Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis

Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis

Chronic volume overload is associated with left ventricular hypertrophy and high cardiovascular mortality in patients undergoing dialysis. Therefore, estimating body fluid status is important in these patients. However, most dry-weight assessments are still performed clinically, while attempts have been made to measure the volume status and dry weight of patients undergoing dialysis using bioimpedance analysis (BIA). BIA uses the electrical properties of the human body to alternate current flow and measures resistance values to estimate body water content and composition. BIA is divided into single-frequency BIA, multi-frequency BIA, and bioimpedance spectroscopy (BIS) according to the number of frequencies used, and into whole-body and segmental BIA according to whether or not the whole body is divided into segments. Extracellular water (ECW), intracellular water, and total body water (TBW) contents can be measured with BIA. Dry weight can be estimated by measuring the volume overload of the patient through the ECW/TBW and ECW-to-body weight ratios. Other estimation methods include the normovolemia/hypervolemia slope method, a resistance-reactance (RXc) graph, overhydration measurements using a body composition monitor, and calf BIS. In this review, we will examine the principles of BIA, introduce various volume status measurement methods, and identify the optimal method for patients undergoing dialysis.

Pre-pregnancy overweight or obesity and gestational diabetes as predictors of body composition in offspring twenty years later: evidence from two birth cohort studies

BACKGROUND

Global prevalence of overweight/obesity and gestational diabetes (GDM) is increasing. In pregnant women both conditions affect offspring's later health. Overweight/obesity is a risk factor of GDM; to what extent maternal overweight/obesity explains long-term effects of GDM in offspring is unknown.

OBJECTIVE

To evaluate effects of maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m^-2) and GDM, occurring together or separately, on body composition among adult offspring.

METHODS

Participants include 891 individuals aged 24.1 years (s.d. 1.4) from two longitudinal cohort studies (ESTER and AYLS). Adult offspring of normoglycemic mothers with overweight/obesity (ONOO, n=153), offspring of mothers with GDM (OGDM; n=191) and controls (n=547) underwent anthropometric measurements and bioimpedance analysis. Gestational diabetes mellitus was diagnosed by oral glucose tolerance test. Data were analyzed by linear regression models adjusted for confounders.

RESULTS

Compared with controls, ONOO-participants showed higher BMI (men 1.64 kg m^-2 (95% confidence interval 0.57, 2.72); women 1.41 kg m^-2 (0.20, 2.63)) and fat percentage (men 2.70% (0.99, 4.41); women 2.98% (0.87, 5.09)) with larger waist circumferences (men 3.34 cm (0.68, 5.99); women 3.09 cm (0.35, 5.83)). Likewise, OGDM-participants showed higher fat percentage (men 1.97% (0.32, 3.61); women 2.32% (0.24, 4.41)). Body mass index was non-significantly different between OGDM-participants and controls (men 0.88 kg m^-2 (-0.17, 1.92); women 0.82 kg m^-2 (-0.39, 2.04)). Also waist circumferences were larger (men 2.63 cm (-0.01, 5.28); women 3.39 cm (0.60, 6.18)); this difference was statistically significant in OGDM-women only. Differences in body composition measures were stronger among offspring of women with both GDM and overweight/obesity. For instance, fat mass was higher among OGDM-participants of overweight mothers (men 4.24 kg (1.36, 7.11) vs controls; women 5.22 kg (1.33, 9.11)) than OGDM participants of normal weight mothers (men 1.50 kg (-2.11, 5.11) higher vs controls; women 1.57 kg (-3.27, 6.42)).

CONCLUSIONS

Maternal pre-pregnancy overweight and GDM are associated with unhealthy body size and composition in offspring over 20 years later. Effects of maternal pre-pregnancy overweight appear more pronounced.

Sex-based Differences in the Association between Body Composition and Incident Fracture Risk in Koreans

The relative contribution of lean mass and fat mass on bone health is inconclusive. We investigated the relative contributions of lean and fat masses on fragility fracture risk in Korean men and women. This was an ongoing prospective community-dwelling cohort study at Ansung beginning in 2001, which included 2,189 men and 2,625 women over 40 years old. Study subjects were classified into the following four groups according to lean mass (LM)/height² and percentage fat mass (PF). Clinical fragility fracture events were assessed at baseline and biennially using self-reported questionnaires. During a median follow-up of 9.4 years, 77 (3.5%) men and 203 (7.7%) women experienced at least one incident fracture. In Cox proportional hazard models, men with low LM under normal and high PF had a 2.16 and 2.59- fold higher risk for fragility fractures than normal ones even after adjusting for covariates. However, in women, low LM or high FM was not associated with fracture risk. We demonstrated sex-based differences in the association of body composition and incident fracture risk in Koreans aged over 40 years during a 10-year follow-up duration. Maintaining muscle mass in men is vital to maintaining bone health and preventing fragility fractures in Koreans.

Hyperglycemia-induced hyponatremia: Reevaluation of the Na+ correction factor

This study addresses the clinically important relationship between the decreases in plasma Na⁺ and the increases in plasma glucose concentrations seen in diabetes and other hyperglycemic syndromes. This plasma 'Na⁺ correction factor', is generally accepted as 1.6mM Na⁺ per 100mg% glucose (0.29mM/mM in SI units) assuming osmotic equilibrium, although much larger numbers have been measured in experiments on normal humans. To resolve this controversy, a mathematical model of whole-body fluid-electrolyte balance was used to perform the experiment wherein plasma glucose concentration was increased to diabetic levels and the plasma Na⁺ concentration changes assessed, without the complications seen in human experiments. The findings, based on osmotic grounds, were that the factor 1) was significantly <1.6, approaching 1 in some cases, 2) depended upon the anthropometry of the subject; it was inversely proportional to the ratio of extracellular to total body water, which increases with higher fat content and 3) was approximately linear up to glucose concentrations of about 800mg%, but decreased up to 10% for higher glucose concentrations. To explain the experimental data, a hypothesis of Na⁺ sequestration in cells was incorporated in the model, resulting in close prediction of measured transient Na⁺ changes.

Low muscle mass and risk of type 2 diabetes in middle-aged and older adults: findings from the KoGES

AIMS/HYPOTHESIS

Asians have a propensity to develop type 2 diabetes with a lower BMI than Western populations. This discrepancy may be due to differences in body fat and muscle mass for a given BMI. However, unlike adiposity, it is unclear whether muscle mass affects the risk of type 2 diabetes in Asian populations.

METHODS

We conducted a 2-yearly prospective assessment of 6895 participants who were free of diabetes at the baseline examination as part of the Korean Genome Epidemiology Study. The muscle mass index (MMI) was defined as the weight-adjusted appendicular skeletal muscle mass. Using Cox regression models, we evaluated the association between MMI and the risk of developing type 2 diabetes across sex-specific tertiles of MMI. Low muscle mass was defined as the sex-specific lowest tertile of MMI. Main covariates included age, sex, urban or rural residence, family history of diabetes, hypertension, smoking status, education level, monthly income, physical activity, alcohol consumption and diet. In addition, body fat mass, waist circumference and BMI were controlled as categorical variables. Obesity was defined as a BMI of ≥25 kg/m² or a waist circumference of ≥90 cm for men and ≥85 cm for women.

RESULTS

During a median follow-up of 9.06 years, 1336 participants developed type 2 diabetes. At baseline, the mean age was 52.1 years and the mean BMI was 24.4 kg/m². The mean MMI for men and women was 32.1% and 26.0%, respectively. There was an inverse association between MMI and the risk of type 2 diabetes. Multivariate-adjusted HRs for the risk of developing type 2 diabetes were 2.05 (95% CI 1.73, 2.43), 1.39 (95% CI 1.17, 1.66) and 1.0 from the lowest to highest sex-specific MMI tertile, with an HR of 1.35 (95% CI 1.26, 1.45) per SD decline in MMI. Further adjustments for fat mass, waist circumference and BMI as categorical variables did not modify the relationship (each p < 0.01). In BMI-stratified analyses, the population-attributable fraction of the lowest tertile of MMI for developing type 2 diabetes was increased by 11.9% in the non-obese group and 19.7% in the obese group.

CONCLUSIONS/INTERPRETATION

Low muscle mass as defined by MMI was associated with an increased risk of type 2 diabetes, independent of general obesity, in middle-aged and older Korean adults.

Effects of BodyPump and resistance training with and without a personal trainer on muscle strength and body composition in overweight and obese women-A randomised controlled trial

OBJECTIVES

Overweight and obese individuals are recommended to perform regular resistance training, and the health- and fitness industry offer several exercise programs with purpose to improve muscle strength and body composition. This randomised controlled trial aimed to compare 12 weeks (45-60min, 3 sessions/weeks) of popular exercise programs, available at health- and fitness centers worldwide.

METHODS

Previous untrained women with BMI≥25 were allocated to either BodyPump (a high-repetition group session) (n=25), individual resistance training with a personal trainer (n=25), non-supervised individual resistance training (n=21) and non-exercising control group (n=21). Primary outcome was one repetition maximum (1RM) in squat and bench press, and secondary outcome was body composition (Inbody720).

RESULTS

The BodyPump group did not improve muscle strength, compared to any of the other groups. In 1RM squat, the personal trainer group increased 17% (95% CI 5.1-23.0), 20% (95% CI 7.5-24.8) and 30% (95% CI 15.8-33.0kg) more than the non-supervised group, BodyPump and controls, respectively. In bench press the personal trainer group increased 10% (95% CI 1.5-7.2) and 16% (95% CI 3.5-9.3kg) more compared to BodyPump and controls. No difference was found compared to the non-supervised group in bench press. There were no between-group differences in body composition.

CONCLUSION

Twelve weeks of BodyPump did not improve muscle strength in overweight women, but a personal trainer amplified the effects of individual resistance training on maximal strength in squat. None of the intervention groups showed effect in body composition.

DIFERENCIAS ESPACIO-TEMPORALES DE LA LOCOMOCIÓN EN ADULTOS VARONES CON NORMOPESO Y SOBREPESO

RESUMEN Introducción: La obesidad ha estado relacionada con la presencia de adaptaciones estructurales y funcionales que provocan limitaciones en el control del movimiento. Objetivo: Determinar el efecto del exceso de peso sobre las variables espacio-temporales de la locomoción en varones jóvenes y activos. Métodos: Estudio de corte transversal de muestreo no probabilístico con 55 sujetos con normopeso (IMC ≤25) y 22 sujetos con sobrepeso (IMC >25). Se analizó el IMC, % de masa grasa, y el % de masa magra de ambos grupos con un bioimpedanciómetro multifrecuencia (Inbody 230). También se analizaron las variables cinemáticas de la locomoción utilizando una plataforma de presiones GaitRite. Resultados: El grupo con sobrepeso mostró una disminución significativa de la fase de oscilación y fase de apoyo monopodal (p <0,001) junto con un aumento de la fase de apoyo y fase de apoyo bipodal (p <0,001) comparado con el grupo normopeso. Conclusión: La reducción de la fase de oscilación y el incremento de la fase de apoyo y fase de apoyo bipodal que manifestaron el grupo con sobrepeso puede ser consecuencia del aumento de la inestabilidad que se produce durante la marcha debido al sobrepeso.

Evaluation of metabolic parameters and body composition in Japanese patients with type 2 diabetes mellitus who were administered tofogliflozin for 48 weeks

Sodium glucose cotransporter 2 inhibitors are unique antihyperglycemic agents that cause osmotic diuresis and calorie loss to urine. We previously reported that administration of tofogliflozin, a sodium glucose cotransporter 2 inhibitor, for 8 weeks decreased fat-free mass without affecting fat mass. We thus investigated the impact of tofogliflozin on metabolic parameters and body composition for 48 weeks in Japanese patients with type 2 diabetes mellitus. This single-arm open-label study enrolled 20 patients. Patients received tofogliflozin 20 mg once daily for 48 weeks. At week 48, changes in metabolic parameters and body composition from baseline were evaluated. Two patients discontinued administration due to adverse events during the first 8 weeks; however, no other adverse events occurred after that period. Seventeen patients completed the 48 weeks of administration of tofogliflodin. Body weight and body mass index decreased during the treatment period. Hemoglobin A1c decreased from 7.8% to 7.1%. The degree of improvement in hemoglobin A1c was correlated with body mass index, fat mass, and plasma glucose level at baseline. As for body composition, fat mass decreased without any change in fat-free mass (including total body water, extracellular water, and intracellular water). Red blood cell count and hematocrit increased, while the estimated glomerular filtration rate decreased. ALT and γ-GTP decreased and the decrease in γ-GTP was correlated with the loss of fat mass. In conclusion, our study clearly suggests that the body weight reduction caused by tofogliflozin administration for 48 weeks was almost entirely due to fat mass dissipation.

Bioelectrical Impedance Analysis (BIA) of the association of the Japanese Kampo concept "Suidoku" (fluid disturbance) and the body composition of women

Background

In Japanese Kampo medical practice, suidoku (fluid disturbance) is one of the most important concepts for selecting the proper medication. Suidoku is an excessive or uneven distribution of fluid that is indicated by splashing sounds and pitting edema. However, few objective reports about suidoku have been published. Bioelectrical impedance analysis (BIA) uses resistance values obtained from weak electrical currents to estimate body composition, including intracellular and extracellular water and muscle and fat mass. In this study, we used BIA to search for objective factors that can discriminate the various types of suidoku.

Methods

Two hundred twenty-nine patients who visited the Kampo Medicine Clinic of Kyushu University Hospital from June 2010 to August 2015 were divided into non-suidoku (n = 180, 80 male and 100 female), splashing sound (n = 32, 8 male and 24 female) and edema groups (n = 17, 5 male and 12 female). Body composition values were taken from the electronic medical records of InBody730 (a vertical, segmental, multi-frequency analyzer by InBody, Tokyo Japan) testing done at the initial visit. Various parameters of the body composition values of female in the non-suidoku and suidoku groups (splashing sound and edema groups) were compared: there were too few male patients to provide significance.

Results

The age and body weight were significantly lower in the splashing sound group than in the non-suidoku group (p < 0.05). In contrast, the body weight of the edema group was significantly heavier than that of the non-suidoku group (p < 0.05). In ROC analysis, the percent Body Fat ≤ 27.8 %, Muscle Mass Index of the Trunk ≤ 6.5 kg/m², VFA (Visceral fat area) ≤ 5.4 and BMI ≤ 19.2 kg/m² were associated with splashing sound, and Muscle Mass Index of Legs ≥ 4.8 kg/m² and BMI ≥ 21.4 kg/m² were associated with edema.

Conclusion

Our data suggest that the use of this type of BIA to estimate body composition would be a useful tool for the diagnosis of suidoku for women.

Modified body adiposity index for body fat estimation in severe obesity

BACKGROUND

The body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity.

METHODS

A cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equation in this population. The new equation proposed was validated in another 158 patients with severe obesity (Group 2: G2).

RESULTS

There was a significant difference between BF determination by BIA and BAI (P = 0.039). The mean (SD) BF in G1 was 52.3% (6.1%) determined by BIA and 51.6% (8.1%) determined by BAI. Sex, waist-hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation (modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI% = 23.6 + 0.5 × (BAI); add 2.2 if body mass index ≥ 50 kg m^-2 and 2.4 if WHR ≥ 1.05]. The new equation reduced the difference [1.2% (5.9%), P < 0.001 to 0.4% (4.12%), P = 0.315] and improved the correlation (0.6-0.7) between methods.

CONCLUSIONS

BAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.

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.

Body composition in overweight and obese women postpartum: bioimpedance methods validated by dual energy X-ray absorptiometry and doubly labeled water

BACKGROUND/OBJECTIVES

Obesity, pregnancy and lactation all affect body composition. Simple methods to estimate body composition are useful in clinical practice and to evaluate interventions. In overweight and obese lactating women, such methods are not fully validated. The objective of this study was to validate the accuracy and precision of bioimpedance spectroscopy (BIS) by Xitron 4200 and 8-electrode multifrequency impedance (multifrequency bioimpedance analysis, MFBIA) by Tanita MC180MA with the reference methods dual energy X-ray absorptiometry (DXA) and doubly labeled water (DLW) for the assessment of body composition in 70 overweight and obese women postpartum.

SUBJECTS/METHODS

The LEVA-study (Lifestyle for Effective Weight loss during lactation) consisted of an intervention and follow-up with three assessments at 3, 6 and 15 months postpartum, which made possible the validation of both accuracy and precision. Mean differences between methods were tested by a paired t-test and Bland-Altman plots for systematic bias.

RESULTS

At baseline, BIS and MFBIA underestimated fat mass (FM) by 2.6±2.8 and 8.0±4.2 kg compared with DXA (P<0.001) but without systematic bias. BIS and MFBIA overestimated total body water (TBW) by 2.4±2.2 and 4.4±3.2 kg (P<0.001) compared with DLW, with slight systematic bias by BIS. BIS correctly estimated muscle mass without systematic bias (P>0.05). BIS overestimated changes in TBW (P=0.01) without systematic bias, whereas MFBIA varied greatly and with systematic bias.

CONCLUSIONS

BIS underestimates mean FM compared with DXA but can detect mean changes in body composition, although with large limits of agreement. BIS both accurately and precisely estimates muscle mass in overweight and obese women postpartum. MFBIA underestimates FM and overestimates TBW by proprietary equations compared with DXA and DLW.

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.

Dual Impact of Tolvaptan on Intracellular and Extracellular Water in Chronic Kidney Disease Patients with Fluid Retention

Objective Tolvaptan, an oral selective V2-receptor antagonist, is a water diuretic that ameliorates fluid retention with a lower risk of a worsening renal function than conventional loop diuretics. Although loop diuretics predominantly decrease extracellular water (ECW) compared with intracellular water (ICW), the effect of tolvaptan on fluid distribution remains unclear. We therefore examined how tolvaptan changes ICW and ECW in accordance with the renal function. Methods Six advanced chronic kidney disease patients (stage 4 or 5) with fluid retention were enrolled in this study. Tolvaptan (7.5 mg/day) added to conventional diuretic treatment was administered to remove fluid retention. The fluid volume was measured using a bioimpedance analysis device before (day 0) and after (day 5 or 6) tolvaptan treatment. Results Body weight decreased by 2.6%±1.3% (64.4±6.5 vs. 62.8±6.3 kg, p=0.06), and urine volume increased by 54.8%±23.9% (1,215±169 vs. 1,709±137 mL/day, p=0.03) between before and after tolvaptan treatment. Tolvaptan significantly decreased ICW (6.5%±1.5%, p=0.01) and ECW (7.5%±1.4%, p=0.02), which had similar reduction rates (p=0.32). The estimated glomerular filtration rate remained unchanged during the treatment (14.6±2.8 vs. 14.9±2.7 mL/min/1.73² m, p=0.35). Conclusion Tolvaptan ameliorates body fluid retention, and induces an equivalent reduction rate of ICW and ECW without a worsening renal function. Tolvaptan is a novel water diuretic that has a different effect on fluid distribution compared with conventional loop diuretics.

Impact of the 8-week Administration of Tofogliflozin for Glycemic Control and Body Composition in Japanese Patients with Type 2 Diabetes Mellitus

Objective The adverse effects of selective sodium-glucose co-transporter 2 (SGLT2) inhibitors generally appear within about two or three months after treatment initiation in Japan. Therefore, we investigated the impact of tofogliflozin, a class of SGLT2 inhibitors, on glycemic control and body composition during this period in Japanese patients with type 2 diabetes mellitus. Methods This single-arm open-label study enrolled 20 patients. Patients received tofogliflozin 20 mg once daily for 8 weeks. At week 8, changes from baseline in body weight, serum metabolic markers, and body composition were evaluated. Results A total of 17 patients completed the 8-week administration of tofogliflodin. No serious adverse events were noted. Hemoglobin A1c (HbA1c) decreased significantly, from 7.8% to 7.3% with 8-week administration of tofogliflozin. Both the body weight and body mass index (BMI) also decreased. In addition, a decreased renal function of the boundary zone and hemoconcentration were detected. As for body composition, the free fat mass, total body water, extracellular water and intracellular water were all decreased significantly. Interestingly, the amount of fat mass did not change. The degree of improvement in HbA1c was correlated with the baseline fat mass and BMI. Conclusion An eight-week administration of tofogliflozin improved glycemic control and reduced the body weight and free fat mass in type 2 diabetic patients without affecting the fat mass. In this period, the hematocrit level and renal function should be monitored to guard against hemoconcentration and renal impairment, respectively.

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.

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.

Assessment of fat-free mass from bioelectrical impedance analysis in obese women with Prader-Willi syndrome

BACKGROUND

Fat-free mass (FFM) is lower in obese subjects with Prader-Willi syndrome (PWS) than in obese subjects without PWS. FFM prediction equations developed in non-PWS subjects may, thus, not work in PWS subjects.

AIM

To test whether the estimation of FFM from bioelectrical impedance analysis (BIA) in PWS subjects requires population-specific equations.

METHODS

Using dual-energy X-ray absorptiometry, this study measured FFM in 27 PWS and 56 non-PWS obese women and evaluated its association with the impedance index at 50 kHz (ZI50), i.e. the ratio between squared height and whole-body impedance at 50 kHz.

RESULTS

At the same level of ZI50, PWS women had a lower FFM than non-PWS women. However, when PWS-specific equations were used, FFM was accurately estimated at the population level. An equation employing a dummy variable coding for PWS status was able to explain 85% of the variance of FFM with a root mean squared error of 3.3 kg in the pooled sample (n = 83).

CONCLUSION

Population-specific equations are needed to estimate FFM from BIA in obese PWS women.

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.

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.

The importance of visceral fat mass in obese pregnant women and relation with pregnancy outcomes

BACKGROUND

Maternal obesity is a well established risk factor for gestational diabetes but it is not known if the pattern of maternal fat distribution predicts adverse pregnancy outcomes.

METHODS

Body composition was assessed by bioimpedance using Inbody 720® in 302 consecutive obese pregnant women attending a weight management clinic. The relation of visceral fat mass and total percentage body fat with the development of gestational diabetes and perinatal outcomes was evaluated.

RESULTS

Women developing gestational diabetes (Group 1; n = 72) were older, had higher body mass indices and greater central obesity (waist:hip ratio, visceral fat mass) compared with those remaining normoglycaemic. Visceral fat mass, but not percentage body fat, correlated with fasting glucose in all patients (r = 0.2, p < 0.001) and particularly those in Group 1 (r = 0.35, p = 0.002). Visceral fat mass, but not percentage body fat, also correlated strongly with glycaemia, particularly in Group 1 (r = 0.47, p < 0.0001). Visceral fat mass also showed a weak but significant correlation with baby weight (r = 0.17, p = 0.01).

DISCUSSION

Central obesity, as assessed by early pregnancy waist:hip ratio and particularly by visceral fat mass, is a predictor of gestational diabetes in addition to classical risk factors and may help identify those obese patients at increased risk of complications.

Change in body composition in accordance with residual renal function in patients on peritoneal dialysis

OBJECTIVES

The aim of this study is to evaluate changes in body composition in accordance with residual renal function (RRF).

SUBJECTS AND METHODS

Two hundred forty-four patients with more than 1 year of follow-up were enrolled. The mean value of RRF at peritoneal dialysis (PD) initiation and 1 year after PD initiation was used as an indicator of the time-averaged RRF (TA-RRF). The patients were divided into 3 groups with respect to the tertile of the TA-RRF level: low tertile (n = 81), middle tertile (n = 82), and high tertile (n = 81). Body composition measurement was determined from dual-energy X-ray absorptiometry and bioimpedance analysis. This analysis was performed at PD initiation and 1 year after PD initiation.

RESULTS

Multivariate analysis showed that the high TA-RRF tertile was associated with an increase in lean mass index. Fat mass index in all tertiles and bone mineral content index in the middle and high TA-RRF tertiles were increased, but no significant difference were observed in these changes among the 3 tertiles. The edema index decreased over the 1-year PD period. The high TA-RRF tertile was associated with a lower edema index. Although there was no statistical significance, the increase in fat mass/lean mass ratio (FM/LM) attenuated as the grade of TA-RRF tertile increased. The increase in fat mass index was similar to the trend in FM/LM.

CONCLUSION

TA-RRF was associated with an increase in total lean mass and a decrease in edema index.

Effect of fasting in Ramadan on body composition and nutritional intake: a prospective study

BACKGROUND

The present study aimed to assess the effects of Ramadan intermittent fasting on body weight and composition and the effects of age and sex.

METHODS

Body weight, height, waist and hip circumferences were measured, body mass index (BMI) was calculated and fat mass, fat-free mass and percentage body fat were assessed by bioelectrical impedance on 240 adult subjects (male: 158) who fasted between sunrise and sunset for at least 20 days. Measurements were taken 1 week before and 1 week after Ramadan. Energy and macronutrient intakes were assessed using a 3-day food frequency questionnaire on a sub-sample of subjects before and during Ramadan.

RESULTS

Subjects were grouped according to age and sex: ≤35 years (n = 82, males: 31) and 36-70 years (n = 158, males: 127). There were significant reductions in weight and BMI (P < 0.001) in almost all subjects, with the biggest being in males ≤35 years [-2.2% (SE 2.2%), P < 0.001]. Waist and hip circumferences fell in most subjects, except females aged 36-70 years. Fat mass fell in most subjects, ranging from 2.3% to 4.3% from baseline, except in females aged 36-70 years who did not experience a significant change. Fat-free mass was significantly reduced in all subjects (P < 0.001), whereas percentage body fat was lower only in males by 2.5% (SE 3.2%) (P = 0.029) in those aged ≤35 years and by 1.1% (SE 1.5%) (P < 0.001) in those aged 36-70 years. Dietary intake was similar before and during Ramadan, except in males whose protein intake fell during Ramadan (P = 0.032).

CONCLUSIONS

Ramadan fasting leads to weight loss and fat-free mass reductions. Body composition changes vary depending on age and sex.

Proanthocyanidin-rich grape seed extract reduces leg swelling in healthy women during prolonged sitting

BACKGROUND

Leg swelling is a modern-day affliction of sedentary working women. The aim of this study was to evaluate the effectiveness of the intake of grape seed extract (GSE) on leg swelling in healthy Japanese women while sitting.

RESULTS

Single intake trials and 14 day intake trials were held in a double-blind, placebo-controlled, crossover clinical study. A prolonged sedentary position was maintained for 6 h after GSE or placebo administration. Leg volume distension, increase in body extracellular fluid, and leg water were significantly suppressed in the GSE groups.

CONCLUSION

The intake of GSE is a contributing factor in the inhibition of leg swelling in healthy women during prolonged sitting.

Changes in body composition, cardiovascular disease risk factors, and eating behavior after an intensive lifestyle intervention with high volume of physical activity in severely obese subjects: a prospective clinical controlled trial

We examined the effects of a 10-14-weeks inpatient lifestyle modification program, including minimum 90 min of physical activity (PA) five days/week, on body composition, CVD risk factors, and eating behavior in 139 obese subjects (BMI 42.6 ± 5.2 kg/m²). Completion rate was 71% (n = 71) in the intensive lifestyle intervention (ILI) group and 85% (n = 33) among waiting list controls. Compared to controls body weight (-17.0 (95% CI: -18.7, -15.3) kg, P < 0.0001), fat mass (-15.2 (95% CI: -17.4, -13.1) kg, P < 0.0001), fat free mass (-1.2 (95% CI: -2.2, -0.2) kg, P = 0.016) and visceral fat (-86.6(95% CI: -97.4, -75.7) cm², P < 0.0001) were reduced in the ILI-group after 10-14 weeks. Within the ILI-group weight loss was -23.8 (95% CI: -25.9, -21.7) kg, P < 0.0001 and -20.3 (95% CI: -23.3, -17.3) kg, P < 0.0001, after six and 12 months, respectively. Systolic BP, glucose, triglycerides, and LDL-C were reduced, and HDL-C was increased (all P ≤ 0.006) after 10-14 weeks within the ILI group. The reduction in glucose and increase in HDL-C were sustained after 12 months (all P < 0.0001). After one year, weight loss was related to increased cognitive restraint and decreased uncontrolled eating (all P < 0.05). Thus, ILI including high volume of PA resulted in weight loss with almost maintenance of fat-free mass, favorable changes in CVD risk factors, and eating behavior in subjects with severe obesity.

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.

Protein feeding pattern, casein feeding, or milk-soluble protein feeding did not change the evolution of body composition during a short-term weight loss program

Studies have shown that timing of protein intake, leucine content, and speed of digestion significantly affect postprandial protein utilization. Our aim was to determine if one can spare lean body mass during energy restriction by varying the quality and the timing of protein intake. Obese volunteers followed a 6-wk restricted energy diet. Four groups were compared: casein pulse, casein spread, milk-soluble protein (MSP, = whey) pulse, and MSP spread (n = 10-11 per group). In casein groups, caseins were the only protein source; it was MSP in MSP groups. Proteins were distributed in four meals per day in the proportion 8:80:4:8% in the pulse groups; it was 25:25:25:25% in the spread groups. We measured weight, body composition, nitrogen balance, 3-methylhistidine excretion, perception of hunger, plasma parameters, adipose tissue metabolism, and whole body protein metabolism. Volunteers lost 7.5 ± 0.4 kg of weight, 5.1 ± 0.2 kg of fat, and 2.2 ± 0.2 kg of lean mass, with no difference between groups. In adipose tissue, cell size and mRNA expression of various genes were reduced with no difference between groups. Hunger perception was also never different between groups. In the last week, due to a higher inhibition of protein degradation and despite a lower stimulation of protein synthesis, postprandial balance between whole body protein synthesis and degradation was better with caseins than with MSP. It seems likely that the positive effect of caseins on protein balance occurred only at the end of the experiment.

Comparison between serum free triiodothyronine levels and body fluid distribution in hemodialysis patients

AIM

Low free triiodothyronine (fT3) has been associated with the presence of malnutrition-inflammation syndrome in patients with end-stage renal disease (ESRD) and decreased overall survival in ESRD. Since thyroid hormone has a particular effect on body fluid status, we hypothesized that hemodialysis patients with low-T3 syndrome might have interstitial edema. In this study, we examined the relationship between levels of thyroid hormone and body composition parameters in Japanese hemodialysis patients.

METHODS

The subjects were 52 patients on maintenance hemodialysis. Serum levels of thyroid hormone and atrial natriuretic peptide (hANP) were measured. Body composition parameters were measured using a bioimpedance body composition analyzer.

RESULTS

Serum fT3 had positive correlations with body mass index (BMI), body fat mass (BFM), total body water (TBW) and intracellular water (ICW), and negative correlations with the ratio of extracellular water to total body water (ECW/TBW) and hANP. There were no correlations between serum fT4 and any body composition parameter. The 49 patients with data at baseline and after 1 year were divided into groups with increased (n = 33) and decreased (n = 16) fT3 after 1 year. ΔBMI and ΔBFM were significantly lower and ΔTBW, ΔICW, ΔECW and ΔECW/TBW (changes over 1 year from baseline) were significantly higher in patients with decreased fT3 compared to those with increased fT3. There was no significant difference in ΔhANP or Δcardiothoracic ratio between the two groups.

CONCLUSION

These results show that a decrease in fT3 might be associated with emaciation and interstitial edema in Japanese hemodialysis patients.

Birth-weight and resting metabolic rate in adulthood - sex-specific differences

INTRODUCTION

Low birth-weight is associated with an increased risk of cardiovascular disease, hypertension, and the metabolic syndrome (MetS) in adulthood. Resting metabolic rate (RMR) has been suggested to be associated with the development of obesity as well as MetS and might be an indirect indicator of sympathetic activity. This study's aim was to examine the association between birth-weight and adult RMR.

METHODS

A total of 896 men and women from the Helsinki Birth Cohort Study born 1934-44, for whom a detailed set of birth records were available, underwent measurement of body composition and RMR in adulthood.

RESULTS

Among women, birth-weight adjusted for age and fat-free mass (FFM) was inversely associated with RMR (r = -0.12; P < 0.01). For men, a u-shaped relationship was observed, both independently and after adjustment for age, fat mass, and FFM (P = 0.05 for final model).

DISCUSSION

The sex-specific differences for the association between birth-weight and adult RMR might partly be explained by differences in the developmental programming of the sympathetic nervous system between men and women. The higher adjusted RMR among those with the lowest birth-weights is consistent with previous evidence of higher sympathetic drive among these individuals.

Assessment tools in obesity - psychological measures, diet, activity, and body composition

The global increase in the prevalence of obesity has led to an increased need for measurement tools for research, management and treatment of the obese person. The physical size limitations imposed by obesity, variations in body composition from that of normal weight, and a complex psychopathology all pose tremendous challenges to the assessment of an obese person. There is little published research regarding what tools can be used with confidence. This review is designed to provide researchers and clinicians with a guide to the current and emerging measurement tools specifically associated with obesity research and practice. Section 1 addresses psychological measures of well being. Sections 2, 3, and 4 focus on the assessment of food intake, activity, and body composition. All sections address basic challenges involved in the study and management of obesity, and highlight methodological issues associated with the use of common assessment tools. The best available methods for use in the obese both in research and clinical practice are recommended.

Are there gender differences in quality of life and symptomatology between fibromyalgia patients?

The purpose of this study is to examine gender differences in quality of life (QoL) and symptomatology in fibromyalgia (FM) patients. A total of 20 men (48.0 ± 8.0 years) and 78 women (49.8 ± 7.2 years) with FM participated in the study (age range 31-63 years). Health-related QoL and FM impact were assessed by means of the Spanish versions of the Short-Form-36 Health Survey (SF36) and the Fibromyalgia Impact Questionnaire (FIQ), respectively. Comparisons in QoL were performed using one-way analysis of covariance adjusted by age and body mass index (BMI), and comparisons in FIQ dimensions were performed using Mann-Whitney test. Overall FM impact, as measured by FIQ-total score (p = .01) and FIQ-physical impairment (p = .02) was higher in men, whereas women presented higher values of FIQ-fatigue and FIQ-morning tiredness (p = .04) and less SF36-vitality (p = .02). Therefore, women appear to feel more fatigue, whereas men present higher FM overall impact. Due to the small number of men included in this study and the consequent small statistical power, these results should be taken as preliminary. Higher powered studies are warranted to further address gender differences in FM in order to design more successful treatments.

Fibromyalgia's key symptoms in normal-weight, overweight, and obese female patients

Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.

Bioimpedance analysis: should it be used in morbid obesity?

OBJECTIVES

Questions about reliability of bioimpedance analysis (BIA) in morbidly obese subjects have curtailed its use in this setting, but metabolic implications might reignite the debate. In a prospective study, it was aimed to analyze anthropometric and clinical associations.

METHODS

Bariatric candidates (n = 94) with or without metabolic syndrome were consecutively investigated. Age was 34.9 ± 10.4 years (68.1% females), and BMI was 40.8 ± 4.6 kg m(-2) . Methods included single-frequency BIA, anthropometrics, inflammatory indices, and general biochemical profile.

RESULTS

Body composition results (water, fat) in females, but not in males, were entirely consistent with the literature. In both genders good association was observed with anthropometrics (BMI, waist circumference), inflammatory indices (ferritin, C-reactive protein) and general biochemical variables. Anthropometric measurements also displayed comparable associations. Multivariate tests including the two sets of measurements indicated no predominance of one method over the other, one complementing the other as metabolic marker.

CONCLUSIONS

BIA limitations were mostly relevant for males, not females. Despite such discrepancies, good associations with anthropometry were demonstrated for both genders. Correlations with liver enzymes, and indices of protein, carbohydrate, and lipid metabolism could be demonstrated. BIA deserves more investigations concerning liver steatosis and ongoing inflammation, and it could contribute as well, synergistically with anthropometry, to monitor weight loss, body fat shifts, and metabolic risk.

Drug disposition in obesity and protein–energy malnutrition

Clinical response to medication can differ between patients. Among the known sources of variability is an individual's nutrition status. This review defines some pharmacokinetic terms, provides relevant body size metrics and describes the physiologic influences of protein–energy malnutrition and obesity on drug disposition. Weight-based drug dosing, which presumes a healthy BMI, can be problematic in the protein–energy malnourished or obese patient. The use of total body weight, lean body weight, or an adjusted body weight depends on the drug and how it is differently handled in malnutrition or obesity. Most of the recognized influences are seen in drug distribution and drug elimination as a result of altered body composition and function. Distribution characteristics of each drug are determined by several drug-related factors (e.g. tissue affinity) in combination with body-related factors (e.g. composition). Drug elimination occurs through metabolic and excretory pathways that can also vary with body composition. The current data are limited to select drugs that have been reported in small studies or case reports. In the meantime, a rational approach to evaluate the potential influences of malnutrition and obesity can be used clinically based on available information. Antimicrobials are discussed as a useful example of this approach. Further advancement in this field would require collaboration between experts in body composition and those in drug disposition. Until more data are available, routine monitoring by the clinician of the protein–energy malnourished or obese patient receiving weight-based drug regimens is necessary.

Body composition in psychotic disorders: a general population survey

BACKGROUND

The literature suggests an association between obesity and schizophrenia but fat mass and fat-free mass, which have been shown to be more predictive of all-cause mortality than only waist circumference and obesity [body mass index (BMI) 30 kg/m2], have not been reported in psychotic disorders. We examined the detailed body composition of people with different psychotic disorders in a large population-based sample.

METHOD

We used a nationally representative sample of 8082 adult Finns aged 30 years with measured anthropometrics (height, weight, waist circumference, fat percentage, fat-free mass and segmental muscle mass). Psychiatric diagnoses were based on a consensus procedure utilizing the Structured Clinical Interview for DSM-IV (SCID)-interview, case-notes and comprehensive register data.

RESULTS

Schizophrenia (including schizo-affective disorder) was associated with obesity [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.5-3.6], abdominal obesity (waist circumference 88 cm for women, 102 cm for men) (OR 2.2, 95% CI 1.3-3.6) and with higher fat percentage (mean difference 3.8%, 95% CI 2.0-5.7%), adjusted for age and gender, than in the remaining sample. The associations between schizophrenia and low fat-free mass and decreased muscle mass on trunk and upper limbs became statistically significant after adjusting for BMI. After further adjusting for current antipsychotic medication, education, diet and smoking, schizophrenia remained associated with obesity (OR 1.9, 95% CI 1.1-3.6) and abdominal obesity (OR 3.8, 95% CI 1.5-9.4). Participants with affective psychoses did not differ from the general population.

CONCLUSIONS

Individuals with schizophrenia have metabolically unfavorable body composition, comprising abdominal obesity, high fat percentage and low muscle mass. This leads to increased risk of metabolic and cardiovascular diseases.

Cross-calibration of multi-frequency bioelectrical impedance analysis with eight-point tactile electrodes and dual-energy X-ray absorptiometry for assessment of body composition in healthy children aged 6-18 years

BACKGROUND

In diagnosis and treatment of obesity, body composition analysis including percent body fat (%BF) is useful in the clinical setting. Because bioelectrical impedance analysis (BIA) could be used quickly, easily and was non-invasive in clinical setting, the purpose of the present study was to evaluate the usefulness of multi-frequency BIA with eight-point tactile electrodes (MF-BIA8; InBody 720, Biospace) compared with dual-energy X-ray absorptiometry (DXA) in healthy children and adolescents.

METHODS

A total of 166 children and adolescents under 18 (male, n = 86; female, n = 80) were recruited. Height, weight, body mass index (BMI) and Tanner stage were measured for each subject. The body composition such as fat-free mass (FFM), fat mass (FM), and %BF was measured on BIA and DXA and compared.

RESULTS

On linear regression analysis, DXA FFM = 1.006(BIA FFM) + 0.554, R(2) = 0.99 and the standard error of the estimate (SEE) was 1.16 kg; DXA FM = 0.971(BIA FM) - 0.596, R(2) = 0.93; SEE, 1.34 kg; and DXA %BF = 0.940(BIA %BF) - 1.026, R(2) = 0.858; SEE, 3.03%. Limit of agreement in FFM, FM, and %BF was 0.7 +/- 2.3 kg, -0.9 +/- 2.9 kg and -2.2 +/- 6.1%, respectively.

CONCLUSIONS

Although the %BF was not interchangeable with DXA, MF-BIA8 (InBody 720; Biospace) could be used to measure body composition of children and adolescents in the clinical field because of its high precision.