Search

Background and Aims: Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery., Methods: We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs)., Results: The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I 2  = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I 2  = 39%), compared with rehabilitation or standard pre- and post-surgical care., Conclusion: Prehabilitation was acceptable to patients, with good adherence, and improved physical function., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

COVID-19, along with most respiratory diseases in the medical field, demonstrates significant ability to take its toll on global population. There is a particular difficulty in studying these conditions, which stems especially from the short supply of in vitro models for detailed investigation, the specific therapeutic knowledge required for disease scrutinization and the occasional need of BSL-3 [Biosafety Level 3] laboratories for research. Based on this, the process of drug development is hampered to a great extent. In the scenario of COVID-19, this difficulty is even more substantial on account of the current undefinition regarding the exact role of the ACE2 [Angiotensin-converting enzyme 2] receptor upon SARS-CoV-2 kinetics in human cells and the great level of demand in the investigation process of ACE2, which usually requires the laborious and ethically complicated usage of transgenic animal models overexpressing the receptor. Moreover, the rapid progression of the aforementioned diseases, especially COVID-19, poses a crucial necessity for adequate therapeutic solutions emergence. In this context, the work herein presented introduces a groundbreaking set of 3D models, namely spheroids and MatriWell cell culture inserts, whose remarkable ability to mimic the in vivo environment makes them highly suitable for respiratory diseases investigation, particularly SARS-CoV-2 infection. Using MatriWells, we developed an innovative platform for COVID-19 research: a pulmonary air-liquid interface [ALI] associated with endothelial (HUVEC) cells. Infection studies revealed that pulmonary (BEAS-2B) cells in the ALI reached peak viral load at 24h and endothelial cells, at 48h, demonstrating lung viral replication and subsequent hematogenous dissemination, which provides us with a unique and realistic framework for studying COVID-19. Simultaneously, the spheroids were used to address the understudied ACE2 receptor, aiming at a pronounced process of COVID-19 investigation. ACE2 expression not only increased spheroid diameter by 20% (p<0.001) and volume by 60% (p≤0.0001) but also led to a remarkable 640-fold increase in intracellular viral load (p≤0.01). The previously mentioned finding supports ACE2 as a potential target for COVID-19 treatment. Lastly, we observed a higher viral load in the MatriWells compared to spheroids (150-fold, p<0.0001), suggesting the MatriWells as a more appropriate approach for COVID-19 investigation. By establishing an advanced method for respiratory tract conditions research, this work paves the way toward an efficacious process of drug development, contributing to a change in the course of respiratory diseases such as COVID-19., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Gabriel Romero Liguori and Tácia Tavares Aquinas Liguori are, respectively, the Chief Executive Officer and the Chief Scientific Officer of TissueLabs Sagl (Manno, Switzerland), the company which developed and produced MatriWell cell culture inserts. The remaining authors have no conflict of interest to declare., (© 2023 The Author(s).)

Background & Aim: Phase angle (PhA) obtained from bioelectrical impedance analysis (BIA) is an indicator of cellular integrity and relates to several chronic conditions. The purpose of this secondary analysis was to evaluate the association of PhA with health-related physical fitness, namely, cardiorespiratory fitness, skeletal muscle volume, and myosteatosis (i.e. muscle health) in older breast cancer survivors., Methods: Twenty-two women ≥60 years with a body mass index (BMI) ≥25 kg/m 2 and who completed chemotherapy for early-stage breast cancer were included. BIA, cardiopulmonary exercise tests and magnetic resonance imaging scans were completed before and after eight weeks of time-restricted eating., Results: At baseline, PhA was associated with cardiorespiratory fitness (R 2  = 0.54, p < 0.01) and skeletal muscle volume (R 2  = 0.83, p < 0.01) and myosteatosis (R 2  = 0.25, p = 0.02). Results were similar at follow-up., Conclusion: Findings from this pilot study suggest that higher values of PhA are associated with better health-related physical fitness among older breast cancer survivors., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to the contents of this paper., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background & Aims: It is well known that dietary fiber positively impacts the microbiome and health as a whole. However, the health effects of β-glucan, a dietary fiber extracted from oats, have been questioned when administered alone or incorporated into other foods. The purpose of this systematic review and meta-analysis was to evaluate the impact of oats or β-glucan supplements on the lipid profile., Methods: Randomized controlled trials with parallel-arm or crossover blinded interventions at least two weeks in duration, for hyperlipidemic or non-hyperlipidemic men and women ≥18 years of age were selected. Only single (participants blinded) or double-blinded studies that compared oat or isolated β-glucan with a placebo/control group were considered for this review. The databases EMBASE, PubMed, Web of science and CINHAL were searched, from the earliest indexed year available online to the end of January 2022. Random-effects models were used to combine the estimated effects extracted from individual studies, and data were summarized as standardized mean difference (SMD) and 95% confidence interval (95%CI)., Results: A total of 811 articles were screened for eligibility, and relevant data were extracted from 28 studies, totaling 1494 subjects. Oat interventions TC (-0.61, 95%CI: -0.84;-0.39, p < 0.00001, and -0.70, 95%CI: -1.07;-0.34, p = 0.0002, respectively) and LDL (-0.51, 95%CI: -0.71;-0.31, p < 0.00001, and -0.38, 95%CI: -0.60;-0.15, p = 0.001, respectively). Moreover, isolated β-glucan interventions from parallel-arm studies decreased TC (-0.73, 95%CI: -1.01;-0.45, p < 0.00001), LDL (-0.58, 95%CI: -0.85;-0.32, p < 0.0001) and triglycerides (-0.30, 95%CI: -0.49;-0.12, p = 0.001). HDL was not altered by either oat or isolated β-glucan (p > 0.05)., Conclusion: Overall, this review showed that both oat and isolated β-glucan interventions improved lipid profiles. Furthermore, the ingestion of oats or isolated β-glucan supplements are effective tools to combat dyslipidemia and should be considered in cardiovascular disease prevention., Competing Interests: Declaration of competing interest The authors report there are no competing interests to declare., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objective: Individuals with advanced knee osteoarthritis (OA) and a large body size [a body mass index (BMI) ≥35 ​kg/m 2 ] have a higher risk of complications with total knee arthroplasty (TKA), and hence may be ineligible for surgery unless they reduce their BMI. However, pre-TKA weight-loss has not been shown to reduce surgical infection risk and may inadvertently increase risk for muscle loss and development of sarcopenic obesity (low muscle and low strength with higher fat mass). This suggests that a knee OA management approach that doesn't focus on weight change (weight-neutral) may be beneficial. This study examines if a weight-neutral behavioural intervention is feasible and acceptable to participants, and improves muscle mass and physical function in comparison to usual care., Design: This pilot randomized clinical trial compares a 12-week multimodal intervention [including targeted nutrition, progressive resistance exercise, and arthritis self-management support] to usual care. Co-primary outcomes are feasibility and acceptability, with secondary outcomes of change in lean soft tissue and physical function within and between groups at 3-months and 9-months from baseline. Change in waist circumference, fat mass, blood biomarkers, energy metabolism, OA-related pain and function, health-related quality of life, self-efficacy for arthritis management, and interest in pursuing a TKA within and between groups will be explored., Conclusion: This study will inform future development of more personalized knee OA treatment approaches for adults with larger bodies. Further, this will contribute to effective alternative treatment pathways that reduce inequities in access to OA care for this understudied patient population., Competing Interests: All authors declare no competing interests that would create a conflict of interest in connection with this manuscript. KG and MF have no disclosures. CMP has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Fresenius Kabi, and Pfizer, and funding from Almased for research not related to this study., (© 2022 The Authors.)

Background: Diet and nutrition applications (apps) have become more readily accessible as smartphone ownership increases. These apps have the potential to improve nutritional outcomes, but it remains unclear whether they are effective in patients with catabolism-prone conditions and specialized nutritional needs., Aims: The primary aim of this rapid review was to determine if delivery of a nutrition intervention via an app was more effective than standard care in improving nutritional outcomes in patients with a selected set of catabolism-prone chronic diseases. Secondary aims included summarizing intervention components and reviewing adherence and acceptance., Methods: The research question was developed using the Population, Intervention, Comparison, Outcomes (PICO) framework. Comprehensive literature searches were conducted across three databases. Screening, study selection, extraction, and risk of bias (RoB) assessment were conducted for the included randomized controlled trials (RCTs)., Results: 15 articles were included, including 5 RCTs; 3/5 RCTs were judged to be at high RoB. The study aims, measured outcomes, and intervention components were diverse. Adherence and acceptance to the app interventions were encouraging., Conclusions: Due to the heterogeneity of study design, nutrition interventions, outcomes, and reporting across studies, we were unable to aggregate data regarding the impact on nutritional outcomes. Reassuringly though, the available evidence suggests high adherence and acceptance, which needs to be interpreted in light of the associated personnel support provided within each study. The use of digital technology to deliver diet and nutrition interventions in catabolism-prone conditions is feasible, easy to adhere to, and well-accepted by participants., Competing Interests: Declaration of competing interest At the time of conducting this rapid review, the authors were engaged in the Heal-Me Personalized Online Nutrition and Exercise Routines (PiONEeR) RCT (ClinicalTrials.gov Identifier: NCT04666558)., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Severe muscle mass (MM) loss is a defining feature of cancer observed across all types and stages of disease and is an independent predictor of poor clinical outcomes including higher incidences of chemotherapy toxicity and decreased survival. Protein is essential to build MM, yet the optimal amount for preventing or treating muscle loss in patients with cancer remains undefined., Methods: The Protein Recommendation to Increase Muscle (PRIMe) study is a single-center, two-armed, parallel, randomized, controlled pilot trial that assesses the feasibility of utilizing a high protein (HP) diet to positively impact clinical outcomes in people undergoing chemotherapy to treat colorectal cancer. Forty patients with newly diagnosed stage II-IV colorectal cancer who are scheduled to receive chemotherapy will be included. Participants are randomly assigned to a HP or normal protein (NP) diet for twelve weeks. The HP and NP groups receive nutrition recommendations to achieve 2.0 g of protein per kilogram of body weight per day (g∙kg -1 ∙d -1 ) and 1.0 g⋅kg -1 ⋅d -1 , respectively. These values refer to the upper and lower recommended range of protein intake for people with cancer. Energy recommendations are based on measured energy expenditure. Assessments are completed within two weeks of starting chemotherapy (baseline), at week 6, and at week 12. Changes to skeletal MM, physical function, anthropometrics, body composition, muscle strength, physical activity, energy metabolism, metabolic markers, nutritional status, quality of life, readiness to change and psychosocial determinants of behavioural change are assessed between the HP and NP groups. Feasibility of the nutritional intervention is assessed by change in MM as a surrogate marker., Conclusions: This evidence-based study investigates the feasibility of increasing protein intake following a diagnosis of cancer on clinical outcomes during treatment for colorectal cancer. This study will inform larger trials assessing the impact of increasing protein intake in cancer to determine their importance and integration into standard clinical care for people with cancer., Competing Interests: Declaration of competing interest Olymel, Cargill, Nestle Health Sciences have had nor will have no role in the design of the study, in the collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the article for publication. CMP reports receiving honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Fresenius Kabi, Pfizer, and Helsinn. KNPS has received compensation from Abbott Nutrition Health Institute for speaking and consultation services provided. IRD is currently employed by Danone Nutricia., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Sarcopenic obesity (defined as low muscle mass and strength with high adiposity) requires attention in adults with advanced knee osteoarthritis (OA) due to implications on treatment outcomes. This study aimed to identify muscle function measures and patient characteristics associated with the presence of low muscle mass that could be used to screen and detect sarcopenic obesity in patients with knee OA in the clinical setting., Methods: Cross-sectional study of patients with knee OA and a body mass index (BMI) ≥30 kg/m 2 . Body composition was measured in n = 151 patients (59% female, mean age 65.1 ± 7.9 years) using dual-energy x-ray absorptiometry. Appendicular skeletal muscle mass (ASM) adjusted by BMI and below established sex-specific cut-points was used to differentiate low muscle mass. Muscle function was assessed by 4-m gait speed, 6 min walk test, and maximal grip strength (absolute, and relative, adjusted by BMI). Logistic regression was used to assess the relationship between muscle function measures, patient characteristics, and low muscle mass. Receiver operating characteristic curves and area under the curve (AUC) were used to examine the final model and identify potential clinical cut-points., Results: Sex and relative grip strength were associated with low muscle mass (AUC 0.774, p < 0.001). Cut-points for low relative grip strength (<0.65 kg/m 2 in females and <1.1 kg/m 2 in males) were distinguished and used in combination with low muscle mass to screen and identify sarcopenic obesity. Patients with both low relative grip strength and low muscle mass (sarcopenic obesity) had impaired mobility and quality of life., Conclusion: Relative grip strength shows promise as a clinical screening measure for sarcopenic obesity in patients with knee OA., Competing Interests: Declaration of Competing Interest All authors declare no competing interests that would create a conflict of interest in connection with this manuscript. KG, CMP and MF have no disclosures. LJW has received consulting fees from Eli Lily and Scholar Rock for research not related to this study., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: The accuracy of some portable indirect calorimeters in estimating resting energy expenditure (REE) - and hence energy recommendations - among pre-bariatric patients is unknown. Our objective was to assess the accuracy of the MedGem® among individuals with class II or III obesity awaiting bariatric surgery., Methods: Male and female adults who were awaiting bariatric surgery were recruited to this cross-sectional study. MedGem-derived oxygen consumption (O 2 ) and REE were compared to O 2 and REE from a metabolic cart. REE was also calculated using several common equations to assess the clinical utility of this portable tool. Body composition was assessed by dual energy X-Ray absorptiometry. Paired t-test and Bland-Altman analysis (expressed as bias [average difference] and limits of agreement [bias ± 2 standard deviations]) evaluated O 2 and REE accuracy., Results: Twenty-six individuals were included (34 ± 9 years old; n = 20, 76.9% female), with the majority (n = 15, 57.7%) having class II obesity. Neither O 2 (MedGem: 283 ± 63 vs. metabolic cart: 293 ± 64 ml/min, p = 0.114) nor REE (MedGem: 1963 ± 437 vs. metabolic cart: 2047 ± 440 kcal/day, p = 0.057) were different between devices. Body composition did not relate to bias. The MedGem had wide limits of agreement for REE (-504 to 336 kcal/day), which was similar to predictive equations., Conclusions: Although REE from the MedGem was not different than REE from the metabolic cart, individual-level accuracy was poor and similar to predictive equations in patients with class II or III obesity. Nonetheless, efficacy of repeated assessments during weight loss warrant future investigation., Competing Interests: Declaration of competing interest There are no conflict of interests with any of the companies/manufacturers of devices/techniques used in this study. This research study included the opinions of the authors; no official endorsement by the Canadian Foundation for Dietetic Research (CFDR) was intended or inferred., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background/objectives: Resting energy expenditure (REE) is the largest component of total energy expenditure. As such, inaccurate estimation or measurement of REE may impact the development of individualized energy intake recommendations. The objective of this observational study was to assess the accuracy and reliability of REE measured with a portable indirect calorimeter with ventilated hood - Fitmate GS - compared to REE from whole-body indirect calorimetry (WBC)., Methods: REE was assessed using the Fitmate GS and compared to REE from WBC in male and female adults. Fitmate GS tests were repeated on a separate visit. Body fat percent, fat mass, and fat-free mass were assessed using dual X-ray absorptiometry in a subset of individuals with body mass index (BMI) ≥35 kg/m 2 . Paired t-tests and Bland-Altman analyses were used to describe REE accuracy; intra-class correlation coefficient (ICC) examined test-retest reliability of repeated Fitmate GS assessments., Results: Fitmate GS and WBC REE was assessed in 77 adults (age 32 ± 8 years; 63.6% females; 53.2% with BMI ≥ 30 kg/m 2 ). The Fitmate GS underestimated REE (1680 ± 420 vs. 1916 ± 461 kcal/day, p < 0.001) and wide limits of agreement were observed (95% confidence intervals [CI]: -727, 246 kcal/day). Bias was similar across sex and BMI categories and did not correlate to any body composition parameter. Fitmate GS ICC was 0.80 (95% CI: 0.70-0.87), indicating 'good' reliability with repeated testing after median follow-up of 4 days (interquartile range 2-7 days)., Conclusion: The Fitmate GS did not accurately quantify REE but produced reliable REE measurements., Competing Interests: Conflict of interest disclosure COSMED (Chicago, IL) provided the portable indirect calorimeter (Fitmate GS) used in this study. COSMED did not provide financial support nor played a role in data analysis or drafting of the manuscript. This research study included the opinions of the authors; no official endorsement by the Canadian Foundation for Dietetic Research (CFDR) was intended or inferred., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Higher protein (HP) intake and physical activity (PA) have been associated with improved lean soft tissue (LST) and reduced fat mass (FM). Puerto Ricans have among the highest age-adjusted prevalence (42.5%) of obesity, which may be associated with inadequate protein consumption and PA. We examined the relationship between protein intake and PA with body composition and biomarkers of cardiometabolic health in Puerto Rican adults., Methods: Participants included 959 Puerto Rican adults (71.4% women, 28.6% men) from the Boston Puerto Rican Health Study (BPRHS), aged 46-79 y (Women: age, 60.4 ± 7.6 y, BMI, 32.9 ± 6.8 kg/m 2 ; Men: age, 59.8 ± 7.9 y, BMI, 30.1 ± 5.2 kg/m 2 ). Protein intake was assessed using a food frequency questionnaire and expressed as g/kg body weight/day in energy intake-adjusted equal cut point tertile categories (lower, moderate, higher: LP < 0.91 g/kg/d, MP ≥ 0.91 ≤ 1.11 g/kg/d, and HP > 1.11 g/kg/d). PA was assessed by questionnaire and expressed in tertile categories (low, moderate and high; PA1: <0.8 km/d, PA2: ≥0.8  ≤ 3.2 km/d, PA3: >3.2 km/d)., Results: Participants with energy-adjusted HP had lower appendicular LST (ALST: 16.2 ± 3.8 kg), LST (39.7 ± 8.0 kg) and FM (25.6 ± 8.1 kg) when compared to LP (ALST: 20.1 ± 4.5 kg; LST: 49.5 ± 10.0 kg; FM: 40.8 ± 12.3 kg; P < 0.001) and MP (ALST: 18.2 ± 4.3 kg; LST: 44.1 ± 8.8 kg; FM: 32.2 ± 9.8 kg; P < 0.001). However, when adjusted for total body weight (kg), relative LST was significantly greater in HP (58 ± 9%) when compared to LP (53 ± 9%; P < 0.001) and MP (56 ± 9%; P < 0.001). Participants in PA3 had greater ALST (19.5 ± 5.4 kg), and LST (58 ± 10%), compared to PA1 (ALST: 17.2 ± 4.3 kg; LST: 53 ± 9%; P < 0.001) or PA2 (ALST: 17.7 ± 4.7 kg; LST: 56 ± 9%; P < 0.05). Those in HP + PA3 or MP + PA2 had lower c-reactive protein (CRP; HP + PA3: 5.1 ± 6.8 mg/L; MP + PA2: 6.4 ± 10.0 mg/L), when compared to LP + PA1 (8.7 ± 8.8 mg/L; P < 0.05). Insulin concentration was lower for those in both the HP and PA3 (HP + PA3; 11.4 ± 7.9 IU/mL) compared to those in both the LP and PA1 (LP + PA1; 20.7 ± 16.3 UI/mL) (P < 0.001)., Conclusions: The highest tertiles of energy-adjusted protein intake (≥1.11 g/kg/d) and PA (>3.2 km/d) were associated with more desirable indicators of overall body composition and cardiometabolic health, when adjusted for body weight, than those in the lower protein intake and PA in Puerto Rican adults., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background & Aims: In the intensive care unit (ICU) setting, body composition is typically estimated through anthropometry, which does not specifically quantify skeletal muscle (SM). Recent findings have shown that computed tomography (CT) is a useful tool to identify low SM in critically ill patients, which in turn is associated with poor clinical outcomes. So, the present study aims at comparing low SM assessed by CT to BMI anthropometric data and its association with outcomes in critically ill patients., Methods: Observational study was used, which included >18 year-old patients, with over 72 h of ICU length of stay, who had an abdominal CT at ICU admission. Demographic, body mass index (BMI), hospital outcomes and abdominal CT data (SM and adipose tissue at the 3rd lumbar vertebrae) were collected for analysis. ROC curve optimal stratification analysis for hospital mortality was applied to classify people into low SM (sarcopenic) versus normal SM (non-sarcopenic). A Cox regression was applied to find independent associations between sarcopenia and 30-day survival., Results: The study involved 99 patients, 56% male, mean-age of 61.6 years old, BMI 24.19 ± 4.49 kg/m 2 ; hospital mortality was 26%. According to BMI, 19.4% of the patients were underweight. However, a poor correlation was observed between BMI and SM index by CT: R 2  = 0.39, P < 0.001. The cutoff point for determining sarcopenia by CT was 41.2 cm 2 /m 2 (sensitivity 70%, specificity 69.5%, AUC 70.3) for both sexes. The sarcopenia diagnosis by CT as nutritional evaluation parameters was correlated with malnutrition BMI diagnosis in only 35.5%. When compared to non-sarcopenic patients, those with sarcopenia presented worse 30-day survival adjusted by age and SAPS 3 (HR = 2.74, 95%CI = 1.02-7.35, P = 0.04), higher hospital mortality (41.9% vs 14.6%, P = 0.006) and ICU non-infectious complications (76.7% vs 52.1%, P = 0.016)., Conclusion: Sarcopenia assessed by abdominal CT demonstrated low correlation with BMI and was a risk factor for lower 30-day survival, higher hospital mortality and higher complications in critically ill patients., (Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Aim: To investigate the prevalence of sarcopenic obesity (SO) and its association with health outcomes in patients seeking weight loss treatment from a bariatric center., Methods: In this retrospective study, patients [≥18 years old, body mass index (BMI) ≥30 kg/m 2 ] from the Tallahassee Memorial Bariatric Center and with baseline body composition assessment by bioelectrical impedance analysis were included. Fat mass index (FMI = fat mass/height 2 ) and fat-free mass index (FFMI = fat free mass/height 2 ) were calculated. SO was defined by a FMI/FFMI ratio greater than the 95 percentile of sex, BMI and ethnicity specific population-representative references. Medical records were reviewed for biochemical and comorbidity measures., Results: One hundred and forty-four patients (∼69% females, mean age 55.6 years, mean BMI 46.6 kg/m 2 ) were included. Patients' FMI/FFMI ratios ranged from 0.35 to 1.60 kg/m 2 across body weight spectrum, with 51% having SO. Blood pressure, fasting glucose, triglycerides, HDL or LDL were not different between patients with and without SO. However, the prevalence of high cholesterol, asthma, alcoholism and hernia were higher in patients with SO. SO was the strongest univariate predictor of high cholesterol (OR = 2.08, 95% CI 1.07-4.04) and asthma (OR = 2.77, 95% CI = 1.12-6.83)., Conclusion: SO was prevalent and associated with adverse health outcomes, beyond that captured by anthropometric measures in the present study., (Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Body composition may influence clinical outcomes of certain chemotherapeutic agents. We examined the prognostic significance of skeletal muscle mass and adipose tissue on docetaxel toxicity and overall survival in patients with metastatic castrate resistant prostate cancer (mCRPC)., Methods: A retrospective review of patients medical records with mCRPC, treated with docetaxel was conducted. Body composition parameters (skeletal muscle mass, muscle attenuation [MA], visceral and subcutaneous adipose tissue) were measured at L3 by computed tomography (CT) and defined using previously established cut points. Toxicity profile was assessed after 3 cycles of the drug and graded according to the National Cancer Institute Common Toxicity Criteria (version 4). Overall survival was analysed., Results: Overall 63 patients, mean age 69 years (SD 8.3), were included. Sarcopenia was present in 47% (n = 30) and of these 26.7% (8/30) were sarcopenic obese. Common toxicities (all grades) observed included fatigue (80.9%), pain (46%), and constipation (34.9%). DLT occurred in 22 (34.9%) patients; of these 10 patients (15.8%) experienced dose reductions and 12 patients (19%) experienced dose terminations. Measurements of adiposity were not predictive of DLT, however 59.1% patients who had a combination of both sarcopenia and low MA experienced DLT compared to 29.3% of patients without sarcopenia and low MA (p = 0.021). Skeletal muscle index and MA were significantly lower in patients who experienced neutropenia (grade I-II) (46.5 cm 2 /m 2 vs. 51.2 cm 2 /m 2 , p = 0.005) compared to their counterparts (24.6 HU vs. 32.2 HU, p = 0.044). Neither sarcopenia nor sarcopenic obesity was associated with overall survival. In multivariate analysis, BMI ≥25 kg/m 2 (HR: 0.349, CI: 0.156-0.782, p = 0.010) was a significant predictor of longer overall survival and both visceral fat index ≥ median 58.7 cm 2 /m 2 (HR: 2.266 CI: 1.066-4.814, p = 0.033) and anaemia (HR: 2.81, CI: 1.297-6.091, p = 0.009) were significant predictors of shorter overall survival., Conclusions: Sarcopenia and low MA are associated with neutropenia (grade I-II). Furthermore, presence of anaemia, high volume of visceral fat and BMI <25 kg/m 2 are associated with reduced survival in patients with castrate resistant prostate cancer being treated with docetaxel chemotherapy., (Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)