Miji Kim

Aerobic exercise training reduces epicardial fat in obese men

The purpose of this study was to determine the effects of exercise training on ventricular epicardial fat thickness in obese men and to investigate the relationship of the change in epicardial fat thickness to changes in abdominal fat tissue following exercise training. Twenty-four obese middle-aged men [age, 49.4 +/- 9.6 yr; weight, 87.7 +/- 11.2 kg; body mass index (BMI), 30.7 +/- 3.3 kg/m(2); peak oxygen consumption, 28.4 +/- 7.2 ml.kg(-1).min(-1); means +/- SD] participated in this study. Each participant completed a 12-wk supervised exercise training program (60-70% of the maximal heart rate; 60 min/day, 3 days/wk) and underwent a transthoracic echocardiography. The epicardial fat thickness on the free wall of the right ventricle was measured from both parasternal long- and short-axis views. The visceral adipose tissue (VAT) and subcutaneous adipose tissues were measured by computed tomography. Following exercise training, the epicardial fat thickness was significantly decreased (P < 0.001). The percentage change of epicardial fat thickness was twice as high compared with those of waist, BMI, and body weight of original values (P <0.05). There was a significant relationship (r = 0.525, P = 0.008) between changes in the epicardial fat thickness and VAT with exercise training. Stepwise multiple regression analysis revealed that the change in VAT, change in systolic blood pressure, and change in quantitative insulin sensitivity check index were independently related to the change epicardial fat thickness (P < 0.05). The ventricular epicardial fat thickness is reduced significantly after aerobic exercise training and is associated with a decrease in VAT. These results suggest that aerobic exercise training may be an effective nonpharmacological strategy for decreasing the ventricular epicardial fat thickness and visceral fat area in obese middle-aged men.

Comparison of epicardial, abdominal and regional fat compartments in response to weight loss

BACKGROUND AND AIMS Echocardiographic measurement of epicardial fat (EF) seems to be a reliable and diagnostic marker of visceral adipose tissue (VAT). However, the weight loss-induced changes in EF have not been compared with those in VAT or the truncal depot. In this study, we aimed to compare the weight loss-induced changes in EF, VAT and other regional fat compartments in obese men. METHODS AND RESULTS In this study, 27 moderately obese men (age 45.8+/-1.7 years; body mass index 30.5+/-0.7 kg/m(2)) followed a daily low-calorie diet as part of a clinical 12-week weight loss interventional study. We evaluated the EF thickness by transthoracic echocardiography, assessed the abdominal fat tissues by computed tomography scans, and examined the regional and whole body fat compartments by dual X-ray absorptiometry. An average decrease of 26.8% in the initial calorie intake corresponded to post-program reductions of 17.2%, 11.0%, 16.6%, and 29.8% in EF thickness (P<0.001), body mass, percentage fat mass, and abdominal fat compartments, respectively. The percentage change in VAT in response to weight loss was twice as high as the substantial change in EF tissue (P<0.001). CONCLUSION The results of the study suggest that a low-calorie diet-induced weight loss decreases EF thickness. Moderate diet-induced weight loss alone may represent an effective nonpharmacological strategy for reducing EF, which is a unique, pathogenic fat depot and an emerging marker of VAT.

Effects of exercise and milk fat globule membrane (MFGM) supplementation on body composition, physical function, and hematological parameters in community-dwelling frail Japanese women: a randomized double blind, placebo-controlled, follow-up trial.

Objective To investigate the combined and separate effects of exercise and milk fat globule membrane (MFGM) supplementation on frailty, physical function, physical activity level, and hematological parameters in community-dwelling elderly Japanese women. Methods A total of 131 frail, elderly women over 75 years were randomly assigned to one of four groups: exercise and MFGM supplementation (Ex+MFGM), exercise and placebo (Ex+Plac), MFGM supplementation, or the placebo group. The exercise group attended a 60-minute training program twice a week for three months, and the MFGM group ingested 1g of the MFGM supplement in pill form, daily for 3 months. The primary outcome measure was change in frailty status based on Fried’s frailty phenotype. Secondary outcome measures included body composition, physical function and hematological parameters, and interview survey components assessing lifestyle factors. Participants were followed for 4 months post-intervention. Results Significant group×time interactions were observed for usual walking speed (P = 0.005), timed up & go (P<0.001), and insulin-like growth factor-binding protein 3 / insulin-like growth factor 1 ratio (P = 0.013). The frailty components revealed that weight loss, exhaustion, low physical activity, and slow walking speed were reversed, but low muscle strength did not significantly changed. Frailty reversal rate was significantly higher in the Ex+MFGM (57.6%) than in the MFGM (28.1%) or placebo (30.3%) groups at post-intervention (χ2 = 8.827, P = 0.032), and at the follow-up was also significantly greater in the Ex+MFGM (45.5%) and Ex+Plac (39.4%) groups compared with the placebo (15.2%) group (χ2 = 8.607, P = 0.035). The exercise+MFGM group had the highest odds ratio (OR) for frailty reversal at post-intervention and follow-up (OR = 3.12, 95% confidence interval (CI) = 1.13–8.60; and OR = 4.67, 95% CI = 1.45–15.08, respectively). Conclusion This study suggests that interventions including exercise and nutrition can improve frailty status. Statistically significant additive effects of MFGM with exercise could not be confirmed in this population, and further investigation in larger samples is necessary. Trial Registration The Japan Medical Association Clinical Trial Registry (JMACCT)JMA-IIA00069

Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older.

Aim:  To identify individuals at hierarchical levels of physical disability by using physical performance tests and to determine threshold values for the discriminating of levels of physical disability in women aged 75 years or older.

Mobility performance tests for discriminating high risk of frailty in community-dwelling older women

We aimed to compare and identify high and low risk of frailty in community-dwelling older women by using five mobility performance tests. The participants were 166 older women at high risk and 171 age-matched controls at low risk of frailty according to the long-term care insurance (LTCI) system (age: 65-90 years). The mobility performance tests included 5-chair sit-to-stand (STS), alternate step, timed up-and-go (TUG), timed rapid gait (TRG), and usual gait speed (UGS). Data analysis showed that high-risk individuals (81.9%) were more likely to be pre-frail than low-risk individuals (55.0%) by Frieds frailty phenotype. The four mobility performance tests, except the 5-chair STS, had the largest areas under the curve (AUC) for discriminating older women at high and low risk (AUC>0.80, p<0.001). The optimal cutpoint (6 s) for the TRG test had the highest sensitivity (78%) and specificity (83%) in identifying high risk of frailty. Our results suggest that walking ability tests are clinically useful in screening older individuals at high risk of frailty. In particular, the TRG test is more likely than other tests to discriminate older women at high risk of frailty based on the LTCI system.

Effects of exercise and tea catechins on muscle mass, strength and walking ability in community‐dwelling elderly Japanese sarcopenic women: A randomized controlled trial

Aim:  To investigate the effects of exercise and/or tea catechin supplementation on muscle mass, strength and walking ability in elderly Japanese women with sarcopenia.

Sarcopenia: Prevalence and associated factors based on different suggested definitions in community-dwelling older adults.

The age‐related loss of muscle mass and/or strength and performance, sarcopenia, has been associated with geriatric syndromes, morbidity and mortality. Although sarcopenia has been researched for many years, currently there is a lack of consensus on its definition. Some studies define sarcopenia as low muscle mass alone, whereas other studies have recently combined low muscle mass, strength and physical performance suggested by the European Working Group on Sarcopenia in Older People, as well as the Asian Working Group for Sarcopenia. The arbitrary use of various available sarcopenia definitions within the literature can cause discrepancies in the prevalence and associated risk factors. The application of population‐specific cut‐off values in any sample population can be problematic, particularly among different ethnicities. Using commonly used cut‐off points to define sarcopenia, including solely muscle mass and combined definitions, on a community‐dwelling elderly Japanese population, the prevalence of sarcopenia ranged from 2.5 to 28.0% in men and 2.3 to 11.7% in women, with muscle mass measured by dual‐energy X‐ray absorptiometry, and 7.1–98.0% in men and 19.8–88.0% in women measured by bioelectrical impedance analysis. Body mass index was the most prominent related factor for sarcopenia across the definitions in this Japanese sample. However, other associated hematological and chronic condition factors varied depending on the definition. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 110–122.

Comparison of segmental multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body composition in a community-dwelling older population

The purpose of the present study was to examine the agreement of segmental multifrequency bioelectrical impedance analysis (SMF‐BIA) for the assessment of whole‐body and appendicular fat mass (FM) and lean soft tissue mass (LSTM) compared with dual‐energy X‐ray absorptiometry (DXA) in a community‐dwelling Japanese older population.

Validation of lower extremity performance tests for determining the mobility limitation levels in community-dwelling older women

Background and aims: Assessment of mobility status among community-dwelling older people is important for preventing further deterioration of mobility and identifying changes in mobility as early as possible. We attempted to identify the optimal cut-off values for eight lower extremity performance (LEP) tests in community-dwelling older women with mobility limitation (ML) levels. Methods: The ML levels of 433 community-dwelling older women, mean age 73.2 years (SD 5.7, range 65–93) were classified according to self-reports. ML levels were identified by face-to-face interviews and according to self-reported difficulty in walking one-quarter of a mile or climbing 10 steps without resting. The LEP tests comprised one-legged stance, tandem stance, functional reach, tandem walk, alternate step, five chair sit-to-stands, timed up-and-go (TUG) and usual gait speed. Receiver-operating characteristic curves were obtained for all scales to assess optimal cut-off values. Results: The optimal cut-off value of 6.52 (s) for the TUG test was shown by the highest sensitivity (74%) and specificity (71%) in the discrimination of no ML from moderate ML, whereas the optimal cut-off value of 1.05 (m/s) in the usual gait speed test showed the highest sensitivity (73%) and specificity (67%) in the discrimination of moderate ML from severe ML. Conclusions: Among community-dwelling older women, TUG and usual gait speed had the highest sensitivity and specificity in discriminating ML levels.

Indirect lifestyle intervention through wives improves metabolic syndrome components in men

Objectives:It is well known that body weight loss through a direct (supervised) lifestyle intervention (LSI) improves obesity-related metabolic disorders. The purpose of this study was to investigate the effects of an indirect LSI on weight loss and metabolic syndrome (MetS) in spouses of LSI participants.Methods:A total of 104 men (abdominal circumference⩾85 cm; age, 52.1±9.3 years) were assigned to one of three groups: no intervention (NI, n=34), direct intervention (DI, n=34) or indirect intervention (II, n=36), the last of which consisted of subjects who did not participate in the direct LSI but whose wives did. Body weight and MetS components were measured before and after a 14-week intervention. Daily energy intake and activity-related energy expenditure were assessed before and during the intervention. The LSI program was mainly consisted of dietary modifications with a physical activity program.Results:No differences were observed across the three groups in any of the measures at baseline. Significant differences were observed among the groups in weight loss (NI, −0.7±1.4; DI, −6.2±3.3 and II, −4.4±3.7 kg) during the intervention. Along with the body weight reductions, significant improvements were observed in most of MetS components within the DI and II groups. When analyzing the spouse pairs in group II, significant correlations were observed in weight loss (r=0.57) and decreased total energy intake (r=0.54) between wives and husbands.Conclusions:Indirect LSI in abdominally obese men whose wives were undergoing LSI led to loss of weight and a decreased incidence of MetS, suggesting that indirect LSI may be an effective program for eliciting beneficial change in health status.