39(18), 21332143 (2021). FibroScan measures scarring by measuring the stiffness of your liver. Med. Article BMR has been reported to increase by 57% in individuals with T2DM21,22. Berclaz, P.-Y. The current study suggested that adiponectin was a strong positive determinant for REE in individuals with NAFLD and T2DM. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. In the present study, the CAP values of the 19 NAFLD patients ranged from 248 to 400 dB/m, with . Ultrasonography and FibroScan were performed twice and once, respectively ( Table 5 ). A fibrosis score of F2 (7.5 to 10 kPa) indicates moderate scarring that has spread outside the liver. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Gougeon, R. et al. Some possible mechanisms that explain the relationship between BMR and blood pressure are as follows: (1) increased activity of the sympathetic nervous system, which can elevates BMR and blood pressure64,65; (2) thyroid hormones levels (T3 and T4) which can affect both blood pressure and metabolism64,66; (3) accumulation of reactive oxygen species (ROS) related to the oxidative stress conditions that can elevate BMR and also increase blood pressure through endothelial dysfunction, inflammation and changes in the regulation of nitric oxide64,67,68. (E) French NAFLD cohort (n=182). 2020, 116 (2020). have shown that REE increases significantly among adults (33 to 69-year-old) with T2DM in response to the 6-week walking program of 10,000 steps on five or more days of the week70. Diagnostic performance in the derivation, Diagnostic performance in the derivation cohort of the FAST score for the diagnostic, Calibration plots in external validation, Calibration plots in external validation cohorts (A) French bariatric cohort (n=110). Development of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers. The cross-sectional design of the current study made it impossible to draw a conclusion on causality. Ann. BMI was calculated as weight in kg divided by the square of height in meters. 89(3), 977984 (2000). Google Scholar. Accessibility Care 6(1), 5563 (2003). The short version of the international physical activity questionnaire (IPAQ) was used to measure the physical activity of participants28. Decision making for liver biopsy in NASH, not so FAST? s -w64'?*TM|_*>&7VZG|Ze~_-c\;7b 4+T*=P *xtocd~ _t~D8, AuA? Nutr. Syndr. Physiol. Fatty change is when fat builds up in your liver cells. Nat Rev Gastroenterol Hepatol. Rathaus, M. & Bernheim, J. Liver Int. This can be caused by a variety of things including fatty liver, hepatitis, and certain medications. (C) China Hong-Kong NAFLD cohort (n=83). Then, look at the top of that column to see the fibrosis score. The CAP score is measured in decibels per meter (dB/m). Calibration of the data is estimated using a smoothed regression line (dotted line) using locally estimated scatterplot smoothing (Loess) that allows inspection of the calibration across the range of predicted values and determination of whether there are segments of the range in which the model is poorly calibrated. Clin. ET reports personal fees from Pfizer, Intercept, Gilead, Promethera, and Dr Falk, outside the submitted work. & Benedict, F. G. A biometric study of human basal metabolism. The median CAP was higher among patients with significant steatosis (317 [IQR 284-339] vs. 250 [227-279] dB/m with <10% steatosis; P < 0.0005) and the AUROC for this outcome was 0.81 (95% CI 0.74-0.88). 2012 Feb;36(1):13-20. doi: 10.1016/j.clinre.2011.08.001. Yanai, H. & Yoshida, H. Beneficical effect of adiponectin on glucose and lipid metabolism and atherosclerothic progression: Mechanisms and perspectives. Effect of acute resistance exercise on postexercise energy expenditure and resting metabolic rate. Investig. Echosens and UK National Institute for Health Research. Here are some helpful terms to know related to your FibroScan results: Fibrosis and steatosis are measured separately from one another. Understanding NAFLD: From Case Identification to Interventions, Outcomes, and Future Perspectives. Your healthcare provider will use your CAP score to find out your steatosis grade. Article MS, CF, LS, VM, JJD, and PNN were involved in study design and data analysis and data interpretation. The French (E) and Turkish (G) NAFLD external validation cohorts are well calibrated; their calibration curve is nearly linear, their intercept is close to zero (CIs include zero), and their slope is close to one (CIs include one). If you have any questions or to schedule your Fibroscan, call our location nearest you or use our appointment request form. PLoS One. Google Scholar. 8(1), 111 (2011). The dotted line represents the calibrations estimated on the data using locally estimated scatterplot smoothing (Loess). 76(1), 133137 (1994). Ther Adv Endocrinol Metab. 2020 Dec;72(6):2228-2230. doi: 10.1002/hep.31498. According to the results of multivariable logistic regression analyses, hypermetabolism had a positive association with adiponectin (odds ratio [OR] 1.167, 95% confidence interval [CI] 1.0151.342, p=0.030), physical activity (OR 1.134, 95% CI 1.0021.284, p=0.046), alanine transaminase (OR 1.062, 95% CI 1.0061.122, p=0.031) and diastolic blood pressure (OR 1.067, 95% CI 1.0101.127, p=0.021). If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. /ColorSpace << To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Contact us CAP: tried and trusted CAP provides a convenient and patient-friendly method to assess lipid turnover during lifestyle and dietary interventions to combat NAFLD. Non-alcoholic fatty liver disease: A major challenge in type 2 diabetes mellitus. 137(2), 145155 (2008). -, Tsochatzis EA, Newsome PN. Therefore, the objective of the present study was to find the predictive or determining factors that could affect hypermetabolism in subjects with both T2DM and NAFLD. The mechanisms underlying adiponectin and hypermetabolism are not precisely understood. Your CAP score is a measurement of fatty change in your liver. Validation of controlled attenuation parameter measured by fibroscan as a novel surrogate marker for the evaluation of metabolic derangement. MS, VM, CF-P, and LS are Echosens employees. Alcohol consumption in diabetic patients with nonalcoholic fatty liver disease. Please do not use it to ask about your care. Funding: Adv. The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD). J. Mol. There is also evidence showing that resistance training programs increases REE71,72,73,74. Li, G. & Zhong, L. Genetic variations in adiponectin levels and dietary patterns on metabolic health among children with normal weight versus obesity: The BCAMS study. Your fibrosis result may be over-estimated (your liver may have less scarring than what your fibrosis result says) if you have: Your FibroScan results may also be less accurate if you have: Fibrosis score F0 to F1: No liver scarring or mild liver scarring, Fibrosis score F2: Moderate liver scarring, Fibrosis score F3: Severe liver scarring Fibrosis score. A score below 238 dB/m means the amount of fatty change in your liver is not higher than normal. official website and that any information you provide is encrypted Work-up for Incidentally Detected NAFLD: How Far is It Worth? 0. endobj Hipskind, P. et al. In addition, JFC has a patent pending for protein-based biomarkers of fatty liver disease. 11(Suppl), S208S217 (2001). The higher level of BMR in obese NAFLD individuals with metabolic syndrome has been to some extent attributed to low-grade, chronic inflammation17. The main causes of fatty liver disease are excessive alcohol consumption and/or poor diet and sedentary lifestyle. 2012 Jul;32(6):875-7. doi: 10.1111/j.1478-3231.2012.02824.x. J. Clin. Endocrinol. image, Download .pdf (.32 Int. Normal livers fall between 2 and 6 kPa, with anything outside this range indicating some degree of liver disease. Driving Nonalcoholic Steatohepatitis Forward Using the FibroScan Aspartate Aminotransferase Score, But Obey the Traffic Lights. Front. (C) Sensitivity, specificity, positive predictive value, and negative predictive value versus all possible FAST score values. Resting energy expenditure is not increased in mildly hyperglycaemic obese diabetic patients. BMC Gastroenterol. Impaired glycemic control and elevated glucose output from the liver due to increased gluconeogenesis and glycogenolysis, which is caused by insulin inefficiency, as well as higher protein turnover, higher sympathetic nervous system activity, oxidative stress, visceral fat and altered body metabolism are potential mechanisms which have been suggested for the increased metabolism in diabetic subjects21,22,23. In those four cohorts, the FAST score overestimates the probability of being NASH+NAS4+F2. MeSH Next Steps Evidence Pract. @Ev*B{p\Qk[Ll0T!]\3# Epub 2019 Jan 25. The .gov means its official. Sheikhi, A. et al. [0 /XYZ 35.2500000 ADS The Shear wave speed and stiffness measurements may be used as an aid to clinical management of adult patients with liver disease. FibroScan is a special ultrasound technology that measures liver stiffness (hardness) and fatty changes in your liver. Liver inflammation. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver . National Library of Medicine BMC Nephrol. Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. CAPis unique, patented and validated for liver disease management2,3. 37(2), 558565 (2018). The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. YY reports grants and speaker fees/advisory board fees from Gilead Sciences; and speaker fees/advisory board fees from Bilim la, AbbVie, and Abdi brahim outside the submitted work. If you have more than one liver disease, this table may not apply to you. The lower the percentage of the liver with fatty change indicates that your liver is healthier. Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are both progressive health problems worldwide1,2. Disclaimer. With cancer, where you get treated first matters. Resting energy expenditure and protein turnover are increased in patients with severe chronic obstructive pulmonary disease. /F9 9 0 R We used FibroScan to detect the incidence of fatty liver and fibrosis in CHB patients, and to assess the correlation of FibroScan measurements with blood chemistry tests. Sayed Mahmoud Sajjadi-Jazi. 2019;71:313322. Huang, Z. et al. Herrera-Amante, C. A. et al. Considering the progressive prevalence and co-occurrence of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD), as well as the current evidence suggesting the elevated levels of basal metabolic rate (BMR) among these individuals, the present study aimed to identify factors determining hypermetabolism in such subjects. It measures fibrosis (scarring) and steatosis (fatty change) in your liver. PubMed Hypermetabolismwas definedas an elevated measured REE>110% of predicted REE31. Therefore, this suggests that the elevated protein turnover, among other factors such as systemic inflammatory response, may be contributing to FFM depletion and increase REE levels in subjects with NALFD and diabetes. Google Scholar. JB reports personal fees from Echosens outside the submitted work. >> Bethesda, MD 20894, Web Policies The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia. To update your cookie settings, please visit the, https://doi.org/10.1016/S2468-1253(19)30383-8, FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study, View Large The FibroMeter NAFLD score was determined using a proprietary algorithm (regression score). This information will help you understand your FibroScan results. 12, 739875 (2021). eCollection 2023. Acad. Gastroenterology. Your healthcare provider will use your FibroScan fibrosis result and your medical history to determine your fibrosis score. Ther. et al. 2019 May;156(6):1717-1730. doi: 10.1053/j.gastro.2019.01.042. Another cross sectional study has also reported no relationship between circulating adiponectin and REE in both young and elderly women after adjusting for several confounding factors such as fat mass and FFM53. FibroScan is a special ultrasound technology that measures liver stiffness (hardness) and fatty changes in your liver. Diagnostic performance in the derivation cohort of the FAST score for the diagnostic of NASH+NAS4+F2 (A) Receiver operating characteristic curve. Between September, 2017, and March, 2018, a total of 95 eligible participants (64.40% male) with both T2DM and NAFLD were included, while 32.63% of them were classified as hypermetabolic. (D) China Wenzhou NAFLD cohort (n=104). Although there are limitations in applying ALT in the diagnosis of NAFLD and NASH, it is widely used as a surrogate marker of hepatocellular inflammation and damage in liver diseases75, and as it is known, inflammation is significantly related to the elevation of REE76,77. 2019 May;156(6):1717-1730. doi: 10.1053/j.gastro.2019.01.042. Nutr. Effect of bariatric surgeries on metabolic rate, a systematic review and meta-analyses. Front. You can keep reading to learn more about your results. Twenty-four-hour energy expenditure in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. 13(1), 112 (2021). Here are some helpful terms to know related to your FibroScan results: Fibrosis (fy-BROH-sis): Scarring in your liver. Crit. Pannacciulli, N. et al. However, our study has some limitations. endobj FibroScan is a type of liver elastography. Google Scholar. J. Obes. Your care team cannot see anything you write on this feedback form. Between September, 2017, and March, 2018, a total of 108 subjects with both T2DM and NAFLD who met the inclusion criteria and were willingness to participate in the study were recruited from diabetes clinics in the Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences (Tehran, Iran). Younossi, Z. M. et al. The cells become scarred and cannot divide. The Lancet Regional Health Southeast Asia, The Lancet Regional Health Western Pacific, Detection of colorectal adenomas with a real-time computer-aided system (ENDOANGEL): a randomised controlled study, Global prevalence of hepatitis C virus in children in 2018: a modelling study, Derivation and external validation cohort patient characteristics, Diagnostic performance in the derivation cohort of the FAST score for the diagnostic of NASH+NAS4+F2, Calibration plots in external validation cohorts, Diagnostic performance of the FAST score for the diagnosis of NASH+NAS4+F2 in the derivation and external validation cohorts. government site. The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Acquisition of data, M.R.M.T. This score will range from 100 dB/m to 400 dB/m. Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area. 258(6), E990E998 (1990). An official website of the United States government. To ensure hydration and obtain a valid evaluation, subjects were asked to follow the instructions before the body composition assessment as previously described27. Opin. The data about demography, past medical history and drug consumption were collected through face-to-face interviews. Transient elastography was performed by one experienced operator, using FibroScan 502 instrument (EchoSense, France, 5MHz), to detect and quantify liver steatosis (CAP, dB/m) and fibrosis (LSM, kPa). PNN and JJD were supported by the NIHR Birmingham BRC. 26(4), 426433 (2011). Current smoker was attributed to those who had smoked cigarette regularly in the past 6months. livers can have up to 5% of fatty changes in them. Metab. A FibroScan can reveal fatty changes to the liver (steatosis) and scarring. Therap. In addition, there was a stepwise increase in Cap score parallel to the increase in severity of liver fibrosis (p < 0.001) . MA reports speaker fees/advisory board fees from MedImmune/Astra Zeneca, E3Bio, and Intercept, outside the submitted work. Br. The Chinese Hong-Kong NAFLD cohort (C) has a zone in which the risk of being NASH+NAS4+F2 is overestimated using the FAST score (grey ribbon below the ideal calibration curve) and a zone in which the calibration seem adequate (grey ribbon zone includes the ideal calibration curve). 73 to 1 using the dual cutoffs approach, with cutoffs derived in the derivation cohort. Pediatr. If patients remain undiagnosed and untreated, they may go on to develop irreversible cirrhosis of the liver. CAP performance was not influenced by measurement variability, but was higher in patients with mild (F0-F1) fibrosis (AUROC 0.89 vs. 0.72 with F2-F4; P = 0.03). Carneiro, I. P. et al. Scarring of the liver is measured by four stages. Anthropol. The intercept compares the mean of all predicted risks with the mean observed risk and indicates the extent that predictions are systematically too low or too high. /GSa 3 0 R SAH reports grants from Conatus, Immuron, Second Genome, and Tobira/Allergan; grants and personal fees from Axcella, Cirius, CymaBay, Galmed, Gilead, HightTide, Intercept, NGM, Novartis, Novo Nordisk, Pfizer, Galectin, Genfit, and Madrigal; and personal fees from Metacrine, 3V Bio, Albereo, Alexion, Blade Therapeutics, Bristol-Myers Squibb, Civi BioPharma, CLDF, Contravir, Consynance, Concept, Echosens, Gelesis, HistoIndex, Innovate, IQVIA, Medpace, Perspectum, Poxel, Pometheus, Prometic, Terns, Akero, and Lipocine, outside the submitted work. Both LSM by VCTEand CAP are measured simultaneously without lengthening the examination time. AUROC=area under the receiver operating curve. Correspondence to Endocrinol. FibroScan has been in available in the European market since 2003 and was expanded to China, Canada, Brazil, Japan, and many other countries before being approved by the FDA in 2013. Publication Arslanow et al. Other studies have also indicated that REE is only elevated in uncontrolled diabetic subjects and diabetic cases who took blood glucose lowering drugs experienced a decrease in REE38,39,40. (D) Screen failure rate, missed cases rate, and proportion of patients identified, versus FAST scores values. 2014 Apr 28;20(16):4702-11. doi: 10.3748/wjg.v20.i16.4702. The spleen-strengthening and liver-draining herbal formula treatment of non-alcoholic fatty liver disease by regulation of intestinal flora in clinical trial. Google Scholar. ISSN 2045-2322 (online). However, the literature represents diverse findings in regard to adiponectin levels and REE. Disclaimer. Oxidative stress, renal infiltration of immune cells, and salt-sensitive hypertension: All for one and one for all. J. Clin. /CSp /DeviceRGB Find your liver stiffness result in the second column from the left. CAP Score Steatosis grade Portion of your liver affected by fatty change 238 to 260 dB/m S1 Less than (11% to 33%) 260 to 290 dB/m S2 Between and (34% to 66%) 290 to 400 dB/m S3 More than (67%) PMC In combination, these scores can help you understand your overall liver health and how it may change over time with lifestyle or medical interventions. A systematic review of literature. Woreta TA, Van Natta ML, Lazo M, Krishnan A, Neuschwander-Tetri BA, Loomba R, Mae Diehl A, Abdelmalek MF, Chalasani N, Gawrieh S, Dasarathy S, Vuppalanchi R, Siddiqui MS, Kowdley KV, McCullough A, Terrault NA, Behling C, Kleiner DE, Fishbein M, Hertel P, Wilson LA, Mitchell EP, Miriel LA, Clark JM, Tonascia J, Sanyal AJ; NASH Clinical Research Network. Arrese, M. & Barrera, F. Concurrent nonalcoholic fatty liver disease and type 2 diabetes: Diagnostic and therapeutic considerations. Nutr. There is a silent epidemic of fatty liver disease in the general population, called NAFLD/NASH. Would you like email updates of new search results? Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Lakatos PL, Bessissow T, Sebastiani G. Crohns Colitis 360. << To find a location near you with a FibroScan machine, use Echosens locator, which can be found here. I had a fibroscan done last month with a 17 Kpa (cirrhosis). Google Scholar. Controlled attenuation parameter for the detection and quantification of hepatic steatosis in nonalcoholic fatty liver disease. Both LSM by VCTEand CAP are measured simultaneously without lengthening the examination time. They may use blood tests or a certain type of MRI to measure scarring and fatty changes in your liver. FibroScan is a specialized ultrasound machine for your liver. Interpretation: 26(12), 15471552 (2002). 8 . Over 34% but less than 66% is moderate, while over 66% is severe. The test can also be used to monitor liver health in patients with a history of alcohol abuse and a family history of liver disease. Diagnostic abilities of FAST score, fatty liver index, CAP, and BMI for fatty liver in patients with MAFLD and NAFLD . He decided to order a Fibroscan to rule out any liver disease. After overnight fasting, intravenous blood was drawn to measure enzymes and biomarkers. Epub 2020 Dec 3. Zheng, Y., Ley, S. H. & Hu, F. B. 46(2), 325332 (2022). 64(3 Suppl), 449s452s (1996). Taghadomi Masoumi, Z. et al. These measurements help your healthcare provider learn more about your liver disease. We have over 20 locations across California, which makes it easy and convenient for our patients to schedule their appointments. Article Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. The non-invasive Products in the FibroScanrange are Class IIa medical devices as defined by Directive 93/42/EEC (EC 0459). Tarantino, G., Savastano, S. & Colao, A. Hepatic steatosis, low-grade chronic inflammation and hormone/growth factor/adipokine imbalance. In contrast, FFM was negatively related to hypermetabolism (OR 0.93, 95% CI 0.880.99, p=0.023). Lifestyle factors can influence the progression of non-alcoholic fatty liver disease. Clin. Although, historically, a negative relationship between obesity and REE has been shown32, recent studies have challenged this finding, indicating that obese individuals have higher BMR or REE33,34. /MediaBox [0 0 612 792] To check the normality of continuous variables, the KolmogorovSmirnov test was applied. A CAP score of 5% or lower indicates a healthy liver, while a CAP score of 5% to 33% with a steatosis grade of S1 indicates a mild fatty liver. When determining your actual fibrosis score, in addition to your fibrosis measurement, your provider will take into consideration your health history and the grade of steatosis. This site needs JavaScript to work properly. Qi, Y. et al. In the meantime, to ensure continued support, we are displaying the site without styles Res. From diagnosis to treatment, our experts provide the care and support you need, when you need it. Variables with a p-value<0.2 in univariate analysis were enteredinto the multivariate model using the backward selection approach. Liver elastography is a non-invasive test your healthcare provider can use this to learn about your livers health. This can be caused by a recent liver illness or drinking alcohol. Salmenniemi, U. et al. Nat. Fatty liver can also happen during pregnancy, although this is uncommon. By submitting a comment you agree to abide by our Terms and Community Guidelines. Mansour, A., Motamed, S., Hekmatdoost, A. et al. Obes. (Lausanne) 12, 768850 (2021). Calibration plots in external validation cohorts (A) French bariatric cohort (n=110). Association between uncoupling protein 2, adiponectin and resting energy expenditure in obese women with normal and low resting energy expenditure. The CAP was significantly correlated with the percentage of steatosis ( = 0.47) and steatosis grade ( = 0.51; both P < 0.00005). Thirdly, the wide availability of FibroScan devices based on VCTE technology, the need for just a serum AST value, its non-invasive nature, its low cost per scan, and its modest requirement to attain technical proficiency required to do the scans, mean the method can be rolled out easily across most clinical practices. Kao, C. C. et al. World J Gastroenterol. Med. 2020 Apr;5(4):e3. FibroScan is an imaging-based diagnostic test developed by Echosens that looks at liver fibrosis (stiffness, scarring) and steatosis (fat) using transient-elastography technology. Get the latest news and updates on MSKs cancer care and research breakthroughs sent straight to your inbox with our e-newsletters. TE was performed using the Fibroscan apparatus. Read across the row from left to right until you find the range that includes your fibrosis result. The measurement of fatty change in your liver is the CAP score, while the measurement of scarring is the fibrosis score. 2022 Nov 16;12(11):2822. doi: 10.3390/diagnostics12112822. volume13, Articlenumber:3669 (2023) Operators are expressly recommended to carefully read the instructions given in the user manual and on the labelling of these products. Association between blood pressure and resting energy expenditure independent of body size. World J. Gastroenterol. J. Phys. Waist circumference (WC) was measured at the midpoint between the lower costal margin and the iliac crest. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review. Natl. Hypermetabolism was defined as an elevated measured REE>110% of the predicted REE. The table below shows ranges of CAP scores and the matching steatosis grade and amount of fatty change. Your feedback will help us improve the educational information we provide. Vitaminol. There is a silent epidemic of fatty liver disease in the general population, called NAFLD/NASH. Starling, R. D. Energy expenditure and aging: Effects of physical activity. Your result may be higher than the normal range if you have liver disease. Enhance FibroScan liver disease assessment with biological markers, The non-invasive solution for comprehensive management of liver health, Enhance your FibroScan capabilities for improved management of fatty liver patients, Optimize clinical workflows with real-time secure data transmission. For instance, bioelectrical impedance can be affected by some factors including the level of body hydration, body geometry, etc., which could result in the incorrect estimation of body composition78. Lombardo, M. et al. Overall, the mean recruitment agestandard deviation and median (interquartile range) body mass index were 44.695.47years and 30.20 (27.8033.30) kg/m2, respectively. CAS Sport Nutr.