Low fat-free mass as a marker of mortality in community-dwelling healthy elderly subjects†

Background: low fat-free mass has been related to high mortality in patients. This study evaluated the relationship between body composition of healthy elderly subjects and mortality. Methods: in 1999, 203 older subjects underwent measurements of body composition by bioelectrical impedance analysis, Charlson co-morbidity index and estimation of energy expenditure through physical activity by a validated questionnaire. These measurements were repeated in 2002, 2005 and 2008 in all consenting subjects. Mortality data between 1999 and 2010 were retrieved from the local death registers. The relationship between mortality and the last indexes of fat and fat-free masses was analysed by multiple Cox regression models. Results: women's and men's data at last follow-up were: age 81.1±5.9 and 80.9±5.8 years, body mass index 25.3±4.6 and 26.1±3.4kg/m2, fat-free mass index 16.4±1.8 and 19.3±1.9kg/m2 and fat mass index 9.0±3.2 and 6.8±2.0kg/m2. Fifty-eight subjects died between 1999 and 2010. The fat-free mass index (hazard ratio 0.77; 95% confidence interval 0.63-0.95) but not the fat mass index, predicted mortality in addition to sex and Charlson index. The multiple Cox regression model explained 31% of the variance of mortality. Conclusion: a low fat-free mass index is an independent risk factor of mortality in elderly subjects, healthy at the time of body composition measuremen

Rationale for the treatment of children with CCSK in the UMBRELLA SIOP-RTSG 2016 protocol

The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) has developed a new protocol for the diagnosis, treatment, and follow-up monitoring of childhood renal tumours-the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). This protocol has been designed to continue international collaboration in the treatment of childhood renal tumours and will be implemented in over 50 different countries. Clear cell sarcoma of the kidney, which is a rare paediatric renal tumour that most commonly occurs in childre

How to Prevent Loss of Muscle Mass and Strength among Older People in Neuro-Rehabilitation?

Stroke is the second leading cause of death worldwide but also of disability. Stroke induces certain alterations of muscle metabolism associated with gross muscle atrophy and a decrease in muscle function, leading to sarcopenia. The vast majority of stroke cases occur in adults over 65 years of age, and the prevalence is expected to massively increase in the coming years in this population. Sarcopenia is associated with higher mortality and functional decline. Therefore, the identification of interventions that prevent muscle alterations after stroke is of great interest. The purpose of this review is to carry out a systematic literature review to identify evidence for nutritional and pharmacological interventions, which may prevent loss of muscle mass in the elderly after stroke. The search was performed on Medline in December 2018. Randomized controlled studies, observational studies and case reports conducted in the last 20 years on post-stroke patients aged 65 or older were included. In total, 684 studies were screened, and eight randomized control trials and two cohort studies were finally included and examined. This review reveals that interventions such as amino acid supplementation or anabolic steroid administration are efficient to prevent muscle mass. Little evidence is reported on nutritional aspects specifically in sarcopenia prevention after stroke. It pinpoints the need for future studies in this particular population

Bioimpedance-Derived Phase Angle and Mortality Among Older People.

BACKGROUND Phase angle measured by bioelectrical impedance analysis (BIA) may be a marker of health state. OBJECTIVE This historical cohort study of prospectively collected BIA measurements aims to investigate the link between phase angle and mortality in older people and evaluate whether a phase angle cutoff can be defined. DESIGN We included all adults aged ≥65 years who underwent a BIA measurement by the Nutriguard(®) device at the Geneva University Hospitals. We retrieved retrospectively the phase angle and comorbidities at the last BIA measurement and mortality until December 2012. We calculated phase angle standardized for sex, age, and body mass index (BMI), using reference values determined with the same brand of BIA device. Sex-specific and standardized phase angle were categorized into quartiles. The association of mortality with sex-specific or standardized phase angle was evaluated through univariate and multivariate Cox regression models, Kaplan-Meier curves, and receiver operating characteristic (ROC) curves. RESULTS We included 1307 (38% women) participants, among whom 628 (44% women) died. In a multivariate Cox regression model adjusted for comorbidities and setting of measurement (ambulatory vs. hospitalized), the protective effect against mortality increased progressively as the standardized phase angle quartile increased (HR 0.71 [95% CI 0.58, 0.86], 0.53 [95% CI 0.42, 0.67], and 0.32 [95% CI 0.23, 0.43]). The discriminative value of continuous standardized phase angle, assessed as the area under the ROC curve, was 0.72 (95%CI 0.70, 0.75). We could not define an acceptable phase angle cutoff for individual prediction of mortality (LK), based on sensibility and specificity values. CONCLUSIONS This study shows the association of phase angle and mortality in older patients, independent of age, sex, comorbidities, BMI categories, and setting of measurement

Association of mortality and phase angle measured by different bioelectrical impedance analysis (BIA) devices.

PURPOSE A high phase angle measured by the Nutriguard(®) bioelectrical impedance analysis device is associated with a reduced mortality risk in older people. This retrospective study aims to analyze whether this association persists with the other devices that have been used in our hospital. METHODS This study encompasses all people 65 yrs and older who underwent a phase angle measurement between 1990 and 2011 at the Geneva University Hospitals, with the RJL-101(®) (RJL Systems), Xitron 4000B(®) (Xitron Technologies), Eugedia(®) (Eugédia-Spengler) and Bio-Z(®) (Spengler). Diseases at the time of phase angle measurement were reported in the form of the Cumulative Illness Rating Scale. Date of death was retrieved until December 2012. Phase angle values were categorized into sex- and device-specific quartiles, where quartile 1 represents the lowest quartile and reference value. Cox regressions were performed to evaluate the association between phase angle quartiles and mortality. RESULTS We considered 1878 people (969 women), of whom 1151 had died. In univariate sex-specific Cox regressions, the death risk decreased progressively as the phase angle quartile measured by the Bio-Z(®) or RJL-101(®) increased. The HR (95% CI) in quartile 4 was 0.36 (0.26, 0.50) and 0.38 (0.29, 052) in women and men measured with the Bio-Z(®) (both p < 0.001), and 0.23 (0.14, 0.39) and 0.19 (0.10, 0.36) in women and men measured with the RJL-101(®) (both p < 0.001). The association between phase angle and mortality persisted when adjusted for age, body mass index or co-morbidities. The small number of deaths in people who underwent a measurement by Eugedia(®) (n = 93) or Xitron 4000B(®) (n = 56) did not allow performing multivariate Cox regressions. CONCLUSIONS Phase angle quartiles are associated with mortality in people aged ≥65 years when using the RJL-101(®) or Bio-Z device(®)

Dynamic image denoising for voxel-wise quantification with Statistical Parametric Mapping in molecular neuroimaging.

PURPOSE:PET and SPECT voxel kinetics are highly noised. To our knowledge, no study has determined the effect of denoising on the ability to detect differences in binding at the voxel level using Statistical Parametric Mapping (SPM). METHODS:In the present study, groups of subject-images with a 10%- and 20%- difference in binding of [123I]iomazenil (IMZ) were simulated. They were denoised with Factor Analysis (FA). Parametric images of binding potential (BPND) were produced with the simplified reference tissue model (SRTM) and the Logan non-invasive graphical analysis (LNIGA) and analyzed using SPM to detect group differences. FA was also applied to [123I]IMZ and [11C]flumazenil (FMZ) clinical images (n = 4) and the variance of BPND was evaluated. RESULTS:Estimations from FA-denoised simulated images provided a more favorable bias-precision profile in SRTM and LNIGA quantification. Simulated differences were detected in a higher number of voxels when denoised simulated images were used for voxel-wise estimations, compared to quantification on raw simulated images. Variability of voxel-wise binding estimations on denoised clinical SPECT and PET images was also significantly diminished. CONCLUSION:In conclusion, noise removal from dynamic brain SPECT and PET images may optimize voxel-wise BPND estimations and detection of biological differences using SPM

Body composition and all-cause mortality in subjects older than 65 y.

BACKGROUND A low or high body mass index (BMI) has been associated with increased mortality risk in older subjects without taking fat mass index (FMI) and fat-free mass index (FFMI) into account. This information is essential because FMI is modulated through different healthcare strategies than is FFMI. OBJECTIVE We aimed to determine the relation between body composition and mortality in older subjects. DESIGN We included all adults ≥65 y old who were living in Switzerland and had a body-composition measurement by bioelectrical impedance analysis at the Geneva University Hospitals between 1990 and 2011. FMI and FFMI were divided into sex-specific quartiles. Quartile 1 (i.e., the reference category) corresponded to the lowest FMI or FFMI quartile. Mortality data were retrieved from the hospital database, the Geneva death register, and the Swiss National Cohort until December 2012. Comorbidities were assessed by using the Cumulative Illness Rating Scale. RESULTS Of 3181 subjects included, 766 women and 1007 men died at a mean age of 82.8 and 78.5 y, respectively. Sex-specific Cox regression models, which were used to adjust for age, BMI, smoking, ambulatory or hospitalized state, and calendar time, showed that body composition did not predict mortality in women irrespective of whether comorbidities were taken into account. In men, risk of mortality was lower with FFMI in quartiles 3 and 4 [HR: 0.78 (95% CI: 0.62, 0.98) and 0.64 (95% CI: 0.49, 0.85), respectively] but was not affected by FMI. When comorbidities were adjusted for, FFMI in quartile 4 (>19.5 kg/m(2)) still predicted a lower risk of mortality (HR: 0.72; 95% CI: 0.54, 0.96). CONCLUSIONS Low FFMI is a stronger predictor of mortality than is BMI in older men but not older women. FMI had no impact on mortality. These results suggest potential benefits of preventive interventions with the aim of maintaining muscle mass in older men. This trial was registered at clinicaltrials.gov as NCT01472679

Prognostic Role of Subcutaneous and Visceral Adiposity in Hospitalized Octogenarians with COVID-19

Background: We investigated the prognostic significance of visceral and subcutaneous adiposity in octogenarians with COVID-19. Methods: This paper presents a monocentric retrospective study that was conducted in acute geriatric wards with 64 hospitalized patients aged 80+ who had a diagnosis of COVID-19 and who underwent a chest CT scan. A quantification of the subcutaneous, visceral, and total fat areas was performed after segmentations on the first abdominal slice caudal to the deepest pleural recess on a soft-tissue window setting. Logistic regression models were applied to investigate the association with in-hospital mortality and the extent of COVID-19 pneumonia. Results: The patients had a mean age of 86.4 ± 6.0 years, and 46.9% were male, with a mean BMI of 24.1 ± 4.4Kg/m2 and mortality rate of 32.8%. A higher subcutaneous fat area had a protective effect against mortality (OR 0.416; 0.183–0.944 95% CI; p = 0.036), which remained significant after adjustments for age, sex, and BMI (OR 0.231; 0.071–0.751 95% CI; p = 0.015). Inversely, higher abdominal circumference, total fat area, subcutaneous fat area, and visceral fat were associated with worse COVID-19 pneumonia, with the latter presenting the strongest association after adjustments for age, sex, and BMI (OR 2.862; 1.523–5.379 95% CI; p = 0.001). Conclusion: Subcutaneous and visceral fat areas measured on chest CT scans were associated with prognosis in octogenarians with COVID-19