Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA

BACKGROUND/OBJECTIVES: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. SUBJECTS/METHODS: Body composition of 13 females with ED and 117 controls, aged 10-18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. RESULTS: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5 +/- 36% and underestimated FFM by 1 +/- 9% in ED patients. CONCLUSION: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients

Different degrees of malnutrition and immunological alterations according to the aetiology of cirrhosis: a prospective and sequential study

OBJECTIVES: In this work we investigated how immunological dysfunction and malnutrition interact in alcoholic and viral aetiologies of cirrhosis. METHODS: To investigate the matter, 77 cirrhotic patients divided in three aetiologies [Alcohol, HCV and Alcohol + HCV) and 32 controls were prospectivelly and sequentially studied. Parameters of humoral immunity (Components 3 and 4 of seric complement and immunoglobulins A M, G and E) and of cellular immunity (total leukocytes and lymphocytes in peripheral blood, T lymphocytes subpopulations, CD4+ and CD8+, CD4+/CD8+ ratio and intradermic tests of delayed hypersensitivity), as well as nutrititional parameters: anthropometric measures, serum albumin and transferrin were evaluated. RESULTS: Multiple statistical comparisons showed that IgM was higher in HCV group; IgG was significantly elevated in both HCV and Alcohol + HCV, whereas for the Alcohol group, IgE was found at higher titles. The analysis of T- lymphocytes subpopulations showed no aetiologic differences, but intradermic tests of delayed hypersensitivity did show greater frequency of anergy in the Alcohol group. For anthropometric parameters, the Alcohol +HCV group displayed the lowest triceps skinfold whereas creatinine – height index evaluation was more preserved in the HCV group. Body mass index, arm muscle area and arm fat area showed that differently from alcohol group, the HCV group was similar to control. CONCLUSION: Significant differences were found among the main aetiologies of cirrhosis concerning immunological alterations and nutritional status: better nutrition and worse immunology for HCV and vice-versa for alcohol

Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático

INTRODUÇÃO: A doença hepática crônica resulta em grande impacto funcional, causando perda de massa e função muscular com consequente redução da capacidade funcional. OBJETIVO: Avaliar e comparar a força muscular respiratória e a capacidade funcional dos candidatos ao transplante hepático que possuem classe B ou C segundo o Child-Pugh Score e correlacionar estas variáveis dentro de cada grupo. MÉTODOS: Estudo transversal, com amostra de conveniência composta por 35 pacientes, divididos em dois grupos a partir da pontuação obtida no Child-Pugh Score, sendo B (19 pacientes) e C (16 pacientes). Todos os indivíduos foram avaliados em um único momento, sendo mensuradas as pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) e a distância percorrida no teste de caminhada de seis minutos (TC6M). RESULTADOS: Os indivíduos classificados com Child-Pugh Score B apresentaram maiores valores na PImáx (-86,05 ± 23,89 vs. -57,94 ± 14,14), p = 0,001, na PEmáx (84,16 ± 28,26 vs. 72,00 ± 16,94), p = 0,142, e na distância percorrida no TC6M (473,63 ± 55,276 vs. 376,13 ± 39,00), p = 0,001. Encontramos, ainda, correlação positiva entre os valores da PImáx e a distância percorrida no TC6M dentro grupo Child-Pugh Score B, r = 0,64 e p = 0,003. CONCLUSÃO: O progresso da doença hepática contribui para o surgimento de diversas complicações que, em conjunto, parecem contribuir para a redução da capacidade funcional dos indivíduos. Em nosso trabalho, isso ficou evidenciado pelo pior desempenho do grupo Child-Pugh Score C. Isto pode sugerir que a espera para o transplante hepático (TxH) pode agravar a capacidade funcional e a força muscular respiratória desses indivíduos