Alessandra Zivelonghi

Body composition changes in stable-weight elderly subjects: the effect of sex.

Background and aims: Although cross-sectional and longitudinal studies have shown age-related changes in body composition and fat distribution, they may be related to body weight changes. The aim of this study was to evaluate yearly age-related changes in body composition and fat distribution, over a two-year period, in 101 women and 60 men (age range: 68 to 78 years at baseline). Methods: Body composition was evaluated by dual energy X-ray absorptiometry (DXA), and fat distribution by waist and hip circumferences and waist-to-hip circumference ratio. Baseline free testosterone, IGF-1 and serum albumin were evaluated in all subjects, as well as physical activity. Clinical evaluation was performed at baseline and yearly in order to exclude subjects with any condition inducing pathological changes in body composition or fat distribution. Subjects with a weight change >5% of their baseline body weight during the study period, were excluded. Results: Significant increases occurred in Body Mass Index (BMI) (1.18% in women, 1.13% in men), waist (1.75% in women, 1.39% in men), and hip circumference (1.06% in women, 1.31% in men), whereas height decreased significantly in both men (0A2%) and women (0.55%). Significant increases in total body fat (1.31%) and percent body fat (1.27%) were observed in women but not in men. Lean body mass did not change significantly throughout the study in either sex. Significant losses in leg muscle mass and appendicular skeletal muscle mass (ASM), calculated as the sum of arm and leg fat-free soft tissue, were observed in men (respectively 3.56 and 2.77%) and women (respectively 2A1 and 1.59%). A significant decrease in ASM adjusted by stature (ASM/height2), a proposed proxy for sarcopenia, was found in men only (1.97%). The rates of loss in leg muscle mass and appendicular muscle mass were significantly higher in men than in women, even after adjusting for free testosterone, IGF-1, physical activity and serum albumin. Conclusions: These data demonstrate significant changes in body composition and fat distribution in independently living, weight-stable elderly men and women. These changes are dependent on sex and independent of physical activity, hormones or serum albumin.

Interrelationships between weight loss, body fat distribution and sex hormones in pre‐ and postmenopausal obese women

Objectives. Relationships between regional body fat distribution and sex hormones as well as changes in sex hormones after weight loss were evaluated.

Relation between adiponectin and bone mineral density in elderly post-menopausal women: role of body composition, leptin, insulin resistance, and dehydroepiandrosterone sulfate.

Introduction: Adipocytokines have been proposed as new mediators of the protective effects of fat mass on the skeleton. The aim of this study was to test the relationship between adiponectin, leptin, and bone mineral density (BMD), independently of body composition, insulin resistance, and other factors known to affect bone metabolism. Methods: Thirty-six post-menopausal non-diabetic elderly women, with ages ranging from 66 to 77 yr took part in the study. In all subjects we evaluated body weight, height, body mass index (BMI), waist circumference, adiponectin, leptin, insulin, DHEAS, and homeostasis model assessment of insulin resistance (HOMA), as well as yr since menopause. Total body fat mass (FM) and BMD at whole body and femoral level were measured with Dual energy X-ray Absorptiometry (DXA). Volumetric BMD was defined as the ratio between total body BMD and height. Results: Leptin was positively and adiponectin negatively related with whole body and femoral BMD. Positive associations between insulin, HOMA, DHEAS, and BMD measures were also found. After adjusting for FM, only adiponectin maintained a significant relation with whole body and femoral BMD; the strength of this association was reduced after adjustment for insulin resistance, estimated by HOMA. In stepwise multiple linear regression analyses adiponectin explained 11.7% of total BMD variance, 17.4% of femoral neck BMD variance, and 30.7% of volumetric BMD variance, independently of BMI, FM, leptin, HOMA, and DHEAS. Conclusions: The present study may suggest possible involvement of adiponectin in bone metabolism, independently of FM and insulin resistance even in elderly post-menopausal women.

Identifying sarcopenia in acute care setting patients.

OBJECTIVES To evaluate the prevalence of sarcopenia by applying European Working Group on Sarcopenia in Older People (EWGSOP) flow chart in an acute care geriatric unit as well as to test a modified version of the EWGSOP diagnostic algorithm combining handgrip and gait speed test to identify subjects with low muscle mass. DESIGN Observational cohort study. SETTING Geriatric unit in an academic medical department. PARTICIPANTS One hundred nineteen acutely ill persons (34.4% female), with mean age 80.4 ± 6.9 years and body mass index 26.3 ± 4.9 kg/m(2). MEASUREMENTS Assessment of muscle mass by bioimpedence analysis, muscle strength by handheld dynamometer, and gait speed with the 4-meter walking test. RESULTS Using the EWGSOP classification for sarcopenia, 5.0% presented with sarcopenia and 21.0% with severe sarcopenia. Combining gait speed test and handgrip strength measurement, the highest predictive power in detecting subjects with low muscle mass was observed (sensitivity and specificity, 80.6% and 62.5%, respectively). Subjects presenting with both normal gait speed and handgrip showed normal values of muscle mass as assessed with bioimpedence analysis. By using the ROC method, when the 2 tests were combined, the AUC was statistically higher than when using each test separately (0.740; P = .018). CONCLUSIONS Our study shows that 1 of 4 patients admitted to the acute care department were recognized to be sarcopenic. When a modifived version of the EWGSOP flow chart, obtained combining both gait speed and handgrip was used, sensitivity and specificity of algorithm to identify subjects with low muscle mass was improved.

Insulin-like growth factor-1 is associated with bone formation markers, PTH and bone mineral density in healthy premenopausal women

Bone turnover markers (BTM) progressively decrease in young adult women. This might be linked to changes in insulin-like growth factor-1 (IGF-I). Four serum BTMs [serum C-telopeptide of type 1 collagen (CTX), osteocalcin (OC), N-terminal propeptide of type 1 procollagen (P1NP), and bone alkaline phosphatase (bone AP)], serum calcium (sCa), phosphate (sPO(4)), magnesium, 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (PTH) and IGF-I were measured in 531 young healthy premenopausal women aged 20-50 years participating in the BONTURNO study. In all subjects bone mineral density (BMD) was measured at the spine and at the hip by dual-energy X-ray densitometry. Hip BMD, IGF-I, the four BTMs, sCa and sPO(4) progressively decreased with advancing age and this was associated with proportional increases in PTH. IGF-I levels were significantly and positively correlated with sCa, sPO(4), CTX, OC, P1NP, bone AP, spine BMD, femoral neck BMD and total hip BMD and negatively with age, BMI and serum PTH. When the IGF-I levels were adjusted for age and BMI, the only correlations maintaining a statistical significance were those with serum PTH, P1NP and bone AP. These associations were weak and IGF-I accounted for a only a small proportion of the BTM variance. The mean, age-adjusted IGF-I values were significantly higher in women practicing physical exercises for more then 60 min per week than in sedentary women. In conclusion, in this study we provide evidence of an association between the age-related decline in IGF-I with the progressive decrease in bone formation markers in premenopausal women.

Relationships between leisure-time physical activity, obesity and disability in elderly men

Background and aims: Relationships have already been shown between leisure-time physical activity, obesity and body composition in young adults. However, this association needs to be confirmed in the elderly. The aim of this study was to investigate the relationship between leisure-time physical activity, obesity, preservation of muscle mass and disability in elderly men. Methods: Cross-sectional analysis of a sample of 85 community-dwelling men, 68 to 79 years of age. Body mass index (BMI) was used to quantify obesity. Body composition was evaluated using Dual Energy X-ray Absorptiometry. Disability was measured using a modified version of the Activities of Daily Living scale. Leisure-time physical activity was evaluated by a validated self-administered questionnaire. Results: A negative relation between obesity and weekly walking was observed. Walking less than 30 minutes per day was associated with a 2.7 greater probability of being obese (95% CI 1.1–6.7). High-intensity exercise, such as brisk walking or gardening, was inversely correlated with body fat (R=−0.296, p<0.01) and directly correlated with appendicular skeletal mass (R=0.238, p<0.05). The prevalence of disability was the highest (58%) among overweight elderly subjects at the lowest tertile of exercise. Multiple logistic regression selected BMI as a positive predictor and high-intensity exercise as a negative predictor of disability. Conclusions: Our study shows that, in elderly men, leisure-time physical activity is inversely associated with body fat, BMI, and reported disability, but positively associated with appendicular fat-free mass. The highest prevalence of reported disability was observed in sedentary subjects with BMI higher than 25 kg/m2.

EFFECT OF AGE ON THE DYNAMICS OF ACYLATED GHRELIN IN FASTING CONDITIONS AND IN RESPONSE TO A MEAL

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High baseline values of fat mass, independently of appendicular skeletal mass, predict 2- year onset of disability in elderly subjects at the high end of the functional spectrum

Background and aims: To evaluate the relation between baseline body composition and 2-year onset of functional limitation in elderly subjects at the high end of the functional spectrum. Methods: An-thropometric measurements, physical functioning as measured by a modified version of the Activities of Daily Living Scale, and baseline albumin, were evaluated in 145 men and women aged 66–78 years, free of functional limitations, selected from the general population of Verona. In each subject, total body fat mass (FM) and appendicular FFM (ASMM) were measured by dual-energy X-ray absorptiometry; the FM (FMI) and ASMM indexes (ASMMI) were also calculated by dividing each body composition variable by height squared. Results: After 2 years of follow-up, 48.2% of women and 40% of men had developed mild levels of disability, with limitations in kneeling, bending and climbing stairs. In women, but not in men, a BMI higher than 25 Kg/m2 or values of FMI higher than the 50th percentile, were significantly associated with a 3 to 5 times increased risk of limitations in climbing stairs and lower body performance. In men, a trend was found between low values of ASMMI and an increased risk of limitations in kneeling and bending. After cross-tabulating categories based on the 50th percentile of ASMMI and FMI, high values of FMI, independently of ASMMI, were significantly related with higher incidence of limitation in climbing stairs in women. In women, the highest 2-year incidence of limitation in climbing stairs was found in the group of obese subjects. Conclusions: High body fat and high BMI values were associated with a greater probability of developing functional limitations 2 years later in a population of elderly subjects at the high end of the functional spectrum. Moreover, in women, high baseline values of fat mass, independently of appendicular fat-free mass, were more likely to predict the future onset of functional limitations.

A case of bronchiolitis obliterans organising pneumoniae (BOOP) after nine months post-operative irradiation for breast cancer

A 71-year-old woman was referred to our unit with fever (38.5◦C). During the preceding 3 weeks she reported sweats and non-productive cough despite previous antibiotic therapy. In May 2005 she had undergone a quadrantectomy and sentinel-node biopsy at our hospital for right upperouter quadrant breast cancer. She received radiation therapy through conventional tangential-field irradiation using photons from August to September 2005. Chest X-ray showed a right-sided pulmonary area of consolidation. CT scan demonstrated dense pneumonic infiltrate with bronchograms in the right mid-lobe. A second CT scan (21 days after the first) (see Figure 1a in the supplementary data on the journal’s website http://www.ageing.oxfordjournals.org) showed patchy consolidation in the right mid-lobe and the appearance of bilateral nodules (diameter 1–2 cm) at the posterior segment of the right upper lobe. The patient underwent lung biopsies via bronchoscopy at the midand upper right lobes from the radiographically abnormal area. Histology confirmed the diagnosis of bronchiolitis obliterans organising pneumoniae (BOOP). After oral prednisone there was a dramatic resolution of respiratory symptoms within 1 week, and a CT scan (see Figure 1b in the supplementary data on the journal’s website http://www.ageing.oxfordjournals.org) 3 weeks after initiating steroid therapy, showed resolution of the right area of consolidation. This case implies that BOOP should always be kept in mind when treating patients who present these types of symptoms following irradiation of the breast [1–3].

Use of tigecycline in elderly patients for Clostridium difficile infection.

ous cases of complete atrioventricular block associated with rivastigmine. Autonomic dysfunction is a common feature of Parkinson’s disease and DLB, although Ballard et al. found that rivastigmine has a favorable profile of cardiac safety in such patients. The present patient had DLB, and sinus arrest occurred only after sputum inspiration, which might have induced a vagal reflex. Thus, other factors influencing autonomic function might also be related to rivastigmine-induced sinus arrest.