Management of Sarcopenic Obesity for Older Adults with Lower-Extremity Osteoarthritis

Lower-extremity osteoarthritis (OA) is a prevalent musculoskeletal disease in elder population. The main symptom of OA is pain which leads to muscle weakness and physical disability. Recently, muscle weakness, function limitation, and severity of disease in OA are addressed to aging-related muscle attenuations. Therefore, elder individuals with OA are under potential sarcopenia risks. In addition, obesity, which exerts negative impacts on disease outcomes, has become a burden in OA population. Under multifactor risks of OA, it is important to identify effectiveness of multidisciplinary management for such elder population to prevent sarcopenic obesity and maintain physical function. Previous studies have indicated that diet intervention (DI) using protein supplement, dietary protein, or weight loss enhances exercise efficacy in terms of additional muscle mass and strength gains to exercise training (ET) for elder individuals with high sarcopenia and frailty risks. However, it remains unclear whether DI in combination with ET augments any benefit for older adults with lower-extremity OA. This chapter aimed to review the effects of DI plus ET on muscle mass, strength, and physical function outcomes in older individuals with lower-extremity OA

Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency

BackgroundIndependence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored.MethodsA total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children’s daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment.FindingsA negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment.ConclusionsChildren’s participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed

A pilot study of videoconferencing for an Internet-based weight loss programme for obese adults in Taiwan

[[abstract]]We conducted a pilot study of the feasibility of an Internet-based weight loss programme using videoconferencing to emulate face-to-face situations and a Web service to support self-monitoring. A pre–post test design was used to compare changes in bodyweight, metabolic variables and attendance rate. Nine subjects lost on average 5.9 kg (6.0% of body weight, P<0.001) over the course of the 12-week programme. Waist circumference was reduced significantly (10.2 cm, P=0.03). Total cholesterol, aspartate transferase (AST) and alanine transferase (ALT) significantly decreased. Eight participants completed a questionnaire after the intervention. Overall, responders were satisfied with the protocol and considered the Internet weight loss programme to be helpful to them. One technical problem was that Internet congestion could reduce the quality of audio and video. The Internet appears to hold promise as a medium to facilitate communication in weight loss programmes

Esr1, Fto, and Ucp2 Genes Interact with Bariatric Surgery Affecting Weight Loss and Glycemic Control in Severely Obese Patients

Significant variability in weight loss and glycemic control has been observed in obese patients receiving bariatric surgery. Genetic factors may play a role in the different outcomes. Five hundred and twenty severely obese patients with body mass index (BMI) a parts per thousand yen35 were recruited. Among them, 149 and 371 subjects received laparoscopic adjustable gastric banding (LAGB) and laparoscopic mini- gastric bypass (LMGB), respectively. All individuals were genotyped for five obesity-related single nucleotide polymorphisms on ESR1, FTO, PPAR gamma, and UCP2 genes to explore how these genes affect weight loss and glycemic control after bariatric surgery at the 6th month. Obese patients with risk genotypes on rs660339-UCP2 had greater decrease in BMI after LAGB compared to patients with non-risk genotypes (-7.5 vs. -6 U, p = 0.02 ). In contrast, after LMGB, obese patients with risk genotypes on either rs 712221-ESR1 or rs9939609-FTO had significant decreases in BMI (risk vs. non-risk genotype, -12.5 vs. -10.0 U on rs 712221, p = 0.02 and -12.1 vs. -10.6 U on rs9939609, p = 0. 04) and a significant amelioration in HbA1c levels (p = 0. 038 for rs712221 and p < 0.0001 for rs9939609). The synergic effect of ESR1 and FTO genes on HbA1c amelioration was greater (- 1.54%, p for trend < 0.001) than any of these genes alone in obese patients receiving LMGB. The genetic variants in the ESR, FTO, and UCP2 genes may be considered as a screening tool prior to bariatric surgery to help clinicians predict weight loss or glycemic control outcomes for severely obese patients

Prevalence and secular trends in overweight and obese Taiwanese children and adolescents in 1991-2003

[[abstract]]OBJECTIVE: To describe recent trends in overweight and obese schoolchildren in Taiwan using international cut-off points. DESIGN: Three independent cross-sectional surveys were used. PARTICIPANTS: The study enrolled 157 485 students in 1991, 130 770 students in 1997 and 72 789 students in 2003, all aged 6-18 years, from elementary schools, secondary high schools and senior vocational high schools. RESULTS: The prevalence of overweight and obese students increased significantly between 1991 and 2003. During this period, the percentage of male overweight and obese students increased from 5.7% to 14.2% and from 7.9% to 17.4%, respectively. The prevalence of female overweight and obese students increased from 11.1% to 13.4% and from 3.1% to 4.1%, respectively. Covariance analysis indicates that both sexes in 2003 had significantly higher percentages of overweight and obese subjects than those in 1991 and 1997 (p<0.001). Additionally, the prevalence of overweight and obese boys was higher than that for girls in each survey (p<0.001). DISCUSSION: Analytical results demonstrate that prevalence and secular trends in overweight and obese Taiwanese children and adolescents increased significantly from 1991 to 2003. Taiwanese boys are more likely to become overweight and obese than their female counterparts

Improving sleep quality for cancer patients: Benefits of a home-based exercise intervention

Purpose: 1) To determine the effect of a home-based walking exercise program on the sleep quality and quality of life of cancer patients, as well as 2) to determine if enhanced sleep quality was associated with improvement in quality of life over time. Methods: This is a prospective, longitudinal, two-armed, randomized clinical trial. Participants were recruited from oncology outpatient clinics in two university-based medical centers and were allocated to either usual care (n=35) or a home-based walking exercise intervention for 8 weeks (n=36). Measurements included the Taiwanese version of the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Short Form-36, the Taiwanese Version Ratings of the Perceived Exertion Scale, and a walking exercise log. This study was analyzed on an intention-to-treat basis. Effects of the walking exercise program on sleep quality and quality of life were analyzed by the generalized estimating equation method. Results: Patients in the exercise group reported significant improvements in sleep quality (β=-3.54, p<0.01) and the mental health dimension of quality of life (β=10.48, p<0.01). Among patients who exercised, enhanced sleep quality also corresponded with reduced bodily pain (β=0.98, p=0.04) and improvements over time in the mental health dimension of quality of life (β=-3.87, p<0.01). Conclusions: A home-based walking exercise program can be easily incorporated into care for cancer patients who are suffering from sleep disturbances. © Springer-Verlag 2009.Link_to_subscribed_fulltex

Patients with Rheumatoid Arthritis Were Associated with a Risk of Rotator Cuff Diseases

Rheumatoid arthritis (RA) commonly causes inflammation in the joints and periarticular structures. The association between RA and rotator cuff (RC) has been reported; however, epidemiological studies on RA and RC tendons are scant. Therefore, we investigated RC disease (RCD) risk and analyzed the effects of RA medication, steroids, and methotrexate, on the risk of RCD for patients with RA. We conducted a retrospective cohort study with a 6-year longitudinal follow-up in Taiwan. Patients who received RA diagnoses between 2004 and 2008 were enrolled in the study cohort. The non-RA control cohort comprised age- and sex-matched controls. Propensity score matching was used for other comorbidities and treatments. The hazard ratios (HRs) and adjusted HRs (aHRs) were estimated after confounders were adjusted for. Effects of steroid and methotrexate use on RCD risk were also analyzed. We enrolled 4521 RA patients (study cohort) and 22,605 matched controls. RCD incidence was 145 and 91 per 100,000 person-years in the RA and control cohorts, respectively. In the RA cohort, the crude HR for RCD was 1.62 (95% confidence interval (CI), 1.41–1.86, p &lt; 0.001), and the aHR was 1.56 (95% CI, 1.36–1.79, p &lt; 0.001). The methotrexate nonusers exhibited an aHR (vs. controls) of 1.61 (95% CI, 1.40–1.85, p &lt; 0.001), but the methotrexate users did not have a significantly higher aHR than the controls. The steroid nonusers had an aHR (vs. controls) of 1.69 (95% CI, 1.46–1.96, p &lt; 0.001), but the aHR of the steroid users was not significantly higher than the control aHR. Patients with RA had a higher risk for RCD compared with the non-RA control cohort. Steroids or methotrexate use significantly reduces the risk of RCD occurrence in patients with RA. Treatment for RCD symptoms and controlling inflammatory process are important to ensure high-quality care for patients with RA