Comparison of segmental with whole-body impedance measurements in peritoneal dialysis patients

Segmental body composition estimated by specific BIVA and dual-energy X-ray absorptiometry

AIMS

The aim of this study was to analyse the association between specific bioelectric impedance vector analysis (BIVA) and dual-energy X-ray absorptiometry (DXA) to assess segmental body composition using DXA as the reference technique.

METHODS

The sample comprised 50 young active students who practised or played different sports (25 men, age: 24.37 ± 4.79 y; 25 women, age: 24.32 ± 4.43 y) from the National Institute of Physical Education of Catalonia (INEFC). Anthropometric data (height, weight, arm, waist, and calf circumferences) and bioelectrical measurements (R, ohm; Xc, ohm) were recorded. Body composition was analysed with specific BIVA. DXA was used as the reference method to assess body composition of the whole-body, the trunk, and the limbs. The percentage of fat mass (%FM_DXA) and fat-free mass index (FFMI_DXA = FFM/length²) were calculated. The agreement between specific BIVA and DXA was evaluated by a depth-depth analysis, two-way ANOVA, and Pearson's correlations.

RESULTS

The depth-depth analysis showed a good agreement between DXA and BIVA (F = 14.89, p < 0.001) in both sexes and all body segments. Specific vector length (Zsp; i.e. indicative of %FM) was correlated with %FM_DXA in the whole body and all body segments, and the phase angle was correlated with FFMI_DXA, with he trunk in women as the only exception. Specific BIVA demonstrated to balance the effect of body size on bioelectrical measurements in both whole and segmental approaches.

CONCLUSIONS

Segmental specific BIVA and DXA provided a consistent evaluation of body composition in both sexes, of the whole body and each body segment. The indices %FM and FFMI obtained with DXA were correlated to vector length and phase angle in each segment, respectively. Specific BIVA represents a promising technique for monitoring segmental body composition changes in sport science and clinical applications.

Different displacement of bioimpedance vector due to Ag/AgCl electrode effect

BACKGROUND/OBJECTIVES

Bioelectrical impedance vector analysis (BIVA) is increasingly used in clinical research to assess soft tissue hydration. It is known that physical characteristics of electrodes, such as low intrinsic impedance, low electrode/skin contact impedance and type of gel, affect the reliability of noninvasive bioimpedance assessments. The aim of this study was to determine the effect of intrinsic impedance of electrode on the bioimpedance vector displacement in RXc graph.

SUBJECTS/METHODS

The intrinsic impedance is measured in nine pregelled disposable Ag/AgCl electrodes usually used for bioimpedance measures. The BIVA method is performed on 35 healthy volunteers using a 50 kHz phase-sensitive bioimpedance analyzer (BIA 101 Anniversary) with the lowest intrinsic impedance electrode and highest. The individual bioimpedance vector is plotted on the bivariate normal interval of reference population. The differences in the mean bioimpedance vectors obtained with each electrode are plotted, with their 95% confidence ellipses, on the dRXc graph. The paired one-sample Hotelling's T²-test is used to compare the differences of the mean bioimpedance vectors.

RESULTS

We found large variability in intrinsic resistance (11-665 Ω) and reactance (0.25-2.5 Ω) values of the electrodes analyzed and significant displacement (P<0.05) of bioimpedance vector positions in healthy adults according to the paired one-sample Hotelling's T²-test.

CONCLUSIONS

A robust study of all physical characteristics of commercial Ag/AgCl electrodes is necessary to reach consensus on pregelled Ag/AgCl electrodes valid for bioimpedance measurement. This information will enable BIVA users to avoid systemic errors when performing BIVA assessments, specifically when these measurements are used for clinical interpretations.

Bioimpedance Analysis as a Method to Evaluate the Proportion of Fatty and Muscle Tissues in Progressive Myopathy in Pompe Disease

During progressive myopathy, the space of atrophic muscle tissue is gradually filled by fatty tissue. The proportion of these two tissue types relative to body mass provides an indication of the extent of muscle tissue destruction, i.e., the progression and severity of the disease.In this study we use Pompe disease as an example to report the new possibility of using bioimpedance analysis (BIA) to assess the relative proportion of fatty and muscle tissue in diseases associated with muscle atrophy, thus enabling the assessment of disease progression and the effectiveness of treatment. Results from BIA analysis were compared with magnetic resonance images.The results of muscle magnetic resonance images and BIA analysis were similar, which suggests that BIA may provide valuable diagnostic guidance for the assessment of the progression of the disorder.

The consequences of sudden fluid shifts on body composition in critically ill patients

INTRODUCTION

Estimation of body composition as fat-free mass (FFM) is subjected to many variations caused by injury and stress conditions in the intensive care unit (ICU). Body cell mass (BCM), the metabolically active part of FFM, is reported to be more specifically correlated to changes in nutritional status. Bedside estimation of BCM could help to provide more valuable markers of nutritional status and may promote understanding of metabolic consequences of energy deficit in the ICU patients. We aimed to quantify BCM, water compartments and FFM by methods usable at the bedside for evaluating the impact of sudden and massive fluid shifts on body composition in ICU patients.

METHODS

We conducted a prospective experimental study over an 6 month-period in a 18-bed ICU. Body composition of 31 consecutive hemodynamically stable patients requiring acute renal replacement therapy for fluid overload (ultrafiltration ≥5% body weight) was investigated before and after the hemodialysis session. Intra-(ICW) and extracellular (ECW) water volumes were calculated from the raw values of the low- and high-frequency resistances measured by multi-frequency bioelectrical impedance. BCM was assessed by a calculated method recently developed for ICU patients. FFM was derived from BCM and ECW.

RESULTS

Intradialytic weight loss was 3.8 ± 0.8 kg. Percentage changes of ECW (-7.99 ± 4.60%) and of ICW (-7.63 ± 5.11%) were similar, resulting ECW/ICW ratio constant (1.26 ± 0.20). The fall of FFM (-2.24 ± 1.56 kg, -4.43 ± 2.65%) was less pronounced than the decrease of ECW (P < 0.001) or ICW (P < 0.001). Intradialytic variation of BCM was clinically negligible (-0.38 ± 0.93 kg, -1.56 ± 3.94%) and was significantly less than FFM (P < 0.001).

CONCLUSIONS

BCM estimation is less driven by sudden massive fluid shifts than FMM. Assessment of BCM should be preferred to FFM when severe hydration disturbances are present in ICU patients.

Measurement errors in multifrequency bioelectrical impedance analyzers with and without impedance electrode mismatch

The purpose of this study is to compare measurement errors in two commercially available multi-frequency bioimpedance analyzers, a Xitron 4000B and an ImpediMed SFB7, including electrode impedance mismatch. The comparison was made using resistive electrical models and in ten human volunteers. We used three different electrical models simulating three different body segments: the right-side, leg and thorax. In the electrical models, we tested the effect of the capacitive coupling of the patient to ground and the skin-electrode impedance mismatch. Results showed that both sets of equipment are optimized for right-side measurements and for moderate skin-electrode impedance mismatch. In right-side measurements with mismatch electrode, 4000B is more accurate than SFB7. When an electrode impedance mismatch was simulated, errors increased in both bioimpedance analyzers and the effect of the mismatch in the voltage detection leads was greater than that in current injection leads. For segments with lower impedance as the leg and thorax, SFB7 is more accurate than 4000B and also shows less dependence on electrode mismatch. In both devices, impedance measurements were not significantly affected (p > 0.05) by the capacitive coupling to ground.