Body composition in underweight elderly subjects: reliability of bioelectrical impedance analysis

Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty

Age-related changes in body composition reflect an increased risk for disease as well as disability. Bioimpedance analysis is a safe and inexpensive bed side method to measure body composition, but the calculation of body compartments with BIA is hampered in older adults. Phase angle, a raw parameter derived from bioimpedance analysis, is free from calculation-inherent errors. It declines with age and disease and is highly predictive of a variety of clinical outcomes as well as mortality. This review summarizes the current evidence linking the phase angle to geriatric syndromes such as malnutrition, sarcopenia and frailty and also investigates whether the phase angle reacts to interventions. Since the majority of studies show an association between the phase angle and these geriatric syndromes, a low phase angle is not suitable to exclusively indicate a specific condition. It does not inform on the underlying cause and as such, a low phase angle mainly indicates increased risk. Phase angle decline over time is reflected by deterioration of e.g. frailty status. It reacts to physical training and detraining, but studies investigating whether these induced changes are also associated with improved outcome are missing.

Determinants of Resting Energy Expenditure in Very Old Nursing Home Residents

OBJECTIVES

This study aimed to measure resting energy expenditure (REE) in institutionalized old persons and to determine factors possibly related to change in REE as a basis for estimating energy requirements.

DESIGN AND SETTINGS

A monocentric cross-sectional study was conducted. Statistical approaches were conducted to determine independent factors associated with REE. Various published predictive equations of REE were compared to our population.

PARTICIPANTS

72 residents of a nursing home, mostly women (80.5%) aged 87.4±6.6 years were included.

MEASUREMENTS

REE (indirect calorimetry), body composition (bio-impedance analysis), biological and anthropometric data were collected.

RESULTS

Mean REE was 1006±181 kcal/d and was higher in men than in (1227±195 vs. 953±131 kcal/d, p<0.05). According to criteria adapted from the Global Leadership Initiative on Malnutrition consensus, 65.3 % of the institutionalized population were malnourished. In multivariate analysis adjusted on gender and age, REE was positively associated with calorie intake, fat-free mass (FFM), functional abilities (French Autonomie Gérontologie Groupe Iso Ressources scale), and elevated CRP level (> 25 mg/l). Significant differences (p<0.05) appeared between measured REE and predicted REE by using various published equations.

CONCLUSION

REE of very old nursing home residents is influenced by FFM, calorie intake, functional abilities, and CRP levels and is poorly predicted by classical equations based on age, gender, height, and weight. This suggests a metabolic adaptation to caloric restriction and inflammation and prompts to consider the level of physical activity and muscle loss when assessing caloric requirements in this population.

Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients

Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.

Equation models developed with bioelectric impedance analysis tools to assess muscle mass: A systematic review

BACKGROUND & AIMS

This systematic review aims to systematically assess and summarize the equation models developed to estimate muscle mass with bioelectric impedance analysis (BIA) instruments against a reference instrument (DXA, MRI, CT-scan, Ultrasonography), in order to help researchers and clinicians choose the most adapted equation, depending on the device and the population in question.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. Medline (via Ovid) and Scopus were searched in January 2019 for observational (transversal, longitudinal, retrospective) studies developing an equation prediction model to validate BIA against another reference method for the assessment of muscle mass. Study selection and data extraction was performed independently by two researchers. Methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

RESULTS

25 studies matched the inclusion criteria and were included in the present systematic review. Among them, 10 studies proposed an equation for subjects aged 65 years and older, 9 for adults, 4 for infants and 2 did not report the age of the population. A large heterogeneity was observed regarding the brand and type of BIA as well as the administration protocol (mode, frequency, number of electrodes, administration position and empty bladder/stomach or not). Most of the studies used DXA as the reference instrument, except 4 that used MRI. In each of the included papers authors provided, through simple or multiple regression, a predictive equation for muscle mass. BIA resistance index, sex, weight, age, BIA reactance and height were most frequently included as predictive variables. The majority of the equations developed explained more than 80% of the variance between both instruments. Out of the 25 equations available, only 9 were also validated in another population within the same paper.

CONCLUSION

This systematic review of the literature offers clinicians and researchers the opportunity to verify the existence of a prediction equation when using a BIA device for estimating muscle mass. This will help them to obtain a valid estimation of muscle mass in a specific population and with a specific instrument. If the equation exists and has been validated by a study free of high risk of bias, it's use is recommended because the development of a new equation in the same context seems redundant and undesirable. If a validation has not been carried out for a specific brand of BIA, reference method or population, we recommend the development and cross-validation of a new equation.

Relationships between muscle size, strength, and physical activity in adults with muscular dystrophy

BACKGROUND

Muscular dystrophy (MD) is characterized by progressive muscle wasting and weakness, yet few comparisons to non-MD controls (CTRL) of muscle strength and size in this adult population exist. Physical activity (PA) is promoted to maintain health and muscle strength within MD; however, PA reporting in adults with MD is limited to recall data, and its impact on muscle strength is seldom explored.

METHODS

This study included 76 participants: 16 non-MD (CTRL, mean age 35.4), 15 Duchenne MD (DMD, mean age 24.2), 18 Becker's MD (BMD, mean age 42.4), 13 limb-girdle MD (LGMD, mean age 43.1), and 14 facioscapulohumeral MD (mean age 47.7). Body fat (%) and lean body mass (LBM) were measured using bioelectrical-impedance. Gastrocnemius medialis (GM) anatomical cross-sectional area (ACSA) was determined using B-mode ultrasound. Isometric maximal voluntary contraction (MVC) was assessed during plantar flexion (PFMVC) and knee extension (KEMVC). PA was measured for seven continuous days using triaxial accelerometry and was expressed as daily average minutes being physically active (TPAmins ) or average daily percentage of waking hours being sedentary (sedentary behaviour). Additionally, 10 m walk time was assessed.

RESULTS

Muscular dystrophy groups had 34-46% higher body fat (%) than CTRL. DMD showed differences in LBM with 21-28% less LBM than all other groups. PFMVC and KEMVC were 36-75% and 24-92% lower, respectively, in MD groups than CTRL. GM ACSA was 47% and 39% larger in BMD and LGMD, respectively, compared with CTRL. PFMVC was associated with GM ACSA in DMD (P = 0.026, R = 0.429) and CTRL (P = 0.015, R = 0.553). MD groups were 14-38% more sedentary than CTRL groups, while DMD were more sedentary than BMD (14%), LGMD (8%), and facioscapulohumeral MD (14%). Sedentary behaviour was associated with LBM in DMD participants (P = 0.021, R = -0.446). TPAmins was associated with KEMVC (P = 0.020, R = 0.540) in BMD participants, while TPAmins was also the best predictor of 10 m walk time (P < 0.001, R2  = 0.540) in ambulant MD, revealed by multiple linear regression.

CONCLUSIONS

Quantified muscle weakness and impaired 10 m walking time is reported in adults with MD. Muscle weakness and 10 m walk time were associated with lower levels of TPA in adults with MD. Higher levels of sedentary behaviour were associated with reduced LBM in DMD. These findings suggest a need for investigations into patterns of PA behaviour, and relevant interventions to reduce sedentary behaviour and encourage PA in adults with MD regardless of impairment severity.

Improving nutritional status assessment in patients with chronic pancreatitis

INTRODUCTION

Chronic pancreatitis (CP) is a progressive inflammatory disorder causing irreversible destruction of pancreatic tissue, leading to malnutrition. A previous study has found that currently used screening methods (periodic recording of body weight and faecal and serological markers) fall short in identifying and curbing malnutrition. Moreover, data is lacking regarding change in nutritional status over time. The aim of our study is to investigate changes in nutritional status in CP patients over time and to determine whether a more extensive set of measurements would be beneficial for nutritional screening of these patients.

METHODS

CP patients who had undergone a nutritional assessment in 2012 were recruited to undergo a second assessment. The assessment consisted of anthropometric measurements, bioelectrical impedance analysis (BIA), handgrip strength (HGS), the Mini Nutritional Assessment (MNA), determination of faecal and serological markers and the Short Form Health (SF-36) questionnaire. These two assessments were compared and correlations between the various measures were calculated.

RESULTS

Twenty-eight patients underwent a second assessment. An increase in fat mass and a decrease in both fat free mass (FFM) and HGS were observed. The number of patients scoring under the 10th percentile for FFM (43%-54%) and HGS in their dominant side (38%-46%) increased. FFM and HGS were positively correlated (R = 0.57).

CONCLUSION

Even though current guidelines for CP follow-up were adhered to, there was a general deterioration in nutritional status. HGS correlated with FFM. HGS might be useful as a screening instrument for malnutrition in CP patients.

Nutritional interventions for optimizing healthy body composition in older adults in the community: an umbrella review of systematic reviews

BACKGROUND

Optimizing body composition for healthy aging in the community is a significant challenge. There are a number of potential interventions available for older people to support both weight gain (for those who are underweight) and weight loss (for overweight or obese people). While the benefits of weight gain for underweight people are generally clearly defined, the value of weight loss in overweight or obese people is less clear, particularly for older people.

OBJECTIVES

This umbrella review aimed to measure the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to explore theirqualitative perceptions.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

The participants were older adults, 60 years of age or older, living in the community.

TYPES OF INTERVENTIONS

The review examinedsix types of nutritional interventions: (i) dietary programs, (ii) nutritional supplements, (iii) meal replacements, (iv) food groups, (v) food delivery support and eating behavior, and (vi) nutritional counselling or education.

TYPES OF STUDIES

This umbrella review considered any quantitative systematic reviews and meta-analyses of effectiveness, or qualitative systematic reviews, or a combination (i.e. comprehensive reviews).

TYPES OF OUTCOMES

The quantitative outcome measures of body composition were: (i) nutritional status (e.g. proportion of overweight or underweight patients); (ii) fat mass (kg), (iii) lean mass or muscle mass (kg), (iv) weight (kg) or BMI (kg/m), (v) bone mass (kg) or bone measures such as bone mineral density, and (vi) hydration status.

PHENOMENA OF INTEREST

The phenomena of interestwere the qualitative perceptions and experiences of participants.

SEARCH STRATEGY

We developed an iterative search strategy for nine bibliometric databases and gray literature.

METHODOLOGICAL QUALITY

Critical appraisal of 13 studies was conducted independently in pairs using standard Joanna Briggs Institute tools. Six medium quality and seven high quality studies were identified.

DATA EXTRACTION

Data was extracted independently in pairs from all 13 included studies using the standard Joanna Briggs Institute data extraction tool.

DATA SUMMARY

Only quantitative studies of effectiveness were included. The strength of evidence assessing the effectiveness of interventionswas graded using a traffic light system (green, amber, red). An overall assessment of the quality of the evidence for each comparison was undertaken.

RESULTS

More systematic reviews investigating weight gain than those investigating weight loss were included. Studies onweight gain showed improved body composition for oral nutritional supplements on its own, for oral nutritional supplements in combination with resistance exercise training, and for oral nutritional supplements in combination with nutrition counselling. Studies on weight loss showed that diet in combination with exercise, diet in combination with exercise and nutrition counselling, and nutrition counselling on its own all can lead to reduced weight in older people. The outcomes of lean mass and weight/BMI were responsive to nutritional interventions, but fat mass did not vary. There were no qualitative reviews identified.

CONCLUSIONS

Although effective interventions for weight gain and weight loss to optimize body composition of older people in the community were identified,making long term, clinically relevant changes in body composition is difficult. Multiple interventions are more effective than single interventions.

Estimating of Residual Kidney Function by Multi-Frequency Bioelectrical Impedance Analysis in Hemodialysis Patients Without Urine Collection

BACKGROUND/AIMS

Residual kidney function (RKF) is a pivotal predictor of better clinical outcomes in maintenance hemodialysis (MHD) patients. So far there has been no attempt to use bioimpedance analysis (BIA) measurements to calculate residual glomerular filtration rate (GFR) in dialysis population. We hypothesized that performing of multi-frequency BIA at the beginning and end of hemodialysis session can enable us to predict the measured residual GFR in MHD patients. Thus our aim was to develop and validate a new RKF prediction equation using multi-frequency BIA in MHD patients.

METHODS

It was diagnostic test evaluation study in a prospective cohort. Participants (n=88; mean age, 66.3±13.2 years, 59.1% males) were recruited from a single hemodialysis center. A new equation (eGFRBIA) to predict RKF, utilizing BIA measurements performed pre- and post-dialysis, was generated and cross-validated by the leave-one-out procedure. GFR estimated as the mean of urea and creatinine clearance (mGFR) using urine collections during entire interdialytic period.

RESULTS

A prediction equation for mGFR that includes both pre- and post-dialysis BIA measurements provided a better estimate than either pre- or post-dialysis measurements alone. Mean bias between predicted and measured GFR was -0.12 ml/min. Passing and Bablok regression showed no bias and no significant deviation in linearity. Concordance correlation coefficient indicated good agreement between the eGFRBIA and mGFR (0.75, P<0.001). Using cut-off predicted mGFR levels >2 ml/min/1.73 m2 yielded an area under curve of 0.96, sensitivity 85%, and specificity 89% in predicting mGFR. The κ scores for intraobserver reproducibility were consistent with substantial agreement between first and second estimation of RKF according to eGFRBIA (weighted κ was 0.60 [0.37-0.83]).

CONCLUSION

We present a valid and clinically obtainable method to predict RKF in MHD patients. This method, which uses BIA, may prove as accurate, convenient and easily reproducible while it is operator independent.

Which method to use for a fast assessment of body fat percentage?

Body position affects body water distribution and in turn the accuracy of bioelectrical impedance analysis (BIA), which may consequently distort conclusions about an individual's body composition.We compared body fat percentage (BFP) obtained with leg-to-leg-BIA (LL) and hand-to-leg-BIA (HL) with the reference values.The BFPs of 97 individuals were determined with an LL- (Tanita TBF 215GS, Japan) and HL- (Akern, STA/BIA, Italy) BIA-analyser and with reference skinfold thickness (SF) measurements. Each subject was measured upright with the LL-analyser, and upright and supine with the HL-analyser, both before and after 20 min of supine rest. The one-way ANOVA for repeated measures (HL-BIA), Student's t-test (LL-BIA), intraclass correlation coefficients, and Bland-Altman's plots were used for statistical analysis.BFPs determined with HL/LL BIA in upright/supine positions differ significantly. Compared to the SF method, HL-BIA mostly overestimates, while LL-BIA mostly underestimates BFP. Agreement between anthropometrically determined BFP and HL/LL-BIA determined BFP is better with HL for both sexes, and generally better in females than males.HL-BIA-determined estimates of BFP are more similar to reference values than LL-BIA. However, for both BIA methods, BIA-determined estimates of BFP are significantly affected by body position. Consequently, different BIA methods will classify approximately one fifth of subjects into the erroneous body-fat-content category, which calls for urgent standardization.

The frailty syndrome: a comprehensive review

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.

Body composition assessment of undernourished older subjects by dual-energy x-ray absorptiometry and bioelectric impedance analysis

BACKGROUND

The prevention and treatment of diseases related to changes in body composition require accurate methods for the measurement of body composition. However, few studies have dealt specifically with the assessment of body composition of undernourished older subjects by different methodologies.

OBJECTIVES

To assess the body composition of undernourished older subjects by two different methods, dual energy x-ray absorptiometry (DXA) and bioelectric impedance (BIA), and to compare results with those of an eutrophic group.

DESIGN

The study model was cross-sectional; the study was performed at the University Hospital of the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.

PARTICIPANTS

Forty-one male volunteers aged 62 to 91 years. The groups were selected on the basis of anamnesis, physical examination and nutritional assessment according to the Mini Nutritional Assessment (MNA) score. Body composition was assessed by DXA and BIA.

RESULTS

Body weight, arm and calf circumference, body mass index (BMI), fat free mass (FFM) and fat mass (FM) were significantly lower in the undernourished group as compared to the eutrophic group. There were no significant differences between FFM and FM mean values determined by DXA and BIA in both groups, but the agreement between methods in the undernourished group was less strong.

CONCLUSION

Our results suggest caution when BIA is to be applied in studies including undernourished older subjects. This study does not support BIA as an accurate method for the individual assessment of body composition.

Regional and total body bioelectrical impedance analysis compared with DXA in Icelandic elderly

BACKGROUND/OBJECTIVES

The aims were (1) to compare fat free mass (FFM) estimates from regional hand-held bioelectrical impedance analysis (HHBIA) with conventional BIA (CBIA) and dual energy X-ray absorptiometry (DXA) and (2) to develop a population specific equation for FFM prediction in Icelandic elderly.

SUBJECTS/METHODS

DXA, CBIA and HHBIA data were available for 98 free-living Icelandic elderly (age=73.0 ± 5.6 years, body mass index=28.8 ± 5.2 kg/m(2)). Participants were randomized into a development block (n=50) and validation block (n=48). A population specific equation for FFM prediction was calculated using CBIA-derived resistance and anthropometric data from the development block and then compared with other BIA equations (Deurenberg, Segal, company-specific equations) and DXA estimates using the validation block.

RESULTS

The correlations between BIA methods and DXA were very high, that is, >0.9; however, mean differences compared with DXA were quite variable, ranging from -5.0 (Deurenberg) to +2.5 (Segal, HHBIA) and +3.3 kg (CBIA). Mean difference of the population-specific equation was below 0.1 kg. The standard deviations of the differences ranged from 2.6 to 3.3 kg. The limits of agreement of the BIA methods were similar and between 9.9 and 12.9 kg.

CONCLUSIONS

In Icelandic elderly, HHBIA and CBIA produce similar FFM estimates when using company-specific prediction equations. CBIA provides the additional possibility to use a population-specific prediction equation, which yields best results. However, limits of agreement were wide and similar of all employed BIA methods, which indicates principal limitations of BIA analysis in the determination of FFM.

Precision and reliability of strength (Jamar vs. Biodex handgrip) and body composition (dual-energy X-ray absorptiometry vs. bioimpedance analysis) measurements in advanced cancer patients

Important deteriorations in body composition and strength occur and need to be accurately measured in advanced cancer patients (ACPs). The aim of this study was to establish the relationship between a single-frequency bioimpedance analyzer (BIA) and the dual-energy X-ray absorptiometer (DXA), as well as the Jamar handgrip dynometer and the Biodex handgrip attachment, and to determine the precision of each of these instruments in ACPs. Eighty-one ACPs with non-small-cell lung cancer and gastrointestinal cancer were recruited from the McGill University Health Centre (Montreal, Que.). Consecutive paired measurements, with repositioning between measurements, were obtained for total-body DXA, BIA, Biodex handgrip, and BIA plus Jamar handgrip. The total-body percent coefficient of variation (%CV) for the BIA and DXA were 1.34 and 1.56 for fat mass (FM), respectively, and 0.42 and 0.72 for fat free mass (FFM), respectively. The %CV for the Jamar and Biodex handgrips were 6.3 and 16.7, respectively. Bland–Altman plots were used to characterize the limits of agreement between DXA and BIA for FM (4.60 ± 7.80 (–3.19 to 12.39) kg) and FFM (–1.87 ± 7.16 (–9.03 to 5.29) kg). Both DXA and BIA demonstrate good short-term precision in ACPs. However, given its poor accuracy, it remains to be determined if BIA can be used to monitor ACPs for changes in total-body tissue composition as a function of time, whether for observation or response to treatment. Furthermore, because of wide limits of agreement, the DXA and BIA cannot be used interchangeably in research or clinical settings. The Jamar handgrip dynamometer shows more consistency than the Biodex handgrip attachment in ACPs, and should therefore be the preferred measure of changes in strength over time.

Validation of bioelectrical impedance for the prediction of fat-free mass in brazilian elderly subjects

Aging involves both nutritional and physiological changes, reducing fat-free mass (FFM) and increasing body fat, both of which are associated with physical weakness, unfitness and morbidity among the elderly. This study was undertaken to analyze the cross-validity of bioelectrical impedance equations for the prediction of fat-free mass (FFM) in elderly Brazilians. A cross-sectional population-based study, was performed in Florianópolis, Santa Catarina, Brazil, 2006. The study sample comprised 60 men and 120 women, aged 60 to 81. The dual energy X-ray absorptiometry (DEXA) served as gold standard. Predicted %BF and FFM were obtained from various anthropometric equations and bioelectric impedance. The cross-validation criteria suggested by Lohman and Bland-Altman plots of differences against the mean were used. The body mass index of the sample ranged from 18.4 to 39.3 kg/m². Mean percent body fat was 23.1 ± 5.8% in men and 37.3 ± 6.9% in women (range: 6 to 51.4%). In men, the equations of Kyle et al. (2001), Dey et al. (2003) and Sun et al. (2003) did not differ significantly from the DEXA measurement, with a constant error (CE) of 0.7 to 2.5 kg. In contrast, among women only the equations of Kyle et al. (2001) and Dey et al. (2003) were found to be valid (CE: 0.3 to 2.7 kg). The bioelectrical impedance equations validated in this study can be used in the Brazilian elderly population.

Nutritional issues in older adults with wounds in a clinical setting

BACKGROUND

The ability for patients to access and consume sufficient quantities of nutrients to meet recommendations for wound management is vital if decline in nutritional status during hospital admission is to be prevented. This study aims to investigate menu quality, consumption patterns, and changes in nutritional status for inpatients with wounds.

METHODS

Wound healing recommendations were compared against the nutrient content of the inpatient menu. Individual intakes were compared to estimated requirements: energy using the Schofield equation; protein using wound healing recommendations; vitamin A, C, and zinc using the recommended daily intake (RDI).

RESULTS

The inpatient menu did not provide sufficient energy or zinc to meet the estimated average requirement while the ordering practices of participants allowed all RDI to be achieved except for zinc. Actual intake fell below recommendations: 62%, 41%, 55%, and 79% of patients not meeting energy, minimum protein requirements, vitamin A or zinc RDI respectively. A nonsignificant trend for weight loss, particularly fat mass, was observed over time.

CONCLUSION

Inpatients with wounds are at risk of being unable to consume sufficient quantities of nutrients important for healing and prevention of decline in nutritional status. This is despite the menu seemingly providing sufficient nutrients. More attention to education, encouragement, and supplementation are recommended.

Body composition in male elite athletes, comparison of bioelectrical impedance spectroscopy with dual energy X-ray absorptiometry

Background

The aim of this study was to compare body composition results from bioelectrical spectroscopy (BIS) with results from dual energy X-ray absorptiometry (DXA) in a population of male elite athletes. Body composition was assessed using DXA (Lunar Prodigy, GE Lunar Corp., Madison, USA) and BIS (Hydra 4200, Xitron Technologies Inc, San Diego, California, USA) at the same occasion. Agreement between methods was assessed using paired t-tests and agreement-plots.

Results

Thirty-three male elite athletes (soccer and ice hockey) were included in the study. The results showed that BIS underestimates the proportion of fat mass by 4.6% points in the ice hockey players. In soccer players the BIS resulted in a lower mean fat mass by 1.1% points. Agreement between the methods at the individual level was highly variable.

Conclusion

Body composition results assessed by BIS in elite athletes should be interpreted with caution, especially in individual subjects. BIS may present values of fat mass that is either higher or lower than fat mass assessed by DXA, independent of true fat content of the individual.

Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality?

OBJECTIVE

The calculation of body composition using bioelectrical impedance analysis is difficult in the elderly because most equations have been found to be inadequate, especially in the malnourished elderly. We therefore evaluated the use of bioelectrical impedance vector analysis in elderly nursing home residents.

METHODS

One hundred twelve nursing home residents were included in the study (34 men, 78 women, age 85.1 y, age range 79.1-91.4 y). Nutritional status was determined by the Mini Nutritional Assessment (MNA), functional status was assessed by handgrip strength, knee extension strength, and Barthel's index, and bioelectrical impedance analysis was performed using Nutriguard M (Data Input, Darmstadt, Germany).

RESULTS

Twenty-two nursing home residents were classified as well nourished (MNA I), 80 were considered to be at nutritional risk (MNA II), and 10 were classified as malnourished (MNA III). Handgrip strength, knee extension strength, and Barthel's index were lower in MNA II and MNA III than in MNA I. Phase angle also decreased significantly with the MNA (4.0, 3.8-4.7 degrees; 3.7, 3.3-4.3 degrees; and 2.9, 2.6-3.5 degrees). There was a significant displacement of the mean vector in MNA II and MNA III compared with MNA I.

CONCLUSION

The bioelectrical impedance vector analysis resistance/reactance graph could represent a valuable tool to assess changes in body cell mass and hydration status in elderly nursing home residents.

Body composition and resting energy expenditure in elderly male patients with chronic obstructive pulmonary disease

STUDY OBJECTIVE

Our study investigates nutritional status, resting energy expenditure (REE) and physical performance in elderly patients with stable COPD to identify any early conditions of hypermetabolism, malnutrition and sarcopenia.

METHODS

Eighty-six males (40 stable COPD and 46 healthy subjects) over 65 years old were studied. All subjects underwent spirometry, blood gas analysis and a 6-min walking test (6MWT). Fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM) were measured by dual energy X-ray absorptiometry (DEXA). REE was measured by indirect calorimetry.

RESULTS

COPD patients had a lower FFM both expressed in kilograms and after correction for height squared. The prevalence of sarcopenia was higher for COPD subjects (38% vs 31%). REE, both in absolute values and adjusted for FFM was significantly higher in COPD patients. Hypermetabolism was found in 60% of COPD cases and 13.7% (P<0.01) of healthy subjects. No relationship was found in COPD patients between the measured/predicted REE ratio (REE(m)/REE(p)) and FEV1. In the hypermetabolic COPD subgroup, the REE(m)/REE(p) ratio correlated with 6MWT.

CONCLUSIONS

Elderly patients with stable COPD develop an increased REE. This hypermetabolism seems to be independent of the severity of the pulmonary obstruction and to influence the patient's physical performance.

Body composition assessment in adults with cystic fibrosis: comparison of dual-energy X-ray absorptiometry with skinfolds and bioelectrical impedance analysis

OBJECTIVE

We compared body composition measurement in adults with cystic fibrosis (CF) by using non-invasive methods (skinfold thicknesses and bioelectrical impedance analysis [BIA]) with dual-energy X-ray absorptiometry (DXA).

METHODS

Seventy-six adults with CF (mean age 29.9 +/- 7.9 y, mean body mass index 21.5 +/- 2.5 kg/m(2)) were studied. Body composition was measured to calculate fat-free mass (FFM) using DXA, the sum of four skinfold thicknesses, and BIA (predictive equations of Lukaski and of Segal).

RESULTS

Mean FFM values +/- standard deviation measured using DXA were 54.8 +/- 7.3 kg in men and 41.2 +/- 3.9 kg in women. Mean FFM values measured using BIA/Lukaski were 51.5 +/- 7.8 kg in men and 40.4 +/- 4.9 kg in women (P < 0.0005 for men, not significant for women for comparison with DXA). Mean FFM values measured using BIA/Segal were 54.2 +/- 7.5 kg for men and 44.1 +/- 5.9 kg for women (not significant for men, P < 0.0005 for women for comparison with DXA). Mean FFM values measured using skinfolds were significantly higher than those for FFM with DXA (57.2 +/- 7.2 kg in men, 43.3 +/- 4.3 kg in women, P < 0.0005 for comparison with DXA). The 95% limits of agreement with FFM using DXA were, for men and women, respectively, -8.3 to 1.7 kg and -6.4 to 4.8 kg for BIA/Lukaski, -4.8 to 3.6 kg and -3.1 to 8.9 kg for BIA/Segal, and -2.8 to 7.3 kg and -1.5 to 5.7 kg for skinfolds.

CONCLUSION

This study suggests that skinfold thickness measurements and BIA will incorrectly estimate FFM in many adults with CF compared with DXA measurements of FFM. These methods have limited application in the assessment of body composition in individual adult patients with CF.

Die Bioelektrische Impedanzanalyse in der Diagnostik der Malnutrition

Malnutrition is one of the most common comorbidities in the elderly. Despite several screening and assessment tools, the diagnosis can be difficult in some cases. In the geriatric population, classical anthropometry does not help very much. For that reason there is a need for further diagnostic criteria. Bioelectrical impedance analysis (BIA) is a fast, low-cost and non-invasive method, which has shown its value in several fields of medicine. Whether this method could be a useful part in the diagnosis of malnutrition in geriatric patients, is the question of this study. In comparison with the Mini-Nutritional Assessment (MNA), serum-albumin and other diagnostic markers of malnutrition, especially the phase angle (50 kHz) of bioelectric impedance analysis showed a consistent correlation with most of the parameters. The calculation of body-fat mass and fat-free mass from bioelectrical impedance analysis is not yet sufficiently validated for geriatric patients. In this study there was no good correlation of the BIA-calculated body-fat mass and fat-free mass with the observed nutritional parameters.