Search

Background This study was performed to evaluate the potential clinical usefulness of a new non-invasive electrodermal biofeedback device in reducing perceived pain levels and chronic systemic inflammation. Materials and methods This multicenter study was designed and coordinated by BioTekna, included 20 general practice medical centers, took place between June 2010 and January 2011, and was validated clinically at the National and Kapodistrian University of Athens, Greece. The study participants were 1015 Caucasian men (401) and women (614), while the placebo-treated controls were 950 Caucasian men (500) and women (450). Patients were aged between 30 and 86 years (average age about 50 years) and all suffered from chronic pain and other medically unexplained symptoms (MUS). The RegMatEx electrodermal biofeedback device (brand BioTekna - Biomedical Technologies, Marcon, Venice, Italy) was used to evaluate the clinical efficacy of electrodermal biofeedback in reducing the level of pain perceived by decreasing the chronic systemic inflammation of the subjects. All subjects received 6 × 30 min sessions of electrodermal or placebo biofeedback given twice a week over 3 weeks. Perceived pain was evaluated using the Numeric Rating Scale (NRS) for pain, while systemic inflammation was examined with measurements of morning circulating C-reactive protein (CRP) concentrations. Results Perceived pain in the treatment group was significantly lessened in the NRS scale (p

Exploration of photoplethysmography (PPG), a technique that can be translated to the clinic, has the potential to assess the autonomic nervous system (ANS) through heart rate variable (HRV) in pregnant individuals. This novel study explores the complexity of mental health of individuals in a clinical sample responding to a task in late pregnancy; finding those with several types of past or current anxiety disorders, greater trait anxiety, or greater exposure to childhood traumatic events had significantly different HRV findings from the others in the cohort. Lower high frequency (HF), a measure of parasympathetic activity, was found for women who met the criteria for the history of obsessive–compulsive disorder (OCD) (p = 0.004) compared with women who did not meet the criteria for OCD, and for women exposed to greater than five childhood traumatic events (p = 0.006) compared with those exposed to four or less childhood traumatic events. Conversely higher low frequency (LF), a measure thought to be impacted by sympathetic system effects, and the LF/HF ratio was found for those meeting criteria for a panic disorder (p = 0.006), meeting criteria for social phobia (p = 0.002), had elevated trait anxiety (p = 0.006), or exposure to greater than five childhood traumatic events (p = 0.004). This study indicates further research is needed to understand the role of PPG and in assessing ANS functioning in late pregnancy. Study of the impact of lower parasympathetic functioning and higher sympathetic functioning separately and in conjunction at baseline and in relation to tasks during late pregnancy has the potential to identify individuals that require more support and direct intervention.

OBJECTIVES: Elderly are at the highest risk for COVID-19 infections. The risk is heightened among NHR for several reasons, including unhealthy body composition and poor nutrition. Previously, we showed high prevalence of osteosarcopenic adiposity (OSA; concomitant osteoporosis, sarcopenia and adiposity) in NRH. Objective of this study was to assess body composition and dietary intake of NHR in one Croatian nursing home. METHODS: Participants, n = 84 (81.2 ± 6.8 y), were 82.1% females. Body composition, assessed with bio-impedance, BIA-ACC (BioTekna®, Marcon, Italy), yielded fat, lean/muscle tissue and volumetric bone mineral density (BMD g/cm(3)). Dietary intake, estimated via 24-hour recall, was analyzed with “Nutrition” (Infosistem, d.d., Croatia). All NHR signed the informed consent. RESULTS: Both women and men were overweight with corresponding BMI of 29.6 ± 5.2 and 27.2 ± 3.2 kg/m(2) (P = 0.027). Women, compared to men, had higher body fat (42.1 ± 5.9% vs. 36.6 ± 5.4%; ranking as obese), but lower skeletal muscle (11.3 ± 3.3 kg vs. 17.3 ± 3.1 kg). The respective BMD (1.006 ± 0.012 vs. 1.018 ± 0.012 g/cm3) was also low (all P ≤ 0.001) influencing high OSA prevalence (>50%). There was no difference in energy and macronutrient intake between women and men. Protein (0.71 and 0.68 g/kg for women and men) and fiber (∼16 g/day) were below recommendation. Fat intake was ∼35% of energy, with high saturated fatty acids (∼14%); cholesterol was within recommendations. Most of the minerals (calcium, magnesium, potassium, iron) were below, while sodium and phosphorus were above recommendations for both women and men. About 42% women were taking vitamin supplements which increased the average intake above recommendations except for vitamin A. Men were below recommendations for all vitamins. CONCLUSIONS: High body fat and low muscle and bone mass leading to high prevalence of OSA, as well as poor dietary intake placed these NHR at higher risk for COVID-19. Their diet should be planned with higher nutrient-dense food, particularly protein and multiple minerals and vitamins, possibly through intake of fresh foods/vegetables and/or supplements. Personalized diets and exercise should be implemented to prevent further weight gain and improve muscle and bones, to render them less susceptible to COVID-19 infections. FUNDING SOURCES: None

Post-operative pain is a common clinical problem after surgery, yet its predictors are inconsistent and unclear. This study examined whether pre-surgical vagal cardiac efferent nerve activity, indirectly indexed by heart rate variability (HRV), predicts patients' pain after epileptic surgery.Using a prospective design, HRV was measured at rest during 5 min in n = 30 patients, prior to undergoing epileptic surgery. Post-operative pain was assessed every 8 h during the first 2 days after surgery, and our analyses focused on the worse pain level. We used multiple regression analyses and statistically considered several confounders (age, surgical duration, and analgesics during various surgical phases).Multiple HRV indexes strongly and inversely predicted post-operative pain, with high-frequency HRV (HF-HRV) being the strongest predictor (r = -0.81, p 0.001). In a hierarchical multiple regression, HF-HRV accounted for an additional and significant 18% of the variance in post-operative pain, after statistically considering effects of age, surgical duration and effects of two anaesthetics.Pre-surgical HF-HRV independently, strongly and inversely predicts post-operative pain. These results are in line with a neuromodulatory role of the vagus nerve in pain and have clinical implications for predicting and managing post-operative pain.

Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

Chronic stress and low-grade chronic inflammation (LGCI) are key underlying factors for many diseases, including bone and body composition impairments. Objectives of this narrative review were to examine the mechanisms by which chronic stress and LGCI may influence osteosarcopenic adiposity (OSA) syndrome, originally named as ostoesarcopenic obesity (OSO). We also examined the crucial nutrients presumed to be affected by or cause of stress and inflammation and compared/contrasted them to those of our prehistoric ancestors. The evidence shows that stress (particularly chronic) and its related inflammatory processes, contribute to osteoporosis, sarcopenia, and adiposity ultimately leading to OSA as a final and most deranged state of body composition, commencing at the mesenchymal cell lineage disturbance. The foods/nutrients consumed by modern humans, as well as their altered lifestyle, also contribute to stress, LGCI and subsequently to OSA. The processes can also go in opposite direction when stress and inflammation impact nutritional status, particularly some micronutrients’ levels. While nutritional management of body composition and LGCI have been studied, the nutrients (and their quantities) most affected by stressors and those which may act toward the alleviation of stressful state, ultimately leading to better body composition outcomes, need to be elucidated.

IntroductionChronic stress and low-grade chronic inflammation (LGCI) influence body composition and are key underlying factors in health and disease. New syndrome, osteosarcopenic obesity (OSO), signifies the simultaneous impairment of bone, muscle, and adipose tissues and has been associated with poor diet and metabolic derangements. Hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis associated with hypercortisolemia and LGCI disrupts the metabolism of bone, muscle and, adipose tissue and may cause changes in eating behavior. Some nutrients involved in preventing/alleviating OSO and LCGI include protein, calcium, magnesium, vitamin D, fiber and omega-3 fatty acids. The aim of this study was to examine the relations between chronic stress, LGCI, body composition and dietary intake in university students.Materials and MethodsParticipants were n = 50 graduate nutritional students (Age, 23.0 ± 1.4 years; BMI, 22.1 ± 2.7 kg/m2) [n = 45 females (90%)]. Advanced bio-impedance devices, BIA-ACC® and PPG-StressFlow® (BioTekna S.r.l., Marcon-Venice, Italy), were used to determine total bone mass (kg) and T-score; muscle mass (kg and % fat free mass) and S-score; and fat mass (kg and % of body weight), as well as extracellular water and HPA index (reference value > 3.5) as indicators of underlying LGCI and stress. Dietary intake was estimated by 24-hour recall and analyzed for all macro- and micro-nutrients.ResultsPositive correlation was found between HPA index and the intake of either total or animal protein, calcium and riboflavin, with r ranging from 0.3–0.35, all p < 0.05. HPA index also positively correlated with T-score (r = 0.39, p = 0.005) and S-score (r = 0.49, p = 0.0003). Total protein intake positively correlated with T-score (r = 0.32, p = 0.024) and animal protein with S-score (r = 0.34, p = 0.017).DiscussionOur results show that chronic stress, LGCI and body composition were interrelated in this young population and possibly augmented by higher protein and calcium intake. Screening for body composition dyshomeostasis, chronic stress and LGCI using innovative, non-invasive devices, along with assessing intake of some crucial nutrients, may provide quick and useful health information enabling prevention or early treatment of some linked disorders.

Rationale: Osteosarcopenic adiposity (OSA) is characterized by bone and muscle loss with increased adiposity either as overweight/obesity or redistributed and/or infiltrated fat in bone and muscle. OSA was related to metabolic disorders, poor nutrition and declined physical function. There are no studies evaluating OSA in nursing home residents (NHR) suffering from multiple comorbidities. With recognized vulnerability of NHR to COVID-19 and OSA being a potential risk factor, we aimed to determine prevalence of OSA in that population. We also explored OSA association with low-grade chronic inflammation (LGCI) and dietary parameters. Methods: Participants were n=84 NHR (81.2±6.8y ; BMI, 29.2±5.0 kg/m2), 82.1% females, with multiple comorbidities. Advanced bio-impedance devices, BIA-ACC and PPG- Stress Flow (BioTekna®, Marcon- Venice, Italy), were used to determine total body bone mass (kg, T-score) ; muscle mass (kg, S- score) ; fat mass (kg and % of body weight), extracellular water (ECW%) and phase angle, as indicators of LGCI. Dietary intake was estimated by 24-hour recall. Protocol was approved by the Institutional review board and each subject signed the informed consent. Results: OSA was identified in 66.7% women and 40.0% men. Phase angle was low (0.73±0.70, normal >3.5) and ECW% was elevated (53.7±5.4%, normal

To prospectively compare two different approaches for estimating the amount of intravenous contrast media (CM) needed for multiphasic MDCT of the liver in obese patients. This single-center, HIPAA-compliant prospective study was approved by our Institutional Review Board. Ninety-six patients (55 men, 41 women), with a total of 42 hypovascular liver lesions, underwent MDCT of the liver. The amount of contrast medium injected was computed according to the patient’s lean body weight which was estimated using either a bioimpedance device (Group A) or the James formula (Group B). The following variables were compared between the two groups: the amount of contrast medium injected (in grams of Iodine, gI), the contrast enhancement index (CEI) and the lesion-to-liver contrast-to-noise ratio. Protocols A and B yielded significant differences in the amount of CM injected (mean values 41.9 ± 4.41 gI in Group A vs. 35.9 ± 5.75 gI in Group B; P = 0.021). The mean CEI value and lesion-to-liver contrast-to-noise ratio measured on the portal phase were significantly higher with protocol A than with protocol B (P

Scarce data exist on the body composition of lean women with polycystic ovary syndrome (PCOS) on treatment with metformin and oral contraceptives (OCs). Thirty-four lean (body mass index 18.5&ndash, 24.9 kg/m2) women (17 with PCOS on metformin and OCs treatment for six months and 17 controls) aged 18&ndash, 40 years were assessed for body composition parameters (fat, muscle, glycogen, protein masses, bone masses, and body water compartments) and phase angles. PCOS patients demonstrated lower muscle, glycogen and protein masses (U = 60, p = 0.003), along with a lower bone mineral content and mass (U = 78, p = 0.021, U = 74, p = 0.014) than their healthy counterparts, while total and abdominal fat masses were similar between the two groups. PCOS patients also exhibited increased extracellular body water (U = 10, p &lt, 0.001) and decreased intracellular water, compatible with low-grade inflammation and cellular dehydration. Key differences in body composition between women with PCOS and controls demonstrated an osteosarcopenic body composition phenotype in PCOS patients. A confirmation of these findings in larger studies may render osteosarcopenia management a targeted adjunct therapy in women with PCOS.

Osteosarcopenic obesity (OSO) syndrome describes the simultaneous deterioration of bone, muscle and excess fat, resulting in reduced functionality and systemic metabolic dysregulation. The key component contributing to this may be ectopic fat in the viscera, bone and muscle. OSO research to date is summarized, and the revised criteria for its identification for research purposes are reviewed and proposed, including new criteria to assess visceral fat in males and females. Finally, nutritional and physical activity recommendations are consolidated into a treatment algorithm, which can be validated in future studies and which may also be applied to preventative management.

The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3–95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using “Nutrition” software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (&gt, 50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.

Osteosarcopenic obesity was recently described as a variant phenotype of obesity, mainly, observed in old age. This nested case-control study was performed to detect differences in body composition between young, healthy overweight/obese, and healthy lean populations of both genders. Our null hypothesis was that, except for the fat mass, there would be absence of body composition differences, namely skeletal muscle and bone masses, between the groups. We used an advanced bioimpedance device to determine body composition and measured circulating hsCRP and diurnal salivary cortisol concentrations, as indices of inflammation and chronic stress, respectively. Overall, 2,551 subjects aged 18-21 years participated in the study. The healthy lean group included 1,072 participants [900 males (84%), 172 females (16%)], and the healthy overweight/obese group included 1,479 participants [74 males (5%), 1,405 females (95%)]. Healthy overweight/obese participants presented with an increased fat mass (p < 0.001), as expected, but lower muscle (p < 0.001) and bone (p< 0.001) masses than lean controls. These findings were accompanied by increased extracellular water compartments, circulating hsCRP levels and evening salivary cortisol concentrations in the healthy overweight/obese group. Our study suggests that “osteosarcopenic” elements exist even in very young populations. These may represent a “precursor” or forme fruste of the osteosarcopenic obesity phenotype in young healthy overweight/obese subjects, who may progressively develop osteosarcopenia in its full form at an older age. Our study highlights the significance of body composition analysis in medical practice, improving prevention and alleviating later health-related economic burden. This article is protected by copyright. All rights reserved.

The aim of the study is to investigate water compartments in patients with rheumatoid arthritis (RA). Acute inflammatory episodes such as infection stimulate water retention, chiefly implemented by the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis. This is an important compensatory mechanism due to expected water loss (sweating etc.). Since SNS and HPA axis are activated in RA, inflammation might be accompanied by water retention. Using bioimpedance analysis, body composition was investigated in 429 controls and 156 treatment-naive RA patients between January 2008 and December 2014. A group of 34 RA patients was tested before and after 10 days of intensified therapy. Levels of pro-atrial natriuretic peptide (proANP) and expression of atrial natriuretic peptide in synovial tissue were investigated in 15 controls and 14 RA patients. Extracellular water was higher in RA patients than controls (mean ± SEM: 49.5 ± 0.3 vs. 36.7 ± 0.1, % of total body water, p

Prediabetes in the form of impaired fasting glucose, impaired glucose tolerance, or both is considered as a preliminary stage for the onset of diabetes and diabetic complications. Hormonal fluctuations in adolescence are accompanied by body composition modifications, which are associated with insulin resistance and subclinical inflammation. Bioimpedance (BIA) accurately evaluates body composition, and heart rate variability (HRV) assesses cardiac autonomic function, which are frequently afflicted by insulin resistance. We aimed at evaluating the effect of glycemic status on mental stress, anxiety, and depression status in adolescents with impaired fasting glucose, body composition, and HRV parameters. This is a case-control study to evaluate the effect of the hyperglycemia on depression, anxiety, and stress levels (DASS21 questionnaire), body composition (BIA-ACC&mdash, BIOTEKNA&copy, ), and HRV (PPG Stress Flow&mdash, ), between euglycemic adolescents (euglycemic group) and adolescents with impaired fasting glucose (prediabetic group), aged 12&ndash, 20 years. No differences were found between the prediabetic (n = 13) and the euglycemic (n = 16) groups in the outcome measures, possibly due to the number of participants. Interestingly, females, irrespective of their glycemic status, exhibited altered sympathovagal function as revealed by impaired HRV. In the euglycemic group, HRV parameters were significantly correlated and in line with the DASS21 scores, but in the prediabetic group, similarities to those of adults were observed. Impaired fasting glucose had no impact on mental health, body composition, or HRV parameters in adolescents. HRV parameters were impaired in females, irrespective of their glycemic status. This finding implies that females seem to be more prone to stress disorders, even from a young age. Future studies are needed to confirm these findings.

Background This large cross-sectional, multi-centre study evaluated the association of body composition measurements by a novel dual frequency bioimpedance device (BIA-ACC) with chronic stress/inflammation biomarkers and the presence of medically unexplained symptoms (MUS). Materials and methods Participants were adult Caucasians of both sexes and included 10 416 lean subjects with no MUS (Group A), 58 710 lean subjects with MUS (Group B) and 30 445 overweight/obese subjects with no MUS and excessive fat mass (FM) (Group C). Results Total body extracellular water (ECW) was higher, while intracellular water (ICW) was lower in Group B than both other groups (P

Recent studies have suggested that body composition is key to health and disease. First, fat tissue is a complex, essential, and highly active metabolic and endocrine organ that responds to afferent signals from traditional hormone systems and the central nervous system but also expresses and secretes factors with important endocrine, metabolic, and immune functions. Second, skeletal muscle mass is an important predictor of health in adult life, while severe mass loss has been associated with the frailty of old age. Studies have shown that skeletal muscle is also an important endocrine organ that secretes factors with autocrine, paracrine, or endocrine actions, which have been associated with inflammatory processes. Third, the bone is also a systemic endocrine regulator playing a pivotal role in health and disease. Finally, proper hydration in humans has been neglected as a health factor, especially in adults. Chronic stress and stress hormone hypersecretion alone or associated with distinct disorders, such as anxiety, depression, obesity, metabolic syndrome, autoimmune disorders, type 2 diabetes mellitus, and polycystic ovary syndrome (PCOS), have been associated with psychological and somatic manifestations, typically, increased fat mass, osteosarcopenia/frailty, cellular dehydration, and chronic systemic inflammation. This review aims to provide new insights into the newly developed concept of stress-related osteosarcopenic obesity and its prevention.

BACKGROUND-OBJECTIVES: We aimed at evaluating the efficiency of a newly developed, advanced Bioimpedance Analysis (BIA-ACC®) device as a screening tool for determining the degree of obesity and osteosarcopenia in postmenopausal women with normal or decreased bone density determined by Dual-Energy X-Ray absorptiometry (DEXA) in a representative sample of Greek postmenopausal women. METHODS: This is a single-gate cross-sectional study of body composition measured by BIA-ACC® and DEXA. Postmenopausal females with BMI ranging from 18.5 to 40 kg/m2 were subjected to two consecutive measurements of DEXA and BIA-ACC® within 5–10 minutes of each other. We used Pearson’s co-efficient to examine linear correlations, the intraclass correlation co-efficient (ICC) to test reliability, Bland-Atman plots to assess bias and Deming regressions to establish the agreement in parameters measured by BIA-ACC® and DEXA. Last, we used ANOVA, with Bonferroni correction and Dunnett T3 post hoc tests, for assessing the differences between quantitative and Pearson’s x2 between qualitative variables. SAMPLE AND RESULTS: Our sample consisted of 84 overweight/obese postmenopausal women, aged 39–83 years, of whom 22 had normal bone density, 38 had osteopenia and 24 had osteoporosis based on DEXA measurements, using quota sampling. ICCs and Deming regressions showed strong agreement between BIA-ACC® and DEXA and demonstrated minimal proportional differences of no apparent clinical significance. Bland-Altman plots indicated minimal biases. Fat, skeletal and bone mass measured by BIA-ACC® and DEXA were increased in the non-osteopenic/non-osteoporotic women compared with those of the osteopenic and osteoporotic groups. CONCLUSIONS: BIA-ACC® is a rapid, bloodless and useful screening tool for determining body composition, adiposity and presence of osteosarcopenic features in postmenopausal women. Women with osteopenia and osteoporosis evaluated by DEXA had decreased fat, skeletal and bone mass compared with normal bone density women, suggesting concordance in the change of these three organ masses in postmenopausal women.