Objective: Physical function and body composition in older obese adults with knee osteoarthritis (OA) were examined after intensive weight loss. Research Methods and Procedures:Older obese adults (n ϭ 87; Ն60 years; BMI Ն 30.0 kg/m 2 ) with symptomatic knee OA and difficulty with daily activities were recruited for a 6-month trial. Participants were randomized into either a weight stable (WS) or weight loss (WL) program. Participants in WL (10% weight loss goal) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk. WS participants attended health information sessions. Body composition and physical function (Western Ontario and McMaster University Osteoarthritis Index, 6-minute walking distance, and stair climb time) were assessed at baseline and 6 months. Statistical analysis included univariate analysis of covariance on 6-month measurements using baseline values as covariates. Associations between physical function and body composition were performed.Results: Body weight decreased 8.7 Ϯ 0.8% in WL and 0.0 Ϯ 0.7% in WS. Body fat and fat-free mass were lower for WL than WS at 6 months (estimated means: fat ϭ 38.1 Ϯ 0.4% vs. 40.9 Ϯ 0.4%, respectively; fat-free mass ϭ 56.7 Ϯ 0.4 vs. 58.8 Ϯ 0.4 kg, respectively). WL had better function than WS, with lower Western Ontario and McMaster University Osteoarthritis Index scores, greater 6-minute walk distance, and faster stair climb time (p Ͻ 0.05). Changes in function were associated with weight loss in the entire cohort. Discussion: An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA. Greater improvements in function were observed in those with the most weight loss.

Sarcopenia-defined as significant loss of muscle-is associated with cachexia and frailty. Specific diagnostic criteria for sarcopenia continue to evolve, but imaging can play a role in the detection and quantification of muscle depletion. Emerging evidence indicates that sarcopenia is a relevant predictor of quality and quantity of life, particularly in patients who are elderly, have cancer, or undergo surgery.

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With a similar amount of total weight loss, lean mass is preserved, but there is not a preferential loss of abdominal fat when either moderate- or vigorous-intensity aerobic exercise is performed during caloric restriction. This trial was registered at (ClinicalTrials.gov) as: NCT00664729.

Background: Age-related body-composition changes are associated with health-related outcomes in elders. This relation may be explained by inflammation and hemostatic abnormalities. Objectives: Our objectives were to evaluate the relation between body-composition measures [body mass index (BMI), total fat mass, and appendicular lean mass (aLM)] and C-reactive protein (CRP), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI-1) and to explore the effect of obesity and sarcopenia on CRP, IL-6, and PAI-1 concentrations. Design: The data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study baseline visit (n ҃ 286; mean age ҃ 66.0 y). Total fat mass and aLM were assessed with a dual-energy X-ray absorptiometry scan. Linear regressions were performed between body-composition measures and CRP, IL-6, or PAI-1 concentrations. The effect of sarcopenia and obesity (defined as the percentage of fat mass) on CRP, IL-6, and PAI-1 concentrations was evaluated with the use of analyses of covariance. Results: CRP and IL-6 were positively associated with both BMI [␤ ҃ 0.027 (P ҃ 0.03) and ␤ ҃ 0.048 (P 0.001), respectively] and total fat mass [␤ ҃ 0.049 (P 0.001) and ␤ ҃ 0.055 (P 0.001), respectively] and were inversely associated with fat-adjusted aLM [␤ ҃ Ҁ0.629 (P ҃ 0.002) and ␤ ҃ Ҁ0.467 (P ҃ 0.02), respectively]. PAI-1 was positively associated with both BMI (␤ ҃ 0.038, P ҃ 0.005) and total fat mass (␤ ҃ 0.032, P ҃ 0.007). No significant interaction was found between either obesity or sarcopenia and CRP, IL-6, and PAI-1 concentrations. Obesity remained significantly associated with high CRP and IL-6 concentrations after adjustments for sarcopenia. Conclusions: CRP and IL-6 are positively associated with total fat mass and negatively associated with aLM. Obesity-associated inflammation may play an important role in the age-related process that leads to sarcopenia. The relation of inflammation with sarcopenia was not independent of any of the considered obesity indexes.Am J Clin Nutr 2005;82:428 -34.

Background/Objective: There is increasing use of computed tomography (CT) in sarcopenia research using a wide variety of techniques. We performed a systematic review of the CT literature to identify the differences between approaches used. Methods: A comprehensive search of PubMed from 1983 to 2017 was performed to identify studies that used CT muscle measurements to assess muscle mass and myosteatosis. The CT protocols were evaluated based on anatomic landmark(s), thresholding, muscle(s) segmented, key measurement (ie, muscle attenuation, cross-sectional area, volume), derived variables, and analysis software. From the described search, 657 articles were identified and 388 studies met inclusion criteria for this systematic review. Results: Muscle mass was more commonly assessed than myosteatosis (330 vs. 125). The most commonly assessed muscle or muscle groups were total abdominal wall musculature (142/330 and 49/125 for muscle mass and myosteatosis, respectively) and total thigh musculature (90/330 and 48/125). The most commonly used landmark in the abdomen was the L3 vertebra (123/142 and 45/49 for muscle mass and myosteatosis, respectively). Skeletal muscle index and intermuscular adipose tissue were the most commonly used measures of abdominal wall muscle mass (114/142) and myosteatosis (27/49), respectively. Cut points varied across studies. A significant majority of studies failed to report important CT technical parameters, such as use of intravenous contrast and slice thickness (94% and 63%, respectively). Conclusions: There is considerable variation in the CT approaches used for the assessment of muscle mass and myosteatosis. There is a need to develop consensus for CT-based evaluation of sarcopenia and myosteatosis.

The infrapatellar fat pad of Hoffa is an intracapsular structure that is routinely visualized on magnetic resonance images of the knee. Because disease in this region is not uncommon, it is important to be familiar with the various pathologic entities that may occur here. Abnormalities that are intrinsic to this fat pad include Hoffa disease, intracapsular chondroma, localized nodular synovitis, postarthroscopy and postsurgery fibrosis, and shear injury. In addition, the infrapatellar fat pad may be involved secondarily from extrinsic processes, including articular disorders (eg, joint effusion, intraarticular bodies, meniscal cyst, ganglion cyst, cyclops lesion), synovial abnormalities (eg, pigmented villonodular synovitis; hemophilia; synovial hemangioma; primary synovial chondromatosis; chondrosarcoma; lipoma arborescens; rheumatoid, seronegative, and septic arthritis; arthritis associated with inflammatory intestinal disorders; synovitis associated with primary osteoarthritis), and anterior extracapsular abnormalities. The approach to pathologic processes involving the infrapatellar fat pad of Hoffa is simplified when one is familiar with regional anatomy and possible differential diagnostic considerations.

MRI was identified as the most sensitive and specific imaging test for diagnosing stress fractures of the lower extremity. When MRI is available, NS is not recommended because of its low specificity, high dosage of ionizing radiation, and other limitations. Conventional radiographs are likely to result in false negatives upon initial presentation, particularly in the early stages of stress fracture, and in some cases may not reveal an existing stress fracture at any time. A diagnostic imaging algorithm was developed with specific recommendations for cost-efficient imaging of low-risk and high-risk suspected stress fractures.