Search Results (623)

Background/Objectives: Fatigue is the most common systemic manifestation of chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD). Fatigue not only adversely affects quality of life in MASLD patients but also complicates the attainment of therapeutic goals and contributes to a worse prognosis. This study aimed to analyze the relationship between clinically significant fatigue and laboratory parameters reflecting systemic inflammation, liver function, body composition, muscle strength, and blood pressure in patients with MASLD. Methods: A total of 154 patients with a confirmed diagnosis of MASLD were enrolled in this study. All participants underwent anthropometric assessment, laboratory testing, abdominal ultrasonography, and point shear-wave elastography. Muscle strength was evaluated using handgrip strength (GS) measurement and the Five Times Sit-to-Stand Test (5TSTS). Skeletal muscle mass (SMM) was quantified using dual-energy X-ray absorptiometry (DXA). Fatigue was evaluated using the Fatigue Assessment Scale (FAS), with scores ≥ 22 indicating clinically significant fatigue. Results: Patients with FAS scores ≥ 22 exhibited significantly lower hemoglobin levels (p = 0.004) and erythrocyte counts (p = 0.011), along with a significantly elevated erythrocyte sedimentation rate (ESR; p = 0.002) and C-reactive protein level (CRP; p = 0.007). Furthermore, MASLD patients with FAS scores ≥ 22 demonstrated significantly reduced relative grip strength (p = 0.012) and took longer to complete the 5TSTS (p = 0.011). Additionally, these patients had higher maximum systolic and diastolic blood pressure values compared to those with FAS scores < 22 (p = 0.028 and p = 0.019, respectively). Conclusions: These findings underscore the multifactorial nature of fatigue in MASLD and highlight the need for a comprehensive management strategy. Such a strategy should include dietary modification, increased physical activity, targeted treatment of systemic manifestations of MASLD, and appropriate management of comorbidities. Full article

Background: Pregnancy and lactation-associated osteoporosis is a rare cause of severe skeletal fragility in young women typically presenting with vertebral compression fractures during late pregnancy or postpartum. Its rarity and lack of risk factors often delay diagnosis. Case presentation: The patient was a 34-year-old pregnant Italian woman, presenting with severe osteoporosis related to pregnancy and lactation. The patient presented for the first time at the Outpatient clinic of the Rehabilitation Unit in the Department of Public Health at the University of Federico II, Naples in March 2024, exhibiting severe symptoms indicative of osteoporosis, along with acute lower back pain. During the anamnesis, it was revealed that the patient was unable to bend forward, with reduced flexion and extension movements. The symptoms began during the third trimester. Management and diagnosis: In terms of diagnosis, clinical exams were conducted to confirm the disease. The MRI exam showed fractures and vertebral variations, with significant findings including calcification. Additionally, DXA indicated lower values compared to normal Treatment included: breastfeeding cessation, correction of calcium and vitamin D deficiencies, and bisphosphonate injection therapy. It is noteworthy that the rehabilitative approach has been recommended throughout pharmacological treatment and especially upon its suspension. Ultimately, the primary cause of this condition was pregnancy as bone resorption increases during pregnancy. Outcome: Following clodronate treatment completion, the patient showed full clinical recovery and significant radiological improvement. Follow-up DXA one year after diagnosis revealed normalized bone density and the patient had gained autonomy in activities of daily living with no further symptoms. Full article

Background/Objectives: Aging is linked to a loss of muscle mass and strength, which increases the risk of falls, disability, and lower quality of life. Identifying individuals at risk of sarcopenia, cachexia, or malnutrition is important. In settings with limited access to advanced diagnostics, simple anthropometric measurements can serve as practical alternatives. This study aimed to evaluate simple, quick, and non-invasive anthropometric measurements as indicators of muscle mass in older adults, based on body composition analysis (BIA). Methods: The study included 361 patients admitted to a geriatric ward. Standardized protocols were used to measure anthropometric and body composition parameters, including bioelectrical impedance analysis (BIA). Various body composition indices were calculated, such as body mass index (BMI), body adiposity index (BAI), waist-to-hip ratio (WHR), visceral adiposity index (VAI), fat-free mass index (FFMI), and fat mass index (FMI). Results: Strong positive correlations were found between body mass and muscle mass in both women and men. Among anthropometric measures, calf circumference showed the strongest correlation with muscle mass (R = 0.798 in women; R = 0.744 in men, p < 0.001). Other indices, including BMI (R = 0.733 in women; R = 0.606 in men, p < 0.001), FFMI (R = 0.697 in women; R = 0.721 in men, p < 0.001), and FMI (R = 0.600 in women; R = 0.354 in men, p < 0.001), were also positively correlated with muscle mass. Conclusions: Calf circumference is a simple, quick, and non-invasive measure that can effectively estimate muscle mass in older adults. Although other anthropometric parameters, such as body mass, BMI, FMI, and FFMI, also showed positive correlations with muscle mass, calf circumference appears to be the most practical, as it requires minimal equipment, little time, and limited preparation. This makes it particularly useful for routine assessments in primary care and long-term care settings, where access to advanced diagnostic tools like BIA or DXA is limited. These findings support the use of simple anthropometric measurements as cost-effective and easily accessible alternatives for estimating muscle mass in older adults. Further research is needed to determine appropriate cut-off points for specific populations and sexes. Full article

Background: The association between milk-derived or dairy product intake (DPI) and the body composition (BC) of children and adolescents continues to be controversial. Objective: This study sought to evaluate the association between the quantity and quality of DPI and the BC of Mexican children and adolescents. Methods: A secondary data analysis of a cross-sectional population-based sample of 2104 children and adolescents (aged 4–18 years) recruited from schools in Mexico City was performed. To assess the association between the quantity and quality of DPI, evaluated by questionnaire, and BC, dual X-ray densitometry (DXA) and surrogate parameters of the fat mass index (FMI) and lean mass index (LMI) were used. The adequacy of the quantity and quality of DPI was classified according to age-specific recommendations and the sugar, sodium and fat contents of the products consumed. Relationships were assessed by means of lineal regressions adjusted for age, sex, physical activity, sleep time and screen hours. Results: We included a total of 1840 participants aged 4.5–18 years, 52% of whom were female. Average daily DPI was 4.0 ± 2.4 servings/day, with a predominance of milk without sugar (42.7% of DPI). The quantity and quality of DPI significantly reduced the FMI (beta = −0.1 kg/m², 95% CI −0.17 to −0.06, p < 0.001 and beta = −0.17 kg/m², 95% CI −0.26 to −0.07, p < 0.001). No significant relationships were seen with the LMI. Conclusions: Higher quantities of good-quality DPI are associated with lower adiposity in Mexican children and adolescents. Full article

Background/Objectives: Previous multi-ethnic genome-wide association studies (GWAS) have identified the GALNT13 rs10196189 polymorphism as a potential genetic marker linked to sprint–power performance. However, its relevance in East Asian populations, particularly the Han Chinese, remains untested. This study aimed to replicate the association of rs10196189 with elite sprint–power athlete status in Han Chinese males and examine its potential influence on physical performance traits and tissue-specific gene regulation. Methods: A total of 188 healthy Han Chinese males (49 elite sprint–power athletes and 139 non-athletic controls) were genotyped using the TaqMan assay. Assessments included strength, sprint, jump, anaerobic power, DXA-derived body composition, and muscle ultrasound. Logistic regression and ROC analyses evaluated the predictive value of rs10196189. Linear regression models adjusted for age and BMI tested genotype–phenotype associations. Tissue expression and functional networks were analyzed using GTEx and HumanBase databases. Results: The G allele frequency was significantly higher in athletes (12.2%) than in controls (5.4%, p = 0.042). Dominant and additive models effectively predicted athlete status (OR = 2.53–2.58, p < 0.05). Although most traits showed no significant associations post-correction, medial gastrocnemius thickness showed a nominal association (β = 0.371, p = 0.011). Functional analyses revealed high GALNT13 expression in brain tissue and co-expression networks enriched in synaptic signaling and glycosylation pathways. Conclusions: This is the first study to validate the association of GALNT13 rs10196189 with elite athletic status in Han Chinese males. Findings provide novel population-specific evidence and propose tissue-specific glycosylation and neural mechanisms as pathways linking this variant to sprint–power phenotypes. Full article

Background/Objectives: Chronic kidney disease (CKD) and diabetic kidney disease (DKD) are growing public health challenges. While diet and body composition influence metabolic and renal health, their combined role remains underexplored. This study investigates the association between the Planetary Health Diet Index (PHDI), body mass distribution, and the prevalence of CKD and DKD in U.S. adults. Methods: We analyzed data from 8093 adults aged ≥40 years from NHANES 2003–2018. PHDI was computed using two 24 h dietary recalls. Body composition was assessed using dual-energy X-ray absorptiometry (DXA), focusing on the android-to-gynoid fat ratio (AGFR) and lean mass ratio (AGLR). Survey-weighted linear and logistic regressions evaluated cross-sectional associations between PHDI score, body composition indices, and prevalence of CKD and DKD. Mediation analyses explored AGLR, AGFR, and body mass index (BMI) as potential mediators of the association between PHDI score and either CKD or DKD. Results: Higher PHDI scores were mildly associated with lower odds of CKD (OR per 10-point increase: 0.91; 95% CI: 0.83–0.99) and DKD (OR: 0.86; 95% CI: 0.76–0.97). Greater PHDI scores correlated with lower BMI, AGFR, and AGLR. Among participants with diabetes, AGLR mediated 17% of the relationship between a 10-point increase in PHDI score and decreased DKD prevalence, suggesting central lean mass distribution as a relevant pathway. No significant mediation was observed for AGFR, BMI, or for CKD. Conclusions: Adherence to PHD is associated with healthier body composition and lower prevalence of CKD and DKD. These findings support the promotion of dietary strategies that enhance metabolic and renal health in middle-aged and older individuals. Full article

The aim of this study was to analyze the factors that may influence serum osteocalcin levels in children with osteogenesis imperfecta treated with intravenous sodium pamidronate and to define the role of osteocalcin assessment. The study included 61 patients diagnosed with osteogenesis imperfecta type 1 or 3, aged 2 to 18, hospitalized for intravenous sodium pamidronate administration. A retrospective analysis of medical records was conducted, collecting information on age, sex, body weight, height, the number of long bone fractures throughout life, serum levels of osteocalcin, creatinine, alkaline phosphatase, 25(OH)D₃, and DXA BMD z-scores for the L1–L4 spine segment. The concentration of osteocalcin is higher in patients with osteogenesis imperfecta than the reference ranges for sex and age. Patients diagnosed with type 3 have significantly lower osteocalcin levels compared to patients with type 1. Also, increasing the age-standardized pamidronate cycle rate significantly reduced osteocalcin concentration. The strongest predictor of osteocalcin concentration among the factors studied is the type of osteogenesis imperfecta. L1–L4 BMD value and fracture frequency were unrelated to osteocalcin concentration. Osteocalcin is an important marker of bone formation that should be measured at the beginning of treatment, as its concentration decreases after successive doses of bisphosphonates. Full article

Background: Muscle-specific strength (MSS), defined as muscle strength relative to muscle mass, is a key indicator in the assessment of sarcopenia and functional status, especially in patients with cancer. Dual-energy X-ray absorptiometry (DXA) is the reference method for estimating muscle mass, but its limited accessibility hinders routine use. This study aimed to evaluate the correlation between DXA-based MSS and MSS estimated through more accessible techniques. Methods: A cross-sectional study was conducted in 205 adult oncology outpatients. Muscle strength was assessed by handgrip dynamometry, and muscle mass was estimated using DXA, bioimpedance (BIA), ultrasound, and anthropometry. MSS was calculated by dividing grip strength by each muscle mass parameter. Results: MSS calculated with BIA, body weight, and calf circumference showed very strong correlations with MSS-DXA (r > 0.90). Ultrasound-derived MSS showed only a moderate correlation (r = 0.55; p < 0.01). Similar patterns were observed in both men and women. Conclusions: BIA and anthropometric methods, particularly those using body weight and calf circumference, are reliable and accessible alternatives to DXA for estimating MSS in oncology patients. These tools may help improve the identification and monitoring of sarcopenia in clinical settings with limited resources. Full article

Background: Multifrequency bioelectrical impedance devices such as the InBody 770 (IB770) offer faster measurements and lower costs compared with other body composition assessments. This study validated measures from IB770 against the deuterium oxide dilution technique (D2O) and DXA and compared a four-compartment (4C) model using total body water (TBW) derived from IB770 compared with D2O. Methods: A total of 55 adult females (mean ± SD, age: 21.1 ± 2.6 years) completed IB770 and DXA scans and the D2O protocol. Lin’s concordance correlation coefficients (CCCs), Bland–Altman analyses, and other equivalence tests evaluated agreement between IB770 and the criterion for measures of fat mass (FM), fat-free mass (FFM), and TBW individually and as part of 4C models. Results: There was substantial agreement between IB770 and D2O for TBW (MD = Mean Difference) (MD = 0.34 L, CCC = 0.98) and between the IB770 and DXA for FM (MD = −0.22 kg, CCC = 0.99). IB770 overestimated FFM compared with DXA (MD = 3.15 kg, CCC = 0.91). Both 4C models had almost perfect agreement for FM (CCC = 0.99), FFM (CCC = 0.99), and body fat percentage (CCC = 0.99). Conclusions: IB770 is valid for assessing TBW and can be used within the context of a 4C model in females. Full article

Sarcopenia refers to a disorder involving the gradual and overall reduction in skeletal muscle mass and physical capability. It occurs in over one-third of individuals with liver cirrhosis and serves as an independent predictor of increased mortality risk. Assessment of sarcopenia is necessary in all patients with liver cirrhosis, as recommended by the European Association for the Study of the Liver (EASL) and the European Society for Clinical Nutrition and Metabolism (ESPEN). The evaluation of muscle mass can be performed using several validated methods such as the multislice computed tomography (MSCT), abdominal magnetic resonance imaging (MRI), dual X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or muscle ultrasound. Assessment of muscle function encompasses measurements of both muscle strength and physical performance. Sarcopenia has a significant negative impact on the course of the disease, quality of life and outcomes of patients with liver cirrhosis. Considering the global healthcare impact and the significant influence on the course of disease, characteristics of simplicity, swiftness, safety, availability, reproducibility, and diagnostic accuracy are certainly the key factors to consider when choosing the proper diagnostic method for nutritional assessment. The aim of this review is to analyze the pathophysiological mechanisms underlying muscle mass loss in patients with liver cirrhosis, as well as to assess strengths and limitations of the methods currently in use to diagnose sarcopenia. Full article

At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (<3 years), already started on anti-osteoporotic treatment, living in nursing home, age >97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of <0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50–70 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p < 0.000, OR 3.1, 95% CI: 2.4–4.0), hip fracture (p < 0.000, OR 2.60, 95% CI: 1.9–3.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0–1.5), pelvic fracture (p-value < 0.000, OR 3.1, 95% CI: 1.8–5.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value < 0.00, 95% CI: 1.3–2.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value < 0.000, OR 2.8, 95% CI: 2.3–3.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable. Full article

Background/Objectives: Osteoporosis remains a leading cause of morbidity in postmenopausal women, yet many high-risk individuals remain undiagnosed or untreated. This study aimed to assess the prevalence of osteoporosis and osteopenia, treatment patterns, and skeletal fragility indicators in a large cohort of postmenopausal women undergoing DXA screening. Methods: We analyzed data from 1669 postmenopausal women aged 40–89 years who underwent DXA evaluation. BMD status was categorized as normal, osteopenia, or osteoporosis. Treatment status was classified based on active antiosteoporotic therapy, calcium/vitamin D supplementation, hormonal therapy (historical use), or no treatment. Logistic regression models were used to explore independent predictors of osteoporosis and treatment uptake. Results: A total of 45.0% of women had osteoporosis and 43.5% had osteopenia. Despite this, 58.5% of the population, over half of women with osteoporosis, were not receiving any active pharmacologic treatment. Bisphosphonates were the most prescribed therapy (17.9%), followed by calcium/vitamin D supplements (20.6%). A prior history of fragility fractures and radiological bone lesions were significantly associated with lower BMD (p < 0.05). Historical hormone replacement therapy (HRT) use was not associated with current BMD (p = 0.699), but women with HRT use reported significantly fewer fractures (p < 0.001). In multivariate analysis, later menopause age and low BMD status predicted higher odds of receiving active treatment. Conclusions: Our findings highlight a substantial care gap in osteoporosis management, with treatment primarily initiated reactively in more severe cases. Improved screening and earlier intervention strategies are urgently needed to prevent fractures and reduce the long-term burden of osteoporosis. Full article

Gaming has evolved into a cultural phenomenon with a global reach, captivating millions of individuals. Nevertheless, little is known about this population. We aim to physiologically characterise the Portuguese gamers, bearing in mind that phase angle (PhA) is a general indicator of health, to check possible correlations between body composition, strength, and nutrition. A sample of 35 male gamers (individuals who play video games) was evaluated for anthropometry; body composition through DXA for whole-body bone mineral content (BMC), fat-free mass (FFM, kg), fat mass, and visceral adipose tissue, and through BIA (bioelectrical impedance analysis) for total body water (TBW), water pools (extracellular water and intracellular water, ICW), and PhA; strength through maximal isometric handgrip strength using a dynamometer; and nutritional intake using a three-day food record. Results show that participants are within reference metrics for all the analysed variables except regarding protein and carbohydrate intake (all values are above and below the Acceptable Macronutrient Distribution Ranges, respectively). A positive correlation was observed between PhA and TBW, ICW, handgrip strength, BMC and FFM, and a negative correlation with fat mass (absolute, percentage and visceral). In conclusion, PhA correlates with body composition variables, which aligns with previous research as a predictor of health and performance. Full article

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R² = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive patients, emphasizing regional and therapy influences. The patients varying in HIV infection duration underwent DXA scanning to measure BMD in the lumbar spine, femoral neck, and total femur. A high prevalence of low BMD, especially in the lumbar spine, was identified along with significant associations between reduced BMD and factors such as smoking, alcohol use, vitamin D deficiency and serum phosphorus levels. ART like Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors were linked to increased bone loss, emphasizing the multifactorial nature of osteoporosis in HIV-infected individuals and underscore the importance of regular BMD assessments, lifestyle adjustments, and careful management of antiretroviral therapy to minimize fracture risk and enhance overall health and quality of life. Full article