R. Sammarco

Accuracy of Predictive Equations for Estimating Resting Energy Expenditure in Obese Adolescents

OBJECTIVE To compare resting energy expenditure (REE) measured by indirect calorimetry with REE predicted using different equations in obese adolescents. STUDY DESIGN We recruited 264 obese patients (body mass index ranging from 30.0-70.0 kg/m(2)) between 14 and 18 years of age. Data were obtained comparing measured and predicted REE derived from published equations for normal weight and obese adolescents. The average differences between measured and predicted REE, as well as the accuracy at ± 10% level, were evaluated. RESULTS Evaluating the mean REE in 109 males (1938 ± 271 kcal/d) and 155 females (2569 ± 459 kcal/d), we found that the Lazzer equation in males had the smallest difference between measured and predicted REE; in females the Henry-1, Food and Agriculture Organization/World Health Organization/United Nations University, Schmelze, and Lazzer equations were the most accurate. The prediction accuracy was considered adequate within ± 10%. CONCLUSIONS REE predictive equations developed in obese patients and for specific age groups are more suitable than those for the general population. Inaccuracy of predicted REE could affect dietary prescription appropriateness and, consequently, dietary compliance in this age group.

Preliminary evaluation of the prevalence of sarcopenia in obese patients from Southern Italy

OBJECTIVES Sarcopenic obesity has not yet been widely defined. The aim of this study was to evaluate the prevalence of sarcopenia in a group of severely obese adults from southern Italy by using two different indexes: percentage of skeletal muscle mass (SMP) and skeletal muscle mass normalized for height (SMI); and to determine SMP and SMI cutoff points in a southern Italy reference population. METHODS Skeletal muscle mass of 131 consecutive obese adult outpatients (51 men and 80 women; ages 45-67 y; body mass index 44.6 ± 7.7 kg/m(2)), was assessed by bioimpedance analysis. SMP and SMI cutoff points to identify moderate and severe sarcopenia were calculated in a reference group of 500 young southern Italy adults (100 men and 400 women; ages 18-40 y; body mass index 25.2 ± 5.6 kg/m(2)) and applied to assess the prevalence of sarcopenia in the study population. RESULTS SMP cutoff points to identify moderate and severe sarcopenia were, 28.8% to 35.6% and ≤ 28.7% in men and 23.1% to 28.4% and ≤ 23% in women, respectively. The corresponding values for SMI were 8.44 to 9.53 kg/m(2) and ≤ 8.43 kg/m(2) in men, 6.49 to 7.32 kg/m(2) and ≤ 6.48 kg/m(2) in women. According to SMP, 23 of 51 (45.1%) men and 19 of 80 (23.8%) women were moderately sarcopenic; 28 of 51 (54.9%) men and 61 of 80 (76.3%) women met the definition of severe sarcopenia. Based on SMI, only 2 of 51 (3.9%) men were moderately sarcopenic. CONCLUSIONS This study confirms that sarcopenia rates vary widely in obese patients depending on the criteria used. SMP as a screening tool to identify a sarcopenia at-risk population.

Evaluation of Hypocaloric Diet With Protein Supplementation in Middle-Aged Sarcopenic Obese Women: A Pilot Study

Objective: The aim of this study was to evaluate the efficacy of a nutritional program, which is characterized by a different modulation of proteins, in adult patients with sarcopenic obesity. Methods: We studied 18 obese women aged 41-74 years. Obesity was diagnosed as fat mass > 34.8% and sarcopenia was defined when lean body mass was <90% of the subjects ideal fat free mass. All subjects were randomly assigned to different nutritional interventions: Hypocaloric diet plus placebo (A) and hypocaloric high-protein diet (1.2-1.4 g / kg body weight reference / day) (B). Anthropometric measurements, body composition, resting energy expenditure, handgrip test, Short Physical Performance Battery (SPPB), and SF-36 questionnaire were evaluated at baseline and after 4 months. Results: Weight significantly decreased in both groups. Women with high-protein diet preserved lean body mass compared to low-calorie diet and improved significantly muscle strength; SPPB score did not change in both groups. SF-36 test showed a significant change for general health after 4 months in group B. Conclusions: In our study, sarcopenic obese patients with high-protein diet showed an improvement in muscle strength. Furthermore, dietary protein enrichment may represent a protection from the risk of sarcopenia following a hypocaloric diet.

SUN-PP218: Dietary Intervention in Middle Age Obese Sarcopenic Females

Rationale: Undernutrition screening and assessment tools are made up of different components. Undernutrition has been associated with longer length of hospital stay (LOS) but it is not known which components have the greatest power in predicting LOS. We aimed to investigate the association of several under nutrition components with LOS. Methods: Demographic, clinical, anthropometric and nutritional data were obtained in 683 inpatients. LOS was determined from the date of hospital admission and discharge home (event of interest). Cox proportional hazard ratios (HR) models were adjusted for age, education, comorbidities and independence in activities of daily living. Results: Factors independently associated with lower probability of being discharged home were: weight loss >5% (HR = 0.65, 95%CI = 0.53 0.79), depletion of triceps skinfold (0.77, 0.65 0.91) or adductor pollicis (0.76, 0.59 0.98), decreased food intake in the preceding admission month (0.66, 0.55 0.80), gastrointestinal symptoms (0.71, 0.58 0.86), moderate (0.54, 0.40 0.73) and severe (0.66, 0.52 0.83) functional impairment and low handgrip strength quartiles [3rd: 0.77 (0.61 0.96); 2nd: 0.61 (0.48 0.77) and 1st (lowest): 0.50 (0.39 0.64) versus 4th]. Mid arm muscle circumference, oedema and ascites and decreased food intake in the preceding admission week were not associated with LOS. Conclusion: Weight loss, depletion of triceps skinfold and adductor pollicis, decreased food intake in the preceding admission month, gastrointestinal symptoms, functional impairment and low handgrip strength quartiles were the components of under nutrition tools that independently predicted LOS. These results are a relevant contribution in improving under nutrition tools.

Screening for sarcopenia in obesity

Sarcopenia is a progressive and generalized loss of skeletal muscle mass (SM) and function which can also be found in obese adults. The aim of the study was to evaluate the prevalence of sarcopenia in 1 245 obese women (18 – 67 years, weight 114.7±24.5 kg; BMI 44.1±9.2; fat mass 49.0±6.2%) from Southern Italy. Body composition was evaluated by bioimpedance analysis (BIA) and SM calculated by using Janssens equation; therefore the sex-specific cut-off points of percentage skeletal muscle index were used. The whole population was divided in two age groups: A (18-40 years; n. 808; weight 115.4±23.5 kg; BMI 43.8±8.8 kg/m2) and B (41-67 years; n. 438; weight 113.4±26.3 kg; BMI 44.8±9.9 kg/m2). In all the sample there was 2.7% moderate and 0.6% severe sarcopenia; in group A, 1.9% moderate and 0.6% severe sarcopenia whilst in group B 4.3% moderate and 0.7% severe sarcopenia. The results of our study suggest that, based on a screening examination by BIA, moderate/severe sarcopenia can be detected in an unselected middle-aged obese population. Further studies are required to clarify the diagnosis with functional tests.