM in American women was significantly lower (+1.3 and +1.9 kg) and non-significantly higher than FFMNHANES in Swiss women. CONCLUSION: NHANES and Geneva BIA equations estimate body composition equally well in men, but further research is necessary to determine the discrepancies in FFM between BIA equations in women. The greater weight of the American subjects yielded higher values for FFM, BF, and %BF in American than in Swiss men and women.

Adipose Tissue↗
PubMed2005

l-selectin and alpha4beta7 integrin, but not ICAM-1, regulate lymphocyte distribution in gut-associated lymphoid tissue of mice.

BACKGROUND: Adhesion molecules on lymphocytes ( l -selectin and alpha4beta7) and endothelium (MAdCAM-1 and ICAM-1) direct lymphocytes into the gut-associated lymphoid tissue (GALT) of mice. Parenteral nutrition and MAdCAM-1 blockade reduce GALT cell mass. This study examined the effects on GALT cell mass of blockade of l -selectin, alpha4beta7, and ICAM-1 with saturating doses of monoclonal antibodies. METHODS: In experiment 1, l -selectin and alpha4beta7 expression were measured by flow cytometry in chow-fed mice. In experiment 2, 49 mice randomly received chow, parenteral nutrition, chow + intravenous (IV) anti-CD62L, chow + IV anti-LPAM-1, or chow + IV isotype control antibody. After 4 days, lymphocyte yields in GALT and respiratory and intestinal IgA levels were measured. In experiment 3, 27 mice randomly received chow, parenteral nutrition, chow + IV anti-ICAM-1 monoclonal antibody, or chow + IV isotype control antibody for 5 days. Lymphocyte counts and IgA levels were determined as in experiment 2. RESULTS: Some 80% of all circulating lymphocytes were positive for l -selectin and alpha4beta7. Lymphocyte counts in the Peyer's patches, lamina propria, and intraepithelial space were lower in the l -selectin and alpha4beta7 blockade groups (3.1, 1.8, and 0.9 x 10(6) and 2.1, 1.9, and 0.7 x 10(6) , respectively) than in the chow group (5.9, 3.0, and 1.7 x 10(6) ; P < .02 vs the l -selectin group and P <.001 vs the alpha4beta7 group) and similar to the levels in the parenteral group. Respiratory and intestinal IgA levels are maintained in all groups except the parenteral group ( P <.04 vs the chow group). ICAM-1 blockade did not influence cell counts or IgA levels. CONCLUSION: Most circulating lymphocytes have GALT homing potential. Their distribution into GALT is hindered by blockade of l -selectin or alpha4beta7, but not by ICAM-1.

Animals↗
PubMed2005

Hospital length of stay and nutritional status.

PURPOSE OF REVIEW: This review looks at the recent medical literature on the association between hospital length of stay and nutritional status. RECENT FINDINGS: Simple anthropometric parameters underestimate the nutritional risk in hospitalized patients. The Malnutrition Universal Screening Tool and Nutritional Risk Screening are simple screening tools that identify patients who require further monitoring. Recent weight loss appears to be the most important single indicator of nutritional status. Body composition measurements identify patients with muscle mass depletion and excess body fat, both of which are significantly associated with increased length of stay. The Subjective Global Assessment is useful at detecting patients with established malnutrition and the Mini Nutritional Assessment for the elderly is useful at detecting patients who need preventive nutritional measures. The Nutritional Risk Index, which incorporates albumin and weight loss, appears to capture both nutritional risk and poor clinical outcome. SUMMARY: Nutritional risk is associated with the length of stay in hospital. The choice of nutritional screening and assessment tools depends on the type of institution (university hospital versus community hospital), the patient populations (acute care versus intermediary care; general hospital versus elderly population) and the resources available.

Anthropometry↗
PubMed2004

Higher calorie prescription improves nutrient delivery during the first 5 days of enteral nutrition.

AIMS: It is unclear whether prescribing a higher amount of calories by enteral nutrition (EN) increases actual delivery. This prospective controlled study aimed at comparing the progression of EN of two study populations with different levels of calorie prescriptions, during the first 5 days of EN. METHODS: The daily calorie prescription of group 1 (n=346) was 25 and 20 kcal/kg body weight for women <60 and > or =60 years, respectively, and 30 and 25 kcal/kg body weight for men <60 and > or =60 years, respectively. The prescription of group 2 (n=148) was 5 kcal/kg body weight higher than in group 1. Calorie intakes were expressed as percentage of resting energy expenditure (REE) and protein intakes as percentage of requirements estimated as 1.2 g/kg body weight/day. Patients were classified as <60 and > or =60 years and as medical or surgical patients. Statistical analysis was performed with ANOVA for repeated measures. RESULTS: Calorie and protein deliveries increased in both groups independently of age and ward categories (P< or =0.0001). Group 2 showed faster progressions of calorie and protein intakes than group 1 in patients altogether (P< or =0.002), > or =60 years (P< or =0.01) and in surgical patients (P< or =0.02). Differences of calorie and protein intakes between day 1 and day 5 were significantly higher in group 2 than group 1 for patients altogether (75+/-61 vs. 56+/-54% of REE; 41+/-30 vs. 31+/-/-27% of protein requirements), those over 60 years (76+/-67 of REE vs. 52+/-59 of protein requirements) and surgical patients (81+/-52 vs. 58+/-57% of REE; 44+/-27 vs. 33+/-29% of protein requirements). CONCLUSIONS: Increasing the levels of EN prescriptions improved calorie and protein deliveries. While the mean energy delivery over 5 days was sufficient to cover requirements, the protein delivery by EN was insufficient, despite our nutritional support team.

Analysis of Variance↗
PubMed2004

L-ornithine alpha-ketoglutarate in HIV infection: effects on muscle, gastrointestinal, and immune functions.

OBJECTIVES: There have been claims that l-ornithine alpha-ketoglutarate (OKG) exerts anticatabolic, anabolic, and immunomodulating properties. This study aimed at quantifying the effects of OKG on muscle force, body composition, and immune function in outpatients infected with the human immunodeficiency virus (HIV) and presenting weight loss. METHODS: Forty-six HIV(+) patients were included in a double-blind, prospective, randomized, controlled trial for 12 wk (10 g/d of OKG or isonitrogenous placebo and nutritional counseling). Podometry, handgrip strength, step test, triceps skinfold thickness, 50-kHz bioelectrical impedance, 3-d diet record, CD4 cell count, HIV-1 RNA concentration (viral load), and gastrointestinal symptoms were assessed at 0, 4, 8, and 12 wk. RESULTS: At baseline, patients (OKG, n = 22; placebo, n = 24) has similar CD4 counts (338 +/- 172 and 310 +/- 136 cells/mL), viral load (3.6 +/- 1.3 and 3.5 +/- 1.3 log(10) copies/mL), body mass index (20.0 +/- 2.4 and 20.6 +/- 3.0 kg/m(2)), weight loss (9.0 +/- 3.12 and 9.4 +/- 3.0 kg), and food intake (2509 +/- 962 and 2610 +/- 808 kcal/d). Twenty-nine patients completed the protocol. Both groups increased their body mass index (P = 0.02 versus baseline) and triceps skinfold thickness (P < 0.01 versus baseline). They showed a similar positive correlation between handgrip strength and fat-free mass. Frequency of gastrointestinal symptoms increased in the OKG group (86% versus 54% in the placebo group, P = 0.025). No other differences were observed between groups. CONCLUSIONS: All patients increased their body mass index and triceps skinfold thickness due to food supplementation and diet counseling. Oral OKG failed to improve nutritional, functional, or immunologic status in these weight-losing HIV(+) patients and had important gastrointestinal side effects.

Adult↗
PubMed2004

Aging, physical activity and height-normalized body composition parameters.

BACKGROUND & AIM: Regular physical activity prevents or limits weight gain, and gain in body mass index (BMI) and decreases mortality. The aims of the study in healthy adults were to determine the differences in fat-free mass index (FFMI) (kg/m(2)) and body fat mass index (BFMI) between age groups and determine the association between physical activity and FFMI and BFMI. METHODS: Caucasian men (n=3549) and women (n=3184) between 18 and 98 years, were classified as either sedentary or physically active (at least 3h per week at moderate or high-intensity level activity). FFMI and BFMI were measured by 50 kHz bioelectrical impedance analysis. RESULTS: BFMI was significantly higher (P<0.05) in sedentary than physically active subjects and the differences became progressively greater with age. The physically active subjects were significantly less likely to have a low or high FFMI (logistic regression, P<0.001), and a high or very high BFMI (P<0.001), and more likely to have low BFMI (P<0.001) compared to sedentary adults. In contrast with fat-free mass, which was lower in older subjects, the height-normalized FFMI was stable with age until 74 years and lower thereafter. Significantly higher BFMIs were noted in older subjects. CONCLUSION: Physically active subjects are less likely to have low or high FFMI, and high or very high BFMI, and more likely to have low BFMI. In contrast to common claim that fat-free mass decreases with age, we found that FFMI was stable until 74 years. The use of FFMI and BFMI permits comparison of subjects with different heights and age.

Adipose Tissue↗
PubMed2004

[Simplified malnutrition screening tool: Malnutrition Universal Screening Tool (MUST)].

MUST (Malnutrition Universal Screening Tool) is a nutritional screening tool easy to use by any trained care-giver and valid for any adult patient. It considers body mass index, weight change and acute disease effect equally and determines a malnutrition risk score. If necessary, anthropometric measures may be simpliyfied by alternative methods. MUST is reliable between different healthcare settings et promotes detection and management of malnutrition during the patient medical course.

Acute Disease↗
PubMed2004

[Role of impedance measurement in nutritional screening].

Nutritional status has a prognostic value in the clinical evolution of patients who are malnourished, are becoming malnourished or are in process of being rehabilitated. The evaluation of nutritional status is based on a comprehensive approach, and includes body composition measurement by bio-impedance analysis (BIA). BIA determines the quantity of body fat-free and fat mass and has a precision around 4%. The reliability of BIA depends on the use of body composition prediction equations that are adapted to the subjects studied and on the inclusion of various anthropometric parameters (weight, height, sex, age, race, etc). BIA remains imprecise in the presence of abnormal distribution of body compartments (ascites, dialysis, lipodystrophy) or of extreme weights (cachexia, severe obesity). Multi-frequency or segmental BIA were developed to overcome hydration abnormalities and variations in body geometry. However, these techniques require further validation. This review discusses the indications and limitations of BIA.

Anthropometry↗
PubMed2003

Interactions between the enteric nervous system and the immune system: role of neuropeptides and nutrition.

Neuropeptidergic synthesis occurs in enteric nerves and immune cells of the gut-associated lymphoid tissue. Lymphocytes, macrophages, mast cells, and intestinal epithelial cells are capable of responding to these neuropeptides. Neuropeptides generate proliferative or antiproliferative responses of mucosal lymphocytes and intestinal epithelial cells, affect cytokine production and immunoglobulin synthesis by immune cells, and control secretion of water and electrolytes. Some neuropeptides, particularly cholecystokinin, gastrin-releasing peptide, and neurotensin, appear promising to maintain mucosal immunity in patients who cannot receive enteral feeding during critical illness or after GI tract loss. Exogenous administration of neuropeptides to preserve normal immune defenses represents a potential new field of pharmacotherapeutics against bacterial invasion.

B-Lymphocytes↗
PubMed2003

Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM).

RATIONALE: Appendicular skeletal muscle mass (ASMM) is useful in the evaluation of nutritional status because it reflects the body muscle protein mass. The purpose of this study was to validate, against dual-energy X-ray absorptiometry (DEXA), a BIA equation to predict ASMM to be used in volunteers and patients. METHOD: Healthy men (n = 246 men, BMI 25.3+/-2.9 kg/m(2)) and women (n =198, 24.1+/-3.6 kg/m(2)), and heart, lung and liver transplant patients (213 men, BMI of 24.6+/-4.4 kg/m(2); 113 women, BMI 23.0+/-5.2 kg/m(2)) were measured by BIA (Xitron Technologies) and DEXA (Hologic QDR 4500). A BIA equation to predict ASMM (kg) that included height(2)/resistance, weight, gender, age and reactance, was developed by means of multiple regressions. [table: see text] Mean difference (Bland-Altman) for volunteers was 0.1+/-1.1 kg, r =0.95, SEE 1.12 kg and for patients -0.4+/-1.5 kg, r =0.91, SEE 1.5 kg. Best fitted multiple regression equation was -4.211 + (0.267 x height2 / resistance) + (0.095 x weight)+(1.909 x sex (men = 1, women = 0)) + (-0.012 x age) + (0.058 x reactance). CONCLUSIONS: BIA permits the prediction of ASMM in healthy volunteers and patients between 22 and 94 years of age. A slightly larger, though clinically not significant, error was noted in patients.

Absorptiometry, Photon↗
PubMed2003

Controversy of immunonutrition for surgical critical-illness patients.

Specific nutrients such as arginine, glutamine, dietary nucleotides, and omega-3 fatty acids have been shown to influence infectious morbidity, antibiotic use, and hospital length of stay. The combination of these nutrients into one enteral formulation has become known as immune-enhancing diets. Consensus guidelines developed by a number of clinical investigators and published in 2001 concluded that immune-enhancing diets were beneficial in moderate to severely malnourished patients undergoing elective gastrointestinal surgery and patients sustaining severe blunt and penetrating torso trauma. The purpose of this article is to review data published between February 1, 2001, and January 31, 2003, to determine whether new studies substantiated or refuted the current recommendations for the use of immune-enhancing diets in surgical, critically injured, and critically ill patients. Results confirmed the benefits of preoperative administration of immune-enhancing diets in surgical patients but also demonstrated that postoperative administration offered no advantages. Decreased infectious complications were also observed in critically ill patients receiving immune-enhancing diets. Accumulating evidence supports the use of immune-enhancing diets in these specific patient populations.

Arginine↗
PubMed2003

Hip fracture discrimination study: QUS of the radius and the calcaneum.

As an emerging alternative to current radiation-based bone densitometry techniques, there is a growing interest in the use of quantitative ultrasound (QUS) measurements for the noninvasive assessment of fracture risk in the management of osteoporosis. However, there are also a multiplicity of technologically different QUS devices available on the market and, so far, no study has compared heel and radius QUS device for the discrimination of subjects with hip fractures. Our study evaluated the ability of three QUS devices (one calcaneal gel-coupled system, one calcaneal water-coupled system, and one radius system) to discriminate osteoporotic from controls subjects, using the same population. We also checked if the combination of two different skeletal sites (i.e., calcaneum and radius) improve the discriminatory ability of the QUS devices. Forty-five women aged 79.1+/-7.1 yr with hip fractures within the last 4 d were used as the hip-fracture group and compared to 40 healthy controls from 65-87 yr. In addition, 47 young controls, aged 20-40 yr, were used as reference population to express some of the results as T-scores. QUS measurements were performed with the Hologic Sahara, Ge-Lunar Achilles+, and Sunlight Omnisense devices according to the manufacturer's recommendations. Adjusted odds ratio results showed that a decrease in Omnisense SOS of 1 standard deviation (SD) was associated with a significant increase in fracture risk (OR adj.=2.83) comparable with Sahara BUA (OR adj.=2.42) and Achilles BUA (OR adj.=3.29). However, given the large overlap between the 95% intervals of each odds ratio, no significant difference was found between the devices. Similarly, comparison between the areas under ROC curves did not show any significant difference between all the parameters. Considering the parameters provided per default by each QUS device, the Sahara, Achilles, and Omnisense devices classified correctly 70, 67.5, and 62.5% of the subjects, respectively. Although the OR of the combination of radius and calcaneum is improved (3.62 to 4.74) compared with either one of the single skeletal site, the large confidence intervals do not allow to claim a significant difference. The three QUS technologies tested against hip fractures seem to show the same discriminatory ability. However, there is some differences in the definition of the diagnostic threshold underlying the nonusability of the World Health Organization (WHO) osteoporosis definition. Finally the combination of several site using two different devices is not clinically relevant. Potential interest could be seen in combining several sites using the same device, supposing that such device would measure differently active bone.

Aged↗