Dietary protein and/or calorie insufficiencies represent an important problem in elderly patients. The biological and clinical implications, and particularly the influence on bone mass of undernutrition in the elderly, have not been completely defined, although several studies have demonstrated a high prevalence of dietary insufficiencies in patients with a recent fracture of the proximal femur. In the present study the relationship between dietary intakes, physical performance and bone mineral density (BMD) was examined in hospitalized elderly patients. The study comprised 74 patients (48 women, mean age 82 years; and 26 men, mean age 80 years) who were hospitalized for various medical indications. They were divided into two groups according to their dietary protein intakes, evaluated during the first 28 days in hospital while on a regular diet. The first group consisted of 26 patients (14 women and 12 men) whose protein intake was equal to or greater than 1 g per kilogram of ideal body weight. The second group consisted of 48 patients (34 women and 14 men) who consumed less than 1 g of protein per kilogram of ideal body weight. The two groups differed also in their energy, carbohydrate, lipid and calcium intakes. Patients in the group with the higher protein intake displayed higher BMD at the level of the femoral neck as measured by dual-photon absorptiometry. The men in this group also had higher lumbar spine BMD. After 4 weeks in hospital the women with a higher protein intake had significantly enhanced bicipital and quadricipital muscle strength and better performance as indicated by the increased capacity to climb stairs.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe respiratory insufficiency causes patients to be intolerant of physical effort and to be frequently limited in their daily activity and results in an imbalance between food intake and nutritional needs. Undernutrition and overnutrition can both affect the quality of life and survival of patients with pulmonary disease. Protein-energy malnutrition can lead to quantitative, qualitative and functional alterations of muscle [1,2] and this affects muscle function, including respiratory muscle in patients with already limited respiratory reserves. Optimal adaptation of nutrition support through the assessment of fat-free mass (FFM) and fat mass (FM) in patients with chronic respiratory insufficiency can avoid or minimize muscle wasting or obesity. For these reasons, the nutritional assessment should include body composition measurements which are based on objective rather than subjective criteria of nutritional evaluation. Body composition can be measured by a number of techniques, including hydrodensitometry, isotope dilution, and whole-body counting of potassium-40 [3]. However, these methods are not easily applicable in ill subjects.More recent methods for the determination of the FFM are dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). DXA has been validated against independent methods, including a gamma neutronactivation model [4,5], total body potassium and hydrodensitometry [6] and is becoming one of the reference methods for body composition analysis, but requires sophisticated technology. BIA is a method of measuring body composition which is easy, noninvasive and inexpensive [7]. BIA measurements have been validated in healthy adults [8][9][10]. The relationship between body impedance and body composition is dependent on age and sex [11,12]. Over 20 different formulae permit the calculation of the FFM and FM based on BIA measurements and have generally been validated in healthy, young adults. SCHOLS et al. [13] proposed a BIA formula validated against deuterium dilution for patients with chronic obstructive pulmonary disease (COPD) (n=24), which included weight and height 2 /resistance (ht 2 /R) as independent variables. Recently, PICHARD et al. [14] were unable to obtain clinically relevant correlations between FFM calculated by 12 BIA formulae [8,9,11,[15][16][17][18][19][20][21], including SCHOLS et al. [13], and DXA-determined FFM, and suggested that a specific formula should be developed for patients with chronic severe respiratory insufficiency. These results suggest that the bioelectrical impedance analysis formula specific to patients with severe respiratory insufficiency give a better correlation and smaller mean differences than 12 different bioelectrical impedance analysis formulae described in the medical literature. A prediction equation, validated against dual-energy X-ray absorptiometry and based on subjects with similar clinical characteristics, is more applicable to the patients with respiratory insufficiency than a formula developed for healthy subje...

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The so-called peak bone mass (PBM) represents the highest amount of bony tissue achieved during life at a given site of the skeleton. It has been suggested that PBM might be achieved as late as the fourth decade, but recent data have indicated that PBM is already achieved by the end of sexual maturation, namely at the end of the second decade. The solving of this apparent controversy is of interest for a better understanding of bone homeostasis and for defining the cohort of normal subjects to be evaluated in order to establish a PBM reference range--necessary for the diagnosis of osteoporosis and evaluation of the fracture risk. To study bone mass evolution in young healthy adults and to determine whether such a cohort can be used to establish PBM reference values, we measured bone mineral density (BMD) in sixty 20- to 35-year-old young healthy adults by dual-energy X-ray absorptiometry at the levels of the lumbar spine (in both anteroposterior and lateral views), femoral neck, trochanter region, total hip and of Ward's triangle, as well as whole-body BMD and bone mineral content (BMC) in cross-sectional and longitudinal studies. In the cross-sectional analysis, none of the bone mass variables was dependent on age using linear regression analysis. The longitudinal study indicated that the mean changes in lumbar spine, proximal femur and whole body BMD or BMC determined after a 1-year interval were not statistically different from zero in either females or males aged 20-35 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone mass is an important determinant of resistance to fractures. Whether bone mineral density (BMD) in subjects with a fracture of the proximal femur (hip fracture) is different from that of age-matched controls is still debated. We measured BMD of the femoral neck (FN) on the opposite side to the fracture, as well as femoral shaft (FS) and lumbar spine (LS) BMD by dual-photon absorptiometry in 68 patients (57 women and 11 men, mean age 78.8 +/- 1.0) 12.4 +/- 0.8 days after hip fracture following a moderate trauma. These values were compared with BMD of 93 non-fractured elderly control subjects (82 women and 11 men), measured during the same period. As compared with the controls, FN BMD was significantly lower in fractured women (0.592 +/- 0.013 v. 0.728 +/- 0.014 g/cm2, P less than 0.001) and in fractured men (0.697 +/- 0.029 v. 0.840 +/- 0.052, P less than 0.05). Expressed as standard deviations above or below the mean BMD of age and sex-matched normal subjects (Z-score), the difference in FN BMD between fractured women and controls was highly significant (-0.6 +/- 0.1 v. +0.1 +/- 0.1, P less than 0.001). As compared with mean BMD of young normal subjects, BMD was decreased by 36.9 +/- 1.4 and 22.4 +/- 1.5% (P less than 0.001) in fractured and control women, respectively. There was no significant difference between FN BMD of 33 women with cervical and 24 with trochanteric hip fractures (0.603 +/- 0.017 v. 0.577 +/- 0.020). FN BMD was lower than 0.705 g/cm2 in 90% of fractured women.(ABSTRACT TRUNCATED AT 250 WORDS)