RESUMEN
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is currently the outstanding cause of chronic liver disease in children and adolescents, especially in overweight and obese groups. Liver biopsy is the reference standard to diagnose NAFLD but invasive, thus it is not the best choice in clinical diagnosis and follow-up. Magnetic resonance (MR) is widely used in clinical trials to noninvasively quantify liver fat content in adults and children in foreign countries. While currently, it is rarely used in Chinese children and adolescents. We postulated that quantifying hepatic steatosis by MR could be extended to children and adolescents in China. AIM: To investigate the accuracy of MR imaging (MRI) in quantifying liver fat with MR spectroscopy (MRS) as a reference. A secondary goal was to assess the prevalence of NAFLD in overweight and obese Chinese children and adolescents. METHODS: There were 86 children and adolescents enrolled in this study, including 65 overweight and obese children and 21 healthy children. The participants underwent MRI and MRS. MRI and MRS were performed using multi-echo Dixon and HISTO sequences, respectively, to calculate hepatic proton density fat fraction (PDFF). Hepatic steatosis was diagnosed using MRS-PDFF > 5% as the threshold. Spearman's analysis was used to evaluate the correlation between MRI and MRS. The agreement between these two methods was assessed by Bland-Altman analysis. RESULTS: The MRI-PDFF in the MRS region of interest and the entire liver was 9.9% ± 10.3% with a range of 0.3%-39.9%, and 10.6% ± 9.4% with a range of 1.9%-38.9%, respectively. The MRS-PDFF was 9.1% ± 10.0%, with a range of 0.5%-37.8%. The incidence of hepatic steatosis detected by MRS-PDFF was 46.5% (40/86) of all participants, all of whom belonged to the overweight and obese group. Spearman's analysis indicated an excellent correlation between multi-echo Dixon and MRS (r > 0.9, P < 0.01). Bland-Altman analysis also demonstrated a good agreement between these two methods. CONCLUSION: Multi-echo Dixon shows an excellent correlation and agreement with MRS in quantifying liver fat content and could be a potential tool to detect hepatic steatosis in Chinese children and adolescents.
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Hígado/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Sobrepeso/complicaciones , Adolescente , Biopsia , Niño , China/epidemiología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Hígado/patología , Masculino , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/etiología , Enfermedad del Hígado Graso no Alcohólico/patología , PrevalenciaRESUMEN
BACKGROUND: The nature versus nurture debate is one of the oldest issues in the study of longevity, health and successful aging. OBJECTIVE: We present a 97-year-old man (I.K.) as an example of the effects of habitual exercise on the aging process. METHODS: Extensive assessments included medical examinations, interviews, musculoskeletal structure, performance characteristics, cognitive function and gut microbiota composition. RESULTS: I.K. suffers from iatrogenic hypogonadism, prostate cancer, hypothyroidism and a history of deep popliteal thrombosis. Notwithstanding, he cycles up to 5,000 km a year and participates in competitive sports. His musculoskeletal properties, athletic performance, cognitive function and gut microbiota are outstanding. Some traits even exceed those seen in middle-aged men. CONCLUSIONS: His long-term physically and intellectually active lifestyles combined with extensive social interactions have most likely contributed to his exercise capacity, despite his medical history.
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Envejecimiento , Ejercicio Físico , Estilo de Vida , Aptitud Física , Anciano de 80 o más Años , Envejecimiento/fisiología , Envejecimiento/psicología , Cognición , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Evaluación Geriátrica/métodos , Hábitos , Estado de Salud , Humanos , Relaciones Interpersonales , Esperanza de Vida , Longevidad/fisiología , Masculino , Aptitud Física/fisiología , Aptitud Física/psicologíaRESUMEN
This cross-sectional study aimed to investigate whether body fat distribution, physical activity levels and dietary intakes are associated with insomnia and/or obstructive sleep apnea among overweight middle-aged men. Participants were 211 Finnish men aged 30-65 years. Among the 163 overweight or obese participants, 40 had insomnia only, 23 had obstructive sleep apnea only, 24 had comorbid insomnia and obstructive sleep apnea and 76 were without sleep disorder. The remaining 48 participants had normal weight without sleep disorder. Fat mass, levels of physical activity and diet were assessed by dual-energy X-ray densitometry, physical activity questionnaire and 3-day food diary, respectively. Among the overweight participants, we found that: (i) groups with sleep disorders had higher fat mass in trunk and android regions than the group without sleep disorder (P = 0.048-0.004); (ii) the insomnia-only group showed a lower level of leisure-time physical activity (436.9 versus 986.5 MET min week(-1) , P = 0.009) and higher intake of saturated fatty acids (14.8 versus 12.7 E%, P = 0.011) than the group without sleep disorder; and (iii) the comorbid group had a lower level of leisure-time physical activity (344.4 versus 986.5 MET min week(-1) , P = 0.007) and lower folate intake (118.9 versus 152.1 µg, P = 0.002) than the group without sleep disorder, which were independent of body mass index. The results suggest that central obesity is associated with insomnia and/or obstructive sleep apnea. In addition, low levels of leisure-time physical activity and poor dietary intakes are related to insomnia or comorbid insomnia and obstructive sleep apnea among overweight men.
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Distribución de la Grasa Corporal , Dieta/estadística & datos numéricos , Conducta Alimentaria , Actividad Motora/fisiología , Sobrepeso/epidemiología , Apnea Obstructiva del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adiposidad , Adulto , Anciano , Índice de Masa Corporal , Comorbilidad , Estudios Transversales , Grasas de la Dieta/administración & dosificación , Ejercicio Físico/fisiología , Finlandia/epidemiología , Ácido Fólico/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad Abdominal/epidemiología , Encuestas y CuestionariosRESUMEN
Osteoporotic hip fracture is a serious clinical event associated with high morbidity and mortality. Understanding femoral growth patterns is important for promoting bone health in the young and preventing fractures in later life. In this study, growth patterns of areal bone mineral density (aBMD) and geometric properties of the proximal femur were measured by dual-energy X-ray absorptiometry. They were studied in 251 girls from premenarche (11.2 ± 0.7 years) to late adolescence (18.3 ± 1.1 years) and compared with their premenopausal mothers (n = 128, aged 44.9 ± 4.1 years) and postmenopausal grandmothers (n = 128, aged 70.0 ± 6.3 years). Hip axis length (HAL) was the first to reach peak growth velocity (-10.5 months before menarche), followed by neck diameter (ND) and neck cross-sectional area (CSA), (-7.1 and -4.1 months before menarche, respectively). Both neck-shaft angle (NSA) and aBMD of neck and total hip peaked at menarche. At 18 years (7-year follow-up), girls already had higher femoral neck aBMD but similar HAL and NSA compared with their mothers. Grandmothers had the longest HAL, narrowest NSA, widest ND but lowest aBMD and CSA. Hip strength index (HSI), an index of femoral neck strength during a fall, dropped rapidly after menarche in girls but thereafter remained relatively constant. Grandmothers had lower HSI than either mothers or girls. In conclusion, differences in proximal femoral bone mass and structure in adulthood are largely established before menarche, indicating that heritable factors are responsible for most of the individual variance. The development of geometric properties precedes aBMD in puberty, resulting in relatively constant hip strength after menarche. This asynchronous growth leads to adaptation of bone strength to the imposed loads, avoiding fractures in a biologically efficient manner. Both deterioration of aBMD and inadequate compensatory change in bone geometry after menopause contribute to the increased fracture risk later in life.
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Factores de Edad , Fémur/crecimiento & desarrollo , Adolescente , Adulto , Anciano , Niño , Femenino , Fémur/fisiología , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND & AIMS: Recent evidence suggests that in animals gut microbiota composition (GMC) affects the onset and progression of hepatic fat accumulation. The aim of this study was to investigate in humans whether subjects with high hepatic fat content (HHFC) differ in their GMC from those with low hepatic fat content (LHFC), and whether these differences are associated with body composition, biomarkers and abdominal adipose tissue inflammation. METHODS: Hepatic fat content (HFC) was measured using proton magnetic resonance spectroscopy ((1)H MRS). Fecal GMC was profiled by 16S rRNA fluorescence in situ hybridization and flow cytometry. Adipose tissue gene expression was analyzed using Affymetrix microarrays and quantitative PCR. RESULTS: The HHFC group had unfavorable GMC described by lower amount of Faecalibacterium prausnitzii (FPrau) (p<0.05) and relatively higher Enterobacteria than the LHFC group. Metabolically dysbiotic GMC associated with HOMA-IR and triglycerides (p<0.05 for both). Several inflammation-related adipose tissue genes were differentially expressed and correlated with HFC (p<0.05). In addition, the expression of certain genes correlated with GMC dysbiosis, i.e., low FPrau-to-Bacteroides ratio. CONCLUSIONS: HHFC subjects differ unfavorably in their GMC from LHFC subjects. Adipose tissue inflammation may be an important link between GMC, metabolic disturbances, and hepatic fat accumulation.
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Tejido Adiposo/patología , Hígado/patología , Microbiota , Tejido Adiposo/metabolismo , Adulto , Composición Corporal , Estudios Transversales , Sistema Digestivo/microbiología , Femenino , Expresión Génica , Humanos , Inflamación/patología , Resistencia a la Insulina , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/etiología , Enfermedad del Hígado Graso no Alcohólico/microbiología , Enfermedad del Hígado Graso no Alcohólico/patología , Triglicéridos/sangreRESUMEN
BACKGROUND: Pre-diabetes and non-alcoholic fatty liver disease (NAFLD) are associated with an unhealthy lifestyle and pose extremely high costs to the healthcare system. In this study, we aim to explore whether individualized aerobic exercise (AEx) and low carbohydrate diet (LCh) intervention affect hepatic fat content (HFC) in pre-diabetes via modification of gut microbiota composition and other post-interventional effects. METHODS/DESIGN: A 6-month randomized intervention with 6-month follow-up is conducted from January 2013 to December 2015. The target sample size for intervention is 200 postmenopausal women and middle-aged men aged 50-65 year-old with pre-diabetes and NAFLD. The qualified subjects are randomized into 4 groups with 50 subjects in each group: 1 = AEx, 2 = LCh, 3 = AEx + LCh, and 4 = control. In addition, two age-matched reference groups (5 = pre-diabetes without NAFLD (n = 50) and 6 = Healthy without pre-diabetes or NAFLD (n = 50)) are included. The exercise program consists of progressive and variable aerobic exercise (intensity of 60 to 75% of initial fitness level, 3-5 times/week and 30-60 min/time). The diet program includes dietary consultation plus supplementation with a special lunch meal (40% of total energy intake/day) which aims to reduce the amount of carbohydrate consumption (30%). The control and reference groups are advised to maintain their habitual habits during the intervention. The primary outcome measures are HFC, serum metabolomics and gut microbiota composition. The secondary outcome measures include body composition and cytokines. In addition, socio-psychological aspects, social support, physical activity and diet will be performed by means of questionnaire and interview. DISCUSSION: Specific individualized exercise and diet intervention in this study offers a more efficient approach for liver fat reduction and diabetes prevention via modification of gut microbiota composition. Besides, the study explores the importance of incorporating fitness assessment and exercise in the management of patients with pre-diabetes and fatty liver disorders. If our program is shown to be effective, it will open new strategies to combat these chronic diseases. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN42622771.
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Dieta Baja en Carbohidratos , Carbohidratos de la Dieta , Ejercicio Físico , Tracto Gastrointestinal/microbiología , Microbiota , Enfermedad del Hígado Graso no Alcohólico/terapia , Estado Prediabético/terapia , Anciano , Composición Corporal , Carbohidratos de la Dieta/administración & dosificación , Carbohidratos de la Dieta/efectos adversos , Suplementos Dietéticos , Conducta Alimentaria , Femenino , Conductas Relacionadas con la Salud , Humanos , Estilo de Vida , Hígado/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Posmenopausia , Estado Prediabético/complicaciones , Proyectos de Investigación , Encuestas y CuestionariosRESUMEN
CONTEXT: Knowledge about the interrelationship between adiposity and systemic low-grade inflammation during pubertal growth is important in detecting early signs of obesity-related metabolic disorders. OBJECTIVE: The objective of the study was to evaluate the developmental trajectories of fat mass (FM) and high sensitive C-reactive protein (hsCRP) levels and factors that could explain the relationship between FM and hsCRP in girls from prepuberty to early adulthood. DESIGN: This was a 7.5-year longitudinal study. SETTING: The study was conducted at the University of Jyväskylä Sports and Health Science laboratory. PARTICIPANTS: Three hundred ninety-six healthy Finnish girls aged 11.2 ± 0.8 years participated in the study. METHODS: Body composition was assessed by a dual-energy X-ray absorptiometry and serum concentrations of hsCRP, adipokines, and sex hormones by ELISA. RESULTS: Both FM and hsCRP increased with age and had similar trajectories but different inter- and intravariance patterns. A joint analysis of fat distribution and hsCRP indicated that the linkage probabilities across different trajectory subgroups between regional FM and the corresponding hsCRP levels varied from 16% to 53%. In a longitudinal regression model, the common predictor for both FM and hsCRP was T (ß = .065, P < 0.01, and ß = -.213, P < 0.05, respectively) before menarche. Other factors predicting FM before menarche were SHBG (ß = -.196, P < 0.01) and leptin (ß = .381, P < .01); and after menarche hsCRP (ß = .048, P < 0.01), T (ß = .089, P < .01), leptin (ß = .340, P < .01), and adiponectin (ß = -.086, P < .05). Of the factors assessed, only FM was associated with hsCRP both before and after menarche (ß =1.058, P < .01 and ß =1.121, P < .01, respectively). CONCLUSIONS: The differences in regional body fat depots and hsCRP levels in adulthood are largely established early in childhood. However, the intra- and interindividual variances differed between FM and hsCRP. FM explained the variance of hsCRP during pubertal growth, but the reverse was not true, which suggests that FM contributes to low-grade inflammation and not vice versa.
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Tejido Adiposo/metabolismo , Distribución de la Grasa Corporal , Inflamación/metabolismo , Obesidad/epidemiología , Adolescente , Proteína C-Reactiva/metabolismo , Niño , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Metabolismo de los Lípidos , Pubertad/metabolismoRESUMEN
Vitamin D is well known for its regulatory role in calcium and phosphate homeostasis, but its role in muscle mass and strength during growth remains inconclusive. We explored the association of serum 25-hydroxyvitamin D (25(OH)D) with muscle development in girls from 11 to 18-years old. Whole body lean tissue mass (LMWB), appendicular lean mass (aLM), muscle cross-sectional area at the lower leg (mCSA), maximal voluntary contraction of elbow flexors (MVC elbow) and knee extensors (MVC knee) were assessed in 217 girls aged 10-13 years (at baseline), 215 in 2-year and 226 in 7.5-year follow-up. Serum concentration of 25(OH)D and intact parathyroid hormone (PTH) were analyzed retrospectively and girls were categorized according to their 25(OH)D levels (consistently insufficient 25(OH)D GLL <50 nmol/l and consistently sufficient GHH >50 nmol/l from baseline to 7-year follow-up). We found that 25(OH)D level declined until menarche (p<0.05) while LMWB, aLM, mCSA, MVC elbow and MVC knee continued to increase (p<0.001 for all) post menarche. At pre-menarche, the GLL (n = 34) had higher LMWB and aLM than the GHH (n = 21, p<0.05), while post-menarche the GHH (n = 15) had a greater catch-up gain in LMWB (p = 0.004), aLM (p = 0.001) and mCSA (p = 0.027) compared to the GLL (n = 65) over the first 2-year period. At the age of 18, no differences in muscle mass/strength between the low (n = 151) and high (n = 77) levels of 25(OH)D groups were found. This finding was independent of vitamin D receptor genotype and other confounders. In conclusion, our results showed that levels of 25(OH)D have no significant negative influence on the development of muscle mass and strength during pubertal growth both with longitudinal and cross-sectional comparison. On the contrary, our results suggest that the temporary negative association between 25(OH)D and muscle mass arises as a consequence of fast growth prior to menarche, and this negative association is diminished through catch-up growth after menarche.
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Composición Corporal/fisiología , Desarrollo de Músculos/fisiología , Pubertad/fisiología , Vitamina D/análogos & derivados , Adolescente , Calcio/sangre , Niño , Femenino , Humanos , Estudios Longitudinales , Fuerza Muscular/fisiología , Hormona Paratiroidea/sangre , Polimorfismo de Nucleótido Simple , Pubertad/sangre , Receptores de Calcitriol/genética , Vitamina D/sangre , Deficiencia de Vitamina D/sangreRESUMEN
BACKGROUND: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, puberty and adolescence is vital since it holds key information regarding current and future health. Our study aimed to determine how BM, LM and FM track from prepuberty to early adulthood in girls and what factors are associated with intra- and inter-individual variation in these three tissues. METHODS: The study was a 7-year longitudinal cohort study. BM, LM and FM measured using dual-energy X-ray absorptiometry, self-reported dietary information, leisure time physical activity (LTPA) and other factors were assessed one to eight times in 396 girls aged 10 to 13 years (baseline), and in 255 mothers once. RESULTS: The location of a girl's BM, LM and FM in the lower, middle or upper part of the sample distribution was established before puberty and tracked in its percentile of origin over 7 years (r = 0.72 for BM, r = 0.61 for LM, and r = 0.65 for FM all p < 0.001 first vs. last measurements' ranking). Seventy-three percent of those in the lowest quartile for BM and 69% for LM, and 79% of those in the highest quartile for FM at baseline remained in their quartile at 7-year follow-up. Heritability was estimated to contribute 69% of the total variance of the BM, 50% of the LM, and 57% of the FM. Besides body size, diet index (explaining 9% of variance), breast feeding duration (6%) and mother's BM (9%) predicted high BM. Diet index and high LTPA predicted high LM (24% and 14%, respectively), and low FM (25% and 12%, respectively), and low level of parental education predicted high FM (4%). CONCLUSION: Individual levels of BM, LM and FM are established before puberty and track in a trait-specific manner until early adulthood. Girls who are prone to develop low BM and LM and high FM in adulthood can be identified in prepuberty. The developments of three components of body composition are inter-related during growth. BM was the most heritable trait while LM the most environmentally modifiable. Diet and physical activity played an important role in increasing LM and preventing the accumulation of excessive FM.