Dalmo Roberto Lopes Machado

Performance of body fat and body mass index cutoffs in elevated blood pressure screening among male children and adolescents

For percentage of body fat (%BF), there are no internationally accepted cutoffs. The primary function of body fat cutoffs should be to identify not only excessive body fatness, but also the increased risk of unhealthy outcomes, such as hypertension. The purpose of this study was to analyze the accuracy of different %BF and body mass index (BMI) cutoffs as screening measures for EBP in pediatric populations. It was a cross-sectional study with a sample of 358 male subjects from 8 to 18 years old. BP was measured by the oscilometric method, and body composition was measured by dual-energy X-ray absorptiometry (DXA). The accuracy of three reference tables used for body fat cutoffs was assessed. The three body fat reference tables were highly specific, but insensitive, for elevated BP screening. For elevated BP screening, all body fat cutoffs presented similar sensitivity (range=48.3–53.7%) and specificity (range=79.2–84.1%). The body fat cutoffs performed no better than BMI in screening of children and adolescents at risk of elevated BP (EBP). BMI seems a more attractive tool for this function, as it performed similarly and can be applied in large surveys and with lower costs.

Impact of Strength Training on Bone Mineral Density in Patients Infected With HIV Exhibiting Lipodystrophy.

Abstract Santos, WR, Santos, WR, Paes, PP, Ferreira-Silva, IA, Santos, AP, Vercese, N, Machado, DRL, de Paula, FJA, Donadi, EA, Navarro, AM, and Fernandes, APM. Impact of strength training on bone mineral density in patients infected with HIV exhibiting lipodystrophy. J Strength Cond Res 29(12): 3466–3471, 2015—This study aimed to evaluate the impact of strength training on bone mineral density (BMD) in individuals harboring HIV exhibiting lipodystrophy. The study included 20 subjects (16 men) aged 50.60 ± 6.40 years with reduced BMD, presenting positive serology for HIV, using highly active antiretroviral therapy, and performing no regular practice of physical exercise before being enrolled in the study. Bone mineral density levels were evaluated by dual-energy x-ray absorptiometry in the lumbar spine, femoral neck, and 1/3 radius, before and after 36 sessions (12 weeks) of strength training. Compared with pre-exercise period, the results showed increased BMD in lumbar spine (3.28%; p = 0.012), femoral neck (8.45%; p = 0.044), and 1/3 radius (5.41%; p = 0.035). This is the first study evaluating the impact of strength training in patients living with HIV and exhibiting lipodystrophy, showing an increased BMD in all the regions measured (lumbar spine, femoral neck, and 1/3 radius). This study showed the beneficial impact of the strength training on BMD increase in patients living with HIV as an effective and available approach to improve bone health.

Half-ironman induces changes in the kidney function of triathletes

Long duration exercise may lead to the occurrence of urine abnormalities. Aiming to investigate the effects of triathlon training and competition on the renal function, twelve male triathletes (32.60 ± 5.10 years, 175.04 ± 6.67m, 71.83 ± 7.42Kg) were studied during the 12-week training protocol and after a Half Ironman. Urine was collected in M-1 - beginning of the training season, M-2 - before the competition and M-3 - after the half ironman. Urine pH was measured using reagent strips, density with a refractometer, proteinuria by Bradford assay, creatinine with a colorimetric assay and blood cells by microscopy. Data were analyzed using Shapiro-Wilk test, One-Way ANOVA and Tukey-Kramer test (p < 0,05). Changes were found after the competition in the protein (M-1= 7.41 ± 2.48; M-2= 7.57 ± 3.74; M-3= 86.10 ± 76.21 mg/mL), creatinine (M-1= 157.66 ± 41.59; M-2= 177.68 ± 44.46; M-3= 316.46 ± 132.86 mg/mL), erythrocytes (M-1= 1060.00 ± 0.30; M-2= 1142.86 ± 377.96; M-3= 52555.56 ± 58.65 units/mL) and leucocytes (M-1= 2375.00 ± 744.02; M-2= 2090.00 ± 0.50; M-3= 5000.00 ± 2738.60 units/mL) excretion when compared to the other collection times. These effects are probably due to the exercise-induced modifications in the glomerular membrane and endocrine variables such as anti diuretic hormone, catecholamines and aldosterone.

The Multicomponent Anthropometric Model for Assessing Body Composition in a Male Pediatric Population: A Simultaneous Prediction of Fat Mass, Bone Mineral Content, and Lean Soft Tissue

The aim of this study was to propose and cross-validate an anthropometric model for the simultaneous estimation of fat mass (FM), bone mineral content (BMC), and lean soft tissue (LST) using DXA as the reference method. A total of 408 boys (8–18 years) were included in this sample. Whole-body FM, BMC, and LST were measured by DXA and considered as dependent variables. Independent variables included thirty-two anthropometrics measurements and maturity offset determined by the Mirwald equation. From a multivariate regression model (Ymn = x(r + 1)(r + 1)nβ m + εnm), a matrix analysis was performed resulting in a multicomponent anthropometric model. The cross-validation was executed through the sum of squares of residuals (PRESS) method. Five anthropometric variables predicted simultaneously FM, BMC, and LST. Cross-validation parameters indicated that the new model is accurate with high R PRESS 2 values ranging from 0.94 to 0.98 and standard error of estimate ranging from 0.01 to 0.09. The newly proposed model represents an alternative to accurately assess the body composition in male pediatric ages.

Impact of Progressive Resistance Training in Brazilian HIV Patients with Lipodystrophy

Background: The objective of the present study was to evaluate the impact of progressive resistance training on the body composition of HIV/AIDS-seropositive patients with lipodystrophy. Methods: The sample consisted of ten individuals with lipodystrophy submitted to a training program. Lean mass and fat mass levels were determined by double energy X-ray absorptiometry (DXA) before and after 36 sessions (12 weeks) of training divided into a preparatory phase (six sessions with three series of 15 repetitions), a transitory phase (six sessions with three series of 15 repetitions with 40 to 50% of maximum muscle strength), and a specific phase (24 sessions with three series of eight repetitions with 70 to 80% of maximum muscle strength). Data were analyzed statistically by the paired sample test. Results: The results showed a significant increase in total lean mass (P=0.039) in the upper limbs (P=0.004) and in the trunk (P=0.019). Conclusions: On this basis, we conclude that progressive resistance training promotes an increase in lean mass and can be useful for the complementary treatment of lipodystrophy by improving the body harmony and quality of life of patients with HIV/AIDS.

Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS

INTRODUCTION The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.RESUMO: Introducao: A sindrome da lipodistrofia do HIV e caracterizada por alteracoes no metabolismo e na composicao corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potencia (TARV). Objetivo: Avaliar a prevalencia de lipodistrofia e de alteracoes do metabolismo de lipidios e glicose em PVHA em uso da TARV. Metodos: Para avaliacao antropometrica foram aferidos peso, estatura e circunferencia abdominal (CA). Para avaliacao da lipodistrofia foi realizado o exame fisico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razao de massa gorda (RMG). Foram tambem realizados exames de lipidograma e glicemia de jejum e utilizados os criterios sugeridos pelo The National Cholesterol Education Program III para classificacao de alteracoes metabolicas. Resultados: A amostra final consistiu em 262 pacientes com idade media de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame fisico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalencia foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alteracoes metabolicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusoes: A alta prevalencia de lipodistrofia e alteracoes do metabolismo de lipidios e glicose evidenciam a importância da intervencao precoce nesse grupo de pacientes para prevenir complicacoes cardiovasculares.

Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models

BackgroundBody composition alterations, or lipodystrophy, can lead to serious health problems in people living with HIV/AIDS (PLWHA). The objectives of this study are to predict and validate sex-specific anthropometric predictive models for the diagnosis of lipodystrophy in PLWHA.MethodsA cross-sectional design was employed to recruit 106 PLWHA (men = 65 and women = 41) in Brazil during 2013–2014. They were evaluated using dual-energy X-ray absorptiometry, and 19 regions of body perimeters and 6 skinfold thicknesses were taken. Sex-specific predictive models for lipodystrophy diagnosis were developed through stepwise linear regression analysis. Cross-validations using predicted residual error sum of squares was performed to validate each predictive model.ResultsResults support the use of anthropometry for the diagnosis of lipodystrophy in men and women living with HIV/AIDS. A high power of determination with a small degree of error was observed for lipodystrophy diagnosis for men in model six (r2 = 0.77, SEE = 0.14, r2PRESS = 0.73, SEE PRESS = 0.15), that included ratio of skinfold thickness of subscapular to medial calf, skinfold thickness of thigh, body circumference of waist, formal education years, time of diagnosis to HIV months, and type of combined antiretroviral therapy (cART) (with protease inhibitor “WI/PI = 1” or without protease inhibitor “WO/PI = 0”); and model five for women (r2 = 0.78, SEE = 0.11, r2PRESS = 0.71, SEE PRESS = 0.12), that included skinfold thickness of thigh, skinfold thickness of subscapular, time of exposure to cART months, body circumference of chest, and race (Asian) (“Yes” for Asian race = 1; “No” = 0).ConclusionsThe proposed anthropometric models advance the field of public health by facilitating early diagnosis and better management of lipodystrophy, a serious adverse health effect experienced by PLWHA.

Anthropometric multicompartmental model to predict body composition In Brazilian girls

BackgroundAnthropometric models remain appropriate alternatives to estimate body composition of peripubertal populations. However, these traditional models do not consider other body components that undergo major changes during peripubertal growth spurt, with restrictions to a multicompartimental approach as a quantitative growth. DXA has great potential to determine pediatric body composition in more than one component (3-C), but has limited use in field settings. Thus, the aim of this study was to propose and validate an anthropometric model for simultaneous estimation of lean soft tissue (LST), bone mineral content (BMC) and fat mass (FM) in healthy girls, from a multivariate approach of densitometric technique, as the criterion method.MethodsA sample of 84 Brazilian girls (7-17 years) was defined by chronological age and maturity offset. Whole total and regional DXA body scan were performed and, the components were defined (LST, BMC and FM) and considered as dependent variables. Twenty-one anthropometric measures were recorded as independent variables. From a multivariate regression, an anthropometric multicompartmental model was obtained.ResultsIt was possible to predict DXA body components with only four predictive measurements: body weight (BW); supra-iliac skinfold (SiSk); horizontal abdominal skinfold (HaSk) and contracted arm circumference (CaCi) with high coefficients of determination and low estimation errors (LST = 0.6662657 BW - 0. 2157279 SiSk - 0.2069373 HaSk + 0.3411678 CaCi - 1.8504187; BMC = 0.0222185 BW - 0.1001097 SiSk - 0.0064539 HaSk - 0.0084785 CaCi + 0.3733974 and FM = 0.3645630 BW + 0.1000325 SiSk - 0.2888978 HaSk - 0.4752146 CaCi + 2.8461916). The cross-validation was confirmed through the sum of squares of residuals (PRESS) method, presenting accurate coefficients (Q2PRESS from 0.81 to 0.93) and reduced error reliability (SPRESS from 0.01 to 0.30).ConclusionsWhen sophisticated instruments are not available, this model provides valid estimates of multicompartmental body composition of girls in healthy Brazilian pediatric populations.

Accuracy of different cutoff points of body mass index to identify overweight according to body fat values estimated by DEXA

OBJECTIVE To evaluate the sensitivity and specificity of different cutoff points of body mass index for predicting overweight/obesity according to body fat values estimated by DEXA among Brazilian adolescents. METHODS Cross-sectional study including 229 male adolescents aged 10-15 years, in which body adiposity and anthropometric measures were assessed. Nutritional status was classified by BMI according to cutoff points described in scientific literature. RESULTS Moderate agreements were observed between body fat estimated by DEXA and cutoffs proposed by Cole et al. (K=0.61), Conde and Monteiro (K=0.65), Must et al. (K=0.61) and WHO (K=0.63). The BMI in continuous form showed good agreement with the Dexa (ICC=0.72). The highest sensitivity was observed for cutoff by Conde and Monteiro (0.74 [0.62, 0.84]) and the highest specificity by Cole et al. (0.98 [0.94, 0.99]). For the areas under the ROC curve of cutoff points analyzed, significant difference comparing the cutoff points by Cole et al. and Conde and Monteiro (0.0449 [0.00294, 0.0927]) was observed. CONCLUSIONS The cutoff proposed by Conde and Monteiro was more sensitive in identifying overweight and obesity when compared to the reference method, and the cutoff proposed by Cole et al. presented the highest specificity for such outcomes.

The impact of intensive high performance training on adult height of female artistic gymnasts: a retrospective study

The purpose of this study was to identify the potential impact of the high performance training on the anthropometric and maturational characteristics of female artistic gymnasts and to compare the adult target height with international standards of growth. A sample consisted of 23 elite Brazilian female former gymnasts was evaluated. From a historic retrospective, about 29.56 yrs. ago (average of all) they devoted themselves to the training for 9.3 (2.6) years, with a weekly 24.26 (4.2) training hours, and had been retired from competition around at 13.61 (5.12) years old. From the anthropometric data of the gymnasts (while still competing), their parents and their older sister (1) and younger sister (2), the target height was calculated by Tanner method {[(father’s height -13 cm) + mother’s height] ÷ 2}. Additionally, training history, age of menarche occurrence, and growth classifying in accordance with the international standards was recorded, aimed at comparisons. The average stature shown normal adult stature (NCHS), and some cases surpassed the standard 75th, 90th and 95th percentile. They are higher than their mother (p = 0.039), but not their sister 1 (0.952) or sister 2 (p = 0.998), but the age of menarche was significantly later only than their sisters 1 (p = 0.008) and 2 (p = 0.017). According to the Brazilian percentiles reference (IBGE), the final height of the former gymnasts was always higher of the standard, slightly smaller than their sisters 2 (5th and 10th), but was taller than their mothers and sisters 1. In conclusion, there is no evidence of artistic gymnastics high performance training having adverse effects on the final adult height.