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Downloads/Bmiforpactitioners.Pdf) Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2017 Identifying Osteosarcopenic Obesity in a Group of Older Women Julia E. (Julia Ellen) Inglis Follow this and additional works at the DigiNole: FSU's Digital Repository. For more information, please contact [email protected] FLORIDA STATE UNIVERSITY COLLEGE OF HUMAN SCIENCES IDENTIFYING OSTEOSARCOPENIC OBESITY IN A GROUP OF OLDER WOMEN By JULIA E. INGLIS A Dissertation presented to the Department of Nutrition, Food and Exercise Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2017 Julia E. Inglis defended this dissertation on February 28, 2017. The members of the supervisory committee were: Jasminka Ilich-Ernst Professor Directing Dissertation Dan McGee University Representative Bahram H. Arjmandi Committee Member Lynn Panton Committee Member The Graduate School has verified and approved the above-named committee members, and certifies that the dissertation has been approved in accordance with university requirements. ii To my grandfather, Harry B. Eisberg, Jr, MD, who also studied bone health iii ACKNOWLEDGMENTS I would like to offer my utmost appreciation for Dr. Jasminka Ilich-Ernst, who was more than an advisor to me. She played a key role in guiding me with unlimited patience and energy and gave me all the support I could ask for. Her experience and knowledge has enlightened my education and my life, providing me with a vision for my person and my career. I would also like to thank my committee members Dr. Bahram Arjmandi, Dr. Lynn B. Panton, and Dr. Dan McGee for their valuable ideas, encouragement and compassion. I am also grateful to Pamela Black, ultrasound technician and Joni Jones, for allowing me to utilize the ultrasound equipment in the Health Center at the Florida State University for this research. I am grateful to all of my previous professors for my master’s degree and bachelor’s degree including Dr. Maria T. Spicer and all those at the University of North Florida. I am grateful to Pegah Jafarinasabian for her tireless commitment to this project and support as a laboratory partner. I am grateful to my local church for all of their prayers that supported me. I also wish to thank all my friends who have added richness to my life. I am endlessly grateful to my parents, Dr. Craig M. Inglis and Ingrid E. Inglis for their support every step of the way. iv TABLE OF CONTENTS List of Figures ................................................................................................................................ vi List of Tables ................................................................................................................................ vii List of Abbreviations ............................................................................................................................... viii Abstract .......................................................................................................................................... ix 1. BACKGROUND AND SIGNIFICANCE ...................................................................................1 2. LITERATURE REVIEW ............................................................................................................8 3. METHODS ................................................................................................................................22 4. RESULTS ..................................................................................................................................29 5. DISCUSSION ...........................................................................................................................43 6. CONCLUSION .........................................................................................................................52 APPENDICES ...............................................................................................................................54 A. IRB APPROVAL .........................................................................................................54 B. CONSENT FORM .......................................................................................................58 C. INITIAL SCREENING ...............................................................................................62 D. DEMOGRAPHIC SURVEY .......................................................................................64 E. ALLIED DUNBAR SURVEY OF HABITUAL PHYSICAL ACTIVITY ................66 F. EXERCISE ..................................................................................................................68 G. SF-36 FORM ...............................................................................................................70 H. MINI-MENTAL STATE EXAMINATION (MMSE) ................................................75 I. ANTHROPOMETRICS ..............................................................................................78 J. 3-DAY DIETARY RECORD INSTRUCTIONS ........................................................79 K. CDC FALL RISK QUESTIONNAIRE .......................................................................81 L. SMOKING PAST AND PRESENT ............................................................................82 M. PHYSICAL PERFORMANCE TESTS DATA SHEET .............................................84 References ......................................................................................................................................85 Biographical Sketch .....................................................................................................................101 v LIST OF FIGURES Fig. 1 Classification of participants ...............................................................................................31 Fig. 2 Ultrasound image of Rectus femoris muscle .......................................................................36 Fig. 3 Results (mean ± SEM) for sit-to-stand among the four distinct groups of women.............38 Fig. 4 Results (mean ± SEM) for knee extension among the four distinct groups of women .......38 vi LIST OF TABLES Table 1. Clinical and anthropometric characteristics of OSO, OO, obese-only and osteopenic/sarcopenic non-obese groups: mean (SD), min-max (N=59) ......................................33 Table 2. Muscle quality (knee extension), echo intensity and phase angle, of OSO, OO, obese- only and osteopenic/sarcopenic non-obese groups: mean (SD), min-max ....................................35 Table 3. Physical performance of OSO, OO, obese-only and osteopenic/ sarcopenic non-obese, mean (SD), min-max ......................................................................................................................37 Table 4. Assessment and scoring of functional performance and corresponding cut-off values ..39 Table 5. Percentage of participants with functional performance below the cutoff for each test indicating functional decline ..........................................................................................................40 Table 6. Average performance score and percentage of participants OSO, OO, obese-only and osteopenic/sarcopenic non-obese with functional performance below the cutoff, n (%) ..............41 vii LIST OF ABBREVIATIONS ALM Appendicular Lean Mass AMPK Adenosine monophosphate-activated protein kinase ANOVA Analysis of Variance BIA Bioelectrical Impedance Analysis BMD Bone Mineral Density BMI Body Mass Index BMSi Bone material strength index CDC Centers for Disease Control CRP C-reactive protein CT Computed Tomography DXA Dual-Energy X-Ray Absorptiometry EI Echo Intensity IL-6 Interleukin-6 IL-8 Interleukin-8 IL-12 Interleukin-12 L1-L4 Lumbar Spinal Discs L1, L2, L3, L4 MAPK Mitogen activated protein kinase MAT Marrow adipose tissue min minute MRI Magnetic Resonance Imaging mRNA Messenger Ribonucleic Acid NIH National Institute of Health OO Osteopenic obesity OPG Osteoprotegerin OSO Osteosarcopenic Obesity PI Pixel Intensity PPAR Peroxisome proliferator-activated receptors RANK Receptor activated nuclear factor-k RANKL RANK ligand SAS Statistical analysis software SF-36 Short Form Health Survey – 36 questions SMI Skeletal muscle mass index SO Sarcopenic obesity sTnT skeletal muscle specific troponin TNF-α Tumor necrosis factor alpha viii ABSTRACT A cross-sectional study in older women was designed and conducted to identify prevalence, specific characteristics and diagnostic criteria for the newly identified condition named osteosarcopenic obesity syndrome. Osteosarcopenic obesity (OSO) ), a syndrome recently identified by Dr. Ilich-Ernst, is a condition where an older adult experiences bone loss, sarcopenia and increased fat mass, the latter either as a clinically diagnosed overweight/obesity or infiltrated fat into bone and muscle. The study lasted 24 months and a total of N=59 Caucasian ambulatory women aged 76.0±7.3 years (mean ± SD) and BMI of 27.0±5.5 kg/m2 from the local area were assessed for body composition measurements (bone, muscle, fat tissue) using dual energy x-ray absorptiometry scans (DXA). Osteoporosis/osteopenia was identified based on femoral neck and lumbar spine (L1-L4) T-scores (≤-1). A linear regression model was created to identify sarcopenic obesity in the sample, based on the appendicular lean mass, controlling for height (m) and fat mass (kg). Obesity status was based on percent body fat with a cut-off at ≥32%. Muscle quality was measured via echo intensity obtained via ultrasound
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