Search Results (6)

Background/Objectives: Cardiopulmonary exercise testing (CPET) is a well-established tool for risk stratification in patients with heart failure (HF); however, its utility is limited in routine clinical practice due to the associated cost and technical demands. The hemodynamic gain index (HGI), a non-metabolic parameter derived from systolic blood pressure and heart rate changes during exercise, has been demonstrated to play a promising role in HF populations. In this study, we aimed both to validate the prognostic value of the HGI and to evaluate a novel metric, heart hemodynamic reserve (HHR), in patients with HF and left ventricular ejection fraction (LVEF) below 50%. Methods: We retrospectively enrolled 479 consecutive patients with HF and reduced or mildly reduced LVEF who underwent maximal, symptom-limited CPET at three Italian university hospitals between 2012 and 2024. The HGI and HHR were computed using resting and peak exercise hemodynamic data. HHR is defined as the product of systolic blood pressure and heart rate reserve with exercise, normalized for the age-predicted maximum heart rate. The primary endpoint was a composite of cardiovascular death, urgent heart transplantation (HTx), or left ventricular assist device (LVAD) implantation. Prognostic associations were assessed using multivariable Cox regression and area under the receiver operating characteristic curves (AUCs). Results: During a median follow-up of 3.25 years, the composite outcome occurred in 56 patients (11.5%). Both the HGI and HHR were independently associated with the prespecified endpoint (HGI HR: 0.41, 95% CI: 0.20–0.83, p = 0.013; HHR HR: 0.89, 95% CI: 0.83–0.96, p = 0.004), with HHR showing a slightly higher prognostic accuracy than the HGI (AUC 0.78 vs. 0.74; p = 0.033). Conclusions: Both the HGI and HHR are independent prognostic markers in HF patients with LVEF < 50%. Their non-metabolic derivation makes them valuable tools for risk stratification in settings where CPET is unavailable. Full article

Childhood obesity has been associated with altered blood lipids and bad eating habits. In this cross-sectional study, we assessed cardiorespiratory fitness and metabolic health markers in regard to weight status and dietary habits in schoolchildren. In 134 children (6–11 years), we conducted: (1) Anthropometry, namely z-score BMI (z-BMI), waist-to-height ratio (WHtR), and body composition analysis. (2) Measurements of handgrip strength (HGS), resting metabolic rate (RMR) and VO₂max. (3) Quantification of blood lipids and antioxidant vitamins A, E, C. (4) Eating breakfast assessment. About 35% of children were overweight/obese. The z-BMI positively correlated with WHtR (r = 0.637, p < 0.001), and adversely correlated with fat-free mass (r = −0.728, p < 0.001) and vitamin E (r = −0.286, p < 0.001). RMR and VO₂max were greater in normal weight children compared to those with overweight/obesity (p < 0.001). HGS did not differ between these groups, but was negatively correlated with dyslipidemia as shown by TG/HDL-C ratio (r = −0.224, p = 0.037). According to regression analysis, eating breakfast routinely at home was positively associated with RMR and adversely associated with z-BMI. Hence, regular breakfast consumption at home may improve RMR in kids. Cardiorespiratory fitness and physical strength are key modulators of metabolic health in Greek children added to a social determinant of health i.e., eating breakfast at home. Full article

The primary goal in aquaculture is to maximize the growth and survival of farmed fishes at a minimal cost, which requires an understanding of the changes in metabolism undergone by different fish breeds during development. In particular, highly intensive aquaculture production systems, such as recirculating aquaculture systems, require a better understanding of oxygen consumption. Ontogenetic phase shifts (i.e., sudden changes) in metabolism have been observed in several aquaculture species during early development, and such metabolic phase shifts may help to predict the oxygen consumption of aquaculture species during different stages of their development. Here, I analyzed the pattern of metabolic changes in the F₂ hybrid sturgeon, the bester (Huso huso × Acipenser ruthenus; hereafter, referred to as the F₂ bester), during its early development. I observed ontogenetic phase shifts in metabolism in the F₂ bester at body mass values of about 0.2 and 0.8 g. Thus, the F₂ bester undergoes ontogenetic phase shifts in metabolism during early development, which can help to characterize oxygen consumption at a specific developmental period. Therefore, oxygen can be appropriately adjusted and replenished during breeding. Full article

Background: Nivolumab improved patients’ survival in metastatic renal cell carcinoma (mRCC). We aimed to evaluate resting energy expenditure (REE) (i.e., patients’ basal metabolism) to predict efficacy. Methods: We conducted a monocentric, observational study of mRCC patients receiving nivolumab between October 2015 and May 2020. REE was measured prior to initiating immunotherapy using indirect calorimetry to determine hypo, normo and hypermetabolism. Primary endpoint was 6-month, progression-free survival (PFS), and secondary endpoints were response rate, PFS and overall survival (OS). Results: Of the 51 consecutive patients, 15 (29%) were hypermetabolic, 24 (47%) normometabolic, and 12 (24%) hypometabolic. The 6-month PFS was 15% for hypermetabolic patients and 65% for non-hypermetabolic patients (p < 0.01). In the multivariate analysis, hypermetabolism was the only baseline factor predicting 6-month PFS (OR 9.91, 95%CI [1.62–60.55], p = 0.01). Disease progression was noted as the best response in 73% of hypermetabolic patients and 26% of non-hypermetabolic patients (p = 0.02). Median PFS was 2.8 and 8.7 months (p < 0.01), and median OS was 20.2 and 35.1 months (p = 0.13) in the hypermetabolic and non-hypermetabolic groups, respectively. Conclusions: Our study identifies an association between mRCC patients’ energy expenditure and nivolumab efficacy. The measurement of REE by indirect calorimetry in routine practice could help identify patients at risk of nivolumab failure. Full article

AIM: Energy supply in artistic gymnastics is derived mainly through the anaerobic metabolism, due to the brief duration of the competitive routines. However, during training, gymnasts perform repetitive exercises and routines, which may require aerobic adaptations, in order to recover fast and maintain high quality of execution. To improve this aspect of fitness, coaches use high-intensity interval circuit training with sport-specific exercises. Despite the popularity of this training method, there is limited information regarding the demands placed on aerobic metabolism, especially in very young athletes. Thus, the aim of this study was to examine heart rate responses during a high-intensity functional training session in female child gymnasts, to indirectly assess the contribution of aerobic energy metabolism. MATERIAL & METHOD: Seventeen girls aged 9.8 ± 0.8 years (height, 1.38 ± 0.10 m; body mass, 33.7 ± 7.25 kg) performed two 5-min sets, each consisting of five rounds of five gymnastics exercises (5–7 s work and equal rest) executed at maximal effort. The two sets were separated by a 3-min recovery period. Prior to the main measurement, athletes performed a 20-m shuttle run test until exhaustion where maximum heart rate (HRmax) was measured and the maximum oxygen uptake (VO₂max) was estimated. Heart rate was continuously monitored during all sessions using a Polar team 2 system. RESULTS: VO₂max was 47.8 ± 3.0 mL kg^-1 min^-1 and HRmax was 207 ± 5 bpm. During the first set, peak HR was 192 ± 7 bpm and average HR was 171 ± 8 bpm (83% HRmax). During the second set, peak HR was 196 ± 8 bpm and average HR was increased to 186 ± 6 bpm (90% HRmax, p < 0.001 compared with set 1). The time during which HR was above 90% of HRmax was 2.0 ± 1.2min in set 1 and increased to 3.4 ± 1.7 min in set 2 (p < 0.01). HR recovery was similar after both sets, with HR decreasing by about 30% (to 139 ± 7 bpm and 134 ± 10 bpm) after 2 min (p < 0.001). CONCLUSION: These results suggest that high-intensity training using sport-specific exercises increases HR to levels above 90% HRmax for extended time periods. Thus, this type of training may be an appropriate stimulus for concurrent improvements in muscle strength/power and aerobic fitness. Full article

Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes. Full article