Bone density in Ehlers-Danlos syndrome CARBONE, L; TYLAVSKY, F. A; BUSH, A. J ...
Osteoporosis international,
05/2000, Letnik:
11, Številka:
5
Journal Article
Recenzirano
Ehlers-Danlos Syndrome (EDS) is the most common inherited disorder of connective tissue recognized. The objectives of the present study were to determine bone mineral density (BMD) and biochemical ...markers of bone metabolism in EDS. Twenty-three subjects with Type III EDS and 23 matched controls underwent BMD measurement by dual-Energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck. Health history questionnaires and biochemical markers of bone and connective tissue metabolism were also assessed. No significant differences in BMD at the lumbar spine or differences in biochemical markers of bone and connective tissue metabolism were found between EDS subjects and controls. EDS subjects had a significantly decreased BMD at the femoral neck compared with controls, but this difference disappeared after adjustment for body height, weight and physical activity levels.
Objective:
The study aims were to examine the relationship between adiposity and surrogate indices of pancreatic β-cell function and insulin sensitivity obtained from an oral glucose tolerance test ...(OGTT) in overweight adolescents and determine which factors best predict impaired glucose metabolism (IGM).
Methods:
In a sample of adolescents (n=209) severity of overweight was determined by relative body mass index (RBMI). Insulin sensitivity (QUICKI, CISI) and β-cell function (Fasting insulin: FI; Insulinogenic Index: ΔI
30
/ΔG
30
).
Results:
IGM was present in 26.8% (n=56), of which five had type 2 diabetes (T2DM). IGM prevalence was similar among RBMI strata. Once RBMI reached 150%, pronounced deterioration in CISI occurred (∼55%) (P<0.0001) while less dramatic reductions were seen in QUICKI (P<0.05), with fasting blood glucose (FBG) and β-cell indices remaining stable. Compared to those with normal glucose tolerance, the IGM group exhibited higher β-cell activity (FI, P<0.0001; ΔI
30
/ΔG
30
, P=0.004) with reduced insulin sensitivity (CISI, P<0.0001; QUICKI, P<0.0002). CISI was the single predictor of IGM (P<0.0001). Low insulin sensitivity increased adolescents’ chance for IGM (CISI: OR=6.49, 95%CI=2.63, 16.05, P<0.0001; QUICKI: OR=3.16, 95%CI=1.61, 6.05, P=0.0006) as did β-cell deterioration (ΔI
30
/Δ G
30
: OR=3.18, 95%CI=1.33, 7.59, P=0.0069). Normal FBG occurred in 37.5% of youth with IGM.
Conclusion:
The prevalence of IGM escalates in overweight adolescents, even at lower levels of overweight, and is associated with pronounced deterioration of insulin sensitivity. Current screening recommendations for FBG underestimate the prevalence of IGM in overweight adolescents thus limiting the opportunity for earlier intervention to prevent progression to diabetes.
Obesity in middle and old age predicts mobility limitation; however, the cumulative effect of overweight and/or obesity over the adult life course is unknown. The association between overweight ...and/or obesity in young, middle, and late adulthood and its cumulative effect on incident mobility limitation was examined among community-dwelling US adults aged 70-79 years at baseline (1997-1998) in the Health, Aging and Body Composition Study (n = 2,845). Body mass index was calculated by using recalled weight at ages 25 and 50 years and measured weight at ages 70-79 years. Mobility limitation (difficulty walking 1/4 mile (0.4 km) or climbing 10 steps) was assessed semiannually over 7 years of follow-up and was reported by 43.0% of men and 53.7% of women. Men and women who were overweight or obese at all 3 time points had an increased risk of mobility limitation (hazard ratio = 1.61, 95% confidence interval: 1.25, 2.06 and hazard ratio = 2.85, 95% confidence interval: 2.15, 3.78, respectively) compared with those who were normal weight throughout. Furthermore, there was a significant graded response (P < 0.0001) on risk of mobility limitation for the cumulative effect of obesity in men and overweight and/or obesity in women. Onset of overweight and obesity in earlier life contributes to an increased risk of mobility limitation in old age.
BACKGROUND: Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth ...period. OBJECTIVE: The purpose was to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition in girls aged 10-12 y. DESIGN: This placebo-controlled intervention trial randomly assigned 195 healthy girls at Tanner stage I-II, aged 10-12 y, with dietary calcium intakes <900 mg/d to 1 of 4 groups: calcium (1000 mg) + vitamin D₃ (200 IU), calcium (1000 mg), cheese (1000 mg calcium), and placebo. Primary outcomes were bone indexes of the hip, spine, and whole body by dual-energy X-ray absorptiometry and of the radius and tibia by peripheral quantitative computed tomography. RESULTS: With the use of intention-to-treat or efficacy analysis, calcium supplementation with cheese resulted in a higher percentage change in cortical thickness of the tibia than did placebo, calcium, or calcium + vitamin D treatment (P = 0.01, 0.038, and 0.004, respectively) and in higher whole-body bone mineral density than did placebo treatment (P = 0.044) when compliance was >50%. With the use of a hierarchical linear model with random effects to control for growth velocity, these differences disappeared. CONCLUSIONS: Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium. Diverse patterns of growth velocity may mask the efficacy of supplementation in a short-term trial of children transiting through puberty.
Little information is available on the assessment of changes in body composition as a function of weight change with the use of the fan beam of dual-energy X-ray absorptiometry (DXA).
The objective ...was to determine the accuracy of the fan beam of the QDR 4500A densitometer and the pencil beam of the QDR 2000 densitometer in estimating changes in whole-body lean soft tissue mass (LSTM(DXA)) and fat mass (FM) with weight change.
Thirty-seven subjects who lost 5.7 +/- 4.5 kg were measured before and after weight change. Using total body water and computed tomography (CT) of the midthigh, we compared changes in FFM(TBW) and LSTM(CT) with changes in LSTM(DXA).
Overall, compared with TBW, the fan beam gave a larger estimate of change (macro x +/- SD) in LSTM (fan beam - TBW: -0.7 +/- 1.6 kg) than did the pencil beam (pencil beam - TBW: -0.1 +/- 1.6 kg). When the change in LSTM obtained with the fan beam and pencil beam was regressed against the change in FFM(TBW), the slope of the line for the fan beam was 0.97 (r(2) = 0.61) and that for the pencil beam was 0.86 (r(2) = 0.61). Regression analysis showed that the results between the 2 units were not interchangeable. For the midthigh region, the change in LSTM(CT) was moderately correlated with the change in LSTM(DXA) with the fan beam and pencil beam.
The measurement of change in LSTM with the fan and pencil beams provides the same relation to changes in FFM assessed by TBW, but the 2 systems are not interchangeable.
Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health‐related events in older persons.
Design: Prospective cohort study.
...Setting: Health, Aging and Body Composition Study.
Participants: Three thousand forty‐seven well‐functioning older persons (mean age 74.2).
Measurements: Usual gait speed on a 6‐m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait‐speed cutpoints. Rates of persistent lower extremity limitation events (mean follow‐up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high‐ (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health‐related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.
Results: A graded response was seen between risk groups and health‐related outcomes. Participants in the high‐risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76–2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63–3.20), death (RR=1.64, 95% CI=1.14–2.37), and hospitalization (RR=1.48, 95% CI=1.02–2.13) than those in the low‐risk group.
Conclusion: Usual gait speed of less than 1 m/s identifies persons at high risk of health‐related outcomes in well‐functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
Background. Circulating levels of adipokines are elevated with adiposity and are closely linked with the clustering of traditional metabolic risk factors for cardiovascular disease. The purpose of ...this study was to examine the relationship of metabolic syndrome to several adipokines and the role of total and visceral adiposity in influencing this relationship in older adults. Methods. A cross-sectional analysis was conducted including 1914 individuals aged 70–79 years without cardiovascular disease or type 2 diabetes. The metabolic syndrome was defined by the updated Adult Treatment Panel III criteria. Circulating levels of leptin, adiponectin, plasminogen activator inhibitor type 1 (PAI-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were measured. Body composition and abdominal visceral fat area were determined. Results. Both the presence of metabolic syndrome and the number of metabolic syndrome components were associated with higher levels of leptin, PAI-1, IL-6, TNF-α, and CRP and with lower levels of adiponectin (all p <.0001). The odds ratios for the prevalence of metabolic syndrome associated with adipokines were attenuated after adjustment for total fat mass and/or visceral fat area, but remained significant. Levels of leptin, PAI-1, IL-6, and TNF-α were higher (all p <.05 to p <.0001), and adiponectin was lower (all p <.0001), in persons with, compared to those without, metabolic syndrome within each tertile of percent body fat. Conclusion. The metabolic syndrome is associated with adipokines in older adults across a wide range of adiposity, including in those with low or normal overall fatness.
To examine the additive or moderating influences of caregiver COVID-19-related stress, social support, and discrimination on children's behavior problems across racially diverse populations.
In this ...Environmental influences on Child Health Outcomes (ECHO) cohort study (N = 1,999 caregiver/child pairs), we operationalized caregiver COVID-19-related stress in 2 ways: first, as the number of stressors (eg, financial concerns, social distancing); and second, as the level of pandemic-related traumatic stress symptoms reported via questionnaires administered between April 2020 and August 2022. At the same assessment visit, caregivers also reported their current levels of discrimination, and a subsample (n = 968) reported their emotional and instrumental support. Either concurrently or at a later assessment visit, caregivers reported on their children's internalizing and externalizing behavior problems using the Child Behavior Checklist for Ages 6-18 (CBCL/6-18).
Multivariable analyses controlling for maternal education, marital status, child age, and child sex revealed that COVID-19-related stress (caregiver stressors and symptoms) and discrimination were positively associated, and that perceived support was negatively associated with child internalizing and externalizing behavior problems. Unexpectedly, neither emotional nor instrumental support attenuated the relationship between caregiver COVID-19-related stressors nor traumatic stress symptoms and child behavior problems. In the subset of Black American participants, caregiver perceived discrimination moderated the relationship between caregiver COVID-19 traumatic stress symptoms and child internalizing problems, such that the association was stronger at higher levels of discrimination.
Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.
Background: Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown. Objective: We examined the ...associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults. Design: This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed. Results: Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss. Conclusions: Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.
Very few studies have evaluated both parathyroid hormone (PTH) and 25-hydroxyvitamin D 25(OH)D and their effects on bone mass in children.
We studied the associations of serum 25(OH)D and intact PTH ...(iPTH) with bone mineral content (BMC) and bone mineral density (BMD) at different bone sites and the relation between serum 25(OH)D and iPTH in early pubertal and prepubertal Finnish girls.
The subjects were 10-12-y-old girls (n = 193) at Tanner stage 1 or 2, who reported a mean (+/- SD) dietary calcium intake of 733 +/- 288 mg/d. 25(OH)D, iPTH, tartrate-resistant acid phosphatase 5b (TRAP 5b), urinary calcium excretion, BMC, areal BMD, and volumetric BMD were assessed by using different methods.
Thirty-two percent of the girls were vitamin D deficient serum 25(OH)D < or = 25 nmol/L, and 46% of the girls had an insufficient concentration (26-40 nmol/L). iPTH and TRAP 5b concentrations were significantly higher in the deficient group than in the insufficient and sufficient groups iPTH: 43.9 +/- 15.7 compared with 38.6 +/- 11.2 pg/L (P = 0.049) and 32.7 +/- 12.1 pg/L (P < 0.001), respectively; TRAP 5b: 12.2 +/- 2.9 compared with 11.0 +/- 2.8 U/L (P = 0.009) and 10.9 +/- 1.9 U/L (P = 0.006), respectively. The girls in the deficient group also had significantly lower cortical volumetric BMD of the distal radius (P < 0.001) and tibia shaft (P = 0.002). High iPTH concentrations were also associated with low total-body apparent mineral density and urinary calcium excretion (P < 0.007).
Vitamin D-deficient girls have low cortical BMD and high iPTH concentrations, which are consistent with secondary hyperparathyroidism. A low vitamin D concentration accompanied by high bone resorption (TRAP 5b) may limit the accretion of bone mass in young girls.
PDF
