Dual-Energy X-Ray Absorptiometry for Quantification of Visceral Fat

Obesity is the major risk factor for metabolic syndrome and through it diabetes as well as cardiovascular disease. Visceral fat (VF) rather than subcutaneous fat (SF) is the major predictor of adverse events. Currently, the reference standard for measuring VF is abdominal X-ray computed tomography (CT) or magnetic resonance imaging (MRI), requiring highly used clinical equipment. Dual-energy X-ray absorptiometry (DXA) can accurately measure body composition with high-precision, low X-ray exposure, and short-scanning time. The purpose of this study was to validate a new fully automated method whereby abdominal VF can be measured by DXA. Furthermore, we explored the association between DXA-derived abdominal VF and several other indices for obesity: BMI, waist circumference, waist-to-hip ratio, and DXA-derived total abdominal fat (AF), and SF. We studied 124 adult men and women, aged 18–90 years, representing a wide range of BMI values (18.5–40 kg/m2) measured with both DXA and CT in a fasting state within a one hour interval. The coefficient of determination (r2) for regression of CT on DXA values was 0.959 for females, 0.949 for males, and 0.957 combined. The 95% confidence interval for r was 0.968 to 0.985 for the combined data. The 95% confidence interval for the mean of the differences between CT and DXA VF volume was −96.0 to −16.3 cm3. Bland–Altman bias was +67 cm3 for females and +43 cm3 for males. The 95% limits of agreement were −339 to +472 cm3 for females and −379 to +465 cm3 for males. Combined, the bias was +56 cm3 with 95% limits of agreement of −355 to +468 cm3. The correlations between DXA-derived VF and BMI, waist circumference, waist-to-hip ratio, and DXA-derived AF and SF ranged from poor to modest. We conclude that DXA can measure abdominal VF precisely in both men and women. This simple noninvasive method with virtually no radiation can therefore be used to measure VF in individual patients and help define diabetes and cardiovascular risk

Comparing the performance of three generations of ActiGraph accelerometers

ActiGraph accelerometers are a useful tool for objective assessment of physical activity in clinical and epidemiological studies. Several generations of ActiGraph are being used; however, little work has been done to verify that measurements are consistent across generations. This study employed mechanical oscillations to characterize the dynamic response and intermonitor variability of three generations of ActiGraph monitors, from the oldest 7164 (n = 13), 71256 (n = 12), to the newest GT1M (n = 12). The response due to independent radius (22.1–60.4 mm) and frequency (25–250 rpm) changes were measured, as well as intermonitor variability within each generation. The 7164 and 71256 have similar relationships between activity counts and radius (P = 0.229) but were significantly different from the GT1M (P < 0.001). The frequency responses were nonlinear in all three generations. Although the response curve shapes were similar, the differences between generations at various frequencies were significant (P < 0.017), especially in the extremes of the measurement range. Intermonitor variability was markedly reduced in the GT1M compared with the 7164 and 71256. Other measurement differences between generations include decreased peak counts and decreased sensitivity in low-frequency detection in the GT1M. The results of this study revealed an improvement of the intermonitor variability by the GT1M monitor. However, the reduced sensitivity in low-count ranges in the GT1M may not be well suited for monitoring sedentary or light-intensity movements. Furthermore, the algorithms for energy expenditure predictions developed using older 7164 monitors may need to be modified for the GT1M

A Prospective Comparison of the 21-Gene Recurrence Score and the PAM50-Based Prosigna in Estrogen Receptor-Positive Early-Stage Breast Cancer

The 21-gene Recurrence Score(A (R)) assay (Oncotype DXA (R), Genomic Health, Inc.) is a validated predictor of recurrence risk/chemotherapy benefit in patients with estrogen receptor-positive (ER+) early-stage breast cancer treated with endocrine therapy. The Prosigna(A (R)) assay (NanoString Technologies Inc.) is a validated prognosticator in postmenopausal patients with low-risk ER+ early-stage breast cancer treated with endocrine therapy. The assays were analytically/clinically developed and validated differently. This study focused on comparing recurrence risk estimates as determined by these assays and is the first blinded comparison of these assays on matched patient samples. Sequential breast cancer specimens from postmenopausal, node-negative, ER+ patients treated at the Marin General Hospital were analyzed: first by the 21-gene assay then by the Prosigna assay in an independent lab blinded to the Recurrence Score results. The final analysis included 52 patients. Correlation between the Recurrence Score and the Prosigna assay results was poor (r = 0.08). Agreement between risk classifications based on these assays was 54%; 4/7 of patients classified as high risk by the Prosigna assay had low Recurrence Score results. Two tumors with high Recurrence Score results had low ER expression (close to positivity threshold); both of which had a low/intermediate Prosigna assay result. The Prosigna assay classified 73.1% and 23.1% of samples as luminal A and luminal B, respectively. A range of Recurrence Score results was observed within the subtypes; 83% of luminal B samples had a low Recurrence Score result. Consistent with prior comparisons between the 21-gene and other genomic assays, our study demonstrated substantial differences in the way patients are risk stratified, suggesting that the different assays are not interchangeable. Genomic Health, Inc