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Shimizu M, Kinoshita K, Maeno T, Kobayashi H, Maeno T. Can Total Body Resistance Measured Using Bioelectrical Impedance Analysis Be the Index of Dehydration in Older Japanese Patients? J Clin Med Res 2017; 9:926-928. [PMID: 29038670 PMCID: PMC5633093 DOI: 10.14740/jocmr3170w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background Dehydration in older patients has long been considered a significant health problem because it implies increased morbidity and mortality. However, dehydration is detected by a combination of physical signs and blood tests. For older people dwelling at home and in nursing homes, a simple and non-invasive method for detecting dehydration by caregivers is needed. The total body resistance is measured using bioelectrical impedance analysis and is known as an indicator of dehydration. There are no data from older Japanese patients on this issue. We performed this study to examine the relationship between dehydration and total body resistance in Japan. Methods We performed blood tests and measured bioelectrical impedance in older outpatients aged ≥ 65 years from the Internal Medicine Department at Mito Kyodo General Hospital. Patients were classified as dehydrated and non-dehydrated using the dehydration index with a blood urea nitrogen/creatinine ratio > 20, and the mean total body resistance was compared between the two groups. Results Eighty-one patients were recruited in the study. In the dehydrated group, the mean total body resistance was 439 Ω at 50 kHz, which was significantly higher than that in the non-dehydrated group (408 Ω, P = 0.038). Conclusions The total body resistance measurements can be used for simple assessment of dehydration among older Japanese patients.
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Affiliation(s)
- Miyuki Shimizu
- Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kensuke Kinoshita
- Department of General Medicine, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyuki Kobayashi
- Department of General Medicine, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Ibaraki, Japan
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52
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Willshire C, Buckley RJ, Bron AJ. Estimating basal tear osmolarity in normal and dry eye subjects. Cont Lens Anterior Eye 2017; 41:34-46. [PMID: 28958415 DOI: 10.1016/j.clae.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/23/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Tear osmolarity (tOsm) is used as a measure of severity in dry eye disease (DED) and has been proposed as an index of body hydration. In DED the level of tear hyperosmolarity is compared with that of a control population. It is proposed here that a better index of body hydration and a more valid reference point in DED can be acquired by measuring the tOsm after a period of evaporative suppression. METHOD 8 normal and DED subjects were recruited, their tOsm measured in uncontrolled environmental 'clinic conditions'. Then in experiment 1 they entered a controlled environment chamber and had tOsm measured after 45 minutes of eye closure and then, with the eyes open, at 15 minute intervals for a further 45 minutes, at a relative humidity (RH) of 45%. Alternatively, in experiment 2, they had tOsm measured every 15 minutes for 45 minutes during exposure to 70% RH, as a separate measure to suppress evaporation. RESULTS A significant decrease in tOsm occurred in both normal and DED subjects after lid closure in experiment 1 (normal RE p=0.015; normal LE p=0.006; DED RE p=0.0002; DED LE p=0.01). The tOsm also fell slightly after exposure to 70% RH in experiment 2 significant in the LE of normal group only (normal LE p=0.045). CONCLUSIONS Suppression of tear evaporation resulted in a fall in tOsm, close to that of plasma osmolarity (285-295mOsm/L). It is proposed that this new measure, termed Basal Tear Osmolarity (BTO), could provide a valuable index of plasma osmolarity and hence of body hydration and in DED, a personal baseline against which to gauge the severity of tear hyperosmolarity.
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Affiliation(s)
| | - Roger J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Anthony J Bron
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK; Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK
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53
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Taniguchi H, Ushigome K. The development of a pre-dehydration check sheet for independent community dwelling elderly. -A continuation of research about pre-dehydration among elderly individuals who had been admitted to or regularly visited an elderly-care institution. Nihon Ronen Igakkai Zasshi 2017; 54:381-391. [PMID: 28855463 DOI: 10.3143/geriatrics.54.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In the present study, we defined the state of pre-dehydration (PD) as the suspected loss of body fluids, not accompanied by subjective symptoms (serum osmotic pressure: 292-300 mOsm/kg・H2O). The goal of this study was to develop a non-invasive PD check sheet for independent home care for the elderly. METHODS We evaluated the serum osmotic pressure of 222 independent community dwelling elderly individuals who were >65 years of age. We then determined the association between the serum osmotic pressure and various dehydration-related diagnostic factors that we identified in a previous study. We performed a logistic regression analysis to determine the risk factors for dehydration and allotted scores based on the odds ratio. We developed a non-invasive PD check sheet consisting of items with high scores and categorized the risks based on the positive predictive value of the total score of the applied items. RESULTS PD was confirmed in 46 subjects (20.7%) based on their serum osmotic pressure. We developed a PD assessment sheet which consisted of 6 items, (1) Dislike rehydrating before sleeping, as it induces the need to use the toilet (3 points), (2) Using diuretics (8 points), (3) Casual blood sugar ≥126 mg/dl (9 points), (4) Age ≥85 years (3 points), (5) Male sex (4 points), (6) Body weight ≥60 kg (3 points). Patients with a score of >13 points on this sheet were considered to have a high risk of PD (maximum score: 30 points) (positive predictive value, 72%; negative predictive value, 85.6%; P<0.0001). CONCLUSION In the present study, we found that 20.7% of elderly subjects had PD. Based on these data, we developed an effective noninvasive tool for detecting PD among independent community dwelling elderly.
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Affiliation(s)
- Hideki Taniguchi
- Department of Perioperative Support Center, Saiseikai Yokohama-shi Tobu Hospital
| | - Keiko Ushigome
- Department of Perioperative Support Center, Saiseikai Yokohama-shi Tobu Hospital
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54
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Peña-Oyarzun D, Troncoso R, Kretschmar C, Hernando C, Budini M, Morselli E, Lavandero S, Criollo A. Hyperosmotic stress stimulates autophagy via polycystin-2. Oncotarget 2017; 8:55984-55997. [PMID: 28915568 PMCID: PMC5593539 DOI: 10.18632/oncotarget.18995] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/13/2022] Open
Abstract
Various intracellular mechanisms are activated in response to stress, leading to adaptation or death. Autophagy, an intracellular process that promotes lysosomal degradation of proteins, is an adaptive response to several types of stress. Osmotic stress occurs under both physiological and pathological conditions, provoking mechanical stress and activating various osmoadaptive mechanisms. Polycystin-2 (PC2), a membrane protein of the polycystin family, is a mechanical sensor capable of activating the cell signaling pathways required for cell adaptation and survival. Here we show that hyperosmotic stress provoked by treatment with hyperosmolar concentrations of sorbitol or mannitol induces autophagy in HeLa and HCT116 cell lines. In addition, we show that mTOR and AMPK, two stress sensor proteins involved modulating autophagy, are downregulated and upregulated, respectively, when cells are subjected to hyperosmotic stress. Finally, our findings show that PC2 is required to promote hyperosmotic stress-induced autophagy. Downregulation of PC2 prevents inhibition of hyperosmotic stress-induced mTOR pathway activation. In conclusion, our data provide new insight into the role of PC2 as a mechanosensor that modulates autophagy under hyperosmotic stress conditions.
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Affiliation(s)
- Daniel Peña-Oyarzun
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Center for Molecular Studies of the Cell, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rodrigo Troncoso
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Catalina Kretschmar
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Cecilia Hernando
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Mauricio Budini
- Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Eugenia Morselli
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Center for Molecular Studies of the Cell, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alfredo Criollo
- Advanced Center for Chronic Diseases, Facultad Ciencias Quimicas y Farmaceuticas & Facultad Medicina, Universidad de Chile, Santiago, Chile.,Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Santiago, Chile
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Shen Y, Cheng X, Ying M, Chang HT, Zhang W. Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study. BMJ Open 2017; 7:e015729. [PMID: 28490564 PMCID: PMC5623375 DOI: 10.1136/bmjopen-2016-015729] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES This research aims to explore the association between serum osmolarity and mortality in patients who are critically ill with specific categories of disease. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Data were extracted from an online database named 'Multiparameter Intelligent Monitoring in Intensive Care II'. 16 598 patients were included. METHODS Patients were divided into six disease subgroups based on the diagnosis at admission: cardiac, cerebral, vascular, gastrointestinal, respiratory and non-respiratory. The association between maximum osmolarity (osmolaritymax) and hospital mortality in each subgroup was evaluated using osmolaritymax as a design variable (six levels). RESULTS Analysis of the 16 598 patients revealed a 'U'-shaped relationship between osmolarity and mortality with a threshold of 300 mmoL/L. For patients with non-respiratory disease, both hypo-osmolarity and hyperosmolaritymax were associated with increased mortality, with the OR increasing from osmolaritymax level 3 (OR: 1.98, 95% CI 1.69 to 2.33, p<0.001) to level 6 (OR: 4.45, 95% CI 3.58 to 5.53, p<0.001), using level 2 (290-309 mmoL/L) as the reference group. For patients with respiratory disease, however, neither hypo-osmolarity nor hyperosmolaritymax was significantly associated with mortality (levels 1 to 5) except for extreme hyperosmolaritymax (≥340 mmoL/L, OR: 2.03, 95% CI 1.20 to 3.42, p=0.007). ORs of mortality in the other four subgroups (cardiac, cerebral, vascular, gastrointestinal) were similar, with OR progressively increasing from level 3 to 6. In all six subgroups, vasopressin use was consistently associated with increased mortality. CONCLUSIONS Hyperosmolarity is associated with increased mortality in patients who are critically ill with cardiac, cerebral, vascular and gastrointestinal admission diagnoses, with thresholds at 300 mmoL/L. For patients with respiratory disease, however, no significant association was detected.
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Affiliation(s)
- Yanfei Shen
- Department of Intensive Care Unit, Dongyang People’s Hospital, Jinhua, China
| | - Xuping Cheng
- Department of Intensive Care Unit, Dongyang People’s Hospital, Jinhua, China
| | - Manzhen Ying
- Department of Intensive Care Unit, Dongyang People’s Hospital, Jinhua, China
| | - Hao-Tang Chang
- Department of Science and Education, Dongyang People’s Hospital, Jinhua, China
| | - Weimin Zhang
- Department of Intensive Care Unit, Dongyang People’s Hospital, Jinhua, China
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56
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Elevated Serum Osmolality and Total Water Deficit Indicate Impaired Hydration Status in Residents of Long-Term Care Facilities Regardless of Low or High Body Mass Index. J Acad Nutr Diet 2017; 116:828-836.e2. [PMID: 27126154 DOI: 10.1016/j.jand.2015.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/01/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dehydration is typically associated with underweight and malnutrition in long-term care (LTC) settings. Evidence is lacking regarding the influence of the rising prevalence of overweight and obesity on risk factors, prevalence, and presentation of dehydration. OBJECTIVE The aim of this study was to objectively assess hydration status and the adequacy of total water intake, and determine relationships between hydration status, total water intake, and body mass index (BMI) in LTC residents. DESIGN A cross-sectional analysis of baseline data was performed. PARTICIPANTS AND SETTING Baseline data from 247 subjects recruited from eight community-based LTC facilities participating in two randomized trials comparing nutrient and cost-efficacy of between-meal snacks vs oral nutrition supplements (ONS). MAIN OUTCOMES Hydration status was assessed by serum osmolality concentration and total water intakes were quantified by weighed food, beverage, water, and ONS intake. STATISTICAL ANALYSES Simple and multiple linear regression methods were applied. RESULTS Forty-nine (38.3%) subjects were dehydrated (>300 mOsm/kg) and another 39 (30.5%) had impending dehydration (295 to 300 mOsm/kg). The variance in serum osmolality was significantly accounted for by blood urea nitrogen level, mental status score, and having diabetes (R(2)=0.46; P<0.001). Total water intake averaged 1,147.2±433.1 mL/day. Thus, 96% to 100% of subjects did not meet estimated requirements, with a deficit range of 700 to 1,800 mL/day. The variance in total water intake was significantly accounted for by type of liquid beverages (thin vs thick), type of ONS, total energy intake, total activities of daily living dependence, sex, and BMI (R(2)=0.56; P<0.001). CONCLUSIONS Dehydration and inadequate total water intake is prevalent in LTC residents across all BMI categories. Type of liquid beverages, type of ONS, and type of between-meal snacks are factors that could be targeted for nutrition interventions designed to prevent or reverse dehydration.
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58
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Rosinger AY, Lawman HG, Akinbami LJ, Ogden CL. The role of obesity in the relation between total water intake and urine osmolality in US adults, 2009-2012. Am J Clin Nutr 2016; 104:1554-1561. [PMID: 27935519 PMCID: PMC7392307 DOI: 10.3945/ajcn.116.137414] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/05/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adequate water intake is critical to physiologic and cognitive functioning. Although water requirements increase with body size, it remains unclear whether weight status modifies the relation between water intake and hydration status. OBJECTIVE We examined how the association between water intake and urine osmolality, which is a hydration biomarker, varied by weight status. DESIGN NHANES cross-sectional data (2009-2012) were analyzed in 9601 nonpregnant adults aged ≥20 y who did not have kidney failure. Weight status was categorized with the use of body mass index on the basis of measured height and weight (underweight or normal weight, overweight, and obesity). Urine osmolality was determined with the use of freezing-point depression osmometry. Hypohydration was classified according to the following age-dependent formula: ≥831 mOsm/kg - [3.4 × (age - 20 y)]. Total water intake was determined with the use of a 24-h dietary recall and was dichotomized as adequate or low on the basis of the Institute of Medicine's adequate intake recommendations for men and women (men: ≥3.7 or <3.7 L; nonlactating women: ≥2.7 or <2.7 L; lactating women: ≥3.8 or <3.8 L for adequate or low intakes, respectively). We tested interactions and conducted linear and log-binomial regressions. RESULTS Total water intake (P = 0.002), urine osmolality (P < 0.001), and hypohydration prevalence (P < 0.001) all increased with higher weight status. Interactions between weight status and water intake status were significant in linear (P = 0.005) and log-binomial (P = 0.015) models, which were then stratified. The prevalence ratio of hypohydration between subjects with adequate water intake and those with low water intake was 0.56 (95% CI: 0.43, 0.73) in adults who were underweight or normal weight, 0.67 (95% CI: 0.57, 0.79) in adults who were overweight, and 0.78 (95% CI: 0.70, 0.88) in adults who were obese. CONCLUSION On a population level, obesity modifies the association between water intake and hydration status.
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Affiliation(s)
- Asher Y Rosinger
- Epidemic Intelligence Service, Atlanta, GA;
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD; and
| | - Hannah G Lawman
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD; and
| | - Lara J Akinbami
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD; and
- Public Health Service, Rockville, MD
| | - Cynthia L Ogden
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD; and
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59
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Hooper L, Bunn DK, Downing A, Jimoh FO, Groves J, Free C, Cowap V, Potter JF, Hunter PR, Shepstone L. Which Frail Older People Are Dehydrated? The UK DRIE Study. J Gerontol A Biol Sci Med Sci 2016; 71:1341-7. [PMID: 26553658 PMCID: PMC5018558 DOI: 10.1093/gerona/glv205] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Water-loss dehydration in older people is associated with increased mortality and disability. We aimed to assess the prevalence of dehydration in older people living in UK long-term care and associated cognitive, functional, and health characteristics. METHODS The Dehydration Recognition In our Elders (DRIE) cohort study included people aged 65 or older living in long-term care without heart or renal failure. In a cross-sectional baseline analysis, we assessed serum osmolality, previously suggested dehydration risk factors, general health, markers of continence, cognitive and functional health, nutrition status, and medications. Univariate linear regression was used to assess relationships between participant characteristics and serum osmolality, then associated characteristics entered into stepwise backwards multivariate linear regression. RESULTS DRIE included 188 residents (mean age 86 years, 66% women) of whom 20% were dehydrated (serum osmolality >300 mOsm/kg). Linear and logistic regression suggested that renal, cognitive, and diabetic status were consistently associated with serum osmolality and odds of dehydration, while potassium-sparing diuretics, sex, number of recent health contacts, and bladder incontinence were sometimes associated. Thirst was not associated with hydration status. CONCLUSIONS DRIE found high prevalence of dehydration in older people living in UK long-term care, reinforcing the proposed association between cognitive and renal function and hydration. Dehydration is associated with increased mortality and disability in older people, but trials to assess effects of interventions to support healthy fluid intakes in older people living in residential care are needed to enable us to formally assess causal direction and any health benefits of increasing fluid intakes.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norfolk, UK.
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | | | | | - Joyce Groves
- Public and Patient Involvement in Research (PPIRes) Norfolk, UK
| | - Carol Free
- Public and Patient Involvement in Research (PPIRes) Norfolk, UK
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norfolk, UK
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Bunn DK, Abdelhamid A, Copley M, Cowap V, Dickinson A, Howe A, Killett A, Poland F, Potter JF, Richardson K, Smithard D, Fox C, Hooper L. Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC Geriatr 2016; 16:89. [PMID: 27142469 PMCID: PMC4855348 DOI: 10.1186/s12877-016-0256-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Methods We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration’s guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. Results We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. Conclusions We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. Trial registration The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611). Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0256-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK
| | - Maddie Copley
- Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK
| | - Vicky Cowap
- NorseCare, Lancaster House, 16 Central Avenue, St Andrew's Business Park, Norwich, NR7 0HR, UK
| | - Angela Dickinson
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Kate Richardson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - David Smithard
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
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Abstract
Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. A wide range of fluid intakes are compatible with euhydration, whereby total body water varies narrowly from day to day by 600 to 900 mL (<1% body mass). One measure of fluid intake adequacy involves enough fluid to prevent meaningful body water deficits outside this euhydration range (i.e., dehydration). Another measure of fluid intake adequacy involves enough fluid to balance the renal solute load, which can vary widely inside the euhydration range. The subtle but important distinction between the 2 types of adequacy may explain some of the ambiguity surrounding the efficacy of hydration status markers. Both perspectives of fluid intake adequacy are discussed in detail and a simple tool is reviewed that may help healthy, active, low-risk populations answer the question, "Am I drinking enough?" Key Teaching Points • Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. • Fluid needs can differ greatly among individuals due to variation in the factors that influence both water loss and solute balance; thus, adequacy is consistent with a wide range of fluid intakes and is better gauged using hydration assessment methods. • Adequacy of fluid intake for replacing meaningful water losses (dehydration) can be assessed simply, inexpensively, and with reasonable fidelity among healthy, active, low-risk individuals. • Adequacy of fluid intake for solute excretion per se can also be assessed among individuals but is more difficult to define and less practical to measure.
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Affiliation(s)
- Samuel N Cheuvront
- a U.S. Army Research Institute of Environmental Medicine , Natick , Massachusetts
| | - Robert W Kenefick
- a U.S. Army Research Institute of Environmental Medicine , Natick , Massachusetts
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Arnaoutis G, Kavouras SA, Stratakis N, Likka M, Mitrakou A, Papamichael C, Sidossis LS, Stamatelopoulos K. The effect of hypohydration on endothelial function in young healthy adults. Eur J Nutr 2016; 56:1211-1217. [PMID: 26864199 DOI: 10.1007/s00394-016-1170-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Hypohydration has been suggested as a predisposing factor for several pathologies including cardiovascular diseases (CVD). While CVD are the leading cause of death worldwide, no study has investigated whether acute hypohydration affects endothelial function and cardiovascular function. METHODS Ten young, healthy males participated in this crossover study (age: 24.3 ± 2.3 year; weight: 80.8 ± 5.3 kg; BMI: 24.3 ± 0.4 kg m-2). Each subject completed two measurements of endothelial function by flow-mediated dilation (FMD) in euhydrated and hypohydrated state separated by 24 h. Following baseline assessment of hydration status and FMD, the subjects completed 100 min of low-intensity intermittent walking exercise to achieve hypohydration of -2 % of individual body mass. For the rest of the day, a standardized, low water content diet was provided. The following morning, hydration markers and endothelial function were recorded. RESULTS Hypohydration by -1.9 ± 0.1 % of body mass resulted in decreased plasma volume by -3.5 ± 1.8 % and increased plasma osmolality by 9 ± 2 mmol kg-1 (P < 0.001). FMD as a response to hypohydration decreased by -26.8 ± 3.9 % (P < 0.05). CONCLUSION The data suggested that a small degree of hypohydration induced by moderate exercise and fluid restriction significantly impaired endothelial function.
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Affiliation(s)
- Giannis Arnaoutis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Stavros A Kavouras
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, 72701, USA.
| | - Nikolaos Stratakis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Marita Likka
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece
| | - Asimina Mitrakou
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece
| | - Christos Papamichael
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece
| | - Labros S Sidossis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Department of Exercise Science and Sports Studies, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Kimon Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece
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El-Sharkawy AM, Watson P, Neal KR, Ljungqvist O, Maughan RJ, Sahota O, Lobo DN. Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study). Age Ageing 2015; 44:943-7. [PMID: 26316508 PMCID: PMC4621229 DOI: 10.1093/ageing/afv119] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/17/2015] [Indexed: 12/14/2022] Open
Abstract
Background: older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome. Methods: this prospective cohort study was performed on older adult participants who were admitted acutely to a large UK teaching hospital. Data collected included the Charlson comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health and Aging (CSHA) clinical frailty scale and Nutrition Risk Screening Tool (NRS) 2002. Admission bloods were used to measure serum osmolality. HD was defined as serum osmolality >300 mOsmol/kg. Participants who were still in hospital 48 h after admission were reviewed, and the same measurements were repeated. Results: a total of 200 participants were recruited at admission to hospital, 37% of whom were dehydrated. Of those dehydrated, 62% were still dehydrated when reviewed at 48 h after admission. Overall, 7% of the participants died in hospital, 79% of whom were dehydrated at admission (P = 0.001). Cox regression analysis adjusted for age, gender, CCI, NEWS, CSHA and NRS demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated, hazards ratio (HR) 6.04 (1.64–22.25); P = 0.007. Conclusions: HD is common in hospitalised older adults and is associated with poor outcome. Coordinated efforts are necessary to develop comprehensive hydration assessment tools to implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults.
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Affiliation(s)
- Ahmed M El-Sharkawy
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Phillip Watson
- School of Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
| | - Keith R Neal
- Division of Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Olle Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Ron J Maughan
- School of Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
| | - Opinder Sahota
- Department of Elderly Medicine, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Hooper L, Abdelhamid A, Ali A, Bunn DK, Jennings A, John WG, Kerry S, Lindner G, Pfortmueller CA, Sjöstrand F, Walsh NP, Fairweather-Tait SJ, Potter JF, Hunter PR, Shepstone L. Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology laboratory reports. BMJ Open 2015; 5:e008846. [PMID: 26490100 PMCID: PMC4636668 DOI: 10.1136/bmjopen-2015-008846] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 09/18/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To assess which osmolarity equation best predicts directly measured serum/plasma osmolality and whether its use could add value to routine blood test results through screening for dehydration in older people. DESIGN Diagnostic accuracy study. PARTICIPANTS Older people (≥65 years) in 5 cohorts: Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community), Dehydration Recognition In our Elders (DRIE, living in residential care), Fortes (admitted to acute medical care), Sjöstrand (emergency room) or Pfortmueller cohorts (hospitalised with liver cirrhosis). REFERENCE STANDARD FOR HYDRATION STATUS Directly measured serum/plasma osmolality: current dehydration (serum osmolality>300 mOsm/kg), impending/current dehydration (≥295 mOsm/kg). INDEX TESTS 39 osmolarity equations calculated using serum indices from the same blood draw as directly measured osmolality. RESULTS Across 5 cohorts 595 older people were included, of whom 19% were dehydrated (directly measured osmolality>300 mOsm/kg). Of 39 osmolarity equations, 5 showed reasonable agreement with directly measured osmolality and 3 had good predictive accuracy in subgroups with diabetes and poor renal function. Two equations were characterised by narrower limits of agreement, low levels of differential bias and good diagnostic accuracy in receiver operating characteristic plots (areas under the curve>0.8). The best equation was osmolarity=1.86×(Na++K+)+1.15×glucose+urea+14 (all measured in mmol/L). It appeared useful in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, with a range of ages, health, cognitive and functional status. CONCLUSIONS Some commonly used osmolarity equations work poorly, and should not be used. Given costs and prevalence of dehydration in older people we suggest use of the best formula by pathology laboratories using a cutpoint of 295 mOsm/L (sensitivity 85%, specificity 59%), to report dehydration risk opportunistically when serum glucose, urea and electrolytes are measured for other reasons in older adults. TRIAL REGISTRATION NUMBERS DRIE: Research Register for Social Care, 122273; NU-AGE: ClinicalTrials.gov NCT01754012.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Adam Ali
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - W Garry John
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Susan Kerry
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Gregor Lindner
- Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Carmen A Pfortmueller
- Department of General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Fredrik Sjöstrand
- Department of Emergency Medicine, Södersjukhuset AB, Stockholm, Sweden
| | - Neil P Walsh
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
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Reinhart JM, Yancey MR, Girard-Denton JD, Schermerhorn T. Determination of tonicity effects of ketoacids and lactate by use of two canine red blood cell assays. Am J Vet Res 2015; 76:77-83. [PMID: 25535664 DOI: 10.2460/ajvr.76.1.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the tonicity effects of β-hydroxybutyrate, acetoacetate, and lactate in canine RBCs. SAMPLE RBCs from approximately 40 dogs. PROCEDURES 2 in vitro methods were used to conduct 4 experiments. The modified osmotic fragility assay was used to measure the ability of ketoacid salts added to serial sucrose dilutions to protect RBCs from osmotic hemolysis. In a second assay, a handheld cell counting device was used to measure changes in RBC diameter to assess the tonicity effect of solutions of ketoacid and lactate salts. RESULTS For the modified osmotic fragility assay, all ketoacid salts had an osmoprotective effect, but the effect was determined to be completely attributable to the tonicity effect of added cations (sodium and lithium) and not the ketoacid moieties. However, both the sodium and lithium lactate salts provided osmoprotection attributable to both the cation and lactate anion. For the second assay, RBC diameter was significantly increased with the addition of urea (an ineffective osmole) but did not change with the addition of glucose (an effective osmole), which established the behaviors of ineffective and effective osmoles in this assay. The RBC diameter was significantly increased over that of control samples by the addition of sodium β-hydroxybutyrate, lithium acetoacetate, and lithium lactate but was decreased by the addition of sodium lactate. CONCLUSIONS AND CLINICAL RELEVANCE For both assays, β-hydroxybutyrate and acetoacetate acted as ineffective osmoles, whereas lactate acted as an effective osmole in 3 of 4 experiments.
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Affiliation(s)
- Jennifer M Reinhart
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506
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Gandy J. Water intake: validity of population assessment and recommendations. Eur J Nutr 2015; 54 Suppl 2:11-6. [PMID: 26048039 PMCID: PMC4473081 DOI: 10.1007/s00394-015-0944-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/29/2015] [Indexed: 11/08/2022]
Abstract
Good hydration is vital for good health and well-being. Until recently, there was little interest in collecting data on water and drink and beverage intake. However, there is increasing evidence that a low water intake or mild dehydration may be linked with the risk of chronic diseases. Accurate estimates of intake in populations are essential to explore these relationships. This will enable the identification of specific populations at the risk of low water intake and allow exposure assessment of potential contaminates and specific nutrients present in drinks and beverages. In addition, data from these population studies are used as the basis of national and international recommendations on water intake and to set and evaluate national health policies. For example, EFSA based their recommendations on data from population studies from 13 European countries. The range of intakes varied from 720 to 2621 mL/day; this diversity cannot be explained by environmental differences alone. However, this variability may, at least partially, be explained by the inconsistency in methodologies used as none of surveys used a dietary assessment tool validated for total water intake or beverage and drink intake. It is reasonable to suggest that this may result in incomplete data collection and it raises questions on the validity of the recommendations. The relationship between water consumption and health warrants further investigation, and robust methodologies are essential to ensure that these data are accurate and useful for setting public health priorities and policies.
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Affiliation(s)
- Joan Gandy
- School of Life and Medical Services, University of Hertfordshire, Hatfield, AL10 9AB, UK,
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Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lindner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MGM, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJD, Stotts NA, Thomas DR, Vivanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 2015; 2015:CD009647. [PMID: 25924806 PMCID: PMC7097739 DOI: 10.1002/14651858.cd009647.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.
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Abstract
Both acute and chronic dehydration can have important implications for human behaviour and health. Young children, non-autonomous individuals and the elderly are at a greater risk of dehydration. Mild hypertonic dehydration could be related to less efficient cognitive and physical performance and has been reported to be associated with frequently occurring pathological conditions, especially nephrolithiasis. The assessment of hydration status in a large sample appears to be of interest for conducting epidemiological and large clinical studies aimed at improving preventive and curative care. Especially in large-population studies, methods that are used have to be accurate, cheap, quick and require no technical expertise. Body weight change is widely used to determine acute hydration changes, but seems to be insufficiently accurate in longitudinal studies. Bioimpedance analysis methods enable the assessment of total body water content, but their use is still under debate. Because plasma osmolality directly reflects intracellular osmolality, it constitutes a good marker to assess acute hydration changes, but not chronic hydration status because it changes constantly. Moreover, venepuncture is considered to be invasive and is not suitable for a large-sample study, especially in children. Urinary markers appear to be good alternatives for assessing hydration status in large populations. Collection of urine samples is non-invasive and cheap. High technical expertise is not required to perform urinary marker measurements and these measurements can be carried out quickly. Thus, methods based on urinary markers are very well suited for field studies. Urine colour is probably the least sensitive marker despite its high specificity. Urine osmolality and especially urine specific gravity could be easily used for determining hydration status in large-sample studies.
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Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine, and saliva markers. J Am Med Dir Assoc 2014; 16:221-8. [PMID: 25444573 DOI: 10.1016/j.jamda.2014.09.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/11/2014] [Accepted: 09/16/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dehydration in older adults contributes to increased morbidity and mortality during hospitalization. As such, early diagnosis of dehydration may improve patient outcome and reduce the burden on healthcare. This prospective study investigated the diagnostic accuracy of routinely used physical signs, and noninvasive markers of hydration in urine and saliva. DESIGN Prospective diagnostic accuracy study. SETTING Hospital acute medical care unit and emergency department. PARTICIPANTS One hundred thirty older adults [59 males, 71 females, mean (standard deviation) age = 78 (9) years]. MEASUREMENTS Participants with any primary diagnosis underwent a hydration assessment within 30 minutes of admittance to hospital. Hydration assessment comprised 7 physical signs of dehydration [tachycardia (>100 bpm), low systolic blood pressure (<100 mm Hg), dry mucous membrane, dry axilla, poor skin turgor, sunken eyes, and long capillary refill time (>2 seconds)], urine color, urine specific gravity, saliva flow rate, and saliva osmolality. Plasma osmolality and the blood urea nitrogen to creatinine ratio were assessed as reference standards of hydration with 21% of participants classified with water-loss dehydration (plasma osmolality >295 mOsm/kg), 19% classified with water-and-solute-loss dehydration (blood urea nitrogen to creatinine ratio >20), and 60% classified as euhydrated. RESULTS All physical signs showed poor sensitivity (0%-44%) for detecting either form of dehydration, with only low systolic blood pressure demonstrating potential utility for aiding the diagnosis of water-and-solute-loss dehydration [diagnostic odds ratio (OR) = 14.7]. Neither urine color, urine specific gravity, nor saliva flow rate could discriminate hydration status (area under the receiver operating characteristic curve = 0.49-0.57, P > .05). In contrast, saliva osmolality demonstrated moderate diagnostic accuracy (area under the receiver operating characteristic curve = 0.76, P < .001) to distinguish both dehydration types (70% sensitivity, 68% specificity, OR = 5.0 (95% confidence interval 1.7-15.1) for water-loss dehydration, and 78% sensitivity, 72% specificity, OR = 8.9 (95% confidence interval 2.5-30.7) for water-and-solute-loss dehydration). CONCLUSIONS With the exception of low systolic blood pressure, which could aid in the specific diagnosis of water-and-solute-loss dehydration, physical signs and urine markers show little utility to determine if an elderly patient is dehydrated. Saliva osmolality demonstrated superior diagnostic accuracy compared with physical signs and urine markers, and may have utility for the assessment of both water-loss and water-and-solute-loss dehydration in older individuals. It is particularly noteworthy that saliva osmolality was able to detect water-and-solute-loss dehydration, for which a measurement of plasma osmolality would have no diagnostic utility.
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70
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Siervo M, Bunn D, Prado CM, Hooper L. Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes. Am J Clin Nutr 2014; 100:867-76. [PMID: 25030781 PMCID: PMC4135495 DOI: 10.3945/ajcn.114.086769] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Serum osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate serum osmolarity, which is an indirect estimate of serum osmolality, but which serum osmolarity equations best predict serum osmolality in the elderly is unclear. OBJECTIVE We assessed the agreement of measured serum osmolality with calculated serum osmolarity equations in older people. DESIGN Serum osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against serum osmolality (reference standard). RESULTS A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean ± SD age: 85.8 ± 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (serum osmolality ≥295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P < 0.001) and serum osmolality (P < 0.01). Of 38 predictive equations used to calculate osmolarity, 4 equations showed reasonable agreement with measured osmolality. One [calculated osmolarity = 1.86 × (Na⁺ + K⁺) + 1.15 × glucose + urea +14; all in mmol/L] was characterized by narrower limits of agreement and the capacity to predict serum osmolality within 2% in >80% of participants, regardless of diabetes or hydration status. The equation's sensitivity (79%) and specificity (89%) for impending dehydration (≥295 mmol/kg) and current dehydration (>300 mmol/kg) (69% and 93%, respectively) were reasonable. CONCLUSIONS The assessment of a panel of equations for the prediction of serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273.
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Affiliation(s)
- Mario Siervo
- From the Human Nutrition Research Centre, Institute for Ageing and Health, Newcastle University, Newcastle on Tyne, United Kingdom (MS); the Norwich Medical School, University of East Anglia, Norwich, United Kingdom (DB and LH); and the Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Canada (CMP)
| | - Diane Bunn
- From the Human Nutrition Research Centre, Institute for Ageing and Health, Newcastle University, Newcastle on Tyne, United Kingdom (MS); the Norwich Medical School, University of East Anglia, Norwich, United Kingdom (DB and LH); and the Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Canada (CMP)
| | - Carla M Prado
- From the Human Nutrition Research Centre, Institute for Ageing and Health, Newcastle University, Newcastle on Tyne, United Kingdom (MS); the Norwich Medical School, University of East Anglia, Norwich, United Kingdom (DB and LH); and the Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Canada (CMP)
| | - Lee Hooper
- From the Human Nutrition Research Centre, Institute for Ageing and Health, Newcastle University, Newcastle on Tyne, United Kingdom (MS); the Norwich Medical School, University of East Anglia, Norwich, United Kingdom (DB and LH); and the Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Canada (CMP)
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In vitro increase of mean corpuscular volume difference (dMCV) as a marker for serum hypertonicity in dogs. Res Vet Sci 2014; 96:442-6. [PMID: 24656345 DOI: 10.1016/j.rvsc.2014.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/19/2014] [Accepted: 03/01/2014] [Indexed: 11/21/2022]
Abstract
Spurious increase in erythrocyte mean corpuscular volume (MCV) on automated cell analyzers is a well-characterized lab error in hypertonic patients. A difference between automated and manual MCV (dMCV) greater than 2 fl has been shown to predict hypertonicity in humans. The purpose of this study was to investigate dMCV as a marker for serum hypertonicity in dogs and to examine the relationship between dMCV and three methods of estimating serum tonicity: measured (OsMM), calculated (OsMC), and calculated effective (OsMCE) osmolalities. OsMC, OsMCE, and dMCV were calculated from routine blood values and OsMM was directly measured in 121 dogs. The dMCV of hypertonic dogs was significantly larger than that of normotonic dogs for all three osmolality methods. dMCV predicted hypertonicity as estimated by OsMM better than it predicted hypertonicity as estimated by OsMC and OsMCE. A cutoff of 2.96 fl yielded the best sensitivity (76%) and specificity (71%) for hypertonicity estimated by OsMM.
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Water-loss dehydration and aging. Mech Ageing Dev 2013; 136-137:50-8. [PMID: 24333321 DOI: 10.1016/j.mad.2013.11.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/12/2013] [Accepted: 11/27/2013] [Indexed: 11/21/2022]
Abstract
This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial.
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74
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Millard-Stafford M, Wendland DM, O'Dea NK, Norman TL. Thirst and hydration status in everyday life. Nutr Rev 2013; 70 Suppl 2:S147-51. [PMID: 23121351 DOI: 10.1111/j.1753-4887.2012.00527.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Water is an essential nutrient for all persons; thus, maintaining a chronic state of optimal hydration is recognized to provide health benefits. Fluid balance is maintained via thirst, a feedback-controlled variable, regulated acutely by central and peripheral mechanisms. However, voluntary drinking is also a behavior influenced by numerous social and psychological cues. Therefore, whether "thirst-guided" drinking maintains optimal hydration status is a multifactorial issue. Thirst perception is typically assessed by subjective ratings using either categorical or visual analog scales; however, which instrument yields greater sensitivity to change in hydration status has not been examined. Ratings of thirst perception do not always yield predictable patterns of voluntary drinking following dehydration; therefore, perceived thirst and ad libitum drinking are not equivalent measures of human thirst. The recommendation "drink to thirst" is frequently given to healthy individuals during daily life. However, factors and conditions (e.g., age, disease) that influence thirst should be recognized and probed further.
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Affiliation(s)
- Mindy Millard-Stafford
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
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75
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Cheuvront SN, Kenefick RW, Sollanek KJ, Ely BR, Sawka MN. Water-deficit equation: systematic analysis and improvement. Am J Clin Nutr 2013; 97:79-85. [PMID: 23235197 DOI: 10.3945/ajcn.112.046839] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The water-deficit equation {WD(1) = 0.6 × B(m) × [1 - (140 ÷ Na(+))]; B(m) denotes body mass} is used in medicine and nutrition to estimate the volume (L) of water required to correct dehydration during the initial stages of fluid-replacement therapy. Several equation assumptions may limit its accuracy, but none have been systematically tested. OBJECTIVES We quantified the potential error in WD(1) for the estimation of free water (FW) and total body water (TBW) losses and systematically evaluated its assumptions. DESIGN Thirty-six euhydrated volunteers were dehydrated (2.2-5.8% B(m)) via thermoregulatory sweating. Assumptions within WD(1) were tested by substituting measured euhydrated values for assumed or unknown values. These included the known (premorbid) B(m) (WD(2)), a proposed correction for unknown B(m) (WD(3)), the TBW estimated from body composition (WD(4)), the actual plasma sodium (WD(5)), the substitution of plasma osmolality (Posm) for sodium (WD(6)), and actual Posm (WD(7)). RESULTS Dehydration reduced TBW by 3.49 ± 0.91 L, 57% of which (2.02 ± 0.96 L) was FW loss, and increased plasma sodium from 139 (range: 135-143 mmol/L) to 143 (range: 141-148 mmol/L) mmol/L. Calculations for WD(1) through WD(7) all underestimated TBW loss by 1.5-2.5 L (P < 0.05). WD(1) through WD(5) underestimated FW by 0.5 L to 1.0 L (P < 0.05), but WD(6) and WD(7) estimated FW loss to within 0.06-0.16 L (P > 0.05). CONCLUSIONS WD(1) grossly underestimates TBW and FW losses. Corrections for unknowns and assumptions (WD(2) through WD(5)) improved estimates little. The use of WD(6) = 0.6 × B(m) × [1 - (290 ÷ Posm)] accurately estimates FW but still underestimates TBW losses by >40%.
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Affiliation(s)
- Samuel N Cheuvront
- US Army Research Institute of Environmental Medicine, Natick, MA 01760-5007, USA.
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76
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Brocker C, Thompson DC, Vasiliou V. The role of hyperosmotic stress in inflammation and disease. Biomol Concepts 2012; 3:345-364. [PMID: 22977648 PMCID: PMC3438915 DOI: 10.1515/bmc-2012-0001] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hyperosmotic stress is an often overlooked process that potentially contributes to a number of human diseases. Whereas renal hyperosmolarity is a well-studied phenomenon, recent research provides evidence that many non-renal tissues routinely experience hyperosmotic stress that may contribute significantly to disease initiation and progression. Moreover, a growing body of evidence implicates hyperosmotic stress as a potent inflammatory stimulus by triggering proinflammatory cytokine release and inflammation. Under physiological conditions, the urine concentrating mechanism within the inner medullary region of the mammalian kidney exposes cells to high extracellular osmolarity. As such, renal cells have developed many adaptive strategies to compensate for increased osmolarity. Hyperosmotic stress is linked to many maladies, including acute and chronic, as well as local and systemic, inflammatory disorders. Hyperosmolarity triggers cell shrinkage, oxidative stress, protein carbonylation, mitochondrial depolarization, DNA damage, and cell cycle arrest, thus rendering cells susceptible to apoptosis. However, many adaptive mechanisms exist to counter the deleterious effects of hyperosmotic stress, including cytoskeletal rearrangement and up-regulation of antioxidant enzymes, transporters, and heat shock proteins. Osmolyte synthesis is also up-regulated and many of these compounds have been shown to reduce inflammation. The cytoprotective mechanisms and associated regulatory pathways that accompany the renal response to hyperosmolarity are found in many non-renal tissues, suggesting cells are commonly confronted with hyperosmotic conditions. Osmoadaptation allows cells to survive and function under potentially cytotoxic conditions. This review covers the pathological consequences of hyperosmotic stress in relation to disease and emphasizes the importance of considering hyperosmolarity in inflammation and disease progression.
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Affiliation(s)
- Chad Brocker
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - David C. Thompson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Vasilis Vasiliou
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Hooper L, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Lindner G, Mack GW, Mentes JC, Needham RA, Olde Rikkert MGM, Ranson SC, Ritz P, Rowat AM, Smith AC, Stookey JJD, Thomas DR, Wakefield BJ, Ward S, Potter JF, Hunter PR. Clinical and physical signs for identification of impending and current water-loss dehydration in older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tang C, Pathare G, Michael D, Fajol A, Eichenmüller M, Lang F. Downregulation of Klotho expression by dehydration. Am J Physiol Renal Physiol 2011; 301:F745-50. [PMID: 21734097 DOI: 10.1152/ajprenal.00037.2011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Klotho, a transmembrane protein, protease, and hormone mainly expressed in renal tissue counteracts aging. Overexpression of Klotho substantially prolongs the life span. Klotho deficiency leads to excessive formation of 1,25(OH)(2)D(3), growth deficit, accelerated aging, and early death. Aging is frequently paralleled by dehydration, which is considered to accelerate the development of age-related disorders. The present study explored the possibility that dehydration influences Klotho expression. Klotho transcript levels were determined by RT-PCR, and Klotho protein abundance was detected by Western blotting in renal tissue from hydrated and 36-h-dehydrated mice as well as in human embryonic kidney (HEK293) cells. Dehydration was followed by a significant decline of renal Klotho transcript levels and protein abundance, accompanied by an increase in plasma osmolarity as well as plasma ADH, aldosterone, and 1,25(OH)(2)D(3) levels. Antidiuretic hormone (ADH; 50 nM) and aldosterone (1 μM) significantly decreased Klotho transcription and protein expression in HEK293 cells. In conclusion, the present observations disclose a powerful effect of dehydration on Klotho expression, an effect at least partially mediated by enhanced release of ADH and aldosterone.
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Sollanek KJ, Kenefick RW, Cheuvront SN, Axtell RS. Potential impact of a 500-mL water bolus and body mass on plasma osmolality dilution. Eur J Appl Physiol 2011; 111:1999-2004. [PMID: 21249384 DOI: 10.1007/s00421-011-1833-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 01/07/2011] [Indexed: 11/28/2022]
Abstract
A methodological discrepancy exists in the hydration assessment literature regarding the establishment of euhydration, as some investigations utilize a pre-hydration technique, while others do not (overnight fluid/food fast). However, the degree that plasma osmolality (P (osm)) dilutes when using the pre-hydration method and how body mass/composition might influence the results is not known. Thirty subjects (22 M, 8 F; 20 ± 2 years (mean ± SD); 1.8 ± 0.1 m; 75.8 ± 13.5 kg) had P (osm) measured after an 8-h food and fluid fast (overnight fast) and 90 min after a 500-mL (4-9 mL/kg) water bolus (pre-hydration). From pre- to post-bolus, participants' P (osm) declined from 297 ± 3.5 to 295 ± 3.8 mmol/kg (p < 0.05; ∆ -1.7 ± 3.5 mmol/kg). One-third of the sample diluted to more than -3 mmol/kg. The effect of body mass on P (osm) dilution was investigated by comparing dilution in the ten lightest (62.8 ± 3.4 kg) and heaviest (92.0 ± 9.8 kg) participants; however, the change between the light (∆ -1.9 ± 3.8 mmol/kg) versus heavy groups (∆ -1.1 ± 3.0 mmol/kg) was not different (p > 0.05). The correlation between body mass or total body water and change in P (osm) was weak (p > 0.05), as was the correlation between relative fluid intake based on mass and change in P (osm) (p > 0.05). The two methodologies appear to produce similar P (osm) values when measured in most individuals. However, the potential for significant dilution (>3 mmol/kg) should be considered when choosing the pre-hydration methodology.
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Affiliation(s)
- Kurt J Sollanek
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, USA.
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80
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Cheuvront SN, Fraser CG, Kenefick RW, Ely BR, Sawka MN. Reference change values for monitoring dehydration. Clin Chem Lab Med 2011; 49:1033-7. [DOI: 10.1515/cclm.2011.170] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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81
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Culp K, Tonelli S, Ramey SL, Donham K, Fuortes L. Preventing Heat-Related Illness Among Hispanic Farmworkers. ACTA ACUST UNITED AC 2011; 59:23-32. [DOI: 10.3928/08910162-20101228-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 10/19/2010] [Indexed: 11/20/2022]
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82
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Thornton SN. Angiotensin inhibition and longevity: a question of hydration. Pflugers Arch 2010; 461:317-24. [PMID: 21165644 DOI: 10.1007/s00424-010-0911-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 11/25/2010] [Accepted: 11/29/2010] [Indexed: 01/07/2023]
Abstract
With the advancement of medical and investigative science, it is somewhat surprising that although it is possible to stabilise medical patients with hypertension and the associated kidney dysfunction, obesity, diabetes and even cancer, there is still no clear method of significantly reducing these chronic disease pathologies, and thus, extending life expectancy. There is one hormone common to these pathologies, the antagonism of which goes some way to clinical improvements, and this is angiotensin, which is released during hypovolaemia. Angiotensin antagonists are used to treat many of these pathologies, and it has been shown in the obesity literature that angiotensin antagonists decrease weight, but also increase the drinking of water. Increased cellular hydration, and hence, improved mitochondrial metabolism could be one of the mechanisms for the reduction in weight seen in these studies, as well as for reducing the other pathologies, all showing metabolic dysfunction. It appears that the application of straightforward physiological regulation might be an appropriate medical approach to the prevention of hypertension, kidney disease, obesity, diabetes and cancer, and thus, to an increased life expectancy.
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83
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Cheuvront SN, Ely BR, Kenefick RW, Sawka MN. Biological variation and diagnostic accuracy of dehydration assessment markers. Am J Clin Nutr 2010; 92:565-73. [PMID: 20631205 DOI: 10.3945/ajcn.2010.29490] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Well-recognized markers for static (one time) or dynamic (monitoring over time) dehydration assessment have not been rigorously tested for their usefulness in clinical, military, and sports medicine communities. OBJECTIVE This study evaluated the components of biological variation and the accuracy of potential markers in plasma, urine, saliva, and body mass (B(m)) for static and dynamic dehydration assessment. DESIGN We studied 18 healthy volunteers (13 men and 5 women) while carefully controlling hydration and numerous preanalytic factors. Biological variation was determined over 3 consecutive days by using published methods. Atypical values based on statistical deviations from a homeostatic set point were examined. Measured deviations in body fluid were produced by using a separate, prospective dehydration experiment and evaluated by receiver operating characteristic (ROC) analysis to quantify diagnostic accuracy. RESULTS All dehydration markers displayed substantial individuality and one-half of the dehydration markers displayed marked heterogeneity of intraindividual variation. Decision levels for all dehydration markers were within one SD of the ROC criterion values, and most levels were nearly identical to the prospective group means after volunteers were dehydrated by 1.8-7.0% of B(m). However, only plasma osmolality (P(osm)) showed statistical promise for use in the static dehydration assessment. A diagnostic decision level of 301 plusmn 5 mmol/kg was proposed. Reference change values of 9 mmol/kg (P(osm)), 0.010 [urine specific gravity (U(sg))], and 2.5% change in B(m) were also statistically valid for dynamic dehydration assessment at the 95% probability level. CONCLUSIONS P(osm) is the only useful marker for static dehydration assessment. P(osm), U(sg), and B(m) are valid markers in the setting of dynamic dehydration assessment.
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Affiliation(s)
- Samuel N Cheuvront
- US Army Research Institute of Environmental Medicine, Natick, MA 01760-5007, USA.
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84
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Abstract
This review examines the current knowledge of water intake as it pertains to human health, including overall patterns of intake and some factors linked with intake, the complex mechanisms behind water homeostasis, and the effects of variation in water intake on health and energy intake, weight, and human performance and functioning. Water represents a critical nutrient, the absence of which will be lethal within days. Water's importance for the prevention of nutrition-related noncommunicable diseases has received more attention recently because of the shift toward consumption of large proportions of fluids as caloric beverages. Despite this focus, there are major gaps in knowledge related to the measurement of total fluid intake and hydration status at the population level; there are also few longer-term systematic interventions and no published randomized, controlled longer-term trials. This review provides suggestions for ways to examine water requirements and encourages more dialogue on this important topic.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina 27516, USA.
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85
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Kettaneh A, Fardet L, Mario N, Retbi A, Taright N, Tiev K, Reinhard I, Guidet B, Cabane J. The 2003 heat wave in France: hydratation status changes in older inpatients. Eur J Epidemiol 2010; 25:517-24. [PMID: 20549309 DOI: 10.1007/s10654-010-9478-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
Abstract
Little is known about the impact of behavioral changes after the 2003 heat wave on hydration status of elderly citizens in France. We used an administrative data file provided information about 23,022 inpatients aged > or =70 years admitted between 2000 and 2006, including vital status at discharge and Charlson comorbidity index and matched it with the result of five blood tests (sodium, potassium, glucose, urea nitrogen, creatinine) within the first 24 h after admission and with daily temperatures before admission. We then measured the prevalence of plasma tonicity (PT) <275 mOsm/l or >300 mOsm/l, blood urea nitrogen/creatinine ratio (BUNC) >100 and inhospital mortality. In 2000-2002, 2003, 2004-2006, prevalence (%) was, respectively 7.5, 8.0, 9.5 (P < 0.0001) for PT < 275 mMol/l, 8.4, 10.4, 7.2 (P < 0.0001) for PT > 300 mOsm/l, and 35.4, 30.7, 26.7 (P < 0.0001) for BUNC > 100. Inhospital mortality rate was 10.8, 10.8 and 9.0%, respectively (P < 0.0001). After adjustment for covariates, OR (95% CI) in 2004-2006 with reference to 2000-2002 was 1.26 (1.13-1.39) for PT < 275 mMol/l, 0.85 (0.76-0.94) for PT > 300 mOsm/l, and 0.65 (0.61-0.69) for BUNC > 100. Inhospital mortality risk associated with hydration disorders did not vary significantly over periods for PT < 275 mMol/l (HR 1.06 to 1.40) and PT > 300 mOsm/l (HR 1.76 to 1.96) but was lower for BUNC > 100 in 2003 (HR 1.27) than in 2000-2002 (HR 1.64) or 2004-2006 (HR 1.77) (P = 0.04). So, since the 2003 heat wave, significant shifts in prevalence of intracellular hydration disorders indicate behavioral changes with positive impact on hydration status.
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Affiliation(s)
- Adrien Kettaneh
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique/Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75571, Paris cedex 12, France
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86
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Zizza CA, Ellison KJ, Wernette CM. Total water intakes of community-living middle-old and oldest-old adults. J Gerontol A Biol Sci Med Sci 2009; 64:481-6. [PMID: 19213852 DOI: 10.1093/gerona/gln045] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Literature reporting total daily water intake of community-dwelling older adults is limited. We evaluated differences in total water intake, water sources, water from meal and snack beverages, timing of beverage consumption, and beverage selection for three older age groups (young-old, 65-74 years; middle-old, 75-84 years; and oldest-old, >or=85 years). METHODS Data for 2,054 older adults from the 1999-2002 National Health and Nutrition Examination Survey were used for this study. Multivariate analyses controlling for age, sex, race-ethnicity, education, and marital status were conducted to determine differences in water intake variables across the age groups. RESULTS Total water intakes found for the middle-old and oldest-old age groups were significantly lower than those found for the young-old age group. The relative contributions of beverages to total water intake were 40.8%, 38.3%, and 36.4% for the young-old, middle-old, and oldest-old, respectively. The water intakes from beverages consumed at snack occasions were significantly lower for the middle-old and oldest-old groups than those for the young-old group. All groups consumed the greatest amount of water in the morning. Coffee was the predominant source of water from beverages for all groups. CONCLUSIONS This study fills a gap in the literature by providing an analysis of the daily water intake of middle-old and oldest-old adults. We found that the total water intake for the middle-old and oldest-old was significantly lower than that for the young-old. Future research needs to investigate the clinical outcomes associated with declining water intakes of community-dwelling older adults.
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Affiliation(s)
- Claire A Zizza
- Department of Nutrition and Food Science, 260 Lem Morrison Drive, Auburn University, Auburn, AL 36849-5605, USA.
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87
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Wakefield BJ, Mentes J, Holman JE, Culp K. Risk factors and outcomes associated with hospital admission for dehydration. Rehabil Nurs 2009; 33:233-41. [PMID: 19024237 DOI: 10.1002/j.2048-7940.2008.tb00234.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hospital admission rate for dehydration is one of the Agency for Healthcare Research and Quality Prevention's Quality Indicators, which are considered screening tools for potential quality issues. Thus, admission for dehydration may reflect the quality of care provided in community settings. Using a case-control design, this study estimated the incidence, risk factors, and outcomes of dehydration in adults admitted to the hospital. The overall prevalence rate for three International Classification of Diseases codes for dehydration at admission was 0.55%. Cases and controls differed significantly on a number of clinical variables at admission, including weight, body mass index, pulse, blood pressure, use of bulk-forming laxatives, serum sodium and chloride, and presence of generalized weakness or hemiplegia, edema, diarrhea, vomiting, and having nothing by mouth before admission. Mortality rates at 30 and 180 days after discharge were not significantly different between the two groups. Dehydration in community-dwelling adults may delay rehabilitation or result in hospital admission. Prevention, monitoring, and management are critical to preventing dehydration-associated problems.
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88
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Abdallah L, Remington R, Houde S, Zhan L, Melillo KD. Dehydration Reduction in Community-Dwelling Older Adults: Perspectives of Community Health Care Providers. Res Gerontol Nurs 2009; 2:49-57. [DOI: 10.3928/19404921-20090101-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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89
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Rodriguez GJ, Cordina SM, Vazquez G, Suri MFK, Kirmani JF, Ezzeddine MA, Qureshi AI. The Hydration Influence on the Risk of Stroke (THIRST) Study. Neurocrit Care 2008; 10:187-94. [DOI: 10.1007/s12028-008-9169-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/04/2008] [Indexed: 11/28/2022]
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90
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Understanding clinical dehydration and its treatment. J Am Med Dir Assoc 2008; 9:292-301. [PMID: 18519109 DOI: 10.1016/j.jamda.2008.03.006] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/19/2008] [Accepted: 03/24/2008] [Indexed: 01/02/2023]
Abstract
Dehydration in clinical practice, as opposed to a physiological definition, refers to the loss of body water, with or without salt, at a rate greater than the body can replace it. We argue that the clinical definition for dehydration, ie, loss of total body water, addresses the medical needs of the patient most effectively. There are 2 types of dehydration, namely water loss dehydration (hyperosmolar, due either to increased sodium or glucose) and salt and water loss dehydration (hyponatremia). The diagnosis requires an appraisal of the patient and laboratory testing, clinical assessment, and knowledge of the patient's history. Long-term care facilities are reluctant to have practitioners make a diagnosis, in part because dehydration is a sentinel event thought to reflect poor care. Facilities should have an interdisciplinary educational focus on the prevention of dehydration in view of the poor outcomes associated with its development. We also argue that dehydration is rarely due to neglect from formal or informal caregivers, but rather results from a combination of physiological and disease processes. With the availability of recombinant hyaluronidase, subcutaneous infusion of fluids (hypodermoclysis) provides a better opportunity to treat mild to moderate dehydration in the nursing home and at home.
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91
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Popkin BM, Armstrong LE, Bray GA, Caballero B, Frei B, Willett WC. Response to C Weaver et al. Am J Clin Nutr 2006. [DOI: 10.1093/ajcn/84.5.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barry M Popkin
- Carolina Population Center University of North Carolina 123 West Franklin Street Chapel Hill, NC 27516
| | | | - George A Bray
- Louisiana State University Medical Center and Pennington Biomedical Research Center Baton Rouge, LA
| | | | - Balz Frei
- Linus Pauling Institute Oregon State University Corvallis, OR
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92
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Stookey JD, Barclay D, Arieff A, Popkin BM. The altered fluid distribution in obesity may reflect plasma hypertonicity. Eur J Clin Nutr 2006; 61:190-9. [PMID: 17021599 DOI: 10.1038/sj.ejcn.1602521] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study explored whether the increased extracellular relative to intracellular fluid (ECF/ICF) ratio in obesity might reflect osmotic effects of elevated plasma solute concentrations. DESIGN Cross-sectional, epidemiological survey. SETTING AND SUBJECTS The present analysis used nationally representative data from the Third National Health and Nutrition Examination Survey on community-dwelling adults (aged 40-59 years) in the US without evidence of glucose dysregulation or chronic disease (n=1285). INTERVENTION Body mass index (BMI) was estimated from measured height and weight. Total body reactance, an index of body fluid distribution, was determined by bioelectrical impedance analysis. Plasma tonicity (the cumulative index of osmotically effective plasma solute) was estimated from plasma glucose, sodium and potassium. Sex-specific relative odds of lower reactance (<or=50 Omega/m for women, <or=40 Omega/m for men) and plasma hypertonicity (tonicity >or=295 mmol/l) associated with overweight (25<or=BMI <30) and obesity (BMI>or=30) were estimated using logistic regression models that controlled for sociodemographic variables, smoking, leisure-time physical activity, total energy intake, serum creatinine, plasma insulin and glucose. Multinomial logistic regression models tested for associations between weight status and specific serum solute. RESULTS Independent of covariates, in men and women, overweight and obesity were associated with increased odds of lower reactance and hypertonicity. Overweight and obese individuals with lower reactance had significantly higher serum sodium than normal weight individuals. CONCLUSIONS Elevated plasma solute concentrations are associated with obesity in free-living adults. Physicians and researchers should be alert to a possible link between hypertonicity and obesity. SPONSORSHIP Grants from the NIH, Nestle Waters.
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Affiliation(s)
- J D Stookey
- Children's Hospital of Oakland Research Institute, Oakland, CA 94609, USA.
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Meisel HJ, Ganey T, Hutton WC, Libera J, Minkus Y, Alasevic O. Clinical experience in cell-based therapeutics: intervention and outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15 Suppl 3:S397-405. [PMID: 16850291 PMCID: PMC2335385 DOI: 10.1007/s00586-006-0169-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 06/07/2006] [Indexed: 01/26/2023]
Abstract
Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration through the use of autologous disc chondrocyte transplantation (ADCT) offers a potential to achieve functional integration of disc metabolism and mechanics. Nucleus regeneration using autologous cultured disc-derived chondrocytes has been demonstrated in a canine model and in clinical pilot studies. In 2002 a prospective, controlled, randomized, multicentre study comparing safety and efficacy of ADCT plus discectomy, with discectomy alone was initiated. The clinical goals were to provide long-term pain relief, maintain disc height, and prevent adjacent segment disease. Interim analysis was performed after 2 years; Oswestry (Low Back Pain/disability), Quebec Back Pain Disability Scale, as well as Prolo and VAS Score were used for the evaluation. Disc height was assessed by MRI. A clinically significant reduction of low back pain in the ADCT-treated group was shown by all three pain score systems. The median total Oswestry Score was 2 in the ADCT group compared with 6 in the control group. Decreases in the Disability index in ADCT-treated patients correlated with the reduction of low back pain. Decreases in disc height over time were only found in the control group, and of potential significance, intervertebral discs in adjacent segments appeared to retain hydration when compared to those adjacent to levels that had undergone discectomy without cell intervention.
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Affiliation(s)
- Hans Joerg Meisel
- Bergmannstrost, Neurochirurgie klinik, Merseburger Strasse 165, 06112 Halle, Saale, Germany
| | - Timothy Ganey
- Atlanta Medical Center, 303 Parkway Drive NE, BOX 227, Atlanta, GA 30312 USA
| | | | | | - Yvonne Minkus
- Bergmannstrost, Neurochirurgie klinik, Merseburger Strasse 165, 06112 Halle, Saale, Germany
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Enhancing Government-sponsored Nutrition Programs for Older Adults by Integrating Exercise Programs. TOP CLIN NUTR 2006. [DOI: 10.1097/00008486-200601000-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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