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Summary In this study, we compare the extent to which seven available definitions of sarcopenia and two related definitions predict the rate of falling. Our results suggest that the definitions of Baumgartner and Cruz-Jentoft best predict the rate of falls among sarcopenic versus non-sarcopenic community-dwelling seniors. Introduction The purpose of the study is to compare the extent to which seven available definitions of sarcopenia and two related definitions predict the prospective rate of falling. Methods We studied a cohort of 445 seniors (mean age 71 years, 45 % men) living in the community who were followed with a detailed fall assessment for 3 years. For comparing the rate of falls in sarcopenic versus non-sarcopenic individuals, we used multivariate Poisson regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the seven available definitions, three were based on low lean mass alone (Baumgartner, Delmonico 1 and 2) and four required both low muscle mass and decreased performance in a functional test (Fielding, Cruz-Jentoft, Morley, Muscaritoli). The two related definitions were based on low lean mass alone (Studenski 1) and low lean mass contributing to weakness (Studenski 2). Results Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non-sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone (RR = 1.54; 95 % CI 1.09–2.18) with 11 % prevalence of sarcopenia and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance (RR = 1.82; 95 % CI 1.24–2.69) with 7.1 % prevalence of sarcopenia. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico 1, Fielding, and Morley. Conclusion Among the definitions investigated, the Baumgartner definition and the Cruz-Jentoft definition had the highest validity for predicting the rate of falls.

Background We investigated the effects of individualised combined resistance and aerobic exercise on microvascular and macrovascular function in rheumatoid arthritis (RA) patients. Methods Forty age-matched, gender-matched and body mass index (BMI)-matched patients were allocated to either an exercise group, receiving a 6 months tailored aerobic and resistance exercise intervention, or controls receiving only information about the benefits of exercise. Participants were assessed for microvascular (acetylcholine (Ach) and sodium nitroprusside (SNP)) and macrovascular (flow-mediated dilatation (FMD) and glyceryl trinitrate (GTN)) endothelial function, maximal oxygen uptake, disease activity and severity (C-reactive protein (CRP), disease activity score 28 and health assessment questionnaire). Data were collected at baseline, 3 months and at the end of the intervention (6 months). Results At baseline, demographic, anthropometric, disease-related characteristics and endothelial function parameters were similar between the exercise and control groups (p>0.05). Repeated measures analysis of variance revealed a significant improvement in endothelial function parameters at 3 (GTN: p<0.001) or 6 months (Ach: p=0.016, SNP: p=0.045, FMD: p=0.016) in the exercise but not in the control group. Generalised estimated equations detected that maximal oxygen uptake was a strong predictor for the observed changes in Ach (p=0.009) and GTN (p<0.001) whereas logCRP for SNP (p=0.017) and GTN (p=0.008). Conclusions An exercise programme designed to meet individual needs and physical abilities significantly improves microvascular and macrovascular function in parallel with disease-related characteristics in RA patients. The potential long-term beneficial effects of such interventions at reducing cardiovascular risk in these patients merit further exploration. Clinical Trial Registration ISRCTN50861407.

Stimulation and nutrition delivered through health programmes at a large scale could potentially benefit more than 200 million young children worldwide who are not meeting their developmental potential. We investigated the feasibility and effectiveness of the integration of interventions to enhance child development and growth outcomes in the Lady Health Worker (LHW) programme in Sindh, Pakistan. We implemented a community-based cluster-randomised effectiveness trial through the LHW programme in rural Sindh, Pakistan, with a 2 × 2 factorial design. We randomly allocated 80 clusters (LHW catchments) of children to receive routine health and nutrition services (controls; n=368), nutrition education and multiple micronutrient powders (enhanced nutrition; n=364), responsive stimulation (responsive stimulation; n=383), or a combination of both enriched interventions (n=374). The allocation ratio was 1:20 (ie, 20 clusters per intervention group). The data collection team were masked to the allocated intervention. All children born in the study area between April, 2009, and March, 2010, were eligible for enrolment if they were up to 2·5 months old without signs of severe impairments. Interventions were delivered by LHWs to families with children up to 24 months of age in routine monthly group sessions and home visits. The primary endpoints were child development at 12 and 24 months of age (assessed with the Bayley Scales of Infant and Toddler Development, Third Edition) and growth at 24 months of age. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT007159636. 1489 mother–infant dyads were enrolled into the study, of whom 1411 (93%) were followed up until the children were 24 months old. Children who received responsive stimulation had significantly higher development scores on the cognitive, language, and motor scales at 12 and 24 months of age, and on the social–emotional scale at 12 months of age, than did those who did not receive the intervention. Children who received enhanced nutrition had significantly higher development scores on the cognitive, language, and social-emotional scales at 12 months of age than those who did not receive this intervention, but at 24 months of age only the language scores remained significantly higher. We did not record any additive benefits when responsive stimulation was combined with nutrition interventions. Responsive stimulation effect sizes (Cohen's d) were 0·6 for cognition, 0·7 for language, and 0·5 for motor development at 24 months of age; these effect sizes were slightly smaller for the combined intervention group and were low to moderate for the enhanced nutrition intervention alone. Children exposed to enhanced nutrition had significantly better height-for-age Z scores at 6 months (p<0·0001) and 18 months (p=0·02) than did children not exposed to enhanced nutrition. Longitudinal analysis showed a small benefit to linear growth from enrolment to 24 months (p=0·026) in the children who received the enhanced nutrition intervention. The responsive stimulation intervention can be delivered effectively by LHWs and positively affects development outcomes. The absence of a major effect of the enhanced nutrition intervention on growth shows the need for further analysis of mediating variables (eg, household food security status) that will help to optimise future nutrition implementation design. UNICEF.

Ultrasound (US) provides the most accurate technique for thickness measurements of subcutaneous adipose tissue (SAT) layers. This US method was recently standardised using eight sites to capture SAT patterning and allows distinguishing between fat and embedded fibrous structures. These eight sites chosen for fat patterning studies do not represent the mean SAT thickness measured all over the body that is necessary for determining subcutaneous fat mass. This was obtained by SAT measurements at 216 sites distributed randomly all over the body. Ten participants with BMI below 28.5kgm −2 and SAT means (from eight sites) ranging from 3 mm to 10 mm were selected. The means from eight sites overestimated the means obtained from 216 sites (i.e. 2160 US measurements in the ten participants); the calibration factor of 0.65 corrects this; standard deviation (SD) was 0.05, i.e. 8%. The SD of the calibration factor transforms linearly when estimating the error range of the whole body’s SAT volume (body surface area times the calibrated mean SAT thickness). The SAT masses ranged from 3.2 to 12.4 kg in this group. The standard deviations resulting from solely the calibration factor uncertainty were ±0.3 and ±1.0 kg, respectively. For these examples, the SAT percentages were 4.9(±0.4)% and 13.3(±1.0)%.

Abstract Context Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. The hormonal and metabolic effects of coenzyme Q10 (CoQ10) and/or vitamin E in patients with PCOS have not been studied, to our knowledge. Objective To evaluate the effects of CoQ10 and/or vitamin E on glucose homeostasis parameters and reproductive hormones in women with PCOS. Design, Setting, Participants Randomized, double-blind, placebo-controlled clinical trial among 86 women with PCOS. Intervention CoQ10 or vitamin E or combination for 8 weeks. Main Outcome Measures Glucose homeostasis parameters and sex hormone concentrations. Results After adjustment for potential confounders, supplementation with CoQ10 alone or in combination with vitamin E, compared with placebo, had significant effects on fasting blood sugar (FBS); vitamin E’s effect on FBS was not significant. A significant reduction in homeostasis model assessment of insulin resistance (HOMA-IR) was observed in the CoQ10 and combined groups. CoQ10, vitamin E, and cosupplementation led to decreased serum total testosterone levels (P < 0.001) compared with those of the placebo group. CoQ10 supplementation in combination with vitamin E significantly improved in sex hormone–binding globulin (SHBG) levels compared with other groups (P = 0.008). Linear regression analysis revealed that changes in FBS, insulin, and HOMA-IR were predictors of change in free androgen index (P < 0.05). Conclusion CoQ10 with or without vitamin E supplementation among women with PCOS had beneficial effects on serum FBS and insulin levels, as well as HOMA-IR and total testosterone levels. However, only cosupplementation affected SHBG concentrations. CoQ10 with or without vitamin E supplementation for 8 weeks among women with PCOS had beneficial effects on serum FBS and insulin levels, and total testosterone levels.

BackgroundLifestyle interventions focusing on weight loss remain the cornerstone of non-alcoholic fatty liver disease (NAFLD) management. Despite this, the weight losses achieved in research trials are not easily replicated in the clinic and there is an urgent need for therapies independent of weight loss. Aerobic exercise is not well sustained and the effectiveness of the better tolerated resistance exercise upon liver lipid and mediators of liver lipid has not been assessed.MethodsSedentary adults with clinically defined NAFLD were assigned to 8 weeks of resistance exercise (n=11) or continued normal treatment (n=8).Results8 weeks of resistance exercise elicited a 13% relative reduction in liver lipid (14.0±9.1 vs 12.2±9.0; p<0.05). Lipid oxidation (submaximal RQ ∆ −0.020±0.010 vs −0.004±0.003; p<0.05), glucose control (−12% vs +12% change AUC; p<0.01) and homeostasis model assessment insulin resistance (5.9±5.9 to 4.6±4.6 vs 4.7±2.1 to 5.1±2.5; p<0.05) were all improved. Resistance exercise had no effect on body weight, visceral adipose tissue volume, or whole body fat mass (p>0.05).ConclusionThis is the first study to demonstrate that resistance exercise specifically improves NAFLD independent of any change in body weight. These data demonstrate that resistance exercise may provide benefit for the management for non-alcoholic fatty liver, and the long-term impact of this now requires evaluation.

The purpose of this study was to determine whether time‐restricted eating (TRE), also known as time‐restricted feeding, was an effective dietary strategy for reducing fat mass and preserving fat‐free mass while evaluating changes in cardiometabolic biomarkers, hormones, muscle performance, energy intake, and macronutrient intake after aerobic and resistance exercise training in physically inactive and overweight or obese adults. This study was a randomized, controlled trial. Overweight and obese adults (mean ± SD; age: 44 ± 7 years; body mass index [BMI]: 29.6 ± 2.6 kg/m2; female: 85.7%) were randomly assigned to a TRE or normal eating (NE) dietary strategy group. The TRE participants consumed all calories between 12:00 p.m. and 8:00 p.m., whereas NE participants maintained their dietary habits. Both groups completed 8 weeks of aerobic exercise and supervised resistance training. Body composition, muscle performance, energy intake, macronutrient intake, physical activity, and physiological variables were assessed. A total of 21 participants completed the study (NE: n = 10; TRE: n = 11). A mild energy restriction was observed for TRE (~300 kcal/day, 14.5%) and NE (~250 kcal/day, 11.4%). Losses of total body mass were significantly greater for TRE (3.3%) relative to NE (0.2%) pre‐ to post‐intervention, of which TRE had significantly greater losses of fat mass (9.0%) compared to NE (3.3%). Lean mass increased during the intervention for both TRE (0.6%) and NE (1.9%), with no group differences. These data support the use of TRE and concurrent exercise training as a short‐term dietary strategy for reducing fat mass and increasing lean mass in overweight and obese adults.

Currently available anthropometric body composition prediction equations were often developed on small participant samples, included only several measured predictor variables, or were prepared using conventional statistical regression methods. Machine learning approaches are increasingly publicly available and have key advantages over statistical modeling methods when developing prediction algorithms on large datasets with multiple complex covariates. This study aimed to test the feasibility of predicting DXA-measured appendicular lean mass (ALM) with a neural network (NN) algorithm developed on a sample of 576 participants using 10 demographic (sex, age, 7 ethnic groupings) and 43 anthropometric dimensions generated with a 3D optical scanner. NN-predicted and measured ALM were highly correlated (n = 116; R2, 0.95, p < 0.001, non-significant bias) with small mean, absolute, and root-mean square errors (X ± SD, −0.17 ± 1.64 kg and 1.28 ± 1.04 kg; 1.64). These observations demonstrate the application of NN body composition prediction algorithms to rapidly emerging large and complex digital anthropometric datasets. Clinical Trial Registration: NCT03637855, NCT05217524, NCT03771417, and NCT03706612.

•Carbohydrate (CHO)-loading protocols are commonly implemented by bodybuilders.•Four males completed this double-blind randomized crossover trial.•Participants consumed 9 g/kg CHO or placebo drinks following 3 days of 1–2 g/kg CHO.•Changes may not be large enough to exceed measurement error and daily variation.•Coaches and competitors should test protocols well in advance of competition. To acutely enhance muscle size and definition, carbohydrate (CHO)-loading protocols are commonly implemented by bodybuilders in the week before competition. This study sought to evaluate the effects of a bodybuilding CHO-loading protocol on anthropometry. Four dieting males engaging in resistance training (RT) with very low body fat participated in this randomized crossover trial. Each experimental period consisted of data collection on days one, four, and five corresponding to baseline, postdepletion, and postloading phases, respectively. During depletion, a standardized RT regimen and diet was followed. This diet was maintained on day 4 with the addition of placebo (PLA) or CHO drinks which contained 9 g/kg BM CHO for postloading data collection on day 5. Body mass (BM), skinfold thickness (SF), and ultrasound muscle thickness (MT) were obtained with descriptive data at both group and individual level calculated. From baseline, BM, SF, and MT mostly decreased in both conditions following depletion. All outcomes then increased from postdepletion following CHO-loading (BM: +0.8%, SF: +1.1%, MT: +2.9%) but not with PLA. Comparing to baseline, postloading changes were greater with CHO (BM: +0.3%, SF: -2.3%, MT: +2.1%) than PLA (BM: -0.9%, SF: -0.5%, MT: -0.8%). Individual differences in response to each phase were also observed. Group level changes seemingly favor CHO-loading; however, it is difficult to judge whether these changes are practically meaningful as they may not be large enough to exceed measurement error and daily biological fluctuations. Before implementation, coaches and competitors should consider individualizing protocols through precompetition testing and visually assessing changes in physique.

IntroductionAutomatic titration modes of non-invasive ventilation, including average volume assured pressure support (AVAPS), are hybrid technologies that target a set volume by automated adjustment of pressure support (PS). These automated modes could offer potential advantages over fixed level PS, in particular, in patients who are super obese.MethodsConsecutive patients with obesity hypoventilation syndrome were enrolled in a two-centre prospective single-blind randomised controlled trial of AVAPS versus fixed-level PS using a strict protocolised setup.MeasurementsThe primary outcome was change in daytime arterial PCO2 (PaCO2) at 3 months. Body composition, physical activity (7-day actigraphy) and health-related quality of life (severe respiratory insufficiency questionnaire, SRI) were secondary outcome measures.Results50 patients (body mass index 50±7 kg/m2; 55±11 years; 53% men) were enrolled with a mean PaCO2 of 6.9±0.8 kPa and SRI of 53±17. 46 patients (23 AVAPS and 23 PS) completed the trial. At 3 months, improvements in PaCO2 were observed in both groups (AVAPS ∆0.6 kPa, 95% CI 0.2 to 1.1, p<0.01 vs PS ∆0.6 kPa, 95% CI 0.1 to 1.1, p=0.02) but no between-group difference (∆−0.1 kPa, 95% CI −0.7 to 0.6, p=0.87). SRI also improved in both groups (AVAPS ∆11, 95% CI 6 to 17, p<0.001 vs PS ∆7, 95% CI 1 to 12, p=0.02; between groups ∆5, 95% CI −3 to 12, p=0.21). Secondary analysis of both groups combined showed improvements in daytime physical activity that correlated with reduction in fat mass (r=0.48; p=0.01).ConclusionThe study demonstrated no differences between automated AVAPS mode and fixed-level PS mode using a strict protocolised setup in patients who were super obese. The data suggest that the management of sleep-disordered breathing may enhance daytime activity and promote weight loss in super-obese patients. Trial registration details available at http://www.controlled-trials.com/ISRCTN63940700