Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water

Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception

INTRODUCTION

It has yet to be explained why female athletes appear to suffer more often from non-contact ligament injuries during the first half of the menstrual cycle. Fluctuations in balance, caused by impaired proprioception due to increased fluid retention, may be relevant factors contributing to this anomaly in distribution. The aim of this study was therefore to uncover relationships between dynamic stability, proprioception and fluid retention in association with the menstrual cycle as a possible explanation for the observed changes in injury rates.

METHODS

Nine healthy, female, well trained ice hockey players on hormonal contraception with regular cycles were tested at least twelve times during one menstrual cycle. Bioimpedance analysis was applied to investigate body composition and fluid distribution. A joint position sense test was performed to characterize changes in proprioception, while unexpected perturbations on a balance board were used to obtain measures for dynamic postural control.

RESULTS

No distinct changes in proprioception, dynamic stability and fluid retention were identified across the menstrual cycle in this population. Weak correlations were found between parameters for dynamic stability and proprioception.

CONCLUSION

Variations in proprioception, dynamic stability and fluid retention seem unlikely to be major contributors to injury risk peaks, at least in this population of healthy trained athletes using hormonal contraception.

Increased Urine Production Due to Leg Fluid Displacement Reduces Hours of Undisturbed Sleep

OBJECTIVE

To investigate whether or not the leg fluid displacement observed when moving from the standing to recumbent position at bedtime reduces the hours of undisturbed sleep (HUS).

METHODS

Men aged 50 years or older who were hospitalized for urological diseases were investigated. Body water evaluation was performed three times with a bioelectric impedance method: (i) 17:00, (ii) 30 min after (short-term), and (iii) waking up (long-term). A frequency volume chart was used to evaluate the status of nocturnal urine production, and the factors affecting HUS were investigated.

RESULTS

A total of 50 patients (mean age: 68 years) were enrolled. Short-term changes in extracellular fluid (ECF in the legs showed a significant positive correlation with urine production per unit of time at the first nocturnal voiding (UFN/HUS) (r = 0.45, P = 0.01). In the comparison between patients who had <3 HUS vs. those who had ≥3 HUS, the <3 HUS group showed significantly greater short-term changes in leg fluid volume, night-time water intake (17:00-06:00), and UFN/HUS. Multivariate analysis to assess the risk factors for <3 HUS indicated UFN/HUS as a risk factor in the overall model, and short-term changes in leg ECF and night-time water intake as risk factors in the model that only considered factors before sleep.

CONCLUSIONS

Nocturnal leg fluid displacement may increase urine production leading up to first voiding after going to bed, and consequently, induce early awakening after falling asleep.

The Body Composition Monitor: a flexible tool for routine fluid management across the haemodialysis population

Bioimpedance measurements with the Body Composition Monitor (BCM) have been shown to improve fluid management in haemodialysis. However, there is a lack of a sufficiently robust evidence-base for use of the BCM outside of standard protocols. This study aims to characterise BCM measurement variation to allow users to make measurements and interpret the results with confidence in a range of clinical scenarios. BCM measurements were made in 48 healthy controls and in 48 stable haemodialysis patients before and immediately after dialysis. The effect of utilising alternative measurement paths was assessed using mixed effects models and the effect of measuring post-dialysis was assessed by comparing changes in BCM-measured overhydration (OH) with weight changes over dialysis. The data from healthy controls suggest that there is no difference in BCM-measured OH between all the whole-body paths other than the foot-to-foot measurement. Dialysis patients showed similar results other than having higher BCM-measured OH when measured across the site of a vascular access. There was good agreement between BCM-measured OH and change in weight, suggesting post-dialysis measurements can be utilised. These results suggest BCM protocols can be flexible regarding measurement paths and timing of measurement to ensure as many patients as possible can benefit from the technology.

Estimation of prevalence of sarcopenia by using a new bioelectrical impedance analysis in Chinese community-dwelling elderly people

BACKGROUND

The aim of the present study was to validate the usefulness of the new octapolar multifrequency bioelectrical impedance analysis (BIA) for assessment of appendicular skeletal muscle mass (ASM) by comparing it with that of dual-energy X-ray absorptiometry (DXA) and to investigate the prevalence of sarcopenia in Chinese community-dwelling elderly according to Asian Working Group for Sarcopenia (AWGS) definition.

METHODS

A cross-sectional study was conducted in communities of Chengdu, China. A total of 944 community-dwelling elderly adults aged ≥60 years were included. ASM was measured by using DXA as a criterion method to validate a standing eight-electrode multifrequency BIA (InBody 720), followed by a further estimation of the prevalence of sarcopenia according the AWGS definition.

RESULTS

In the Bland-Altman analysis, no significant difference was found between DXA and BIA based on the ASM measurements. The prevalence of AWGS-defined sarcopenia was 12.5% in the elderly women and 8.2% in the elderly men.

CONCLUSIONS

BIA is suitable for body composition monitoring (ASM) in elderly Chinese as a fast, noninvasive, and convenient method; therefore, it may be a better choice in large epidemiological studies in the Chinese population. The prevalence of AWGS-defined sarcopenia was approximately 10.4% and increased with age in the Chinese community-dwelling elderly in this study.

Spinal Muscular Atrophy, types I and II: What are the differences in body composition and resting energy expenditure?

Background & aims

Different neuromuscular functional domains in types I and II Spinal Muscular Atrophy (SMAI and SMAII) could lead to differences in body composition (BC) and resting energy expenditure (REE). Their identification could provide the key to defining appropriate strategies in clinical dietary management, but data comparing SMAI and SMAII in terms of BC and REE are not yet available. We measured total and regional fat (FM), lean (LBM), mineral (BMC) masses, body water (total, intra- and extra-cellular, TBW, ICW, ECW) and REE in a sample of SMAI and II children, matched for age and sex, and also adjusting for body size to compare these features of the two SMA phenotypes.

Methods

15 SMAI and 15 SMAII children, (M/F = 9/6 vs 9/6, age 3.6 ± 1.9 vs 3.5 ± 1.8 years, p = 0.99), confirmed genetically, were measured as follows: Anthropometric measurements [Body Weight (BW), Supine Length (SL), Arm Length (AL), Femur Length (FL), Tibia Length (TL)], Dual x-ray Energy Absorptiometry (DEXA) [total and segmental FM, LBM, FFM, and BMC], Bioelectrical impedance (BIA) [TBW, ICW, ECW] and Indirect Calorimetry (REE, respiratory quotients) were collected by the same trained dietician. BW, SL and Body Mass Index (BMI) Z-scores were calculated according to CDC Growth Charts (2000).

Results

SMA children had high percentages of FM and a lower percentage of TBW and ECW compared to the respective reference values for sex and age, whereas the BMC percentages did not differ, even splitting the two phenotypes. SMA I children had a lower BW and BMI-Z score compared to children with SMA II, but similar total and segmental FM. On the contrary, total FFM and LBM were significantly lower in SMAI (7290.0 ± 1729.1 g vs 8410.1 ± 1508.4 g; 6971.8 ± 1637.1 g vs 8041.7 ± 1427.7 g, p = 0.039, p = 0.037, respectively), particularly at the trunk level. Arm BMC also resulted significantly lower in SMAI. The measured REE values were similar (684 ± 143 kcal/day vs 703 ± 122 Kcal/day p = 0.707) whereas REE per FFM unit was higher in SMA I children than in SMA II (95 ± 12 kcal/FFMkg vs 84 ± 11 kcal/FFMkg p = 0.017).

Conclusions

This study has shown that BW and BMI Z-score measurements alone can be misleading in assessing nutritional status, particularly in SMAI. The differences between SMAI and II in total and regional BC are related only to FFM, LBM and BMC, and seem to be more linked to the magnitude of neurofunctional impairment rather than to the nutritional status derangement. SMA I and SMA II children can have different energy requirements in relation to their specific BC and hypermetabolism of FFM. Based on these results, our recommendation is to use direct BC and REE measurements in the nutritional care process until SMA-specific predictive equations become available.

Interactions with the MC4R rs17782313 variant, mental stress and energy intake and the risk of obesity in Genome Epidemiology Study

Background

The melanocortin-4 receptor (MC4R) regulates metabolism by modulating eating behavior and MC4R variants (rs17782313 and rs571312) are associated with obesity in Asians and Caucasians. However, the impact of their interactions with nutritional and lifestyle factors on obesity are poorly described. Therefore, we investigated the interaction of MC4R variants and dietary patterns on the risk of obesity in Korean middle-aged adults.

Methods

Data collected included, genetic variations, anthropometric and biochemical measurements, dietary and lifestyle habits, and food intake. Data were obtained from the 8830 adults aged 40–69 years in the Ansung and Ansan cohort of the Korean Genome Epidemiology Study.

Results

The MC4R rs18882313 minor allele had a higher frequency in the obese group (P < 0.01). MC4R genotypes were not associated with differences in daily energy and macronutrient intakes. However, the intakes of processed foods and fat (as percentages of energy) were significantly higher and intake of fruits were significantly lower in subjects with MC4R minor alleles (P < 0.05). Interestingly, there was a positive interaction between MC4R variants and mental stress levels that were associated with the risk of obesity after adjusting for age, gender, residence area, daily energy intake, smoking status and physical activity (interaction P = 0.0384). Only in subjects with high stress were MC4R minor alleles associated with higher BMIs after adjusting for confounders. The association was present without modulating energy and nutrient intake. In the group with energy intakes higher than estimated energy requirement (EER), subjects with MC4R minor alleles had higher BMIs than those with the major alleles (P < 0.001).

Conclusions

The interactions of mental stress and energy intakes with the MC4R minor allele genotype might be associated with increased risk of obesity in Korean adults. This research might identify subjects with a specific MC4R minor alleles as a human subset of people with a low metabolic tolerance for excessive energy intake, especially when under stress.

Exploration of Fluid Dynamics in Perioperative Patients Using Bioimpedance Analysis

INTRODUCTION

Perioperative fluid restriction is advocated to reduce complications after major surgeries. Current methods of monitoring body fluids rely on indirect volume markers that may at times be inadequate. In our study, bioimpedance analysis (BIA) was used to explore fluid dynamics, in terms of intercompartmental shift, of perioperative patients undergoing operation for hepato-pancreato-biliary (HPB) diseases.

METHODS

A retrospective review was conducted, examining 36 patients surgically treated for HPB diseases between March 2010 and August 2012. Body fluid compartments were estimated via BIA at baseline (1 day prior to surgery), immediately after surgery, and on postoperative day 1, recording fluid balance during and after procedures. Patients were stratified by net fluid status as balanced (≤500 mL) or imbalanced (>550 mL) and outcomes of BIA compared.

RESULTS

Mean net fluid balance volumes in balanced (n = 16) and imbalanced (n = 20) patient subsets were 231.41 ± 155.44 and 1050.18 ± 548.77 mL, respectively. Total body water (TBW) (p = 0.091), extracellular water (ECW) (p = 0.125), ECW/TBW (p = 0.740), and intracellular water (ICW) (p = 0.173) did not fluctuate significantly in fluid-balanced patients. Although TBW (p = 0.069) in fluid-imbalanced patients did not change significantly (relative to baseline), ECW (p = 0.001), ECW/TBW (p = 0.019), and ICW (p = 0.012) showed significant postoperative increases.

CONCLUSION

The exploration of fluid dynamics using BIA has shown importance of balanced fluid management during perioperative period. Increased ECW/TBW in fluid-imbalanced patients suggests possible causality for the development of ascites or fluid collections during postoperative period in patients undergoing HPB operations.

Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients

Background

Proper monitoring for volume overload is important to improve prognosis in peritoneal dialysis (PD) patients. The association between volume status and residual renal function (RRF) remains an unresolved issue. The aim of the present study was to evaluate the association between the edema index and survival or RRF in incident PD patients.

Patients and Methods

We identified all adults who underwent PD. The edema index was defined as the ratio of extracellular fluid to total body fluid. Participants with available data regarding survivorship or non-survivorship during the first year after PD initiation were included in the area under the receiver operating characteristic curve analysis. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. Participants were divided into two groups according to the cutoff value of their baseline edema indices: High (>cutoff value) and Low (≤cutoff value). Survivors during the first year after PD initiation were divided into two groups according to the initial and 1-year edema index: Non-improvement (maintenance of criteria in the initial Low group during the year) and Other (all participants except those in the Non-improvement group).

Results

In total, 631 patients were enrolled in the present study. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. The respective mean initial RRF values (mL·min^-1·1.73 m^-2) in the Low and High groups, respectively, were 4.88 ± 4.09 and 4.21 ± 3.28 in men (P = 0.108), and 3.19 ± 2.57 and 2.98 ± 2.70 in women (P = 0.531). There were no significant differences between groups in either sex. The respective mean RRF values at 1 year after PD initiation in the Low and High groups, respectively, were 3.56 ± 4.35 and 2.73 ± 2.53 in men, and 2.80 ± 2.36 and 1.85 ± 1.51 in women. RRF at 1 year after PD initiation was higher in the Low group than in the High group (men: P = 0.027; women: P = 0.001). In men, the cumulative 5-year survival rates were 78.7% and 46.2% in the Low and High groups, respectively, whereas in women, rates were 77.2% and 58.8% in the Low and High groups, respectively. For survivors during the first year after PD initiation, the Non-improvement group was associated with a poor survival rate compared with the Other group for both sexes.

Conclusion

A high edema index was associated with mortality in incident PD patients at baseline and follow-up. The edema index may be used as a new marker for predicting mortality in PD patients.

Prenatal and childhood growth and physical performance in old age--findings from the Helsinki Birth Cohort Study 1934-1944

Health in adulthood is in part a consequence of development and growth taking place during sensitive periods in early life. It has not been explored previously whether early growth is associated with physical performance in old age from a life course perspective taking into account health-related behavior, biological risk factors, and early life experiences. At a mean age of 71 years, physical performance was assessed using the Senior Fitness Test (SFT) in 1078 individuals belonging to the Helsinki Birth Cohort Study. We used multiple linear regression analysis to assess the association between the SFT physical fitness scores and individual life course measurements. Several adult characteristics were associated with physical performance including socioeconomic status, lifestyle factors, and adult anthropometry. Higher birth weight and length were associated with better physical performance, even after adjusting for potential confounders (all p values <0.05). The strongest individual association between life course measurements and physical performance in old age was found for adult body fat percentage. However, prenatal growth was independently associated with physical performance seven decades later. These findings suggest that physical performance in old age is at least partly programmed in early life.

Extracellular volume expansion and the preservation of residual renal function in Korean peritoneal dialysis patients: a long-term follow up study

INTRODUCTION

In chronic peritoneal dialysis patients, preservation of residual renal function (RRF) is a major determinant of patient survival, and maintaining sufficient intravascular volume has been hypothesized to be beneficial for the preservation of RRF. The present study aimed to test this hypothesis using multifrequency bioimpedence analyzer (MFBIA), in Korean peritoneal dialysis patients.

METHODS

A total of 129 patients were enrolled in this study. The baseline MFBIA was checked, and the patients were divided into the following two groups: group 1, extracellular water per total body water (ECW/TBW) < median, group 2, ECW/TBW > median. We followed up the patients, and then we analyzed the changes in the urine output (UO) and the solute clearance (weekly uKt/V) in each group. Data associated with patient and technical survivor were collected by medical chart review. The volume measurement was made using Inbody S20 equipment (Biospace, Seoul, Korea). We excluded the anuric patients at baseline.

RESULT

The median value of ECW/TBW was 0.396. The mean patient age was 49.74 ± 10.01 years, and 62.1 % of the patients were male; most of the patients were on continuous ambulatory peritoneal dialysis (89.1 %). The mean dialysis vintage was 26.20 ± 28.71 months. All of the patients were prescribed hypertensive medication, and 48.5 % of the patients had diabetes. After 25.47 ± 6.86 months of follow up, ΔUO and Δweekly Kt/V were not significantly different in the two groups as follows: ΔUO (-236.07 ± 185.15 in group 1 vs -212.21 ± 381.14 in group 2, p = 0.756); Δ weekly Kt/v (-0.23 ± 0.43 in group 1 vs -0.29 ± 0.49 in group 2, p = 0.461). The patient and technical survivor rate was inferior in the group 2, and in the multivariable analysis, initial hypervolemia was an independent factor that predicts both of the patient mortality [HR 1.001 (1.001-1.086), p = 0.047] and the technical failure [HR 1.024 (1.001-1.048), p = 0.042].

CONCLUSIONS

Extracellular volume expansion, measured by MFBIA, does not help preserve residual renal function, and is harmful for the technical and patient survival in Korean peritoneal dialysis patients.

Evaluation of lower leg swelling using EMG measured with voltage divider

The purpose of this study is to evaluate the lower leg swelling using EMG measured with our new voltage divider technology, by which the internal impedance of lower leg can be estimated. The amplitude of EMG measured without voltage divider was compared to it with voltage divider. Eleven healthy subjects (24.3±5.1 y.o.) participated in this study. Six female (swelling group) were asked to work at desk for six hours, and five male (control group) were asked to work a regular day. The internal impedance was calculated and calf circumference was measured before and after desk work. Results show that internal impedance in swelling group significantly decreased with increase in calf circumference, and our new evaluation method was proved to be effective for the evaluation of lower leg swelling.

Novel Anthropometry-Based Calculation of the Body Heat Capacity in the Korean Population

Heat capacity (HC) has an important role in the temperature regulation process, particularly in dealing with the heat load. The actual measurement of the body HC is complicated and is generally estimated by body-composition-specific data. This study compared the previously known HC estimating equations and sought how to define HC using simple anthropometric indices such as weight and body surface area (BSA) in the Korean population. Six hundred participants were randomly selected from a pool of 902 healthy volunteers aged 20 to 70 years for the training set. The remaining 302 participants were used for the test set. Body composition analysis using multi-frequency bioelectrical impedance analysis was used to access body components including body fat, water, protein, and mineral mass. Four different HCs were calculated and compared using a weight-based HC (HC_Eq1), two HCs estimated from fat and fat-free mass (HC_Eq2 and HC_Eq3), and an HC calculated from fat, protein, water, and mineral mass (HC_Eq4). HC_Eq1 generally produced a larger HC than the other HC equations and had a poorer correlation with the other HC equations. HC equations using body composition data were well-correlated to each other. If HC estimated with HC_Eq4 was regarded as a standard, interestingly, the BSA and weight independently contributed to the variation of HC. The model composed of weight, BSA, and gender was able to predict more than a 99% variation of HC_Eq4. Validation analysis on the test set showed a very high satisfactory level of the predictive model. In conclusion, our results suggest that gender, BSA, and weight are the independent factors for calculating HC. For the first time, a predictive equation based on anthropometry data was developed and this equation could be useful for estimating HC in the general Korean population without body-composition measurement.

Feet swelling in a multistage ultraendurance triathlete: a case study

Recent studies investigating ultraendurance athletes showed an association between excessive fluid intake and swelling of the lower limbs such as the feet. To date, this association has been investigated in single-stage ultraendurance races, but not in multistage ultraendurance races. In this case study, we investigated a potential association between fluid intake and feet swelling in a multistage ultraendurance race such as a Deca Iron ultratriathlon with ten Ironman triathlons within 10 consecutive days. A 49-year-old well-experienced ultratriathlete competed in autumn 2013 in the Deca Iron ultratriathlon held in Lonata del Garda, Italy, and finished the race as winner within 129:33 hours:minutes. Changes in body mass (including body fat and lean body mass), foot volume, total body water, and laboratory measurements were assessed. Food and fluid intake during rest and competing were recorded, and energy and fluid turnovers were estimated. During the ten stages, the volume of the feet increased, percentage body fat decreased, creatinine and urea levels increased, hematocrit and hemoglobin values decreased, and plasma [Na⁺] remained unchanged. The increase in foot volume was significantly and positively related to fluid intake during the stages. The poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. This case report shows that the volume of the foot increased during the ten stages, and the increase in volume was significantly and positively related to fluid intake during the stages. Furthermore, the poststage volume of the foot was related to poststage total body water, poststage creatinine, and poststage urea. The continuous feet swelling during the race was most probably due to a combination of a high fluid intake and a progressive decline in renal function (ie, continuous increase in creatinine and urea), leading to body fluid retention (ie, increase in total body water).

A Temperature-Based Bioimpedance Correction for Water Loss Estimation During Sports

The amount of total body water (TBW) can be estimated based on bioimpedance measurements of the human body. In sports, TBW estimations are of importance because mild water losses can impair muscular strength and aerobic endurance. Severe water losses can even be life threatening. TBW estimations based on bioimpedance, however, fail during sports because the increased body temperature corrupts bioimpedance measurements. Therefore, this paper proposes a machine learning method that eliminates the effects of increased temperature on bioimpedance and, consequently, reveals the changes in bioimpedance that are due to TBW loss. This is facilitated by utilizing changes in skin and core temperature. The method was evaluated in a study in which bioimpedance, temperature, and TBW loss were recorded every 15 min during a 2-h running workout. The evaluation demonstrated that the proposed method is able to reduce the error of TBW loss estimation by up to 71%, compared to the state of art. In the future, the proposed method in combination with portable bioimpedance devices might facilitate the development of wearable systems for continuous and noninvasive TBW loss monitoring during sports.

Agreement Between Omron 306 and Biospace InBody 720 Bioelectrical Impedance Analyzers (BIA) in Children and Adolescents

PURPOSE

The purpose of this study was to test the convergent validity of Omron 306 using Biospace InBody 720.

METHOD

A total of 267 participants (145 boys; aged 10.4-17.9 years) completed testing during a single session. Each measure provided percent body fat (%BF), while the InBody 720 included fat-free mass (FFM). The validity was examined using the Pearson correlation. Limits of agreement (LOA) and multiple linear regression were also used to determine the impact of both age and FFM on the associations between the 2 measures.

RESULTS

The 2 measures of %BF were correlated by .63 (p < .001) in boys and .89 (p < .001) in girls. The mean difference (i.e., InBody - Omron) for %BF in boys was - 4.7% with a lower LOA of - 20.5% and upper LOA of 11.2%. The same comparison for girls resulted in a difference of 3.0% with a lower LOA of - 10% and upper LOA of 4%. Examination of the residuals obtained from multiple linear regression indicated that FFM was the only statistically significant predictor of differences in boys (βFFM = - 0.25 ± 0.08%, p = .001). There were no significant associations for girls.

CONCLUSIONS

Findings indicate that estimates of %BF obtained from Omron in boys exceed estimates from InBody 720. Disagreement was evident in younger boys with lower levels of FFM. Girls' %BF was closer between the 2 bioelectrical impedance analyzer measures (less residual) with age and FFM not explaining the disagreement. Overall, the 2 measures were not equivalent.

Maternal weight in pregnancy and offspring body composition in late adulthood: findings from the Helsinki Birth Cohort Study (HBCS)

INTRODUCTION

Maternal obesity has long-term consequences for the offspring's later health, including an increased risk of type 2 diabetes and cardiovascular disease. The underlying mechanisms explaining these associations are, however, not fully understood.

METHODS

A total of 2003 individuals from the Helsinki Birth Cohort Study born 1934-44, underwent measurements of body size, body composition, and clinical characteristics at a mean age of 62 years. Data on maternal anthropometry were available from hospital records.

RESULTS

Maternal BMI was positively associated with BMI in the offspring. Higher maternal BMI was associated with less favorable body composition in the offspring. There was a significant interaction between birth weight and maternal BMI on offspring body fat percentage (P for interaction 0.003). In mothers with low BMI, a higher offspring birth weight was associated with lower fat percentage, while among those with maternal BMI in the highest fourth, higher offspring birth weight predicted higher body fat percentage.

DISCUSSION

Our findings suggest that a disadvantageous body composition is programmed in early life. This may in part underlie the association between maternal obesity and later cardio-metabolic health of the offspring. These findings support the importance of prevention of overweight in women of child-bearing age.

Association between changes in body composition and risk of developing Type 2 diabetes in Koreans

AIMS

To examine the effects of longitudinal changes in fat mass or lean body mass on risk of Type 2 diabetes in Korean adults.

METHODS

Participants included 18 687 Korean adults (aged 20-79 years) who underwent routine medical check-ups in 2007-2008 and again in 2011-2012 with a mean (range) of 4.3 (3.0-5.7) years interval. Total fat, fat-free, and soft fat-free masses were determined using bioelectrical impedance.

RESULTS

A total of 692 subjects (3.7%) developed Type 2 diabetes during follow-up. Those who developed diabetes had a greater increase in percent body fat (2.9 ± 3.0 vs 2.6 ± 3.2 percentage points, P = 0.043), as well as greater decreases in percent fat-free mass (-3.0 ± 3.3 vs -2.7 ± 3.3 percentage points, P = 0.008) and percent soft fat-free mass (-2.8 ± 3.1 vs -2.4 ± 3.1 percentage points, P = 0.003) compared with those who did not develop diabetes. In multiple logistic regression analysis, an increase in total fat mass of > 10% was associated with an increased odds ratio for diabetes (1.29, 1.05-1.60), and a decreased total fat mass was associated with lower odds ratio (0.75, 0.58-0.96). A loss of total fat-free mass of > 5% (odds ratio 1.08, 0.90-1.30) or an increase in total fat-free mass (odds ratio 0.96, 0.71-1.28) was not significantly associated with the risk of diabetes after adjustments for baseline waist circumference and glucose levels.

CONCLUSIONS

These results show that changes in total body fat mass, but not lean body mass, are associated with development of Type 2 diabetes, independently of baseline measures of general or central obesity.

Predialysis NTproBNP predicts magnitude of extracellular volume overload in haemodialysis patients

INTRODUCTION

Increased natriuretic peptides are associated with increased cardiovascular and all-cause mortality for haemodialysis (HD) patients. However, debate continues whether these biomarkers are increased by extracellular water (ECW) excess and can be used to aid clinical assessment of volume status and help determine target weight.

METHODS

We measured N terminal probrain natriuretic peptide (NT-proBNP) predialysis in 375 stable haemodialysis outpatients with corresponding pre and postdialysis multifrequency bioelectrical impedance assessments (MFBIA) of (ECW)/total body water (TBW).

RESULTS

Median age 64 (51-75), 63.9% male, 42.9% diabetic, 43.2% Caucasoid, 14.4% with a history of myocardial infarction, 8.4% coronary artery bypass surgery, dialysis vintage 28.2 (12.3-55.5) months. Median predialysis NT-proBNP 283 (123-989) pmol/l, and predialysis ECW/TBW ratio 0.397 ± 0.029. On multivariate analysis, predialysis log NT-proBNP was associated with predialysis systolic blood pressure (β 0.007, p = 0.000), weight (β -0.008, p = 0.001), valvular heart disease (β 0.342, p = 0.015, ECW/TBW (β 1.3, p = 0.019) and log CRP (β 0.145, p = 0.037). Dividing patients into NTproBNP quartiles, %ECW/TBW and relative ECW overhydration were significantly greater for the highest quartile vs. lowest (40.5 ± 4.1 vs. 39.0 ± 1.1, and 1.51 ± 1.24 vs. 0.61 ± 0.69 l, respectively, p < 0.001).

CONCLUSION

In this study, predialysis NTproBNP values were associated with direct assessments of the extracellular volume excess measured by MFBIA and systolic arterial blood pressure. This suggests that predialysis NTproBNP values can potentially be used to aid clinical assessment of volume status in dialysis patients to determine target weight.

Body composition in 18- to 88-year-old adults--comparison of multifrequency bioimpedance and dual-energy X-ray absorptiometry

OBJECTIVE

This study compared bioimpedance analysis (BIA) in the assessment of body composition with dual-energy X-ray absorptiometry (DXA) in 18- to 88-year-old adults.

DESIGN AND METHODS

Body composition of 882 adults was estimated by eight-polar BIA and DXA. In addition, estimates of lean mass, fat mass, and percentage of fat were investigated across a range of age and leisure time physical activity (LTPA) groups.

RESULTS

Compared to DXA, larger lean masses (mean difference 2.9 and 1.6 kg) and smaller fat masses (3.1 and 2.6 kg) were estimated by BIA in both women and men, respectively. Differences between the methods' mean values were evident in all age and LTPA groups, except in the oldest men (over 70 years). Age, waist circumference, grip strength, and LTPA explained 21% or less of the variance observed in the differences between methods.

CONCLUSIONS

Compared to DXA, BIA provided systematically different body composition estimates throughout the adult age span with considerable amount of intraindividual variation. The differences between estimates may be related to the BIAs' algorithm or body geometry or composition of the population used in this study. Knowledge about the methodological limitations and device comparability is essential for researchers, clinicians, and persons working in rehabilitation and sport centers.

Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients

Residual renal function is a major survival determinant for peritoneal dialysis patients. Hypovolemia can cause acute kidney injury and loss of residual renal function, and it has been suggested that patients receiving peritoneal dialysis should preferably be maintained hypervolemic to preserve residual renal function. Here we determined whether hydration status predicted long-term changes in residual renal function. Changes in residual renal function and extracellular water (ECW) to total body water (TBW) measured by multifrequency bioimpedance in 237 adult patients who had paired baseline and serial 12 monthly measurements were examined. Baseline hydration status (ECW/TBW) was not significantly associated with preservation of residual renal function, unlike baseline and follow-up mean arterial blood pressure. When the cohort was split into tertiles according to baseline hydration status, there was no significant correlation seen between change in hydration status and subsequent loss in residual renal function. Increased ECW/TBW in peritoneal dialysis patients was not associated with preservation of residual renal function. Similarly, increments and decrements in ECW/TBW were not associated with preservation or reduction in residual renal function. Thus, our study does not support the view that overhydration preserves residual renal function and such a policy risks the consequences of persistent hypervolemia.

Effect of basal metabolic rate on the bone mineral density in middle to old age women in Taiwan

BACKGROUND

Basal metabolic rate (BMR) reflects a combination of cardiopulmonary function and lean body mass resulting from regular physical activity. Though many studies have examined the relationships between bone mineral density (BMD) and body composition, little is known regarding the relationship between BMD and BMR.

OBJECTIVE

The purpose of this study was to investigate the relationship between BMR, anthropometric parameters, body composition and BMD in postmenopausal women in Taiwan.

METHODS

Two hundred and eighty-nine women between the ages of 40 and 80 years were included in this cross-sectional study. The following parameters were assessed: height, body weight, total body fat (TBF), BMR, waist-to-hip ratio, grip strength, and back strength. Differences in all variables between osteoporotic and non-osteoporotic women (categorized according to decades in age) were calculated using a one-way analysis of variance (ANOVA) and a Bonferroni post-hoc test. Multiple linear regression with a backward stepwise approach was performed to evaluate the relationship between these measurements and BMD.

RESULTS

Among women over 50 years of age, those who were non-osteoporotic had higher BMR, BMI, and body fat by comparison to their osteoporotic counterparts (p<0.05 for all). Multiple linear regression revealed that BMR and body fat significantly predicted BMD of the femoral neck (adjusted beta coefficients of 0.304 and 0.190, respectively; p<0.05 for both). BMR and body fat also predicted an increased vertebral BMD (adjusted beta coefficients of 0.310 and 0.141, respectively; p<0.05 for both).

CONCLUSION

BMR is closely associated with BMD in elderly persons, and may be a novel target for interventions aimed at preventing the age-related decline in BMD.

Retrospective analysis of safety and efficacy of insulin-to-liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β-cell function

Aims/Introduction

The safety and efficacy of insulin‐to‐liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin‐to‐liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA_1c) and bodyweight in Japanese type 2 diabetes.

Materials and Methods

Japanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β‐cell function‐related indices, such as increment of serum C‐peptide during glucagon stimulation test (GST‐ΔCPR). HbA_1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks.

Results

Of 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12‐week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST‐ΔCPR. Receiver–operating characteristic analysis showed that GST‐ΔCPR of 1.34 ng/mL is a cut‐off point for insulin‐to‐liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA_1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co‐administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas.

Conclusions

Insulin‐to‐liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST‐ΔCPR.

Age-related changes in body composition in a sample of Czech women aged 18-89 years: a cross-sectional study

Background

The Czech Republic lacks body composition data for women. Therefore, the purpose of the study was to analyze body composition [body fat mass (BFM), fat-free mass (FFM), body fat percentage (%BFM) and visceral adipose tissue (VAT)] and to evaluate the changes that occur with aging in women aged 18–89 years. We also analyzed anthropometric characteristics of study participants and developed age-specific percentile curves for body composition parameters.

Methods

A cross-sectional, non‐randomized study was conducted with a sample of 1,970 apparently healthy Czech women. Body composition was measured using a direct segmental multi-frequency bioelectrical impedance analysis (BSM-BIA).

Results

The mean BFM was 19.7 ± 8.9 kg, and BFM reached its peak in women over 70, at 27.6 ± 8.8 kg. There was a strong correlation between BFM and age (r = 0.61; r² = 0.37). Fifty percent of the women in the study had a BFM between 13.0 and 25.0 kg. The %BFM (r = 0.69; r² = 0.47) and VAT (r = 0.88; r² = 0.77) were also significantly associated with age. The reference range for %BFM was 22.0–35.6 % (25th–75th percentile). The mean FFM was 45.8 ± 5.5 kg, and FFM decreased with age (r = −0.27; r² = 0.07).

Conclusions

The results presented in this study showed a statistically significant increase in BFM,  %BFM and VFA as age increased, and the values reached their peak in women over 70. Even when FFM decreased slightly with age, body weight increased because of the increase in BFM.

Is there a role for N-terminal probrain-type natriuretic peptide in determining volume status in haemodialysis patients?

BACKGROUND/AIMS

Natriuretic peptides have been reported to be a valuable biomarker for predicting cardiac events and mortality for haemodialysis patients. However, there has been a debate as to whether these biomarkers can be used to assess volume overload and help determine dry weight.

METHODS

We measured the N-terminal probrain natriuretic peptide (NTproBNP) in 366 stable haemodialysis outpatients with a corresponding pre- and post-dialysis multifrequency bioimpedance assessment of extracellular water (ECW)/total body water (TBW).

RESULTS

Median age was 61 years (46-73); 58.5% were male, 28.5% diabetic, and 37.7% Caucasoid; 71.1% had a history of hypertension, 8.4% of myocardial infarction, and 9.3% of coronary artery bypass surgery; dialysis vintage was 54 months (22-85.5), and urea reduction ratio was 73.4 ± 7.6%. Median post-dialysis NTproBNP was 179 pmol/l (68-535), pre-dialysis ECW/TBW was 0.393 ± 0.014, and post-dialysis ECW/TBW was 0.385 ± 0.015. On multivariate analysis log NTproBNP was associated with post-dialysis ECW/TBW (β 9.09, 95% CI 3.22-14.95, p = 0.003), mean arterial pressure (β 0.0087, 95% CI -0.0045 to -0.013, p = 0.000), and ultrafiltration rate (ml/kg · h; β 0.038, 95% CI 0.01-0.06, p = 0.001).

CONCLUSION

In this study postdialysis NTproBNP values were correlated with direct assessments of volume status in haemodialysis patients, i.e. by ECW/TBW, or indirect measures of volume overload, i.e. ultrafiltration rate and post-dialysis mean arterial blood pressure. This suggests that serial NTproBNP values may aid clinical assessments of volume status in dialysis patients.

Accuracy of segmental multi-frequency bioelectrical impedance analysis for assessing whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older

BACKGROUND/OBJECTIVE

We aimed to examine the accuracy of segmental multi-frequency bioelectrical impedance analysis (SMF-BIA) for the assessment of whole-body and appendicular fat mass (FM) and lean soft tissue mass (LM) in frail older women, using dual-energy X-ray absorptiometry (DXA) as a reference method.

SUBJECTS/METHODS

All 129 community-dwelling Japanese frail older women with a mean age of 80.9 years (range, 75-89 years) from the Frailty Intervention Trial were recruited. The agreements between SMF-BIA and DXA for whole-body and appendicular body composition were assessed using simple linear regression and Bland-Altman analysis.

RESULTS

High coefficients of determination (R(2)) for whole-body FM (R(2)=0.94, s.e. of estimate (SEE)=1.2 kg), whole-body LM (R(2)=0.85, SEE=1.4 kg), and appendicular FM (R(2)=0.82, SEE=1.1 kg) were observed between SMF-BIA and DXA. The R(2) coefficient for appendicular LM was moderate (R(2)=0.76, SEE=0.8 kg). Bland-Altman plots demonstrated that there was systematic (constant) bias (that is, DXA minus SMF-BIA) with overestimation of whole-body FM (bias=-1.2 kg, 95% confidence interval (CI)=-1.5 to -0.1) and underestimation of whole-body LM (bias=2.1 kg, 95% CI=1.8-2.3) by SMF-BIA. Similar, the appendicular measurements also demonstrated systematic bias with overestimation of appendicular FM (bias=-0.3 kg, 95% CI=-0.5 to -0.1) and underestimation of whole-body LM (bias=1.5 kg, 95% CI=1.4-1.7) by SMF-BIA. In addition, the individual level accuracy demonstrated a non-proportional bias for whole-body LM (r=0.08, P=0.338) and appendicular FM (r=0.07, P=0.413).

CONCLUSIONS

SMF-BIA had acceptable accuracy for the estimation of whole-body and appendicular FM and LM in frail older women, although SMF-BIA underestimated LM and overestimated FM relative to DXA.

Association between the SPRY1 gene polymorphism and obesity-related traits and osteoporosis in Korean women

BACKGROUND

Emerging evidence has revealed a close relationship between obesity and osteoporosis. It was reported recently that conditional knockout of the Spry1 gene in mice adipocytes causes an increase in body fat and a decrease in bone mass, and that these phenotypes are rescued by Spry1 overexpression in adipose tissue. In this study, we investigated whether genetic variation in the human SPRY1 gene is associated with obesity-related phenotypes and/or osteoporosis in humans.

METHODS

We performed a candidate gene association analysis between the four single nucleotide polymorphisms (SNPs) and 14 imputed SNPs in the SPRY1 gene and obesity-related traits and osteoporosis in a Korean women cohort (3013 subjects).

RESULTS

All four SPRY1 gene SNPs were significantly associated with either obesity-related traits or osteoporosis. The TGCC haplotype in the SRPY1 gene showed simultaneous association with an increased risk for obesity-related traits, percentage body fat (p=0.0087) and percentage abdominal fat (p=0.047), and osteoporosis (odds ratio=1.50; p=0.025) in the recessive genetic model.

CONCLUSIONS

Our results support a previous finding in conditional Spry1 gene knockout mice and suggest that the SPRY1 gene is an important genetic factor for determining the risk of both obesity and osteoporosis in humans.

Does peritoneal dialysate affect body composition assessments using multi-frequency bioimpedance in peritoneal dialysis patients?

BACKGROUND/OBJECTIVES

Multi-frequency bioelectrical impedance analysis (MFBIA) is increasingly being used to assess peritoneal dialysis patients. Protein energy wasting (PEW) is a recognised complication of peritoneal dialysis. Although MFBIA can be used to assess body composition, measurements can be affected by fluid overload, and we wished to determine whether the presence of peritoneal dialysate in the peritoneal cavity equally could affect MFBIA-derived body composition assessments.

SUBJECTS/METHODS

Fifty consecutive adult patients had MFBIA made with 2l 22.7 g/l dextrose dialysate instilled into the peritoneal cavity and then after draining out.

RESULTS

When full, extracellular water (ECW) and the ratio of ECW to total body water (TBW) were greater compared with when empty: 13.9 ± 3.0l versus 13.4 ± 3.0, and 0.393 ± 0.01 versus 0.391 ± 0.01, P<0.001, respectively. Segmental ECW/TBW was only different for the trunk, 0.395 ± 0.01 full versus 0.392 ± 0.01 empty, P<0.0001. Body composition changed with a fall in skeletal muscle mass from 26.1 ± 6.3 to 25.2 ± 6.1 kg, P<0.001, and a smaller reduction in body fat from 19.3 ± 8.4 to 19.1 ± 8.0 kg, P=0.0104.

CONCLUSION

MFBIA measurements made in peritoneal dialysis patients with peritoneal dialysate instilled can overestimate body composition, including muscle mass, and as such potentially delay the recognition of PEW. Thus, for more accurate MFBIA in peritoneal dialysis patients, the dialysate should be drained out.

Impact of body mass index on the predictive ability of body fat distribution for type 2 diabetes risk in Koreans

AIMS

The optimal anthropometric measure of obesity or body fat distribution that best predicts the risk of Type 2 diabetes in Asians is unclear. Moreover, it has not been determined whether BMI modifies the effect of body fat distribution on diabetes risk in Asians.

METHODS

We analysed the anthropometric and laboratory data of 7658 non-diabetic Korean adults (5061 men and 2597 women, aged 20-79 years) who underwent routine medical check-ups at 5-year intervals. BMI, waist circumference, waist-to-height ratio, and bioelectrical impedance (to calculate fat mass and per cent body fat) were measured at baseline.

RESULTS

Of the 7658 participants, 278 subjects (3.6%) developed diabetes over 5 years. Each of the anthropometric measures of general obesity (BMI, fat mass, per cent body fat) and central body fat distribution (waist circumference and waist-to-height ratio) was a good predictor of Type 2 diabetes. However, when the areas under the receiver-operating characteristic curves were compared, BMI (0.697; 95% CI, 0.669-0.725), waist circumference (0.709, 0.682-0.736) and waist-to-height ratio (0.718, 0.692-0.743) were better predictors of diabetes risk than fat mass (0.672, 0.643-0.700) or per cent body fat (0.657, 0.628-0.686). In the low- (< 23 kg/m(2)) and mid- (23-27 kg/m(2)) BMI groups, the addition of waist-to-height ratio or waist circumference to BMI could improve the prediction of diabetes risk.

CONCLUSIONS

BMI, waist circumference and waist-to-height ratio were good predictors of Type 2 diabetes risk in Koreans. In non-obese or less obese subjects, measures of central body fat distribution can help improve the prediction of Type 2 diabetes risk when added to measures of general obesity.

Cigarette smoking increases abdominal and visceral obesity but not overall fatness: an observational study

BACKGROUND

Cigarette smoking and obesity are leading public health concerns. Both increase the risk for cardiovascular disease, cancer, and metabolic abnormalities. This study was conducted to assess the association between cigarette smoking and different types of obesity.

METHODOLOGY/PRINCIPAL FINDINGS

Two hundred eighty-three visitors to university hospitals located in four main provinces of South Korea were participated. All participants were classified as either current/past or never smokers and were divided into quartiles according to the total pack-years. Body mass index, waist circumference, total body fat percentage, and area of visceral and abdominal subcutaneous fat were measured. These results of each groups were compared. Waist circumference, and visceral fat area showed a J- or U-shaped association with total smoking amount during a lifetime. After restricting the analyses to past/current smokers, we found significant dose-dependent associations of smoking pack-years with abdominal and visceral obesity. Overall obesity measured by body mass index and total body fat percentage did not show such associations. Although current smokers clearly showed significant associations, we could not demonstrate these in past smokers, possibly because of the limited sample size.

CONCLUSIONS/SIGNIFICANCE

Although smokers did not show significant difference in mean body mass index than those who never smoked, they showed more metabolically adverse fat distributions with increasing smoking amounts. This finding suggests that smoking is not beneficial for weight control. Therefore, smoking cessation and avoidance of smoking commencement should be addressed as important public health issues in preventing obesity and related complications.

Effect of a multistage ultraendurance triathlon on aldosterone, vasopressin, extracellular water and urine electrolytes

Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.

Edema index established by a segmental multifrequency bioelectrical impedance analysis provides prognostic value in acute heart failure

OBJECTIVES

A segmental multifrequency bioelectrical impedance analysis (SMBIA) is a noninvasive and reproducible modality for estimating the fluid state. The aim of this study was to test whether the SMBIA-derived edema index provides prognostic value in patients hospitalized due to acute heart failure (AHF).

METHODS

To estimate the 6-month prognostic value of the predischarge edema index in patients hospitalized due to AHF, 112 patients were consecutively enrolled. Both predischarge edema index and B-type natriuretic peptide (BNP) were measured. Outcome follow-up focused on heart failure-related and all-cause re-hospitalizations and all events.

RESULTS

On the basis of a cutoff value of edema index of 0.390, patients were separated into two groups: edema index more than 0.390 (n = 44) and edema index of 0.390 or less (n = 68). Compared with patients with edema index 0.390 or less, those with edema index of more than 0.390 were older, had lower blood albumin and hemoglobin levels, and had higher predischarge BNP levels, functional class, incidence of diabetes mellitus, valvular cause, and diuretic use. Although edema indexes were correlated with BNP levels (r = 0.47, P < 0.0001), a mismatch was noted in 33 (29%) patients. Univariate and multivariate analysis showed that an edema index of more than 0.390 predicted a higher incidence of heart failure-related re-hospitalization [odds ratio (OR) = 4.14, confidence interval (CI) = 1.05-15.28, P = 0.04] and all events (OR = 3.97, CI = 1.4-11.25, P = 0.01). The edema index provided a prognostic value superior to that of BNP. Reducing the edema index in high-risk patients resulted in fewer heart failure-related re-hospitalizations (OR = 0.81, CI = 0.77-0.84, P < 0.001) and all events (OR = 0.8, CI = 0.76-0.85, P < 0.001).

CONCLUSION

Edema index provides 6-month prognostic values in patients hospitalized due to AHF. Reducing the edema index in high-risk patients results in better outcomes.

Comparison of volume status in asymptomatic haemodialysis and peritoneal dialysis outpatients

BACKGROUND

The majority of haemodialysis (HD) patients gain weight between dialysis sessions and thereby become volume overloaded, whereas peritoneal dialysis (PD) is a more continuous technique. Cardiovascular mortality and hypertension is increased with both treatment modalities. We therefore wished to compare volume status in PD and HD to determine whether PD patients are chronically volume overloaded, as a risk factor for cardiovascular mortality. Study Design, Setting and Participants:We retrospectively audited 72 healthy HD patients and 115 healthy PD patients attending a university hospital dialysis centre for routine outpatient treatment, who had multi-frequency bioimpedance measurements of extracellular water to total body water (ECW/TBW).

RESULTS

The groups were well matched for age, sex, weight and ethnicity, PD patients had greater urine output [1,075 (485-1,613) vs. 42.5 (0-1,020) ml/day, p < 0.001], but there was no difference in antihypertensive prescription (63.5 vs. 76.4%), mean arterial blood pressure (post-dialysis 101.6 ± 1.5 mm Hg vs. pre-dialysis 102 ± 2.4 mm Hg), although post-dialysis arterial blood pressure was lower than in PD patients (96.4 ± 3.1 mm Hg, p < 0.05). The ratio of ECW/TBW fell after HD (pre-dialysis 0.394 ± 0.001 vs. post-dialysis 0.389 ± 0.004, p < 0.001) and was similar in the PD group to the group before HD (0.393 ± 0.001), and greater than that in the group after HD (p < 0.001). ECW/TBW was greater than the normal reference range in 30% PD patients, 28% patients before HD and 20% patients after HD.

CONCLUSIONS

Overhydration is common in healthy stable PD outpatients, and ECW volumes in PD patients are not dissimilar to those of pre-dialysis HD patients. The role of chronic volume overload as a risk factor for cardiovascular disease needs further investigation.

Impact of childhood obesity treatment on body composition and metabolic profile

BACKGROUND

Childhood obesity is associated with adverse changes in cardiometabolic risk factors. A family-oriented group program stressing a health-promoting lifestyle has been more effective than routine counselling in the treatment of obesity in school children. The aim of the present study was to compare the impact of group program and routine councelling on body composition and metabolic profile, and to evaluate the associations of changes in adiposity with levels of cardiometabolic risk factors.

METHODS

Seventy obese prepubertal children were randomized into family-oriented group program (15 sessions for parents and children) and routine counselling (2 appointments for children). Body mass index (BMI), body composition and different metabolic risk factors were assessed before and after the 6-month intervention.

RESULTS

Waist/height decreased more in the children attending the group treatment, but there were no significant differences between treatment arms in the changes of metabolic risk factors. When the arms were analyzed as combined, serum triglycerides decreased significantly if BMI standard deviation score (BMI-SDS) decreased ≥ 0.5. Serum fasting insulin decreased if BMISDS decreased ≥ 0.25.

CONCLUSIONS

Obesity-related metabolic risk factors reduced in prepubertal children if BMI-SDS decreased substantially. This result was not dependent on which intervention, family-oriented group program or routine counselling, was used.

The utility of visceral fat level by bioelectrical impedance analysis in the screening of metabolic syndrome - the results of the Kyushu and Okinawa Population Study (KOPS)

AIM

A simple, non-invasive medical device, using bioelectrical impedance analysis (BIA) for the evaluation of visceral fat level (VFL) was developed recently. The aim of this study was to investigate the utility of VFL by BIA in the screening of metabolic syndrome (MetS).

METHODS

VFL was measured by the BIA device in 1,451 Japanese residents (546 men and 905 women, age range 30-69 years).

RESULTS

VFL had significant positive correlations with waist circumference (WC) and body mass index (r=0.772 and 0.849, all P < 0.0001). The overall MetS prevalence using Japanese Diagnosis Criteria was 19.8%: men 36.3% and women 9.8%. The mean VFL of the participants with MetS was significantly higher than those without MetS (men; 12.1 and 9.4, women; 13.3 and 8.7) (both P < 0.001). VFL significantly correlated with blood pressure, lipid profiles, fasting plasma glucose, and hemoglobin A1c (all P < 0.001). Receiver operating characteristic curve analysis for a diagnosis of two or more MetS risk factors excluding WC resulted in the same cutoff values for the VFL (10.0) of men and women.

CONCLUSIONS

The VFL by BIA is useful for the detection of MetS because it is correlated with all metabolic parameters and shows the same normal limit in both sexes.

Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.

Birth size and childhood growth as determinants of physical functioning in older age: the Helsinki Birth Cohort Study

The study reports on the associations of infant and childhood anthropometric measurements, early growth, and the combined effect of birth weight and childhood body mass index with older age physical functioning among 1,999 individuals born in 1934-1944 and belonging to the Helsinki Birth Cohort Study. Physical functioning was assessed by the Short Form 36 scale. Anthropometric data from infancy and childhood were retrieved from medical records. The risk of lower Short Form 36 physical functioning at the mean age of 61.6 years was increased for those with birth weight less than 2.5 kg compared with those weighing 3.0-3.5 kg at birth (odds ratio (OR) = 2.73, 95% confidence interval (CI): 1.57, 4.72). The gain in weight from birth to age 2 years was associated with decreased risk of lower physical functioning for a 1-standard deviation increase (OR = 0.84, 95% CI: 0.75, 0.94). The risk of lower physical functioning was highest for individuals with birth weight in the lowest third and body mass index at 11 years of age in the highest third compared with those whose birth weight was in the middle third and body mass index at age 11 years was in the highest third (OR = 3.08, 95% CI: 1.83, 5.19). The increasing prevalence of obesity at all ages and the aging of populations warrant closer investigation of the role of weight trajectories in old age functional decline.