Publications by authors named "Maria Cristina Gonzalez"

110 Publications

Exploring the potential role of phase angle as a marker of oxidative stress: A narrative review.

Nutrition 2021 Sep 20;93:111493. Epub 2021 Sep 20.

Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. Electronic address:

Chronic conditions including non-communicable diseases have become increasingly prevalent in the past decade. Proinflammatory cytokines are associated with the development of several pathologies, their prognoses, and their associated mortality. Chronic inflammation is also associated with oxidative stress whereby reactive oxygen species (ROS) induce cellular injury and, thus, by doing so, initiate inflammatory signaling. Phase angle (PhA) is a measurable body composition parameter obtained using bioelectrical impedance analysis (BIA). PhA is considered an indicator of cellular health and integrity and is also related to inflammatory markers and inflammation. Given the association among oxidative stress, cell damage, and inflammation that may in turn be associated with low PhA values, it is expected that PhA could mirror oxidative stress. In this hypothesis-generating, narrative review we summarize the current knowledge regarding the potential relationship between PhA and oxidative stress and their interrelationship in chronic conditions.
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http://dx.doi.org/10.1016/j.nut.2021.111493DOI Listing
September 2021

Low hand grip strength is associated with worse functional capacity and higher inflammation in people receiving maintenance hemodialysis.

Nutrition 2021 Aug 30;93:111469. Epub 2021 Aug 30.

School of Nutrition, Federal University of Goiás, Goiania, Brazil. Electronic address:

Objectives: To evaluate the associations of hand grip strength (HGS) with body composition, functional capacity, muscle quality, and inflammatory markers in people receiving maintenance hemodialysis.

Methods: This is a cross-sectional study in people receiving maintenance hemodialysis. HGS was measured by hydraulic dynamometer on the upper limb without fistula. Participants were stratified into low or adequate HGS, based on population-specific cutoff points. Body composition was assessed by dual-energy X-ray absorptiometry, and functional capacity by the Short Physical Performance Battery and timed up-and-go tests. In addition, serum creatinine, interleukin-6 (IL-6), IL-10, tumor necrosis factor-α, and ultra-sensitive C-reactive protein (us-CRP) were measured before the dialysis session.

Results: A total of 67 participants (41.8% women, 58.2% male; ages 54.1 ± 11.7 y) were included. Those with low HGS had worse functional capacity than those with adequate HGS (timed up-and-go test, 10.7 ± 1.0 versus 8.5 ± 0.8 sec, respectively; P < 0.001). IL-6 and us-CRP were higher in those with low HGS than their counterparts (IL-6: 2.7 ± 0.3 versus 1.9 pg/mL, P = 0.03; us-CRP: 14.8 ± 3.0 versus 4.7 ± 1.9 mg/L, P = 0.03). Multiple linear regression analysis showed that appendicular lean mass, us-CRP, age, sex, and seven-point subjective global assessment score were associated with HGS.

Conclusions: Participants with low HGS showed higher inflammation and lower functional capacity. In addition to muscle mass, inflammation and nutritional status also affect HGS..
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http://dx.doi.org/10.1016/j.nut.2021.111469DOI Listing
August 2021

Using bioelectrical impedance analysis in children and adolescents: Pressing issues.

Eur J Clin Nutr 2021 Oct 7. Epub 2021 Oct 7.

Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-002 Li Ka Shing Centre for Health Innovation, Edmonton, AB, T6G 2E1, Canada.

Single- and multifrequency bioelectrical impedance analysis (BIA) has gained popularity as a tool to assess body composition and health status of children and adolescents, but many questions and misconceptions remain. This review addresses pressing issues researchers and health care providers may encounter when using BIA in the young population. The importance of choosing population-specific and device-specific equations to estimate body composition as well as the use of BIA in longitudinal analyses are discussed. When specific equations are not available, raw bioimpedance values (i.e., resistance, reactance, and impedance) can be used to compute bioimpedance parameters, such as phase angle, impedance ratio, and bioelectrical impedance vector analysis. As interpreting these parameters is challenging, suggestions are provided on the use of reference data, cut-off points, and adjustment factors. Furthermore, unsolved technical and analytical issues are listed. Based on existing issues and potential for future development, a greater interaction between industry and academic researchers to improve the validity of BIA measurements among children and adolescents across their developmental stages is encouraged.
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http://dx.doi.org/10.1038/s41430-021-01018-wDOI Listing
October 2021

NCD behavioral risk factors and mortality among older adults in Brazil.

Clin Nutr ESPEN 2021 10 13;45:462-468. Epub 2021 Jul 13.

Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil.

Backgrounds & Aims: Literature shows that the most studied concurrent risk factors for mortality in elderly individuals are smoking, inadequate diet, alcohol consumption and physical inactivity. The combination of such habits can increase from 3 to 11 times the chance of death. To measure the association between concurrence of behavioral risk factors (BRF) for non-communicable diseases (NCD's) and mortality up to three years among the elderly.

Methods: Cohort study started in 2014 named "COMO VAI?" with community-dwelling aged ≥60 years in Pelotas, Rio Grande do Sul, Brazil. We investigated the deaths from all causes occurred until April 2017. The exposure was defined by the presence of physical inactivity, low-quality diet, alcohol consumption and smoking that composed a score ranging from 0 (none) to 4 (all). Cox proportional hazard regression models were used to evaluate the association between BRF concurrence and mortality.

Results: In 2014, 1451 elderly people were interviewed, 145 deaths were identified (10%) by April 2017. Higher risk of death was observed for the combinations of physical inactivity + smoking and low-quality diet + physical inactivity. The simultaneous presence of three or more BRF was associated with a nearly six-fold higher risk of death.

Conclusions: Higher mortality during a 3-year period was observed among those with at least three BRF for NCD's.
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http://dx.doi.org/10.1016/j.clnesp.2021.06.032DOI Listing
October 2021

Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage.

Front Pediatr 2021 21;9:621943. Epub 2021 Jul 21.

Department of Pediatrics, Vega Baja Hospital, Orihuela, Spain.

The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD). Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018. A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) ( < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 ( < 0.001). The referral of patients with PE+1 decreased over time ( = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group ( = 0.018), without affecting LHS ( = 0.814). There were no changes in the use of CTPD in the PE+3 group ( = 0.721). The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.
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http://dx.doi.org/10.3389/fped.2021.621943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335639PMC
July 2021

Dysphagia Perception Among Community-Dwelling Older Adults from a Municipality in Southern Brazil.

Dysphagia 2021 Jul 28. Epub 2021 Jul 28.

Nutrition College, Federal University of Pelotas, Pelotas, Brazil.

To analyse the prevalence of dysphagia perception and associated factors among community-dwelling older adults in Pelotas, Brazil. A total of 1447 community-dwelling individuals aged 60 and older participated in a cross-sectional population-based study carried out in 2014. Dysphagia perception was assessed using the following question: "Do you have swallowing difficulties? (Yes/No)". Independent variables included sociodemographic, behavioural and health characteristics. Poisson regression was used to obtain prevalence ratios. Dysphagia perception prevalence was 8.1%, higher among women (PR 1.63, 95% CI 1.07; 2.46) and in subjects older than 80 years (PR 1.88, 95% CI 1.16; 3.03). Older adults with 1-7 years of schooling were more likely to present dysphagia (PR 1.62; 95% CI 1.09; 2.40). Those who did not use dental prosthesis (PR 1.85; 95% CI 1.08; 3.16), who presented dry mouth sensation (PR 4.10; 95% CI 2.59; 6.51) and multimorbidity (PR 30.0; 95% CI 4.09; 219.45) were more likely to present dysphagia perception. The participants who consumed alcohol were 60% less likely to report dysphagia perception (PR 0.43; 95% CI 0.22; 0.86). One out of twelve older adults presented dysphagia perception, and associations with sociodemographic characteristics and other health problems were found. Early identification of dysphagia should be a public health and clinical concern.
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http://dx.doi.org/10.1007/s00455-021-10347-8DOI Listing
July 2021

Phase angle as a marker for muscle abnormalities and function in patients with colorectal cancer.

Clin Nutr 2021 07 17;40(7):4799-4806. Epub 2021 Jun 17.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Background And Aims: Considering the applicability of phase angle (PhA) as a marker of muscle mass and function, we aimed to investigate whether PhA is a predictor of muscle abnormalities and function in patients with cancer.

Methods: In a sample of patients with colorectal cancer (CRC), PhA was obtained from measurements of resistance and reactance from bioelectrical impedance analysis. Computerized tomography imaging at the third lumbar vertebra was used to evaluate muscle abnormalities by quantifying skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Muscle function was assessed by handgrip strength (HGS) and gait speed (GS).

Results: This cross-sectional study included 190 participants (X±SD), mean age 60.5 ± 11.3 years; 57% men; 78% had cancer stages III to IV. PhA was highly correlated with SMI (r = 0.70) and moderately correlated with HGS (r = 0.54). PhA explained 48% of the SMI variability (R = 0.485), 21% of the SMD variability (R = 0.214), 26% of HGS (R = 0.261) and 9.8% of GS (R = 0.098). In the multivariate model adjusted for age, sex, body mass index, performance status, comorbidities and cancer stage, 1-degree decrease in PhA was associated with low SMI (Odds Ratio (OR) = 6.56, 95% CI: 2.90-14.86) and with low SMI and HGS combined (OR = 11.10, 95% CI: 2.61-47.25). In addition, Receiving Operating Characteristics curve analysis showed that PhA had a good diagnostic accuracy for detecting low SMI, low SMI and SMD combined, low SMD and HGS and low SMI and HGS combined (AUC = 0.81, 95% CI: 0.74-0.88; AUC = 0.88, 95% CI: 0.81-0.95; AUC = 0.80, 95% CI: 0.70-0.91; AUC = 0.82, 95% CI: 0.74-0.89; respectively).

Conclusions: PhA was a predictor of muscle abnormalities and function and had a good diagnostic accuracy for detecting low muscle mass, low muscle mass and radiodensity, low muscle radiodensity and strength, and low muscle mass and strength in patients with CRC.
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http://dx.doi.org/10.1016/j.clnu.2021.06.013DOI Listing
July 2021

Nutrition competencies for undergraduate medical education: Results of an international interdisciplinary consensus.

JPEN J Parenter Enteral Nutr 2021 Jun 12. Epub 2021 Jun 12.

Surgical Department, Medical School, Universidade Federal de Medicina, Belo Horizonte, Brazil.

Background: The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education.

Methods: We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5).

Results: A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process.

Conclusion: The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.
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http://dx.doi.org/10.1002/jpen.2203DOI Listing
June 2021

Tobacco smoking and body composition in persons living with HIV/AIDS.

Cien Saude Colet 2021 May;26(5):1923-1930

Programa de Pós-Graduação em Saúde e Comportamento, Faculdade de Medicina, Universidade Católica de Pelotas. Avenida Duque de Caxias 250, Fragata. 96030-000 Pelotas RS Brasil.

This study aimed to assess the association between tobacco smoking and body composition in patients with HIV/AIDS in combination antiretroviral therapy (cART). This is a cross-sectional study with people of HIV followed in specialized care service for HIV patients located in the South of Brazil. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assess smoking and other psychoactive substance use. Body mass index (BMI) was calculated as the ratio of body weight (in kilograms) to squared height (in meters). Patients also had their body composition evaluated with a multi-frequency bioelectrical impedance (Bodystat® Quadscan 4000, RU) to estimate skeletal muscle index (SMI). In total, 320 subjects were included in the study. The prevalence of smoking was 54.7%. Tobacco smoking was associated with malnutrition, lower body mass index scores, and lower skeletal muscle mass index. It is concluded that there is a high prevalence of smoking among patients with HIV/AIDS and that this behavior is associated with worse body composition. Thus, it is suggested to implement strategies to support smoking cessation among people with HIV/AIDS.
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http://dx.doi.org/10.1590/1413-81232021265.19532019DOI Listing
May 2021

The influence of coffee consumption on bioelectrical impedance parameters: a randomized, double-blind, cross-over trial.

Eur J Clin Nutr 2021 May 13. Epub 2021 May 13.

Department of Agricultural, Food and Nutritional Science, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.

Background: Bioelectrical impedance analysis (BIA) is a widely used method for estimating body composition. Avoiding foods/beverages containing caffeine is a frequently enforced pre-test protocol to ensure reliability of BIA measurements. However, few studies have evaluated whether this is necessary, with conflicting results. We aimed to determine whether the coffee consumption differing in caffeine content influences BIA parameters in healthy adults.

Methods: Twenty-five healthy adults were enrolled in a randomized, double-blind cross-over trial. Three amounts of caffeine were given with 200 mL of coffee: 0 mg (11 g of decaffeinated), 200 mg (5.5 g of caffeinated plus 5.5 g of decaffeinated), and 400 mg of caffeine (11 g of caffeinated). BIA measurements were conducted at 6 different times, and coefficient variations (CV) explored.

Results: No differences were observed for group × time interaction on impedance, resistance, or reactance (p > 0.05). Values of BIA parameters increased after 30-min of coffee consumption, independently of the caffeine dosage (all p < 0.001). Body fat percentage followed the same pattern and increased after 45-min (p < 0.05). Median CV for consecutive impedance, resistance, and reactance measurements were >95%CI of expected device measurement error over 70-min, without difference between groups. Urine output volume was not different between groups (decaffeinated: 440.45 ± 197.57 mL; 200 mg: 471.80 ± 171.88 mL; 400 mg: 489.30 ± 204.10 mL, p > 0.05).

Conclusion: Coffee consumption influenced BIA-derived results after 70-min but was not related to caffeine content, likely due to water intake.
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http://dx.doi.org/10.1038/s41430-021-00932-3DOI Listing
May 2021

All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil.

Rev Bras Epidemiol 2021 2;24:e210015. Epub 2021 Apr 2.

Faculty of Nutrition, Universidade Federal de Pelotas - Pelotas (RS), Brazil.

Objective: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS.

Methods: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016-2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI).

Results: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 - 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 - 6.2), widowhood (HR = 2.2; 95%CI 1.4 - 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 - 4..6), current smoking (HR = 2.1; 95%CI 1.2 - 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 - 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 - 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 - 5.7).

Conclusion: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.
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http://dx.doi.org/10.1590/1980-549720210015DOI Listing
April 2021

Calf circumference: cutoff values from the NHANES 1999-2006.

Am J Clin Nutr 2021 06;113(6):1679-1687

Pennington Biomedical Research Center, LSU System, Baton Rouge, LA, USA.

Background: Calf circumference (CC) is used in geriatric studies as a simple and practical skeletal muscle (SM) marker for diagnosing low SM and sarcopenia. Currently applied CC cutoff points were developed in samples including older participants; values representative of the full adult lifespan are lacking.

Objectives: We aimed to develop CC cutoff points and to identify relevant confounding factors from the large and diverse NHANES 1999-2006 population sample.

Methods: Demographic, anthropometric, and imaging data (DXA, appendicular lean mass) from the adult (age ≥18 y) NHANES sample were partitioned into subgroups according to sex, age, ethnicity, and race. Adults aged 18-39 y and BMI (in kg/m2) 18.5-24.9 were set as a reference population; CC cutoff points were derived at 1 and 2 SDs below the mean.

Results: The sample included 17,789 participants, 51.3% males and 48.7% females, with respective ages (mean ± SD) of 43.3 ± 16.1 y and 45.5 ± 16.9 y. CC was strongly correlated with appendicular lean mass, r = 0.84 and 0.86 for males and females (both P < 0.001), respectively. Significant differences in mean CC were present across sex, ethnic, self-reported race, and BMI groups. Adjusting CC for adiposity using BMI revealed a decrease in CC beginning after the second decade in males and third decade in females. Rounded CC cutoff values for moderately and severely low CC were 34 cm and 32 cm (males), and 33 cm and 31 cm (females), respectively. Our findings support the use of BMI-adjusted CC values for participants outside the normal-weight BMI range (18-24.9).

Conclusions: This study defined CC values in a diverse population sample along with a BMI-adjustment approach that helps to remove the confounding effects of adiposity and thereby improves CC as a useful clinical estimate of SM mass.
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http://dx.doi.org/10.1093/ajcn/nqab029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433492PMC
June 2021

Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study.

PLoS One 2021 19;16(2):e0247322. Epub 2021 Feb 19.

Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil.

The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo's classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247322PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894883PMC
August 2021

Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database.

JPEN J Parenter Enteral Nutr 2021 Feb 7. Epub 2021 Feb 7.

Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria.

Background: Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status.

Methods: We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores.

Results: A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87).

Conclusions: This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.
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http://dx.doi.org/10.1002/jpen.2085DOI Listing
February 2021

2 + 2 (+ 2) = 4: A new approach for appendicular muscle mass assessment by ultrasound.

Nutrition 2021 03 11;83:111056. Epub 2020 Nov 11.

Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.

Objective: The aim of this study was to develop new appendicular lean mass (ALM) prediction models based on ultrasound and anthropometric measurements.

Methods: This was a cross-sectional assessment of a subsample from a population-based study (COMO VAI?), conducted with community-dwelling individuals ≥60 y of age living in a southern Brazilian city. ALM was measured by dual-energy x-ray absorptiometry (DXA). Muscle thickness (MT) from supine participants was assessed by ultrasound on the anterior aspect of both upper and lower limbs. Such measures, along with anthropometric data, were used to develop prediction models (multivariable linear regression) through the backward stepwise method.

Results: The study included 190 participants composed mainly of women, white, and middle-class individuals. The best ALM predictive performance was achieved by a model based on two "lengths" (height and arm length), two circumferences (dominant arm and thigh), and two ultrasound-measured MTs (dominant arm and thigh): R = 0.90, limits of agreement: ±2.36 kg. Closely satisfactory results were also achieved by an "abbreviated" model composed by the two aforementioned "lengths" and MTs (R = 0.89, limits of agreement: ±2.51 kg). ALM estimates from both equations were unbiased and similar to DXA measurements (P = 0.13 and 0.09, respectively). Bootstrap analysis favorably suggested the validity of the models.

Conclusions: Based on two ultrasound assessments and a few anthropometric measurements, the developed equations produced accurate and unbiased ALM estimates in the sample. Hence: 2 MTs + 2 lengths (+ 2 circumferences) = 4 limbs' muscle mass. Such models might represent promising alternatives for muscle assessment among older individuals.
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http://dx.doi.org/10.1016/j.nut.2020.111056DOI Listing
March 2021

Weight loss, phase angle, and survival in cancer patients undergoing radiotherapy: a prospective study with 10-year follow-up.

Eur J Clin Nutr 2021 05 11;75(5):823-828. Epub 2020 Nov 11.

Graduate Program in Human Nutrition, University of Brasilia, Brasilia Federal District, 70910-900, Brazil.

Background/objectives: Cancer patients undergoing radiotherapy (RT) frequently experience weight loss and changes in body composition, which negatively affect their nutritional status, lead to a poor clinical prognosis, and reduce survival rates. This study aimed to evaluate whether changes in body weight, phase angle, and standardized phase angle are associated with longer survival in cancer patients undergoing RT.

Methods: This prospective cohort study included 62 cancer patients who underwent RT between 2008 and 2009 and were followed until 2019. Anthropometric and bioelectrical impedance analysis data were assessed before and after RT. The Kaplan-Meier method was used to calculate survival, and mortality risk was assessed using the Cox proportional hazards model.

Results: Kaplan-Meier analysis indicated no significant difference in survival time after the 10-year follow-up between patients who had weight loss during RT and those with weight maintenance or weight gain during RT. Mortality risk was associated, in the adjusted multivariate analysis, with age (p = 0.023), site of treatment (p = 0.001), and weight loss during RT (p = 0.044). Every 1 kg lost increased the risk of death by 25% compared with patients who maintained or gained weight during RT. Changes in phase angle and standardized phase angle after RT were not associated with increased mortality risk.

Conclusions: Weight loss during RT, site of treatment, and age are associated with a higher risk of death in cancer patients after the 10-year follow-up.
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http://dx.doi.org/10.1038/s41430-020-00799-wDOI Listing
May 2021

Muscle Echogenicity and Changes Related to Age and Body Mass Index.

JPEN J Parenter Enteral Nutr 2021 Sep 8;45(7):1591-1596. Epub 2020 Dec 8.

Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA.

Introduction: Muscle fibers are lost and replaced by fat- and fibrous-tissue infiltration during aging. This process decreases muscle quality and influences tissue appearance on ultrasound images over time. Increased muscle "echogenicity" represents changes caused by fat- and fibrous-tissue infiltration and can be quantified with recently developed software.

Objective: To investigate skeletal muscle quality through echogenicity, estimates according to participant's body mass index (BMI) and age were taken.

Methods: This was a cross-sectional study performed at the Pennington Biomedical Research Center, Baton Rouge, Louisiana with 117 participants (57 men and 60 women), with mean age (±SD) 38.9 ± 17.0 years and BMI 28.6 ± 6.2 kg/m². All participants were examined by ultrasound (LOGIQ GE Healthcare), using a 5.0-MHz linear transducer. Participants had muscle thickness measured by ultrasound at 4 anatomic locations (biceps and triceps brachial, femoral quadriceps, and calf triceps). Echogenicity was analyzed with specific software (Pixel Health) that evaluated the image in gray scale.

Results: According to BMI, 41% of participants were obese. There was a positive correlation between age and thigh-muscle echogenicity (r = 0.534, P < .0001) and a negative correlation between thigh-muscle echogenicity and thickness (r = -0.395, P <.0001). There was high muscle echogenicity in participants with overweight and obesity aged 50 years or older (P < .05).

Conclusion: Older age and higher BMI were associated with stronger echogenicity signals and smaller muscle thickness. People with overweight, obesity, and/or older than 50 years old have reduced muscle quality with smaller muscle thickness, as observed with ultrasound.
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http://dx.doi.org/10.1002/jpen.2030DOI Listing
September 2021

New insights on how and where to measure muscle mass.

Curr Opin Support Palliat Care 2020 12;14(4):316-323

Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Rio Grande do Sul, Brazil.

Purpose Of Review: This article will discuss different muscle mass assessment methods and emphasize their highlights.

Recent Findings: Several measurement techniques can be used to evaluate muscle mass, recognized as important prognostic markers for adverse functional and clinical outcomes. Choosing the best method depends on the knowledge regarding their theoretical and practical limitations and the purpose of the assessment. Image techniques are considered the gold standards, with good accuracy and precision, but not always available in clinical settings. A new biological technique, the D3-creatinine dilution, can provide not only direct information about muscle mass but also shows a strong association with physical function. With the advancement of the use of the computed tomography (CT) images to assess skeletal muscle mass, mainly in patients with cancer, the assessment of skeletal muscle radiodensity (SMD), as a marker of muscle quality, may provide additional information regarding the association between muscle composition, muscle function and prognosis. Additional muscle function assessment can improve the risk prediction in several clinical situations.

Summary: The use of the best tool for the muscle mass assessment should be performed carefully among the various methodologies, according to their characteristics and clinical situation.
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http://dx.doi.org/10.1097/SPC.0000000000000524DOI Listing
December 2020

Pilot study GLIM criteria for categorization of a malnutrition diagnosis of patients undergoing elective gastrointestinal operations: A pilot study of applicability and validation.

Nutrition 2020 Nov - Dec;79-80:110961. Epub 2020 Aug 1.

Department of Surgery, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Electronic address:

Objectives: The Global Leadership Initiative on Malnutrition (GLIM) was proposed to provide a common malnutrition diagnostic framework. The aims of this study were to evaluate the applicability and validity of the GLIM and use machine-learning techniques to help provide the best malnutrition-related variables/combinations to predict complications in patients undergoing gastrointestinal (GI) surgeries.

Method: This was a prospective cohort study enrolling surgical patients with GI diseases. Malnutrition prevalence was classified by the GLIM, subjective global assessment (SGA), and various anthropometric parameters. The various combination of the phenotypic criteria generated 10 different models. Sensibility (SE) and specificity (SP) were calculated using SGA as the reference criterion. Machine-learning approaches were used to predict complications. P < 0.05 was set as statistically significant.

Results: We evaluated 206 patients. Half of the patients were malnourished according SGA, and 16.5% had postoperative complications. The prevalence of malnutrition using GLIM varied from 10.7% to 41.3% among the whole population, 11.7% and 43.6% in the elderly, from 0 to 24% in overweight non-obese and from 0 to 19.6% in obese patients. SE and SP values varied between 61.2% and 100% and 55.3% and 98.1%, respectively, for the general population. Machine-learning models indicated that midarm circumference, one of the GLIM models, and midarm muscle area were the most relevant criteria to predict complications.

Conclusions: The various GLIM combinations provided different rates of malnutrition according to the population. Machine-learning techniques supported the use of common single variables and one GLIM model to predict postoperative complications.
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http://dx.doi.org/10.1016/j.nut.2020.110961DOI Listing
June 2021

Accuracy of SARC-F and SARC-CalF for sarcopenia screening in older women from southern Brazil.

Nutrition 2020 Nov - Dec;79-80:110955. Epub 2020 Jul 24.

Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil. Electronic address:

Objectives: The aim of this study was to verify the accuracy of the SARC-F and the SARC-CalF as screening tools for sarcopenia in community-dwelling older women ≥60 y of age.

Methods: This was a cross-sectional study evaluating a convenience sample of women ≥60 y of age, living in Southern Brazil. Sarcopenia was defined according to the criteria proposed in the latest European Working Group on Sarcopenia in Older People consensus (EWGSOP2). Appendicular muscle mass was assessed by dual-energy x-ray absorptiometry. Muscle strength was measured by handheld dynamometry, and physical performance through the 4-m gait speed test. The SARC-F questionnaire and SARC-CalF score for sarcopenia screening were also applied.

Results: We evaluated 288 participants, with a mean age of 67.6 ± 5.8 y. The frequency of probable and confirmed sarcopenia in the sample was 7.3% and 2.1%, respectively. The frequency of risk for sarcopenia assessed by the SARC-F was 4.5% and SARC-CalF 22.2%. Despite the excellent specificity (95.4%) demonstrated by the SARC-F, its sensitivity in identifying confirmed cases was null, whereas the SARC-CalF showed high sensitivity (83.3%) and good specificity (79%).

Conclusion: The present study findings suggested that SARC-CalF may be able to outperform SARC-F as a sarcopenia screening tool in women ≥60 y of age even under the new EWGSOP2 criteria, the main determinant of which is strength as observed in studies based on the previous definition.
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http://dx.doi.org/10.1016/j.nut.2020.110955DOI Listing
June 2021

Nutritional risk is associated with an increase of in-hospital mortality and a reduction of being discharged home: Results of the 2009-2015 nutritionDay survey.

Clin Nutr ESPEN 2020 08 25;38:138-145. Epub 2020 Jun 25.

Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Hospital of Vienna, Vienna, Austria.

Background: Disease-related malnutrition is a known factor for poor outcomes. However, there is a lack of knowledge about the prevalence and the impact of nutritional risk on outcomes in Colombia. The aim of the present study was to determine the prevalence of nutritional risk, to know how nutrition screening is routinely performed and to determine the impact of nutritional risk on the outcomes of in-hospital mortality and being discharged home outcomes.

Methods: We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples (2009-2015) including a total of 7,994 adult patients in 248 units in Colombia. Data is contrasted with the Latin American and worldwide results. The prevalence of nutritional risk was determined according to the malnutrition screening tool (MST). The impact of nutritional risk in Colombian patients regarding outcomes was assessed by a Fine and Gray competing risk regression model controlling for PANDORA score (age, BMI, length of stay before nutritionDay, cancer diagnosis, and mobility).

Results: The prevalence of nutritional risk (MST score ≥ 2) in Colombia was 38%, 41% in Latin America, and 32% worldwide. Half of the Colombian units screened patients for malnutrition or nutritional risk on admission to hospital, compared to 80% in Latin America and 62% worldwide. Only 23% of the Colombian patients identified as being at nutritional risk in the nutritionDay survey received any nutritional therapy. The hospital mortality hazard ratio of Colombian patients at nutritional risk defined by MST was 1.94 (95% CI, 1.53,2.46; p < 0.001) and 0.82 of being discharged home (95% CI, 0.76,0.88, p < 0.001).

Conclusions: This is the first large-scale study in Colombia evaluating the impact of nutritional risk on clinical outcomes showing an increase of in-hospital mortality and a reduction of being discharged home. Moreover, the study shows that nutritional risk is still highly prevalent worldwide implying the need to promote an optimal nutritional care. The participation of Latin American countries in the nutritionDay survey is an opportunity to increase knowledge and awareness of these issues.
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http://dx.doi.org/10.1016/j.clnesp.2020.05.014DOI Listing
August 2020

Body mass index and mortality among community-dwelling elderly of Southern Brazil.

Prev Med 2020 10 24;139:106173. Epub 2020 Jun 24.

School of Nutrition, Federal University of Pelotas, Brazil; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil; School of Physical Education, Federal University of Pelotas, Brazil.

This study aims to measure the association between body mass index (BMI), comparing two different classifications, and mortality among community-dwelling elderly considering myopenia in Pelotas, Brazil. This is a longitudinal study started in 2014, we followed 1451 elderly people (≥ 60 years) enrolled in the "COMO VAI?" study. BMI was classified according to the World Health Organization (WHO) and the classification with specific cutoff points for older adults. Myopenia was measured by calf circumference (≤33 cm for women and ≤34 cm for men). Cox proportional-hazards models were used to test associations controlling for sociodemographic and behavioral characteristics and number of morbidities. Nearly 10% (N = 145) of the elderly died during almost three years of follow-up. We observed a L-shaped relation between BMI and mortality. Elderly with underweight had a higher mortality risk compared to those with adequate BMI in both classifications. According to the WHO classification, overweight elderly presented protection for mortality (HR: 0.58; 95% CI 0.38-0.87) when compared to those with adequate BMI. Among elderly with myopenia, overweight by WHO continued to protect against mortality, although not significantly, while those with the specific classification underweight presented a higher risk of death compared to those with normal weight (HR: 2.09; 95% CI 1.06-4.14). In conclusion the underweight increased the risk of death in community-dwelling elderly people during a follow-up of three years. The specific classification seemed to be more adequate to indicate risk of mortality in this population. Higher BMI protect against mortality when muscle mass was not considered.
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http://dx.doi.org/10.1016/j.ypmed.2020.106173DOI Listing
October 2020

Food consumption and multimorbidity among non-institutionalized elderly people in Pelotas, 2014: a cross-sectional study.

Epidemiol Serv Saude 2020 19;29(3):e2019050. Epub 2020 Jun 19.

Universidade Federal de Pelotas , Programa de Pós-Graduação em Epidemiologia , Pelotas , RS , Brasil.

Objective: to analyze association between diet quality and multimorbidity among elderly individuals.

Methods: this was a cross-sectional study of elderly people aged 60 years or older in Pelotas, RS, Brazil, 2014; food consumption was assessed using an abridged Food Frequency Questionnaire; diet quality according to the diet quality index (DQI-E) and scores given to food items; multimorbidity (≥5 diseases) was self-reported; Poisson Regression was used to obtain crude and adjusted prevalence ratios and 95% confidence intervals.

Results: 1,426 elderly people were included; men who consumed wholefoods (1 to 6 days) were more likely to have multimorbity (PR=1.64 95%CI 1.21;2.23]); those who ate meat at least weekly were less likely to have multimorbity (PRmen=0.68 95%C I0.51;0.92]; PRwomen=0.70 95%CI 0.61;0.81); no association was found between DQI-E and multimorbidity.

Conclusion: although consumption of most foods was not associated with multimorbidity, the results have produced reflections about dietary habits that are pertinent for discussion by health service managers.
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http://dx.doi.org/10.5123/S1679-49742020000300015DOI Listing
September 2021

Low calf circumference is an independent predictor of mortality in cancer patients: A prospective cohort study.

Nutrition 2020 Nov - Dec;79-80:110816. Epub 2020 Mar 19.

Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil; Postgraduate Program in Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil. Electronic address:

Objective: Loss of muscle mass is associated with worse outcomes in patients with cancer. The objective of this study was to evaluate the prognostic value of calf circumference (CC) and skeletal muscle index from computed tomography (CT) to predict mortality in patients with cancer.

Methods: A single-center prospective study was conducted with patients aged ≥20 y attending a reference center of oncology and who had recent abdominal CT images. Data were collected through a semistructured form and patients' records and included sociodemographic data (sex, age and ethnicity), clinical data (primary site and staging of tumor and treatments performed), anthropometric variables (body mass index and CC), and outcome (death). Low CC for men was considered to be ≤ 34 cm and for women ≤ 33 cm. Muscle mass was assessed by CT images at the level of L3. The Cox proportional hazard model adjusted for age, sex, and staging of disease was used.

Results: A total of 250 patients were evaluated, 52.8% female, with a median age of 63 y (interquartile ratio: 55-73). Normal body mass index was identified in 44.4%; 29.2% had low skeletal muscle index, and 46.4% had low CC. Death by any cause occurred in 16%, and only low CC was a significant predictor of mortality (hazard ratio = 3.01; confidence interval 1.52-5.98; P = 0.002).

Conclusions: Low CC can predict risk of mortality in this cohort of patients. The findings suggest the use of CC as a simple, easy, cost-effective anthropometric measurement to quickly screen patients at risk of death who could benefit from targeted care to improve their prognosis.
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http://dx.doi.org/10.1016/j.nut.2020.110816DOI Listing
June 2021

Objectively Measured Physical Activity and Polypharmacy Among Brazilian Community-Dwelling Older Adults.

J Phys Act Health 2020 05 29;17(7):729-735. Epub 2020 May 29.

Background: Previous observations regarding association between physical activity (PA) and use of medicines among older adults are derived from self-reported PA. This study aimed to evaluate the association between objectively measured PA and polypharmacy among older adults with multimorbidity in Southern Brazil.

Methods: This study included 875 noninstitutionalized older people, aged ≥60 years. Prescribed medicines used in the 15 days prior to the interview, socioeconomic data, and the presence of comorbidities were self-reported. Accelerometers were used to evaluate PA following the interview.

Results: Prevalence of polypharmacy (≥5 medicines) was 38.3% (95% confidence interval, 35.0-41.5); those belonging to the lowest tertile of PA used more medicines. The authors observed a significant inverse association for polypharmacy between men belonging to the second and third tertiles of PA for objectively measured overall PA and light PA compared with the most inactive tertile. For women, the association between PA and polypharmacy was significant for overall, light, and moderate to vigorous PA only in the third tertile.

Conclusions: Overall, light and moderate to vigorous PA were inversely associated to polypharmacy and differed by gender. Promotion of PA in older adults may be an effective intervention to reduce the number of medicines used independent of the number of comorbidities.
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http://dx.doi.org/10.1123/jpah.2019-0461DOI Listing
May 2020

Reply to: Objectively Measured Physical Activity Reduces the Risk of Mortality Among Brazilian Older Adults.

J Am Geriatr Soc 2020 06 15;68(6):1349-1350. Epub 2020 May 15.

Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

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http://dx.doi.org/10.1111/jgs.16461DOI Listing
June 2020

Assessment of body composition in pediatric overweight and obesity: A systematic review of the reliability and validity of common techniques.

Obes Rev 2020 08 6;21(8):e13041. Epub 2020 May 6.

Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.

Accurate measurement of body composition is required to improve health outcomes in children and adolescents with overweight or obesity. This systematic review aimed to summarize the reliability and validity of field and laboratory body composition techniques employed in pediatric obesity studies to facilitate technique selection for research and clinical practice implementation. A systematic search in MEDLINE (via PubMed), EMBASE, CINAHL, and SPORTDiscus from inception up to December 2019 was conducted, using a combination of the following concepts: body composition, pediatric overweight/obesity, and reliability/validity. The search strategy resulted in 66 eligible articles reporting reliability (19.7%), agreement between body composition techniques cross sectionally (80.3%), and/or diagnostic test accuracy (10.6%) in children and adolescents with overweight or obesity (mean age range = 7.0-16.5 years). Skinfolds, air-displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA), and ultrasound presented as reliable techniques. DXA, ADP, and isotope dilution showed similar and the best agreement with reference standards. Compared with these laboratory techniques, the validity of estimating body composition by anthropometric equations, skinfolds, and BIA was inferior. In conclusion, the assessment of body composition by laboratory techniques cannot be replaced by field techniques due to introduction of measurement errors, which potentially conceal actual changes in body components.
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http://dx.doi.org/10.1111/obr.13041DOI Listing
August 2020

Strength and multimorbidity among community-dwelling elderly from southern Brazil.

Nutrition 2020 03 9;71:110636. Epub 2019 Nov 9.

Nutrition School, Federal University of Pelotas, Rio Grande do Sul, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil.

Objective: The number of chronic diseases is associated with the reduction in muscle mass and strength in older people (≥60 y of age). The purpose of this study was to asses the association between multimorbidities and handgrip strength in older community-dwelling individuals from a city in southern Brazil, identifying potential differences according to sex and loss of muscle mass.

Methods: This was a cross-sectional population-based study among older individuals living in the urban area of Pelotas, Rio Grande do Sul, Brazil. Grip strength was assessed with digital dynamometers according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) to define dynapenia. Multimorbidity was defined by self-report as the presence of at least 5 diseases diagnosed by a physician. Covariates of the study were age, sex, socioeconomic status, schooling, marital status, nutritional status, alcohol consumption, and smoking habits. Statistical analyses were stratified according to the presence of myopenia (low muscle mass).

Results: We received completed information from 1336 individuals ≥60 y of age. Multimorbidity was 50% and 16% more prevalent, respectively, among men and women classified in the lower quartile of manual grip strength (prevalence ratio [PR], 1.50; 95% confidence interval [CI], 1.15-1.95 for men and PR, 1.16; 95% CI, 1.03-1.32 for women) compared with those from the upper quartile. Among men without myopenia, the presence of dynapenia increased the odds of having multimorbidity (PR, 1.42; 95% CI, 1.18-1.71). Among those with myopenia, there was a 10% increase in the prevalence of multimorbidity only for women with dynapenia (PR, 1.10; 95% CI, 1.00-1.21).

Conclusion: Results from the present study indicated an association between manual grip strength and multimorbidity among this population, and the effect measures were greater in men. Manual grip strength proved to be a good marker of health in this population, especially in those who did not present with myopenia.
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http://dx.doi.org/10.1016/j.nut.2019.110636DOI Listing
March 2020

Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review.

Clin Nutr 2020 08 27;39(8):2368-2388. Epub 2019 Nov 27.

University of Trieste, Italy.

Background: Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. Currently, different definitions of sarcopenic obesity exist and its diagnostic criteria and cut-offs are not universally established. Therefore, the prevalence and sensitivity of this condition for any disease risk prediction is affected significantly.

Aim: This work was conducted under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). An international expert panel performed a systematic review as an initial step to analyze and summarize the available scientific literature on the definitions and the diagnostic criteria for sarcopenic obesity proposed and/or applied in human studies to date.

Methods: The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in April 2018 in three databases (PubMed, Scopus, Web of Science). Human studies conducted in both sexes, irrespective of ethnicity, and published from 2007 to 2018 were included; cohorts of individuals with obesity and acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity were excluded from final analyses. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies.

Results: The electronic search retrieved 2335 papers of which 75 met the eligibility criteria. A marked heterogeneity in definitions and approaches to diagnose sarcopenic obesity was observed. This was mainly due to differences in the definitions of obesity and sarcopenia, in the methodologies used to assess body composition and physical function, and in the reference values for the variables that have been used (different cut-offs, interquartile analysis, diverse statistical stratification methods). This variability may be attributable, at least in part, to the availability of the methodologies in the different settings, to the variability in specialties and backgrounds of the researcher, and to the different settings (general population, clinical settings, etc.) where studies were performed.

Conclusion: The results of the current work support the need for consensus proposals on: 1) definition of sarcopenic obesity; 2) diagnostic criteria both at the level of potential gold-standards and acceptable surrogates with wide clinical applicability, and with related cut-off values; 3) methodologies to be used in actions 1 and 2. First steps should be aimed at reaching consensus on plausible proposals that would need subsequent validation based on homogeneous studies and databases, possibly based on analyses of existing cohorts, to help define the prevalence of the condition, its clinical and functional relevance as well as most effective prevention and treatment strategies.
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http://dx.doi.org/10.1016/j.clnu.2019.11.024DOI Listing
August 2020

Think Globally, Act Locally: The Importance of Population-Specific Bioelectrical Impedance Analysis Prediction Equations for Muscle Mass Assessment.

JPEN J Parenter Enteral Nutr 2020 09 20;44(7):1338-1346. Epub 2019 Nov 20.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: Bioelectrical impedance analysis (BIA) is a convenient muscle assessment method, but its accuracy highly depends on population-specific aspects of the adopted equation. We aimed to develop appendicular lean mass (ALM) prediction models for older South Americans and to compare their performances to those of reference equations in the same sample.

Methods: Cross-sectional evaluation of 192 community-dwelling Brazilian subjects ≥60 years old from the COMO VAI?

Study: Using measurements from single-frequency and multifrequency devices (BIASF and BIAMF, respectively), new ALM prediction equations were developed (reference method: dual-energy x-ray absorptiometry [DXA]). Validity was assessed by bootstrapping. Four previously established equations were also tested, and the performances were compared using Bland-Altman analysis.

Results: Stepwise variable selection produced the following equations: ALM = (2.08 × sex) + (0.04 × weight) + (0.24 × RI ) + (0.07 × Xc ) - 0.16; ALM = (1.85 × sex) + (0.03 × weight) + (0.31 × RI ) + (0.04 × Xc ) + (0.01 × Z ) - 8.16, where ALM is estimated in kg; female sex = 0 and male sex = 1; weight is measured in kg; RI is the resistance index at 50 kHz measured in cm /Ω); Xc is the reactance at 50 kHz measured in Ω; and Z is impedance at 5 kHz measured in Ω. The equations explained, respectively, 89% and 90% of the variability of ALM in our sample, and their estimates were not significantly different from DXA measurements. Bland-Altman analysis revealed accurate and unbiased performances for both models, with similar limits of agreement (BIA : ±2.58 kg; BIA : ±2.48 kg), and their validity was considered adequate by the bootstrap method. The reference equations, however, systematically overestimated ALM in our sample.

Conclusion: The proposed equations might represent practical options to estimate ALM in older noninstitutionalized South Americans. Further external validation, though, is required to verify the reproducibility of our findings.
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http://dx.doi.org/10.1002/jpen.1742DOI Listing
September 2020
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