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PubMed2004

Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance.

No previous longitudinal studies of calcium intake, anthropometry and bone health in young children with a history of avoiding cow's milk have been undertaken. We report the 2-year changes of a group of 46 Caucasian children (28 girls, l8 boys) aged 8.1+/-2.0 years (mean +/- SD) who had low calcium intakes at baseline and were short in stature, with elevated body mass index, poor skeletons and lower Z scores for both areal bone mineral density (BMD, in grams per square centimeter) and volumetric density (bone mineral apparent density, BMAD, in grams per cubic centimeter), compared with a reference population of milk drinkers. At follow-up, adverse symptoms to milk had diminished and modest increases in milk consumption and calcium intake had occurred. Total body bone mineral content (BMC) and bone area assessed by dual energy X-ray absorptiometry had increased (P<0.05), and calcium intake from all sources was associated with both these measures (P<0.05). However, although some catch-up in height had taken place, the group remained significantly shorter than the reference population (Z scores -0.39+/-1.14), with elevated body mass index (Z scores 0.46+/-1.0). The ultradistal radius BMC Z scores remained low (-0.31+/-0.98). The Z scores for BMD had improved to lie within the normal range at predominantly cortical sites (33% radius, neck of femur and hip trochanter) but had worsened at predominantly trabecular sites (ultradistal radius and lumbar spine), where values lay below those of the reference group (P<0.05). Similarly, although volumetric BMAD Z scores at the 33% radius had normalized, BMAD Z scores at the lumbar spine remained below the reference population at follow-up (-0.67+/-1.12, P<0.001). Our results demonstrate persisting height reduction, overweight and osteopenia at the ultradistal radius and lumbar spine in young milk avoiders over 2 years of follow-up.

Absorptiometry, Photon↗
PubMed2001

Bone mineral density at the hip predicts mortality in elderly men.

Low bone density as assessed by calcaneal ultrasound has been associated with mortality in elderly men and women. We examined the relationship between bone density measured at the hip and all cause and cardiovascular mortality in elderly men. Men aged 65-76 years from the general community were recruited from general practices in Cambridge between 1991 and 1995. At baseline survey, data collection included health questionnaires, measures of anthropometry and cardiovascular risk factors, as well as bone mineral density (BMD) measured using dual energy X-ray absorptiometry. All men have been followed up for vital status up to December 1999. BMD was significantly inversely related to mortality from all causes and cardiovascular disease, with decreasing rates with increasing bone density quartile, and an approximate halving of risk between the bottom and top quartile (p < 0.002, test for trend all causes and p < 0.025, test for trend for cardiovascular deaths). In multivariate analyses using the Cox proportional hazards model, an increase of 1 standard deviation (0.144 g/cm2) in total hip bone density was significantly associated with an age-adjusted 0.77 relative risk (95% CI 0.66-0.91) for all-cause mortality and 0.76 relative risk (95% CI 0.62-0.93) for cardiovascular disease mortality. The association remained significant after adjusting for age, body mass index, cigarette smoking status, serum cholesterol, systolic blood pressure, past history of heart attack, stroke or cancer and other lifestyle factors which included use of alcohol, physical activity and general health status. Low bone density at the hip is thus a strong and independent predictor of all-cause and cardiovascular mortality in older men.

Aged↗
PubMed1999

Ethnic, anthropometric, and lifestyle associations with regional variations in peak bone mass.

The study investigated the ability of ethnicity and anthropometric and lifestyle factors to account for differences within subjects in bone mass at different skeletal sites. The subjects were young, adult, Japanese, Filipino, Hawaiian, and white women ages 25-34. In the preliminary analyses, they were divided into thirds based on their BMD z-scores. Thirty-five percent exhibited high variability in bone mass: they were in the upper third at one or more bone sites and in the lower third at one or more sites. Other women had more generalized low bone mass: 25% were in the lowest third for two or more sites, and there were no sites with low bone mass in the upper third. In subsequent analyses, ethnicity, anthropometry, and lifestyle influences were examined as possible predictors of differences in bone mineral content (BMC) between bone sites in bone-size adjusted models. White women had greater BMC at the proximal radius and calcaneus than at the distal radius compared with other ethnic groups. This may be explained by the fact that they had exceptionally wide bone widths at the distal radius. Of the anthropometric variables, fat mass was associated with higher bone mass at sites with higher proportions of cancellous tissue (calcaneus > spine > radius sites). Muscle mass was associated with greater bone mass at the calcaneus and proximal radius than at the spine. For the lifestyle variables, women with greater milk consumption between the ages of 10-24 years had higher spine bone mass than expected from their measurements at the proximal radius. Women 12-17 years of age who had been more active in sports had higher calcaneous bone mass than expected from their spine measurements. As the study participants were still young women, the results suggest that regional differences in bone mass may partly derive from anthropometric and lifestyle influences during skeletal maturation.

Absorptiometry, Photon↗
PubMed1996

Skeletal age as a determinant of bone mass in preadolescent females.

OBJECTIVE: To evaluate the association between chronological age, skeletal age, pubertal stage, and basic anthropometry with bone mass of the total body, forearm, and second metacarpal bone in 456 healthy Caucasian females, aged 8-13 years. DESIGN: Total body and forearm bone measurements were performed by dual X-ray absorptiometry, while bone mass of the second metacarpal was assessed by radiogrammetry. Skeletal age (SA) was assessed by the FELS method and pubertal stage was self-determined by selecting corresponding illustrations of breast and public hair development. The Cp criterion was used to select the best multiple regression model containing the subset of independent variables with the least bias and best predictive ability for each of the measured bone mass variables. RESULTS: Of all the independent variables, weight, stature, and SA emerged as the most significant predictors for almost all the bone mass variables. Multiple regression models were created based on the Cp criterion with the resulting R2 (adjusted) for bone mineral content of total body, proximal forearm, ultradistal forearm, length of second metacarpal, as well as of total, medullary, and cortical areas: 0.793, 0.523, 0.390, 0.602, 0.232, 0.073, and 0.264, respectively. The measured bone variables were also regressed on SA using either quadratic or linear equations, depending on the shape of the cubic splines used for the best curve fitting. Significant positive association (p < 0.0001) of SA and each of the bone variables was noted, the highest being with bone mineral density and content of total body (R2 = 0.176, 0.338) and proximal and ultradistal forearm (R2 = 0.216, 0.203, 0.106, 0.201), respectively, as well as with the length of the second metacarpal bone (R2 = 0.339). Chronological age and pubertal stage did not have statistically significant predictive abilities for bone mass variables in the multiple regression models. CONCLUSIONS: We conclude that skeletal age is a powerful determinant of bone mass in children. It can be used as the criterion for the selection of a biologically homogeneous population with regard to bone mass. This may be important for the design of intervention studies targeting bone mass of children and adolescents.

Absorptiometry, Photon↗
PubMed2003

About the variability of the shape of the glenoid cavity.

The morphology of the glenoid cavity is highly variable, and no consensus exists regarding how to classify the different forms. We examined 98 dry scapulae to identify a common morphological entity and to define reproducible bony references of the glenoid cavity. The glenoid cavities were photographed perpendicularly in a standardized fashion. The bony peripheral rim was studied on these two-dimensional images, defined by randomly chosen points in order to define one or more circles. This study showed that only the peripheral rim of the inferior quadrants of the articular surface was found to be located on a circle ( P=0.926) with a radius of 12.8 mm (SD 1.3 mm). Defining the center of this circle appeared to be more reliable (ICC 0.98) than determining the middle point of the longitudinal axis (0,0) between the most cranial and most caudal points, defined as Saller's line (ICC 0.89). The distance of the center of this projected circle to the middle point of Saller's line had a unimodal distribution, suggesting the existence of only one glenoid cavity morphotype. We then investigated the relationship between the center of the circle and the area of subchondral bone thickening under the bare spot, the so-called tubercle of Assaki. Ten phenolized cadaveric glenoid cavities were examined with computed tomography. A circle was projected on the first image showing the bony peripheral rim, and this circle was copied on the consecutive slices until the tubercle of Assaki came across. The center of the circle was located within the area of the tubercle of Assaki, in all but one specimen. To investigate the clinical implications of this finding, the cadaver specimens were used to compare the position of the center of the circle with the postulated center of implantation according to the literature, and to the reference guide for a commonly used total shoulder prosthesis. The center of the circle was consistently situated more distal than the postulated center of the guide (mean 5.5 mm, range 4-8 mm) and the middle point of the glenoid cavity (mean 2 mm, range 1-3 mm). These findings could offer a reproducible point of reference for the glenoid cavity in osseous anthropometry and a valuable reference in shoulder replacement surgery, and might help in the definition of osseous glenohumeral instability.

Anatomy, Cross-Sectional↗
PubMed2002

Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India.

BACKGROUND AND AIM: An adverse coronary risk profile has been reported amongst rural-to-urban migrant population living in urban slums undergoing stressful socio-economic transition. These individuals are likely to have low intakes of folic acid and vitamin B12, which may have an adverse impact on serum levels of homocysteine (Hcy). To test this hypothesis, we studied serum levels of Hcy in subjects living in an urban slum of North India and healthy subjects from urban nonslum area. METHODS: Group I consisted of 46 subjects (22 males and 24 females) living in an urban slum, while group II consisted of healthy subjects (n = 26, 13 males and 13 females) living in the adjacent non-slum area. Anthropometric measurements, biochemical profile (fasting blood glucose, total cholesterol, serum triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and fasting serum levels of Hcy were measured. Dietary intakes of folic acid, vitamin B12, vitamin B1, and iron were calculated by the 24-hour dietary recall method. Serum levels of Hcy were correlated with dietary intakes of nutrients, anthropometry, and metabolic variables. RESULTS: Sex-adjusted serum levels of Hcy in micromol/L (Mean +/- SD) were high, though statistically comparable, in both the groups (group I: 20.8 +/- 5.9 and group II: 23.2 +/- 5.9). Overall, higher than normal serum levels of Hcy (> 15 micromol/L) were recorded in 84% of the subjects. A substantial proportion of subjects in both groups had daily nutrient intakes below that recommended for the Asian Indian population (folic acid: 93.4% in group I and 96.7% in group II, vitamin B12: 76.1 % in group I and 88.4% in group II). However, between the two groups, average daily dietary intakes of both the nutrients were statistically comparable. As compared to non-vegetarians, vegetarians showed lower intakes of folic acid (p < 0.01) and vitamin B12 (p < 0.01) in both groups. On multivariate linear regression analysis with serum Hcy as the response variable and vegetarian/non-vegetarian status and sex (male/female) as predictor variables, higher serum levels of Hcy were observed in vegetarians vs non-vegetarians (1 = 4.6, p < 0.05) and males vs females (beta = 5.3, p < 0.01). CONCLUSIONS: Low intakes of folic acid and vitamin B12, and hyperhomocysteinemia, in both the healthy population living in urban slums and adjacent urban non-slum areas, are important observations for the prevention of nutritional and cardiovascular diseases in the Indian subcontinent.

Adult↗
PubMed2004

Factors affecting swimming economy in children and adults.

The aim of this study was to examine the influence of several explanatory factors: anthropometry, buoyancy, passive underwater torque, drag and swimming technique on the energy cost of swimming front crawl in children and adults. Submaximal V(.)O(2) was measured in ten children (age 12) and 13 adults (age 21), as well as body length (BL), body mass, arm length, propelling size, active drag, hydrostatic lift, passive torque, intracyclic velocity fluctuation, hand slip, stroke length and body angle. The results show that body length ( r=0.74), body mass ( r=0.86) propelling size ( r=0.61), arm length ( r=0.66), distance between the center of mass and the center of volume (Delta d, r=0.74) and body angle during swimming ( r=-0.56) all showed significant linear relationships with the cost of swimming at 1.0 m x s(-1) (CS(1.0)). When normalizing the cost of swimming to body size (CS(1.0) x BL(-1)) there were no differences between the two groups. The conclusions of this study are that the combination of BL, body mass, active drag factor, passive torque, drag efficiency and hydrostatic lift were able to explain 97% of the variation in the cost of swimming for the whole group of swimmers. The size-independent factors of torque and floating abilities (density and Delta d in % of BL), together with swimming technique and active drag were found to explain 75% of the variations in CS(1.0) x BL(-1). The identical values for CS(1.0) x BL(-1) for children and adults are explained through the opposing effects of a better swimming technique in the adults, and a better passive torque in the children.

Adolescent↗
PubMed1999

Physiological factors in stretcher carriage performance.

In this study we examined the anthropometric and physiological factors that may account for the ability to carry a casualty on a stretcher. Eleven young soldiers were pretested to obtain their anthropometry, body composition, physical fitness, and muscle cross-sectional areas. They then performed a two-person manual carry of a stretcher containing an 82-kg manikin while walking on a treadmill at a speed of 4.8 km/h. Subjects walked until volitional fatigue, as indicated by slippage of the stretcher from their hands. Average (SD) carriage time was 2.7(1.4) min with a range of 1.4-6.4 min. A stepwise multiple linear regression revealed that forearm bone-plus-muscle cross-sectional area, thigh muscle cross-sectional area, and push-up performance accounted for most of the variance in hand carriage time (r2 = 0.99, P < 0.001). These data suggest that muscle cross-sectional area and upper-body muscular endurance are important physiological factors in the ability to carry a loaded stretcher by hand.

Adult↗
PubMed2001

Human body surface area: measurement and prediction using three dimensional body scans.

The development of three dimensional laser scanning technology and sophisticated graphics editing software have allowed an alternative and potentially more accurate determination of body surface area (BSA). Raw whole-body scans of 641 adults (395 men and 246 women) were obtained from the anthropometric data base of the Civilian American and European Surface Anthropometry Resource project. Following surface restoration of the scans (i.e. patching and smoothing), BSA was calculated. A representative subset of the entire sample population involving 12 men and 12 women (G24) was selected for detailed measurements of hand surface area (SAhand) and ratios of surface area to volume (SA/VOL) of various body segments. Regression equations involving wrist circumference and arm length were used to predict SAhand of the remaining population. The overall [mean (SD)] of BSA were 2.03 (0.19) and 1.73 (0.19) m2 for men and women, respectively. Various prediction equations were tested and although most predicted the measured BSA reasonably closely, residual analysis revealed an overprediction with increasing body size in most cases. Separate non-linear regressions for each sex yielded the following best-fit equations (with root mean square errors of about 1.3%): BSA (cm2) = 128.1 x m0.44 x h0.60 for men and BSA = 147.4 x m0.47 x h0.55 for women, where m, body mass, is in kilograms and h, height, is in centimetres. The SA/VOL ratios of the various body segments were higher for the women compared to the men of G24, significantly for the head plus neck (by 7%), torso (19%), upper arms (15%), forearms (20%), hands (18%), and feet (11%). The SA/VOL for both sexes ranged from approximately 12.m-1 for the pelvic region to 104-123.m-1 for the hands, and shape differences were a factor for the torso and lower leg.

Adult↗
PubMed2006

Maternal perceptions of her child's body weight in infancy and early childhood and their relation to body weight status at age 7.

INTRODUCTION: Maternal perception of her child's weight status has been hypothesised to affect a child's weight development. OBJECTIVE: The aim of this analysis was to determine in how far the maternal weight perception of her child's weight at different ages is related to its future body weight status. MATERIALS AND METHODS: Longitudinal data on body weight, height and skinfolds from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study were used to determine the risk of being overweight at age 7. Complete data on anthropometry, maternal weight perception and confounding variables were available for 253 children. RESULTS AND DISCUSSION: Maternal weight perception assessments at age 6 months, 12 months, 2 years and 4 years of age were related to body weight status as well as changes in body mass index standard deviation score (BMI-SDS) and skinfold SDS between age at assessment and age 7. With respect to the risk of being overweight at age 7, no independent effect of maternal perception was found. When changes in anthropometric measures were considered, it could be observed that children whose weight was considered too low gained more weight until age 7, and those who were considered to be too heavy lost more weight as compared to the children whose weight was considered to be just right. Among infants aged 6 months who were above the 85th percentile, maternal misperception appeared to promote an unfavourable weight development. These latter results support the hypothesis that maternal weight perception might affect a child's weight development. CONCLUSION: As our data suggest, this effect might begin to operate already in infancy.

Adolescent↗
PubMed1997

Assessment of late results of surgery in talipes equino-varus: a reliability study.

UNLABELLED: The variability of a method for clinical and functional assessment of the long-term results of surgical correction of idiopathic congenital talipes equino varus was studied in ten boys and four girls (average age: 19.1 (SD 2.3 years); 22 affected feet) with radiographical evidence of fusion of the foot and ankle ossification centres. Patients were measured twice, 1 week-1 month apart, by the same investigator and were assessed twice on each visit. Assessment included anthropometry, functional assessment and subjective functional evaluation. Calf circumference, skinfold thickness, foot length and width were highly reproducible. Foot length was not significantly influenced by the operation whereas calf circumference, skinfold thickness and foot width were. Although highly reproducible, hopping was not significantly affected by operation. Active and passive range of motion were significantly different. Each was highly reproducible and both were significantly affected by the operation. Patients reported a high and highly reproducible (within two points) functional level. CONCLUSION: An assistant-administered functional questionnaire together with measurement of active and passive range of motion allows easy, valid and reproducible assessment of long-term results of surgery for idiopathic congenital talipes equino-varus correction. A significant effect of the number and type of operation was evidenced.

Adolescent↗
PubMed2005

Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries.

BACKGROUND: In recent years, there has been an increase in numbers of individuals seeking laparoscopic surgical procedures for obesity. The current study compared the benefits and risks between laparoscopic and open Roux-en-Y gastric bypass (RYGBP) performed at the same center for more than 2,000 patients. METHODS: The study population consisted of 1,077 laparoscopic and 1,198 open RYGBP procedures performed between the years 1999 and 2002. Measurements included population characteristics, anthropometries, complications, and hospital stay. RESULTS: The laparoscopic RYGBP has both advantages and disadvantages. The disadvantages include a longer operative time and a higher incidence of fistulas, internal hernias, and small bowel obstruction. The advantages of the laparoscopic procedure are shorter hospital stay, lower incidence of wound infection, and fewer incisional hernias. Both procedures cause similar changes in body weight, but laparoscopic RYGBP is associated with less lean tissue loss during the early postoperative period. CONCLUSION: Both laparoscopic and open RYGBP are effective in inducing massive weight loss. There are, however, differences in the benefits and risks between the two procedures.

Adult↗
PubMed2000

Does growth hormone therapy harmonize distorted morphology and body composition in chronic renal failure?

Recombinant human growth hormone (rhGH) therapy of growth retardation in chronic renal failure (CRF) has become well established. While there are ample data about its effectiveness in restoring longitudinal growth delay, data on complex anthropometry are scarce. Twenty-three children with CRF (6 after renal transplantation) were investigated using 24 different parameters. The analysis revealed disproportionate growth in CRF. While parameters of the trunk and transverse dimension of the head were preserved, the extremities were affected more severely. Bone dimensions of the legs and arms as well as muscle mass were affected the most. RhGH therapy was effective in restoring impaired longitudinal dimensions of the body in CRF. The restoration of growth retardation occurred predominantly in the extremities. This was accompanied by an increase in transversal dimensions, circumferences and soft tissue of the extremities, as well as an increase in bone and muscle volume, indicating harmonization of the total body shape. The dimensions of trunk, forehead diameter and morphological face height remained within the normal range. There was no evidence of acromegaly in children with CRF and rhGH therapy. We conclude that rhGH therapy at a dose of 28 iU/m2/week is effective in restoring previously disproportional body structure and shape in children with CRF.

Anthropometry↗
PubMed2003

Body composition changes following laparoscopic gastric banding for morbid obesity.

Most reports of outcome following obesity surgery report weight and co-morbidity changes only. We studied body composition changes in 17 adult patients (15 F, 2 M, age 43+/-2 years, range 28-58 years), with morbid obesity (initial BMI 40.4+/-4.9 kg/m(2), range 34.7-48.8) who were managed surgically by laparoscopically inserting an adjustable gastric band. Body composition was studied before and after surgery (mean interval of 909+/-51 days, range 441-1155 days) using anthropometry (abdominal circumference, AC, sum of four skinfold thicknesses, SFSUM), whole-body potassium counting (TBK), in vivo neutron activation analysis total body nitrogen (TBProtein) and whole-body dual-energy ray absorptiometry (total body percent fat TBF%, and total body bone mineral density TBBMD). Weight loss over the study period was 23.4+/-2.5 kg. ( p<0.0003) with an AC reduction of 20.0+/-4.5 cm ( p<0.008). Both SFSUM and TBF% were significantly reduced ( p<0.02 and p<0.0005 respectively). Both TBK and TBProtein after normalization for sex and height, were significantly ( p<0.0054 and p<0.001 respectively) reduced, but the ratio of loss of fat mass to fat-free mass, at 4.4:1 was usual for weight loss, and there was no significant changes in the ratio of potassium to protein. TBBMD, after normalization relative to a young same sex adult, was not significantly changed. In this group of patients, most of the substantial weight loss over a 2- to 3-year period was due to loss of fat mass, with relatively less reduction in the components of fat-free mass. Adjustable laparoscopic gastric banding induces fat loss without significant other deleterious effects on body composition.

Absorptiometry, Photon↗
PubMed2005

A new peer instruction method for teaching practical skills in the health sciences: an evaluation of the 'Learning Trail'.

The 'Learning Trail' is an innovative application of peer-mediated instruction designed to enhance student learning in large practical classes. The strategy specifically seeks to improve participants' attention to details of protocol that are often difficult to observe during teacher-centered demonstrations to large groups. Students (n=68) at the University of South Australia trialed this strategy, in which instruction in anthropometric techniques is initiated by an instructor to a group of 3-4 students and then sent in 'waves' from one student group to the next. The final group in the sequence demonstrates the techniques to the instructor, who notes any departures from technical accuracy. As each technical module is flowing from group to group, the instructor initiates the next 'wave' with the first group, and the process is repeated until all of the relevant skills are processed. The final stage is a full class discussion during which sources of technical error are identified and resolved. In this trial, students taught skinfold measurement by the peer instructed method (PI; n=33) were compared with a traditionally instructed group (TI; n=35), in which the instructor was responsible for all information transfer. For each participant, technical errors of measurement (TEM) were calculated; the intra-tester TEM as a measure of reliability, and the inter-tester TEM, in which the student's measures are compared with those of a criterion anthropometrist to give an indication of validity. There were no differences between TI and PI groups on intra-tester TEM (p=0.24), but the PI group had a lower inter-tester TEM for pooled skinfold sites (p=0.006) and for one individual site (triceps; p=0.007), but not the other three sites. The time taken to complete the whole set of instructions did not differ between delivery modes. The results of this trial suggest that the peer-mediated strategy may be more effective than teacher-centered instruction in terms of technical accuracy in anthropometry.

Anthropometry↗
PubMed2002

Improving risk assessment: hip geometry, bone mineral distribution and bone strength in hip fracture cases and controls. The EPOS study. European Prospective Osteoporosis Study.

Hip geometry and bone mineral density (BMD) have previously been shown to relate independently to hip fracture risk. Our objective was to determine by how much hip geometric data improved the identification of hip fracture. Lunar pencil beam scans of the proximal femur were obtained. Geometric and densitometric values from 800 female controls aged 60 years or more (from population samples which were participants in the European Prospective Osteoporosis Study, EPOS) were compared with data from 68 female hip fracture patients aged over 60 years who were scanned within 4 weeks of a contralateral hip fracture. We used Lunar DPX 'beta' versions of hip strength analysis (HSA) and hip axis length (HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated by the HSA software to occur as a result of a typical fall on the greater trochanter, HAL, body mass index (BMI: weight/(height)2) and age were considered alongside femoral neck BMD (FN-BMD, g/cm2) as potential predictors of fracture. Logistic regression was used to generate predictors of fracture initially from FN-BMD. Next age, Cstress (as the most discriminating HSA-derived parameter), HAL and BMI were added to the model as potentially independent predictors. It was not necessary to include both HAL and Cstress in the logistic models, so the entire data set was examined without excluding the subjects missing HAL measurements. Cstress combined with age and BMI provided significantly better prediction of fracture than FN-BMD used alone as is current practice, judged by comparing areas under receiver operating characteristic (ROC) curves (p<0.001, deLong's test). At a specificity of 80%, sensitivity in identification was improved from 66% to 81%. Identifying women at high risk of hip fracture is thus likely to be substantially enhanced by combining bone density with age, simple anthropometry and data on the structural geometry of the hip. HSA might prove to be a valuable enhancement of DXA densitometry in clinical practice and its use could justify a more proactive approach to identifying women at high risk of hip fracture in the community.

Absorptiometry, Photon↗
PubMed1981

Plasma levels of norethidrone in Indian women receiving norethidrone enanthate (20 mg) injectable.

Plasma norethindrone (NET) and progesterone were estimated by radioimmunoassay in seven Indian women after intramuscular administration of 20 mg NET enanthate. One subject had intermenstrual bleeding throughout the cycle. Out of the six subjects considered for analysis, three subjects showed ovulation suppression, two had delayed ovulation and the remaining one exhibited normal ovulatory pattern. Post-peak average plasma NET values ranged from 1.0 to 2.1 ng/ml. These values showed a significant positive correlation with the anthropometric indices such as body weight and mid-arm-circumference. The subjects with lower anthropometry showed exponential decline of plasma NET. A possible role for nutritional status of an individual in drug disposition is indicated from this study.

Adult↗
PubMed1990

The physiology of nutritional assessment and therapy in protein-calorie malnutrition.

Protein-calorie malnutrition (PCM), in the purest sense, is the result of depleted body protein stores due to semistarvation. A review of the hormonal response to simple semistarvation illustrates the elegant adaptive ability of the body to respond to an inadequate diet. By contrast, the body's metabolic response to an injury or illness stimulus is a dynamic process orchestrated by monokines and hormones. Although the injury response, strictly speaking, is not synonymous with PCM, the resultant increased energy expenditure, anorexia, and potential for skeletal muscle breakdown can result in an even more rapid depletion of body protein stores. Ultimately, the need for nutritional support depends on the amount of recent weight loss, anticipated time of insufficient oral intake, and the degree of stress. A discussion of basic concepts of anthropometry precedes examples of advantages and disadvantages of a given anthropometric parameter for selected disease states. The effects of PCM on visceral structure and function are discussed in detail so that the reader can appreciate why the metabolic response to injury may have a very different impact on the nourished compared with the malnourished patient. Particular attention is paid to the adverse effects of PCM on immune function and its antithesis, the beneficial impact of nutritional repletion on the immune system. An approach to refeeding discusses indications for initiation of nutritional support, choice of route, design of a macronutrient and micronutrient regimen, and guidelines for monitoring. Familiarity with the metabolic alterations of refeeding is key to the mitigation of potentially life-threatening complications of sudden refeeding. Appreciation of the anticipated response to nutrition is important, as the response will vary with the degree of stress. A nearly optimal response can be expected with appropriate nutrition in the nonstressed semistarved patient, whereas inefficient repletion is to be expected in the severely stressed patient. The review concludes with a discussion of the role of nutrition as a modifier of the body's metabolic response to injury.

Anthropometry↗