Background: Knowledge of how representative the abdominal region is of total body and appendicular measurements of lean tissue is currently limited to CT/MRI and modern DXA models, while associations ...using older DXA models are less understood. In order to better leverage the prospective Womens Health Initiative (WHI) study with over 25 years of adjudicated health outcomes, we sought to determine if DXA-derived abdominal fat-free mass (FFM) is correlated with total body and appendicular lean soft tissue (LST) in post-menopausal women measured on an older DXA model. Methods: We compared abdominal FFM to total body and appendicular LST in post-menopausal women using measurements from baseline DXAs in the WHI (n = 9905). Scans acquired on Hologic QDR-2000 DXA machines (1993-1998) were recently re-analyzed using APEX 4.0 software (Hologic). The abdominal region was defined as 5cm high spanning the width of the abdomen centered at the 4th lumbar vertebra. Spearman correlation coefficients were calculated. Quartiles of each measure were created and weighted kappa coefficients were calculated using the quartiles to assess abdominal FFMs agreement with total body and appendicular LST. Results: Participants had a mean (SD) abdominal FFM of 1.71 (0.29) kg, total body LST of 37.78 (5.39) kg, and appendicular LST of 14.79 (2.81) kg. Abdominal FFM was correlated with both total body and appendicular LST (Spearman coefficients = 0.77 and 0.71, respectively; p<0.0001). Quartile agreement between abdominal FFM and total body and appendicular LST was moderate (weighted к = 0.56 and 0.51, respectively; p<0.0004). Conclusions: DXA-derived abdominal FFM from the Hologic QDR2000 is positively and strongly associated with total body and appendicular LST measurements in post-menopausal women. This suggests that correlations between abdominal FFM and total body and appendicular LST using older DXA models are similar to those reported on new models.
Background: Waist circumference (WC) predicts metabolic diseases and WC measurements are recommended for adults BMI 25-35 Kg/m2 during office visits. However, we found WC was recorded in only 0.01% ...of eligible patients at Mayo Clinic. We reported that self-measured WC using traditional approaches was unsatisfactory; over 20% of self-measurement underestimated WC enough to place themselves in a falsely low-risk category. To reduce logistical challenges for measuring WC, Mayo Clinic, MDJ and TBJ developed the Perfect Waist Circumference Measurement Device (PWCMD), an abdominal vest-like device with built-in sensors that allows patients to self-measure WC. PWCMD provides 64 sets (one per second) of 5 circumferences over one-minute and generates WC and abdominal volume data through an analytic software. Methods: We first assessed reproducibility by recruiting 15 participants to use the PWCMD and have manual WC measurements for 5 consecutive days. The second study included 81 patients, average BMI of 30.4 Kg/m2 (40 men), scheduled for a diagnostic CT abdomen who underwent manual WC measures by YS and self-measured their WC using the PWCMD prior to the scan. CT scans were analyzed for WC, visceral fat mass and subcutaneous fat mass for comparison with PWCMD data. Results: The PWCMD and professionally measured WC were equally reproducible. Both PWCMD and CT-measured WC correlated with (R2=0.83 and 0.79, both p<0.001) and were not different than professionally measured WC. All three WC measurements highly correlated to the CT-measured visceral fat mass (R2 = 0.45 to 0.46, all p<0.001); the correlation was stronger for men (R2 = 0.62 to 0.66, all p<0.001) than women (R2 = 0.25 to 0.30, all p<0.001). The PWCMD-measured minimal circumference had the strongest correlation to visceral fat mass (R2=0.65; 0.75 for men, 0.46 for women; both p<0.001). Conclusions: The PWCMD is a convenient, reproducible and accurate device that allows self-measurement of WC and that predicts visceral fat as measured by CT. Clinical application of PWCMD could improve screening for high-risk obesity by increasing the proportion of patients that have this data in the medical record.
Background: Prospective studies examining the relationship between whole (WG) and refined grain (RG) consumption and changes in abdominal fat depots are scarce. Such studies are needed given the ...association between visceral abdominal adiposity and cardiometabolic disease. We examined the prospective relationship between changes in WG and RG consumption and changes in abdominal visceral (VAT) versus subcutaneous (SAT) adipose tissues over a median 6-year follow-up period. Methods: Quantity (volume, cm3) of abdominal VAT and SAT was assessed using computed tomography in 972 Framingham Heart Study Third Generation participants (mean baseline age 45.4 ± 6.2 years, 45% female) at exam 1 (2002-2005) and exam 2 (2008-211). Dietary information was assessed using a semi-quantitative food-frequency questionnaire. Change in energy-adjusted WG and RG intake was grouped into sex-specific quartiles. Multiple linear regression models were used to examine the prospective associations with changes in VAT and SAT, adjusting for several demographic, lifestyle, and dietary covariates. Results: Increased WG intake was associated with smaller increases in VAT volume (p-trend = 0.001). VAT increased by 782 ± 47 cm3 in the lowest quartile (i.e., greatest decrease in WG intake) compared to 586 ± 42 cm3 in the highest quartile (i.e., greatest increase in WG intake). No significant association was observed between change in WG intake and change in SAT. In contrast, increased RG intake was associated with greater increases in both VAT (642 ± 45 vs 777 ± 42 cm3 in lowest vs highest quartile) and SAT (485 ± 51 vs 678 ± 48 cm3 in lowest versus highest quartiles) (p-trend = 0.01 for each). Conclusions: Increasing WG and decreasing RG intake was associated with less abdominal fat accumulation, particularly VAT. The findings of this study support replacement of RG for WG in attenuating pathogenic abdominal adiposity.
A 49-year-old Haitian man with hypertension and diabetes mellitus presented with a one year history of abdominal pain, 20 ib unintentional weight loss, fatigue, and myalgias. Physical exam revealed a ...thin man with a soft abdomen and tenderness in the epigastrium. Laboratory testing showed leukocytosis, hemoglobin of 8 with a normal MCV and unremarkable liver chemistries. Computed tomography of the abdomen showed wall thickening in the antrum of the stomach. On esophagogastroduodenoscopy, a hard, ulcerated gastric mass was found in the antrum. Initial biopsy showed ulcerative active gastritis, but no malignant cells. Repeat endoscopy with deep biopsies again failed to confirm a gastric malignancy. Due to ongoing suspicion for cancer, the specimens were sent to another facility for review. Pathology revealed active gastritis with necrotizing inflammatory exudate as well as the presence of organisms resembling Strongyloides. There was no evidence of malignancy. The patient was treated with Ivermectin and had an unremarkable hospital course thereafter including a normal colonoscopy. However, two months after discharge, he returned with intractable diarrhea.
In jeder Notaufnahme können sich Nierentransplantierte notfallmäßig vorstellen und nicht immer ist unmittelbar transplantationsmedizinische Expertise greifbar. Aufgrund der Immunsuppression müssen ...sich klinisches Erscheinungsbild bzw. labormedizinische Präsentation nicht zwangsläufig mit der Erkrankungsschwere decken und lässt diese Patient*innen deshalb zu einer speziellen Gruppe in der Notaufnahme werden. Dieser Beitrag erläutert Grundlagen und vermittelt Hilfestellungen in der Betreuung und Notfallversorgung nierentransplantierter Patient*innen.
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