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

Effects of low-intensity isometric handgrip training on home blood pressure in hypertensive patients: a randomized controlled trial

We examined if lower intensity isometric handgrip (IHG) training than usual load could significantly reduce home blood pressure (HBP) in treated Japanese hypertensive patients. Sixty patients (mean age, 66.9 years; 44.6% men) with high blood pressure to grade 1 hypertension level were randomly assigned to an IHG or control group. The IHG group performed IHG training for 12 weeks, followed by a 12 weeks of detraining. The control group did not any IHG training. The IHG training comprised four sets of 2-min isometric contractions at 15% of maximum voluntary contraction (MVC) or half than usual, including 1 min of rest between sets, for ≥3 days a week. At the end of the former phase, both morning and evening systolic HBP (HSBP) and evening diastolic HBP (HDBP) were significantly higher than those at baseline in the control group while neither morning nor evening HSBP remained unchanged in the IHG group. Morning HBPs increased at the end of the latter phase than those at the end of the former phase in the IHG group and remained unchanged in the control group. The change (Δ) in morning HSBP from baseline to the end of the former phase was smaller in the IHG group than that in the control group (Δ4.1 mmHg vs. Δ0.0 mmHg, p = 0.05). A similar tendency was observed after adjusting baseline HSBP and seasonal variation (p = 0.06). In conclusion, a 12-week IHG training at 15% of MVC significantly lowered morning HSBP by approximately 4.0 mmHg in treated Japanese hypertensive patients. This study showed that a 12-week IHG training at 15% of MVC lowered morning HSBP by about 4.0 mmHg in treated Japanese hypertensive patients. Continuous low-intensity IHG training may provide a stable hypotensive effect in high blood pressure to grade 1 hypertensive population.

Factors associated with skeletal muscle mass in middle-aged men living with HIV

BACKGROUND

Despite extensive research on muscle loss in people living with HIV (PLWH), the prevalence and contributing factors specifically among middle-aged men remain unclear. This study aimed to determine the prevalence of low muscle mass within this demographic and to identify associated factors.

METHODS

A total of 378 men living with HIV were enrolled in the study. They were classified into low muscle mass group if they displayed a skeletal muscle index (SMI) <7.00 kg/m2 or fell within the lowest quintile of SMI based on the criteria established by the Asian Working Group for Sarcopenia 2019.

RESULTS

Out of the 378 men living with HIV enrolled, 351 had normal muscle mass, while 27 (7.1%) had low muscle mass. Antiretroviral drugs Zidovudine (AZT) (OR = 0.246, P = 0.022) and higher serum albumin levels (OR = 0.899, P = 0.026) were found to be protective factors against low muscle mass according to quintile grouping. Strong positive associations between SMI and body mass index (BMI), nutritional risk index (NRI), oedema index and fat-free mass index (FFMI) (R > 0.5, P < 0.001) were observed. In addition, both BMI (sensitivity = 0.741, specificity = 0.906) and NRI (sensitivity = 0.963, specificity = 0.601) had high sensitivity and specificity in diagnosing low muscle mass, with critical values of 19.85 and 114.177 for BMI and NRI, respectively. The oedema index was the most effective measure of body composition in detecting abnormal fluid retention with high sensitivity (92.6%) and moderate specificity (71.8%) in identifying individuals with low muscle mass. Notably, PLWH with low muscle mass participants had a significantly higher prevalence (92.6%) of a high oedema index compared with those with normal muscle mass (28.2%). This observation indicates that individuals with HIV who experience reduced muscle mass is commonly accompanied with abnormal fluid retention within the body.

CONCLUSIONS

Antiretroviral medication types, specifically Zidovudine, BMI and NRI can be independent risk factors for low muscle mass in men with HIV. These factors, along with BMI, could be used conveniently to predict low muscle mass. Furthermore, the association between the oedema index and muscle mass suggests that observing signs of oedema may indicate a risk of low muscle mass in PLWH.

Biologically Informed Polygenic Scores for Brain Insulin Receptor Network Are Associated with Cardiometabolic Risk Markers and Diabetes in Women

BACKGRUOUND

To investigate associations between variations in the co-expression-based brain insulin receptor polygenic score and cardiometabolic risk factors and diabetes mellitus.

METHODS

This cross-sectional study included 1,573 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Cardiometabolic markers included body composition, waist circumference, circulating lipids, insulin-like growth factor 1 (IGF-1), and insulin-like growth factor-binding protein 1 and 3 (IGFBP-1 and -3). Glucose and insulin levels were measured during a standardized 2-hour 75 g oral glucose tolerance test and impaired glucose regulation status was defined by the World Health Organization 2019 criteria. Analyzes were adjusted for population stratification, age, smoking, alcohol consumption, socioeconomic status, chronic diseases, birth weight, and leisure-time physical activity.

RESULTS

Multinomial logistic regression indicated that one standard deviation increase in hePRS-IR was associated with increased risk of diabetes mellitus in all participants (adjusted relative risk ratio, 1.17; 95% confidence interval, 1.01 to 1.35). In women, higher hePRS-IR was associated with greater waist circumference and higher body fat percentage, levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein B, insulin, and IGFBP-1 (all P≤0.02). The mePRS-IR was associated with decreased IGF-1 level in women (P=0.02). No associations were detected in men and studied outcomes.

CONCLUSION

hePRS-IR is associated with sex-specific differences in cardiometabolic risk factor profiles including impaired glucose regulation, abnormal metabolic markers, and unfavorable body composition in women.

Usefulness of the Global Leadership Initiative on malnutrition (GLIM) criteria in preoperative nutritional assessment of patients with primary lung cancer

BACKGROUND AND AIMS

The Global Leadership Initiative on Malnutrition (GLIM) developed a new method for evaluating malnutrition; however, no consensus has been reached regarding the use of these criteria. Therefore, this study aimed to investigate the association between nutritional status assessed using the GLIM criteria and outcomes of lung cancer after surgery.

METHODS

Patients with non-small cell lung cancer who underwent lung resection and bioelectrical impedance analysis to estimate muscle mass before surgery were included. Their background, pathological stage, recurrence, and prognosis were investigated. Patients were divided into two groups according to the GLIM criteria: normal nutrition and malnutrition groups.

RESULTS

The normal and malnutrition groups comprised 110 and 88 patients, respectively. Malnutrition was significantly associated with poor overall survival after surgery (P = 0.025) but not with disease-free survival. Multivariate analysis showed that malnutrition (hazard ratio [HR]:2.374, P = 0.020), advanced pathological stage of lung cancer (HR: 1.919, P = 0.002), and the presence of postoperative complications (HR: 2.035, P = 0.047) were significantly associated with poor overall survival.

CONCLUSION

Malnutrition assessed using the GLIM criteria was associated with the prognosis of patients with postoperative non-small cell lung cancer. Preoperative assessment using the GLIM criteria would allow for effective nutritional and rehabilitative interventions to improve prognosis.

Edema Index Predicts Mortality in Patients with Chronic Heart Failure: A Prospective, Observational Study

Introduction

Chronic fluid accumulation or congestion is considered an important pathophysiologic mechanism in heart failure, leading to cardinal symptoms such as dyspnea, pulmonary congestion, and pitting edema. Edema index (EI) recently emerged as a surrogate for extracellular volume status and has been proven to be able to reflect one's congestion status. In this study, we aimed to evaluate the prognostic value of EI in patients with chronic heart failure (CHF).

Methods

A total of 401 consecutive patients with CHF between August 2019 and October 2021 were prospectively enrolled. EI was obtained by InBody S10. The primary endpoint was long-term all-cause and cardiovascular mortality.

Results

Patients with high EI (>0.397) tended to be older, presented with atrial fibrillation, have higher N-terminal brain natriuretic peptide, and have higher creatinine (all p < 0.05). During a median follow-up of 1200 days, the all-cause and cardiovascular mortality rate was significantly higher in the high EI group compared to the low EI group (all-cause mortality rate 43.8% vs. 30.3%, p < 0.001, and cardiovascular mortality rate 17.5% vs. 13.0%, p < 0.001, respectively). In the multivariate Cox proportional hazard analysis, EI > 0.397 was an independent predictor for both all-cause mortality (HR 1.959; 95% CI 1.304, 2.944; p = 0.001) and cardiovascular mortality (HR 2.051; 95% CI 1.276, 3.296; p = 0.003).

Conclusions

Admission EI could be used as a marker for predicting long-term mortality in patients with CHF, and higher EI was associated with an increased risk of all-cause and cardiovascular mortality. Furthermore, EI-guided management could be a promising therapy in patients with CHF.

Home Bioelectrical Impedance Analysis Management System in Patients With Heart Failure: Rationale and Study Design

Body fluid monitoring and management are essential to control dyspnea and prevent re-hospitalization in patients with chronic heart failure (HF). There are several methods to estimate and monitor patient's volume status, such as symptoms, signs, body weight, and implantable devices. However, these methods might be difficult to use for reasons that are slow to reflect body water change, inaccurate in specific patients' condition, or invasive. Bioelectrical impedance analysis (BIA) is a novel method for body water monitoring in patients with HF, and the value in prognosis has been proven in previous studies. We aim to determine the efficacy and safety of home BIA body water monitoring-guided HF treatment in patients with chronic HF. This multi-center, open-label, randomized control trial will enroll patients with HF who are taking loop diuretics. The home BIA group patients will be monitored for body water using a home BIA device and receive messages regarding their edema status and direction of additional diuretics usage or behavioral changes through the linked application system once weekly. The control group patients will receive the usual HF management. The primary endpoint is the change in N-terminal prohormone of brain natriuretic peptide levels from baseline after 12 weeks. This trial will provide crucial evidence for patient management with a novel home BIA body water monitoring system in patients with HF.

Changes in intracellular water volume after leg lymphedema onset and lymphaticovenular anastomosis as its surgical intervention

OBJECTIVE

To clarify the changes in the intracellular water (ICW) volume in lymphedema-affected legs after lymphedema onset and its surgical intervention (ie, lymphaticovenular anastomosis [LVA]), we investigated the changes in body water composition using bioelectrical impedance analysis.

METHODS

This retrospective case series included 41 women with unilateral secondary leg lymphedema. The volume changes in the ICW and extracellular water (ECW) of the affected leg were measured using an InBody S10 (InBody Co, Ltd) multifrequency bioelectrical impedance analyzer, at both lymphedema onset and 1 year after LVA.

RESULTS

The volume increase with leg lymphedema onset was comparable between the ECW and ICW (0.59 L vs 0.56 L; 95% confidence interval [CI], -0.02 to 0.06; P = .27), and the increase rate was higher for ECW (35.3% vs 22.1%; 95% CI, 9.3%-17.2%; P < .001). The volume reduction at 1 year after LVA was comparable between ECW and ICW (0.23 L vs 0.27 L; 95% CI, -0.08 to 0.02; P = .20), and the reduction rate was higher for ECW (8.7% vs 7.0%, 95% CI, 0.04%-3.2%; P = .044). The volume difference between ICW and ECW remained constant throughout the six measurements before and after LVA (F[3.01, 120.20] = 1.85; P < .14).

CONCLUSIONS

Leg LVA reduced ICW in the lymphedematous leg. The onset of leg lymphedema increased ECW and ICW in the affected limb, and LVA decreased both ECW and ICW. The volume change in the affected leg was comparable between ECW and ICW at both lymphedema onset and after LVA. However, the rate of change was higher for ECW. The volume difference between ICW and ECW remained constant. Using bioelectrical impedance analysis, alterations in ICW volume were detected in the legs affected by lymphedema, both after the onset of lymphedema and after LVA intervention.

A preoperative risk score based on multifrequency bioelectrical impedance analysis in patients undergoing liver resection

PURPOSE

To investigate if body composition parameters measured by bioelectrical impedance analysis (BIA) and are reportedly correlated with clinical outcomes of patients undergoing digestive tract surgery could be useful for reliably evaluating the perioperative risk in patients undergoing hepatectomy.

METHODS

Consecutive 200 patients who underwent BIA before hepatectomy were retrospectively reviewed. A risk prediction model for postoperative morbidity was created using the initial 100 patients, and its performance was validated using the remaining 100 patients.

RESULTS

Based on the correlation with postoperative morbidity, a novel risk prediction model, the protein-edema score, was created using net protein weight and extracellular water/total body water ratio measured through BIA. The protein-edema score (score 0 vs. ≥ 1) showed a reproducible correlation with Clavien-Dindo 2 or greater postoperative morbidity in the validation set (17.7% vs. 46.4%, P = 0.002) as observed in the training set (18.8% vs. 49.0%, P = 0.002) after statistical adjustment. Similar tendency was also confirmed in Clavien-Dindo 3a or greater postoperative morbidity (5.9% vs. 18.2%, P = 0.037) and postoperative refractory ascites (5.5% vs. 17.4%, P = 0.037) in the validation set.

CONCLUSIONS

The protein-edema score created based on BIA is significantly correlated with postoperative morbidity in patients undergoing liver resection.

Impact of Two Whole-Body Vibration Exercise Protocols on Body Composition of Patients with Metabolic Syndrome: A Randomized Controlled Trial

(1) Background: This study investigated the effects of two 6-week whole-body vibration exercise (WBVE) protocols on body composition in patients with metabolic syndrome (MSy). Thirty-three patients were allocated to either the Fixed Frequency WBVE Group (FFG-WBVE) or the Variable Frequency WBVE Group (VFG-WBVE). (2) Methods: A side-alternating vibration platform was used and the patients remained in the semi-squat position on this platform. In the FFG-WBVE (n = 12; median age = 50.50 years) and (body mass index BMI = 31.95 kg/m²), patients were exposed to 10 s of mechanical vibration at a fixed frequency of 5 Hz, followed by 50 s without vibration. In the VFG-WBVE (n = 10; median age = 57.50 years) and (BMI = 32.50 kg/m²), the patients performed 60 s of mechanical vibration at different frequencies from 5 to 16 Hz). Body composition evaluated through (bioelectrical impedance analysis and anthropometric measurements) were was evaluated before and after the all the interventions in each group. (3) Results: The VFG-WBVE decreased waist circumference, p = 0.01 and segmental fat mass [left arm, p = 0.01; right arm, p = 0.02 and trunk, p = 0.03]. Bone content increased, p = 0.01. No significant changes were observed in the FFG- WBVE. (4) Conclusions: In conclusion, this study demonstrated that 6 weeks of WBVE with a protocol with variable frequency can positively modify the body composition of MSY patients. These findings might contribute to improvements in the metabolic health of these patients.

Bioelectrical impedance analysis versus physician adjustment in acute kidney injury patients to reduce intradialytic hypotension: A randomized controlled trial

Introduction

Methods

Result

Conclusion

•

Intradialytic hypotension is common during hemodialysis.

•

Bioimpedance spectroscopy can help assess fluid status in critically ill patients.

•

BIA-guided protocol can reduce significantly the incidence of IDH compared to conventional method.

Differences in extracellular fluid volume between acute heart failure patients with and without high systolic blood pressure

AIMS

Some reports have suggested that hypertensive acute heart failure (AHF) is caused by intravascular congestion, not interstitial congestion. We evaluated the differences in extracellular fluid volume assessed by bioelectrical impedance analysis (BIA) between AHF patients with and without high systolic blood pressure (sBP).

METHODS

This prospective single-centre study (UMIN000030266) included 178 patients hospitalized due to AHF between September 2017 and August 2018. We calculated extracellular water (ECW), intracellular water (ICW), total body water (TBW), and ECW-to-TBW ratio (oedema index: EI) by BIA and evaluated conventional parameters as follows: weight, N-terminal pro brain natriuretic peptide values, and echocardiography parameters on admission and before discharge. One-year outcomes included all-cause death and re-admission due to heart failure. We compared patients with sBP > 140 mmHg on admission [clinical scenario 1 (CS1) group] and with sBP of ≤140 mmHg on admission (non-CS1 group).

RESULTS

The mean age of the patients was 79.5 ± 11.1 years, and 48.9% of the patients were female. EI on admission of 83 patients in the CS1 group was lower than that of 95 patients in the non-CS1 group. The change in EI from admission to before discharge was no significant in the CS1 group but was significant in the non-CS1 group. Comparing the changes from admission to before discharge between the CS1 and the non-CS1 group, delta ECW, delta ICW, delta TBW, and delta EI of the CS1 group were significantly smaller than those of the non-CS1 group. During the 1-year follow-up period after discharge of the 178 patients, the numbers of deaths and re-admissions due to acute HF were 26 (15%) and 49 (28%), respectively. Patients with high EI before discharge [>0.408 (median)] had significantly more cardiac events than patients with low EI [hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.30-3.55]. Cox regression analysis revealed that higher EI as a continuous variable was significantly associated with worse outcome in non-CS1 group (HR: 1.46, 95% CI: 1.13-1.87), but not significantly associated with worse outcome in CS1 group (HR: 1.29, 95% CI: 0.98-1.69).

CONCLUSIONS

EI on admission in patients with high sBP was not elevated, and changes in ECW, ICW, TBW, and EI in patients with high sBP were smaller than those in patients without high sBP. EI measured by BIA could distinguish AHF with interstitial or intravascular congestion.

Application of DSM–BIA in dry weight assessment in continuous ambulatory peritoneal dialysis

Objectives

Dry weight assessment (DWA) is an important part of dialysis and fluid management in patients receiving renal replacement therapy. With the development of bioimpedance analysis (BIA), the development of the direct segmental multi-frequency BIA (DSM–BIA) has provided a more convenient measure for DWA of dialysis patients, but its accuracy remains unclear. This study was designed to evaluate the application of DSM–BIA in DWA of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

This is a cross-sectional study. Using the conventional BIA as a reference, we examined the accuracy of the DSM–BIA technique for assessing dry weight in CAPD patients and analyzed the potential factors influencing their fluid volume status.

Setting and participants

A total of 31 patients with end-stage renal disease receiving CAPD and 310 healthy volunteers were recruited for this study.

Methods

The intraclass correlation coefficients (ICC) and Bland–Altman plots were used to assess the consistency between DSM–BIA and the conventional BIA for DWA. Univariate and multivariate linear regression analyses were used to explore the influencing factors associated with the edema index.

Results

DSM–BIA and the conventional BIA technology were consistent in DWA in CAPD patients (ICC female 0.972, ICC male 0.882, ICC total 0.960). Similarly, Bland–Altman plots showed good agreements between the two methods in DWA for both genders. Univariate and multivariate linear regression analysis showed both eGFR level (P = 0.04) and serum NT-pro BNP concentration (P = 0.007) were positively correlated with the ratio of extracellular water to total body water (ECW/TCW).

Conclusions

DSM–BIA in DWA has good accuracy in clinical applications and has potential application value for fluid volume management in CAPD patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11255-022-03281-7.

Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models

Background

Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation.

Objective

The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework.

Methods

A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m² on system parameters.

Results

In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab^® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m², leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%).

Conclusion

The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m² using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.

Aerobic Dance on an Air Dissipation Platform Improves Cardiorespiratory, Muscular and Cellular Fitness in the Overweight and Obese Elderly

Background: Obesity is a global health problem associated with a high number of comorbidities that decrease functional capacity, especially in elderly people. Aerobic dance is considered a viable strategy to prevent the effects of aging, mainly in obese and overweight elderly people. This study aimed to evaluate the effects of aerobic dance on an air dissipation platform (ADP) on body composition, oxidative stress and muscular and cardiorespiratory fitness in elderly people. Methods: In total, 32 elderly adults (67.1 ± 3.6) were divided into 3 groups based on body mass index: healthy (HG), overweight (OWG) and obese (OG). Training program of aerobic dance on an ADP was carried out twice a week for 12 weeks. Results: OWG (p = 0.016) and OG decreased their weight (p < 0.001). There was a significant decrease in malondialdehyde concentrations in all experimental groups (p < 0.05). OWG and OG significantly improved their peak oxygen uptake (p < 0.01). HG increased the vertical jump height (p < 0.05), and HG and OG improved the power output of the lower extremities (p < 0.05). Conclusions: The aerobic dance on an ADP may be an effective alternative to lose weight, prevent oxidative stress and improve cardiorespiratory fitness in obese and overweight elderly people.

Changes in the skin characteristics associated with dehydration and rehydration

AbstractThe present study aimed to test the hypothesis that changes in the dermal tissue dielectric constant (TDC) and biomechanical properties of the skin would be correlated with the indicators related to dehydration. Ten healthy adult men were enrolled in three trials: no fluid intake (DEH), ad libitum fluid intake (AL-HYD), and programmed fluid intake (P-HYD) after exercise in a randomized crossover design. The participants performed a pedaling exercise at 60% heart rate reserve until 2% body mass loss. At 120 min after exercise, an incremental exercise test was carried out. Aerobic capacity, body composition, TDC, biomechanical properties of the skin (pliability, viscoelasticity, and total recovery), and indicators related to dehydration in the serum and urine were measured before and 120 min after exercise. Higher values of the pliability and viscoelasticity, and lower value of the total recovery on the hand were demonstrated in the P-HYD trial compared to the DEH trial (all P < 0.05). Changes in the TDC were significantly correlated with changes in body mass (P < 0.05), total body water (P < 0.05), serum osmolarity (P < 0.05), and hematocrit (P < 0.01). Changes in the biomechanical properties of the hand were significantly correlated with changes in body mass, hematocrit, and urine specific gravity (all P < 0.05). The present study showed that the changes in skin characteristics correlated with the body water and dehydration-associated indicators in the serum and urine, thus suggesting that skin characteristics may be useful in the assessment of dehydration.

Polygenetic Variants Related to Osteoarthritis Risk and Their Interactions with Energy, Protein, Fat, and Alcohol Intake in Adults in a Large Cohort

Osteoarthritis (OA) is increasing globally, especially among elderly Asian women, and its increase may be due to the interaction between genetic factors and lifestyle. This study tested the hypothesis that polygenetic variants associated with OA risk interacted with lifestyle in adults over 40 years in the Ansan-Ansung cohort. Genetic variants were chosen through a genome-wide association study with OA participants (case; n = 580) and controls without arthritis (n = 4850). Genetic variants with interactions were selected by a generalized multifactor dimensionality reduction. The best model's polygenic risk scores (PRS) were calculated by summing the number of risk alleles in the selected genetic variants. The best five single nucleotide polymorphism (SNP) model included AIG1_rs6570550, COX10_rs62054459, DLG2_rs148643344, SOX5_rs73283615, and PLXNA4_rs1472529430, while IL12A_ rs1491318751 was added to the five-SNP model to produce a six-SNP model. Only COX10_rs62054459 in subcutaneous and visceral adipose tissue was associated with COX10 protein expression. The participants, having high-PRS from the five-SNP and six-SNP models, were at a higher OA risk than those with low-PRS by 3.88 and 4.42 times, respectively. The PRS was not associated with metabolic syndrome or with the insulin resistance index (HOMA-IR). Energy, protein, fat, alcohol, and a Western-style diet intake interacted with the PRS to influence OA risk (p = 0.005, 0.042, and 0.021, respectively). In the high energy and alcohol intake and low protein, fat, Western-style diet intake, the participants with a high-PRS had a higher incidence of OA than those with low-PRS. In conclusion, the adults with a high-PRS were at a higher OA risk. Particularly, adults with high PRS should have a lower energy intake, higher WSD containing higher protein and fat intake, and moderate alcohol intake to alleviate OA risk. These results can be applied to personalized nutrition plans to decrease OA risk.

Development and Validation of an Insulin Resistance Predicting Model Using a Machine-Learning Approach in a Population-Based Cohort in Korea

Background: Insulin resistance is a common etiology of metabolic syndrome, but receiver operating characteristic (ROC) curve analysis shows a weak association in Koreans. Using a machine learning (ML) approach, we aimed to generate the best model for predicting insulin resistance in Korean adults aged > 40 of the Ansan/Ansung cohort using a machine learning (ML) approach. Methods: The demographic, anthropometric, biochemical, genetic, nutrient, and lifestyle variables of 8842 participants were included. The polygenetic risk scores (PRS) generated by a genome-wide association study were added to represent the genetic impact of insulin resistance. They were divided randomly into the training (n = 7037) and test (n = 1769) sets. Potentially important features were selected in the highest area under the curve (AUC) of the ROC curve from 99 features using seven different ML algorithms. The AUC target was ≥0.85 for the best prediction of insulin resistance with the lowest number of features. Results: The cutoff of insulin resistance defined with HOMA-IR was 2.31 using logistic regression before conducting ML. XGBoost and logistic regression algorithms generated the highest AUC (0.86) of the prediction models using 99 features, while the random forest algorithm generated a model with 0.82 AUC. These models showed high accuracy and k-fold values (>0.85). The prediction model containing 15 features had the highest AUC of the ROC curve in XGBoost and random forest algorithms. PRS was one of 15 features. The final prediction models for insulin resistance were generated with the same nine features in the XGBoost (AUC = 0.86), random forest (AUC = 0.84), and artificial neural network (AUC = 0.86) algorithms. The model included the fasting serum glucose, ALT, total bilirubin, HDL concentrations, waist circumference, body fat, pulse, season to enroll in the study, and gender. Conclusion: The liver function, regular pulse checking, and seasonal variation in addition to metabolic syndrome components should be considered to predict insulin resistance in Koreans aged over 40 years.

Waist and hip circumference are independently associated with the risk of liver disease in population-based studies

BACKGROUND & AIMS

While several anthropometric measures predict liver disease, the waist-hip ratio (WHR) has shown superiority in previous studies. We analysed independent and joint associations of waist circumference (WC) and hip circumference (HC) with liver disease and liver-related risk factors.

METHODS

Cross-sectional study (n = 6619) and longitudinal cohort (n = 40 923) comprised individuals from Health 2000 and FINRISK 1992-2012 studies. Prevalent and viral liver diseases were excluded. Longitudinal cohort was linked with national healthcare registers for severe incident liver disease. Linear regression and Cox proportional hazards models were used to analyse anthropometric, lifestyle, metabolic and bioimpedance-related parameters; liver enzymes; and 59 liver-related genetic risk variants.

RESULTS

WC and HC showed independent and opposite associations with both liver enzymes and incident liver disease among men (HR for liver disease: WC, 1.07, 95% CI 1.03-1.11; HC, 0.96, 95% CI 0.92-0.99; P-range .04 to <.001) and women (HR for liver diseases: WC, 1.06, 95% CI 1.02-1.10; HC, 0.93, 95% CI 0.89-0.98; P-range .005 to .004). HC modified associations between WC and liver enzymes, and between WC and incident liver disease, particularly among men. Liver enzymes and risk of liver disease increased with increasing WC, more so among individuals with high WHR compared to with low WHR. WC and HC jointly reflected both body fat distribution and muscle mass, which was largely mirrored by WHR.

CONCLUSIONS

WC and HC exhibit independent and joint associations with liver disease, which are largely reflected by WHR. Both body fat distribution and muscle mass contribute to these anthropometric measures.

Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls

Objective

Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals.

Methods

Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution.

Results

TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001).

Conclusion

Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Bioimpedance Guided Fluid Management in Peritoneal Dialysis: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Bioelectrical impedance analysis (BIA) devices can help assess volume overload in patients receiving maintenance peritoneal dialysis. However, the effects of BIA on the short-term hard end points of peritoneal dialysis lack consistency. This study aimed to test whether BIA-guided fluid management could improve short-term outcomes in patients on peritoneal dialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A single-center, open-labeled, randomized, controlled trial was conducted. Patients on prevalent peritoneal dialysis with volume overload were recruited from July 1, 2013 to March 30, 2014 and followed for 1 year in the initial protocol. All participants with volume overload were 1:1 randomized to the BIA-guided arm (BIA and traditional clinical methods) and control arm (only traditional clinical methods). The primary end point was all-cause mortality and secondary end points were cardiovascular disease mortality and technique survival.

RESULTS

A total of 240 patients (mean age, 49 years; men, 51%; diabetic, 21%, 120 per group) were enrolled. After 1-year follow-up, 11(5%) patients died (three in BIA versus eight in control) and 21 patients were permanently transferred to hemodialysis (eight in BIA versus 13 in control). The rate of extracellular water/total body water decline in the BIA group was significantly higher than that in the control group. The 1-year patient survival rates were 96% and 92% in BIA and control groups, respectively. No significant statistical differences were found between patients randomized to the BIA-guided or control arm in terms of patient survival, cardiovascular disease mortality, and technique survival (P>0.05).

CONCLUSIONS

Although BIA-guided fluid management improved the fluid overload status better than the traditional clinical method, no significant effect was found on 1-year patient survival and technique survival in patients on peritoneal dialysis.

Comparative Impact of Isolated Ultrafiltration and Hemodialysis on Fluid Distribution: A Bioimpedance Study

INTRODUCTION

Isolated ultrafiltration (IUF) is an alternative treatment for diuretic-resistant patients with fluid retention. Although hemodialysis (HD) predominantly decreases extracellular water (ECW), the impact of IUF on fluid distribution compared with HD remains unclear.

METHODS

We compared the effect of HD (n = 22) and IUF (n = 10) sessions on the body fluid status using a bioimpedance analysis device (InBody S10).

RESULTS

The total ultrafiltration volume was similar between HD and IUF (HD 2.5 ± 0.3 vs. ICF 2.1 ± 0.3 L/session, p = 0.196). The reduction rate of ECW was significantly higher than that of intracellular water (ICW) after HD (ECW -7.9% ± 0.8% vs. ICW -3.0% ± 0.9%, p < 0.001) and IUF (ECW -5.8% ± 0.9% vs. ICW -3.6% ± 0.8%, p = 0.048). However, the change in the ratio of ECW to total body water in HD was significantly larger than that in IUF (HD -3.2% ± 0.3% vs. ICF -1.1% ± 0.4%, p < 0.001). The reduction rates in serum tonicity (effective osmolality) were higher after HD than after IUF (HD -1.8% ± 0.5% vs. IUF -0.6% ± 0.2%, p = 0.052). Among the components of effective osmolality, the reduction rates of serum K+ and glucose levels after HD were significantly higher than those after IUF (serum K+: HD -30.5% ± 1.6% vs. IUF -0.5% ± 3.8%, p < 0.001; serum glucose: HD -15.4% ± 5.0% vs. IUF 0.7% ± 4.8%, p = 0.026), while the serum Na+ level was slightly and similarly reduced (HD -0.8% ± 0.4% vs. IUF -0.8% ± 0.4%, p = 0.500). The reduction in the osmolal gap value (measured osmolality-calculated osmolarity) was significantly greater after HD sessions than after IUF sessions (HD -12.4 ± 1.4 vs. IUF 2.0 ± 1.0 mOsm/kg, p = 0.001).

CONCLUSION

The extracellular fluid reduction effect of HD is stronger than that of IUF. The different changes in effective osmolality and osmolal gap after HD and IUF sessions may be related to the different effects of HD and IUF on fluid distribution.

Comparison of lean mass indices as predictors of mortality in incident peritoneal dialysis patients

Background

Few studies have considered optimal adjusted lean mass indices for prediction of clinical outcomes in peritoneal dialysis (PD) patients. We aimed to evaluate clinical variables using various adjusted indices in PD patients.

Methods

Total 528 incident PD patients were included. Lean mass was measured using dual energy X-ray absorptiometry. Appendicular lean mass (ALM) was calculated using the sum for both upper and lower extremities. Each ALM index was calculated using ALM per body weight (ALM/BW), height squared (ALM/Ht²), or body mass index (ALM/BMI). Limb/trunk lean mass (LTLM) ratio was defined as the sum for both upper and lower extremities divided by trunk lean mass.

Results

A total of 528 patients were analyzed men: 286, women: 242. In area under the receiver operating characteristic curve analyses, LTLM alone was associated with 1 year mortality. In the LTLM ratio, the cut-off value for 1-year mortality was ≤ 0.829 in men and ≤ 0.717 in women, respectively. In both sexes, LTLM ratio alone showed statistical significance in all-cause mortality in both univariate and multivariate Cox-regression analyses. Compared with other indices, the LTLM ratio was independent of edema and fat in both sexes. Edema- and C-reactive protein-adjusted correlation analysis showed that LTLM ratio alone was associated with serum albumin in men. Although statistical significance was not obtained for women, the correlation coefficient was highest for the LTLM ratio compared with other indices.

Conclusion

Among various indices using lean mass, LTLM ratio was independent of volume status and fat mass and was associated with mortality in incident PD patients.

Effects of Isometric Handgrip Training on Home Blood Pressure Measurements in Hypertensive Patients: A Randomized Crossover Study

Objective We aimed to examine the effects of isometric handgrip (IHG) training on home blood pressure (BP) levels in hypertensive Japanese patients undergoing treatment. Methods Fifty-three hypertensive patients (mean age, 61.7 years; 56.6% men) with a home systolic BP ≥135 mmHg and/or a home diastolic BP ≥85 mmHg were randomly assigned to either group A or B. As per the crossover design, group A performed 8 weeks of IHG training, followed by an equivalent training-free, control period, while the reverse protocol was performed by group B. The baseline characteristics were similar between both groups. The individualized daily IHG training comprised four sets of 2-min isometric contractions at 30% of the individual's maximum voluntary contraction capacity, including 1 min of rest between sets, for ≥3 days/week. The outcome measure was morning and evening home BP readings taken over the last 2 weeks of the training and control periods. Results A combined data analysis for both groups showed that IHG training was significantly associated with the lowering of both systolic and diastolic BP in the morning (137.9±9.3 vs. 135.3±9.5 mmHg, p=0.007 and 83.0±9.5 vs. 81.2±9.3 mmHg, p<0.001, respectively) and evening (130.0±10.7 vs. 127.6±10.1 mmHg, p=0.003 and 75.8±10.4 vs. 73.8±9.2 mmHg, p<0.001, respectively), while no significant change was observed after the control period. A larger increase in the maximum grip strength due to IHG training was associated with greater BP reductions. Conclusion An 8-week period of IHG training significantly lowered both the morning and evening home BP in hypertensive Japanese patients undergoing treatment.

Extracellular Water to Total Body Water Ratio in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy

(1) Bio-electrical impedance analysis (BIA) is a rapid, simple, and noninvasive tool for evaluating the metabolic status and for assessing volume status in critically ill patients. Little is known, however, the prognostic value of body composition analysis in septic shock patients. This study assessed the association between parameters by body composition analysis and mortality in patients with septic shock in the emergency department (ED). (2) Data were prospectively collected on adult patients with septic shock who underwent protocol-driven resuscitation bundle therapy between December 2019 and January 2021. The primary outcome was 30-day mortality. (3) The study included 261 patients, the average ratio of extracellular water (ECW) to total body water (TBW) was significantly higher in non-survivors than in survivors (0.414 vs. 0.401, p < 0.001). Multivariate analysis showed that ECW/TBW ≥ 0.41 (odds ratio (OR), 4.62; 95% confidence interval (CI), 2.31–9.26, p < 0.001), altered mental status (OR, 2.88; 95% CI, 1.28–6.46, p = 0.010), and lactate level (OR, 1.24; 95% CI, 1.12–1.37, p < 0.001) were significantly associated with 30-day mortality in patients with septic shock. (4) ECW/TBW ≥ 0.41 may be associated with 30-day mortality in patients with septic shock receiving protocol-driven resuscitation bundle therapy in the ED.

The influence of coffee consumption on bioelectrical impedance parameters: a randomized, double-blind, cross-over trial

BACKGROUND

Bioelectrical impedance analysis (BIA) is a widely used method for estimating body composition. Avoiding foods/beverages containing caffeine is a frequently enforced pre-test protocol to ensure reliability of BIA measurements. However, few studies have evaluated whether this is necessary, with conflicting results. We aimed to determine whether the coffee consumption differing in caffeine content influences BIA parameters in healthy adults.

METHODS

Twenty-five healthy adults were enrolled in a randomized, double-blind cross-over trial. Three amounts of caffeine were given with 200 mL of coffee: 0 mg (11 g of decaffeinated), 200 mg (5.5 g of caffeinated plus 5.5 g of decaffeinated), and 400 mg of caffeine (11 g of caffeinated). BIA measurements were conducted at 6 different times, and coefficient variations (CV) explored.

RESULTS

No differences were observed for group × time interaction on impedance, resistance, or reactance (p > 0.05). Values of BIA parameters increased after 30-min of coffee consumption, independently of the caffeine dosage (all p < 0.001). Body fat percentage followed the same pattern and increased after 45-min (p < 0.05). Median CV for consecutive impedance, resistance, and reactance measurements were >95%CI of expected device measurement error over 70-min, without difference between groups. Urine output volume was not different between groups (decaffeinated: 440.45 ± 197.57 mL; 200 mg: 471.80 ± 171.88 mL; 400 mg: 489.30 ± 204.10 mL, p > 0.05).

CONCLUSION

Coffee consumption influenced BIA-derived results after 70-min but was not related to caffeine content, likely due to water intake.

Whole body and regional phase angle as indicators of muscular performance in athletes

Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) has been used to assess cellular health in various populations, but its usefulness as a tool for measuring muscular performance in adult athletes has not been extensively investigated. Our investigation examined the association of whole-body (WB) PhA with muscular performance in 117 adult athletes from different sports and additionally assessed whether regional PhA was a better indicator of muscular performance compared to WB, while accounting for lean soft tissue (LST). Muscular performance was assessed with handgrip strength and countermovement jump power. WB and regional PhA and LST were obtained by BIA and dual-energy x-ray absorptiometry, respectively. Multiple linear regression was used to model outcomes, while adjusting for LST. WB PhA was positively associated with relative power and relative and absolute strength (p < 0.05), irrespective of LST. Regional PhA measures explained similar amounts of variance in absolute and relative power and strength as that of WB PhA after accounting for age, sex, height, and sport type (lower limb adj R² = 0.42, 0.60 for power; upper limb adj R² = 0.38, 0.74 for strength; WB adj R² = 0.44, 0.63 and 0.38, 0.75 for power and strength, respectively). Only upper limb PhA was related with strength (p < 0.05) after accounting for upper limb LST. PhA may have the potential to be used as a marker of functional muscle mass, which is important when it comes to assessing muscular performance of athletes. Regional measures of PhA do not provide a better indicator of regional strength or power when compared to WB PhA.

A high lean body mass is not protecting from type 2 diabetes in the presence of a high body fat mass

AIM

Most studies examining the associations between body composition and type 2 diabetes have been cross-sectional with prevalent diabetes diagnosis or they have analyzed only fat or lean body mass. Hence, the combined effect of fat and lean body mass on the risk of developing type 2 diabetes remains unclear. We investigated whether baseline lean and fat body mass taken simultaneously into account are associated with incidence of type 2 diabetes over a 15-year follow-up in older adults.

METHODS

We studied 704 men (n = 297) and women (n = 407) from the Helsinki Birth Cohort Study (mean age 61 years at baseline) without diabetes at baseline. Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height²) and lean mass index (LMI, lean mass/height²), dichotomized at sex-specific medians. Incident diabetes was defined as the composite of fasting plasma glucose (FPG) ≥ 7.0 mmol/l, haemoglobin A_1c (HbA_1C) ≥ 6.5% (48 mmol/mol) or physician-based diagnosis.

RESULTS

After a median 14.8 (range 12.5-16.8) years of follow-up, 110 incident diabetes cases occurred (15.6%). Participants with high FMI and LMI at baseline had higher composite incidence of type 2 diabetes (P < 0.001), and significantly increased risk of type 2 diabetes after adjustment for potential confounding factors (sex, physical activity, education and body mass index) compared to the other participants.

CONCLUSION

Contrary to a general belief greater muscle mass is not protective against type 2 diabetes. High LMI accompanied with high FMI seem to predict subsequent development of type 2 diabetes.

Total Body and Extracellular Water Measures Are Unrelated to Cramp Sensitivity in Euhydrated Cramp-Prone Individuals

Earp, JE, Stearns, RL, Agostinucci, J, Lepley, AS, and Ward-Ritacco, CL. Total body and extracellular water measures are unrelated to cramp sensitivity in euhydrated cramp-prone individuals. J Strength Cond Res XX(X): 000-000, 2020-Spectral bioelectrical impedance analysis (BIA) is a valid and noninvasive tool for measuring total body water (TBW), intracellular water (ICW), and extracellular water (ECW). As altered hydration and electrolyte imbalance have been proposed as one of 2 etiologies for exercise-associated muscle cramps (EAMC), the purpose of this study was to determine if distribution of body water is related to cramp sensitivity in similarly hydrated cramp-prone individuals. To this end, 11 euhydrated subjects who regularly experience EAMC had their relative TBW, ICW, and ECW assessed using 8-pole spectral BIA. Subjects' cramp sensitivity was then assessed by electrically stimulating the tibial nerve at increasing frequencies until a muscle cramp occurred, allowing for the determination of the threshold frequency (TF) at which the cramp occurred. It was observed that TF was not significantly related to TBW (r = 0.087, p = 0.368), ICW (r = 0.105, p = 0.338), ECW (r = 0.087, p = 0.368), or ECW:TBW (r = 0.147, p = 0.280). As cramp etiology is poorly understood, these results add to a growing body of literature questioning the role of hydration and electrolyte imbalance in EAMC. Although fluid distribution may be unrelated to TF in those who commonly experience EAMC, additional research is needed to compare those who commonly experience cramps (athletes as well as individuals with specific neuropathies or pharmacologically induced cramps) with those who do not experience cramps and to determine if acute shifts in body water compartmentalization are related to changes in cramp sensitivity.

Lean body mass is not beneficial, but may be detrimental for glucose tolerance - Splitting body mass index according to body composition

AIMS

To study the combined effect of lean mass index (LMI) and fat mass index (FMI) on glucose regulation based upon findings in an oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR).

METHODS

We conducted a population-based, cross-sectional study including 1617 participants without diabetes born in Helsinki from 1934 through 1944. LMI and FMI were calculated as lean and fat mass (kg)/height (m²). For analysis of the association between interaction of LMI and FMI and glucose regulation the participants were divided into tertiles of FMI and LMI.

RESULTS

In men LMI correlated positively with (fasting plasma glucose) FPG and HOMA-IR in the middle and high FMI level with a significant interaction between FMI and LMI on HOMA-IR. In women LMI was not associated with glucose regulation. In both men and women increased FMI was associated with increased FPG and 2-h plasma glucose concentrations and HOMA-IR.

CONCLUSIONS

In men high lean mass accompanied with fatness may be detrimental for glucose tolerance, whereas in women lean mass seemed to have little effect on glucose regulation. Fatness is the major determinant of glucose intolerance.

An examination of changes in muscle thickness, isometric strength and body water throughout the menstrual cycle

PURPOSE

The purpose of this study was to examine the changes in muscle size and strength throughout the menstrual cycle in females and to compare these values to a control group of time-matched males.

METHODS

12 males and 16 females visited the laboratory on four occasions. Measures of muscle thickness (MTH), isometric strength and body water were taken during the menstrual phase, ovulation phase and luteal phase of the menstrual cycle. Males scheduled their visits based on a mock menstrual cycle. In addition, participants were asked to complete 4 sets of biceps curls to volitional failure in one arm to examine swelling during each visit.

RESULTS

For MTH there was no interaction (p = .73); however, there was a main effect for sex with males having higher MTH values compared to females [4.07 (0.67) versus. 2.73 (0.42) cm, (p < .001)] at all time points. For changes in MTH (swelling) there was no interaction (p = .28). However, there was a main effect for sex, with males demonstrating greater changes in MTH compared to females [0.53(0.11) versus. 0.40 (0.10) cm, (p < .001)]. Similarly, for total body water, there was no interaction (p = .66). However, males had greater total body water compared to females [49.6 (6.8) versus. 32.3(3.9) kg, p < .001)] at all time points. Finally, for isometric strength, there was no interaction (p = .23). However, there was a main effect for sex. Males had higher isometric strength values compared to females [285 (42) versus. 156(36) N (p < .001)].

CONCLUSIONS

Phase of the menstrual cycle does not appear to influence MTH, isometric strength or total body water.

Prospective study on sedentary behaviour patterns and changes in body composition parameters in older women: A compositional and isotemporal substitution analysis

BACKGROUND & AIMS

The aims of this study were to examine the prospective compositional associations between sedentary behaviour (SB) patterns and longitudinal changes in body composition parameters, and to use compositional isotemporal substitution modelling to analyse the longitudinal changes in body composition parameters associated with time reallocation from SB to physical activity (PA) in older women.

METHODS

The study included women aged 60 years and older (n = 182) with valid data at baseline and at the subsequent 7-year follow-up. For both time points, the ActiGraph GT1M accelerometer was used for SB and PA assessments and multi-frequency bioimpedance analysis was used to assess the body composition parameters related to adiposity and muscle mass. Compositional regression models were used to analyse the associations between proportion of time spent in sedentary bouts of different duration and longitudinal changes in body composition parameters. A compositional isotemporal substitution model was created to estimate the differences in body composition parameters associated with one-to-one time reallocations between baseline SB and PA.

RESULTS

A significant increase in fat mass index (β_ilr1 = 0.61, 95% confidence interval [CI]: 0.18, 1.04) and visceral adipose tissue (β_ilr1 = 6.01, 95% CI: 1.52, 10.5) was associated with a higher baseline proportion of time spent in long sedentary bouts (i.e. sedentary bout of ≥30 min). Reallocating 1 h/week and 3.5 h/week from the time spent in long sedentary bouts in favour of light PA was associated with a significant decrease in fat mass index by 0.78% (95% CI: 0.24, 1.32) and 3.13% (95% CI: 0.97, 5.29), respectively. No association was found for indicators of muscle mass.

CONCLUSIONS

This study suggests that long-term adiposity status could be improved by increasing the proportion of time spent in light PA at the expense of time spent in prolonged SB. This finding may help in designing more effective and feasible interventions for the maintenance of healthy body composition in advanced age.

Comparison of Bioelectrical Impedance Analysis and Dual Energy X-ray Absorptiometry for Total and Segmental Bone Mineral Content with a Three-Compartment Model

Modern bioelectrical impedance analysis (BIA) provides a wide range of body composition estimates such as fat mass (FM), lean body mass (LBM), and body water, using specific algorithms. Assuming that the fat free mass (FFM) and LBM can be accurately estimated by the 8-electrode BIA analyzer (BIA8MF; InBody230, Biospace), the bone mineral content (BMC) may be calculated by subtracting the LBM from the FFM estimates based on the three-compartment (3C) model. In this cross-sectional study, 239 healthy Taiwanese adults (106 male and 133 female) aged 20-45 years were recruited for BIA and dual-energy X-ray absorptiometry (DXA) measurements of the whole body and body segments, with DXA as the reference. The results showed a high correlation between BIA8MF and DXA in estimating total and segmental LBM, FM and percentage body fat (r = 0.909-0.986, 0.757-0.964, and 0.837-0.936, respectively). For BMC estimates, moderate to high correlations (r = 0.425-0.829) between the two methods were noted. The percentage errors and pure errors for BMC estimates between the methods ranged from 33.9% to 93.0% and from 0.159 kg to 0.969 kg, respectively. This study validated that BIA8MF can accurately assesses LBM, FM and body fat percentage (BF%). However, the estimation of segmental BMC based on the difference between FFM and LBM in body segments may not be reliable by BIA8MF.

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

BACKGROUND

The loss of muscle mass, known as sarcopenia, is a natural process of aging that is associated with adverse health outcomes regardless of age. Because cancer is a disease of aging, interest in sarcopenia and its potential impact in multiple cancer populations has increased significantly. Bioelectrical impedance analysis (BIA) is a guideline-accepted method for sarcopenia detection. This systematic review assesses the literature pertaining to BIA use in the detection of sarcopenia in adults with cancer.

MATERIALS AND METHODS

In this systematic review, a search of the literature for randomized controlled trials and observational studies was conducted using MEDLINE, Cochrane CENTRAL, and EMBASE, through July 15, 2019. The study is registered at Prospero (CRD 42019130707). For study inclusion, patients had to be aged 18 years or older and diagnosed with solid or hematological neoplasia, and BIA had to be used to detect sarcopenia.

RESULTS

Through our search strategy, 5,045 articles were identified, of which 24 studies were selected for inclusion in the review (total number of 3,607 patients). In five studies, BIA was rated comparable to axial computed tomography (CT) scan, calf circumference, or grip strength for sarcopenia screening. In 14 studies, BIA-identified sarcopenia was associated with adverse clinical outcomes.

CONCLUSION

BIA is an accurate method for detecting sarcopenia in adults with cancer prior to treatment and is a viable alternative to CT, dual-energy x-ray absorptiometry, and magnetic resonance imaging in oncology clinical practice.

IMPLICATIONS FOR PRACTICE

Bioelectrical impedance analysis (BIA) is an attractive method for identifying sarcopenic patients in clinical practice because it provides an affordable, noninvasive test that can be completed within a few minutes during a clinic visit. BIA does not require highly skilled personnel, and results are immediately available. This systematic review summarizes the literature pertaining to BIA assessment of sarcopenia in adults with cancer, with a focus on its use in diverse cancer populations.

Association of milk consumption frequency on muscle mass and strength: an analysis of three representative Korean population studies

PURPOSE

Sarcopenia is an involuntary loss of muscle mass, strength, and physical performance associated with aging. Sarcopenia contributes to adverse health outcomes. Milk contains essential amino acids important for maintaining muscle. We investigated the relationships among milk consumption frequency (MCF), muscle mass, and strength in Korean adults.

METHODS

We analyzed the data from 16,173 adults in the 2008-2011 Korean National Health and Nutrition Examination Survey (KNHANES), 13,537 adults in the 2014-2016 KNHANES, and 8254 adults in the Korean Genome and Epidemiology Study (KoGES). MCF was divided into two groups: (1) MCF less than once per day (MCF < 1 group) and (2) MCF greater than or equal to once per day (MCF ≥ 1 group). Low skeletal muscle mass index (LSMI) was defined using the Foundation for the National Institutes of Health sarcopenia project criteria for low muscle mass. Muscle strength was measured using the hand-grip strength test.

RESULTS

The odds ratio (95% confidence interval) for LSMI in the MCF < 1 group was 1.250 (1.013-1.543) after adjusting for confounding factors, compared with the MCF ≥ 1 group (2008-2011 KNHANES). The adjusted mean for hand-grip strength was higher in the MCF ≥ 1 group (2014-2016 KNHANES). After a mean follow-up of 9 years, fat-free mass/body mass index was higher in the MCF ≥ 1 group than the MCF < 1 group (KoGES).

CONCLUSION

We found that MCF ≥ 1 was significantly associated with higher skeletal muscle index and muscle strength than lower MCF. Milk consumption could help prevent sarcopenia in adults.

Association of obesity with heart failure outcomes in 11 Asian regions: A cohort study

BACKGROUND

Asians are predisposed to a lean heart failure (HF) phenotype. Data on the 'obesity paradox', reported in Western populations, are scarce in Asia and have only utilised the traditional classification of body mass index (BMI). We aimed to investigate the association between obesity (defined by BMI and abdominal measures) and HF outcomes in Asia.

METHODS AND FINDINGS

Utilising the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry (11 Asian regions including Taiwan, Hong Kong, China, India, Malaysia, Thailand, Singapore, Indonesia, Philippines, Japan, and Korea; 46 centres with enrolment between 1 October 2012 and 6 October 2016), we prospectively examined 5,964 patients with symptomatic HF (mean age 61.3 ± 13.3 years, 26% women, mean BMI 25.3 ± 5.3 kg/m2, 16% with HF with preserved ejection fraction [HFpEF; ejection fraction ≥ 50%]), among whom 2,051 also had waist-to-height ratio (WHtR) measurements (mean age 60.8 ± 12.9 years, 24% women, mean BMI 25.0 ± 5.2 kg/m2, 7% HFpEF). Patients were categorised by BMI quartiles or WHtR quartiles or 4 combined groups of BMI (low, <24.5 kg/m2 [lean], or high, ≥24.5 kg/m2 [obese]) and WHtR (low, <0.55 [thin], or high, ≥0.55 [fat]). Cox proportional hazards models were used to examine a 1-year composite outcome (HF hospitalisation or mortality). Across BMI quartiles, higher BMI was associated with lower risk of the composite outcome (ptrend < 0.001). Contrastingly, higher WHtR was associated with higher risk of the composite outcome. Individuals in the lean-fat group, with low BMI and high WHtR (13.9%), were more likely to be women (35.4%) and to be from low-income countries (47.7%) (predominantly in South/Southeast Asia), and had higher prevalence of diabetes (46%), worse quality of life scores (63.3 ± 24.2), and a higher rate of the composite outcome (51/232; 22%), compared to the other groups (p < 0.05 for all). Following multivariable adjustment, the lean-fat group had higher adjusted risk of the composite outcome (hazard ratio 1.93, 95% CI 1.17-3.18, p = 0.01), compared to the obese-thin group, with high BMI and low WHtR. Results were consistent across both HF subtypes (HFpEF and HF with reduced ejection fraction [HFrEF]; pinteraction = 0.355). Selection bias and residual confounding are potential limitations of such multinational observational registries.

CONCLUSIONS

In this cohort of Asian patients with HF, the 'obesity paradox' is observed only when defined using BMI, with WHtR showing the opposite association with the composite outcome. Lean-fat patients, with high WHtR and low BMI, have the worst outcomes. A direct correlation between high WHtR and the composite outcome is apparent in both HFpEF and HFrEF.

TRIAL REGISTRATION

Asian Sudden Cardiac Death in HF (ASIAN-HF) Registry ClinicalTrials.gov Identifier: NCT01633398.

Assessment of body water distribution in patients with sepsis during fluid resuscitation using multi-frequency direct segmental bioelectrical impedance analysis

BACKGROUND & AIMS

Although initial fluid resuscitation in sepsis is critical for the treatment of tissue hypoperfusion, little evidence supports the distribution of infused fluid in patients with sepsis. This study was designed to assess the body water distribution in patients with sepsis using bioelectrical impedance analysis and correlate the trend in body water distribution during fluid treatment with the prognosis of patients with sepsis.

METHODS

A prospective study in a single emergency department was performed, and adult patients suspected of having sepsis were enrolled. Multi-frequency direct segmental bioelectrical impedance analysis (InBody S10, InBody) measuring total body water (TBW), intracellular water (ICW), and extracellular water (ECW) was applied to patients with sepsis at three periods: before, immediately after, and 1 hour after the fluid treatment. Survival data at 28 days after the fluid treatment were obtained.

RESULTS

Forty-two patients were enrolled in this study. Overall, the ratios of TBW, ICW, and ECW to body weight increased throughout the fluid treatment except the ratio of ICW to body weight at 1 hour in non-survivors. While the ratio of ECW to TBW (ECW/TBW) and the ratio of ICW to TBW (ICW/TBW) in survivors remained stable over the period, the trend of ECW/TBW increased with corresponding decline of ICW/TBW in non-survivors (p = 0.0085 and p = 0.0034 between times and groups, respectively) such that ECW/TBW and ICW/TBW were significantly different at 1 hour after the fluid loading period (p = 0.0120 and p = 0.0085, respectively). This contrast pattern was equivalent with the trend of ECW/TBW in trunk but not that of the other extremities.

CONCLUSIONS

During fluid resuscitation, the trend in ECW/TBW significantly increased with corresponding decrease of ICW/TBW in non-survivors compared with that in survivors, which suggests fluid resuscitation results intracellular dehydration and extracellular edema in non-survivors of patients with sepsis.

A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings

PURPOSE

To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy.

BACKGROUND

Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear.

METHODS

This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2).

RESULTS

Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01.

CONCLUSIONS

Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.

Body Composition Changes During a 24-h Winter Mountain Running Race Under Extremely Cold Conditions

Background: To date, no study has focused on body composition characteristics and on parameters associated with skeletal muscle damage and renal function in runners participating in a 24-h winter race held under extremely cold environmental conditions (average temperature of -14.3°C). Methods: Anthropometric characteristics, plasma urea (PU), plasma creatinine (Pcr), creatine kinase (CK), plasma volume (PV) and total body water (TBW) were assessed pre- and post-race in 20 finishers (14 men and 6 women). Results: In male runners, body mass (BM) (p = 0.003) and body fat (BF) (p = 0.001) decreased [-1.1 kg (-1.4%) and -1.1 kg (-13.4%), respectively]; skeletal muscle mass (SM) and TBW remained stable (p > 0.05). In female runners, BF decreased (p = 0.036) [-1.3 kg (-7.8%)] while BM, SM and TBW remained stable (p > 0.05). The change (Δ) in BM was not related to Δ BF; however, Δ BM was related to Δ SM [r = 0.58, p = 0.007] and Δ TBW (r = 0.59, p = 0.007). Δ SM correlated with Δ TBW (r = 0.51, p = 0.021). Moreover, Δ BF was negatively associated with Δ SM (r = -0.65, p = 0.002). PV (p < 0.001), CK (p < 0.001), Pcr (p = 0.004) and PU (p < 0.001) increased and creatinine clearance (CrCl) decreased (p = 0.002). The decrease in BM was negatively related to the increase in CK (r = -0.71, p < 0.001). Δ Pcr was positively related to Δ PU (r = 0.64, p = 0.002). The decrease in CrCl was negatively associated with the increase in both PU (r = -0.72, p < 0.001) and CK (r = -0.48, p = 0.032). Conclusion: The 24-h running race under extremely cold conditions led to a significant BF decrease, whereas SM and TBW remained stable in both males and females. Nevertheless, the increase in CK, Pcr and PU was related to the damage of SM with transient impaired renal function.

Nutrition-related factors associated with waiting list mortality in patients with interstitial lung disease: A retrospective cohort study

Japanese patients with interstitial lung disease (ILD) sometimes die waiting for lung transplantation (LTx) because it takes about 2 years to receive it in Japan. We evaluated nutrition-related factors associated with waiting list mortality. Seventy-six ILD patients were hospitalized in Kyoto University Hospital at registration for LTx from 2013 to 2015. Among them, 40 patients were included and analyzed. Patient background was as follows: female, 30%; age, 50.3 ± 6.9 years; body mass index, 21.1 ± 4.0 kg/m² ; 6-minute walk distance (6MWD), 356 ± 172 m; serum albumin, 3.8 ± 0.4 g/dL; serum transthyretin (TTR), 25.3 ± 7.5 mg/dL; and C-reactive protein, 0.5 ± 0.5 mg/dL. Median observational period was 497 (range 97-1015) days, and median survival time was 550 (95% CI 414-686) days. Survival rate was 47.5%, and mortality rate was 38.7/100 person-years. Cox analyses showed that TTR (HR 0.791, 95% CI 0.633-0.988) and 6MWD (HR 0.795, 95% CI 0.674-0.938) were independently correlated with mortality and were influenced by body fat mass and leg skeletal muscle mass, respectively. It is suggested that nutritional markers and exercise capacity are important prognostic markers in waitlisted patients, but further study is needed to determine whether nutritional intervention or exercise can change outcomes.

Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother-child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

Body fluid status assessment by bio-impedance analysis in patients presenting to the emergency department with dyspnea

BACKGROUND/AIMS

Fluid retention occurs in patients with heart failure, accounting for dyspnea. We investigated the diagnostic implication of body fluid status, assessed by bio-impedance analysis (BIA), in acute heart failure (AHF) among patients who presented with dyspnea.

METHODS

A total of 100 patients who presented with dyspnea and suspected with AHF were analyzed in this study. We enrolled 50 AHF and 50 non-AHF patients discriminated through echocardiographic analysis and Framingham criteria and were matched by age and sex. Body composition was analyzed using a multifrequency BIA.

RESULTS

AHF patients demonstrated higher extracellular water (ECW)/total body water (TBW) compared with non-AHF patients (0.412 ± 0.017 vs. 0.388 ± 0.023, p < 0.001). A significant difference of ECW/TBW between AHF patients and nonAHF patients was noted when the upper extremities, trunk, and lower extremities were analyzed (all p < 0.001, respectively). ECW/TBW was not different between patients with reduced ejection fraction (EF) and preserved EF along body compartments. The best cut-off value to predict AHF was > 0.412 at lower extremities with sensitivity and specificity of 0.780 and 0.960. The ECW/TBW of the lower extremities (ECW/TBWL) was correlated with log B-type natriuretic peptide (BNP) levels (r = 0.603, p < 0.001) and also improved the net reclassification improvement and integrated discriminated improvement when added to log BNP level. Multivariate analysis revealed that ECW/TBWL > 0.412 had an independent association with AHF patients (p = 0.011).

CONCLUSION

The ECW/TBWL was higher in patients with dyspnea caused by AHF than their counterparts and demonstrated an independent diagnostic implication. It may be a promising marker to diagnose AHF at bedside.

Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry

Background

Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool.

Objective

This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors.

Methods

Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson's correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively.

Results

The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0.78) and also between DXA and InBody 720 (FMI: r=0.96, FFMI: r=0.81). Comparing to DXA, the means of each body composition measured by InBody S10 method were not significantly different in each gender, but differences were found in FM, %FM, and FMI measured by InBody 720.

Conclusions

In maintenance hemodialysis patients, the measurement of body composition with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted.

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.

Clinical Factors Associated with Initial Decrease in Body-Fat Percentage Induced by Add-on Sodium-Glucose Co-transporter 2 Inhibitors in Patient with Type 2 Diabetes Mellitus

BACKGROUND AND OBJECTIVE

Obesity is globally recognized as an important clinical problem and sodium-glucose co-transporter 2 (SGLT2) inhibitors are considered a suitable therapy for obese patients with type 2 diabetes mellitus (T2DM). We examined the clinical factors associated with initial decrease in body-fat percentage (Fat %) induced by SGLT2 inhibitors in patients with T2DM.

METHODS

We retrospectively enrolled patients newly treated with SGLT2 inhibitors in addition to ongoing medications at Jinnouchi Hospital between April 2014 and December 2015. We examined the SGLT2 inhibitor-induced change in body composition by using a bioelectrical impedance analyzer (InBody770^®) before SGLT2 inhibitor administration and after 4 weeks' treatment.

RESULTS

A total of 175 patients with T2DM were enrolled and we analyzed 148 patients. Add-on SGLT2 inhibitor treatment significantly reduced body weight (- 1.04 ± 1.18 kg, p < 0.01), total fat quantity (- 0.62 ± 1.19 kg, p < 0.01), and Fat % (- 0.4 ± 1.4%, p < 0.01). Pretreatment levels of glycated hemoglobin (HbA1c) [odds ratio (OR), 1.61; 95% confidence interval (CI), 1.15-2.25, p < 0.01] and smoking (OR, 2.65; 95% CI, 1.14-6.15, p = 0.02) were significantly associated factors for greater fat-reduction defined as more than 0.4% (median) decrease in Fat % in multivariate logistic regression analysis. In receiver operator characteristic analysis, the cut-off value of pretreatment levels of HbA1c for a greater Fat % decrease was 7.7% (sensitivity 53% and specificity 69%, p < 0.01).

CONCLUSION

Additional treatment with SGLT2 inhibitors effectively decreased Fat % in T2DM patients with high HbA1c levels before SGLT2 inhibitor administration. Our results suggest a greater initial response in Fat % reduction to SGLT2 inhibitor therapy in diabetic patients with pretreatment HbA1c levels ≥ 7.7%.

Carrying minor allele of FADS1 and haplotype of FADS1 and FADS2 increased the risk of metabolic syndrome and moderate but not low fat diets lowered the risk in two Korean cohorts

PURPOSE

Delta-5-desaturase (fatty acid desaturase-1, FADS1) and delta-6 desaturase (fatty acid desaturase-2, FADS2), rate-limiting enzymes in the biosynthesis of long-chain polyunsaturated fatty acids, may be associated with the risk of metabolic syndrome (MetS). We investigated how FADS1 rs174547 and FADS2 rs2845573 variants modify the prevalence of MetS and whether the risk is modulated by interactions with dietary fat.

METHODS

Genetic, anthropometric, biochemical, and dietary data were collected from the Ansan/Ansung (8842 adults) and City-Rural (5512 adults) cohorts in Korea. The association between FADS1 rs174547(C/T) and FADS2 rs2845573(C/T) variants and MetS was analyzed, as was the interaction of genotypes and fatty acid intake and the risk of MetS after adjusting for MetS-related confounders.

RESULTS

Carriers of FADS1 rs174547 and FADS2 rs2845573 minor alleles had lower serum HDL-cholesterol and glucose levels and higher triglyceride levels than those with major alleles. Ansan/Ansung cohort individuals with FADS1 minor alleles or haplotypes of FADS1 and FADS2 minor alleles had increased risk of MetS, including lower serum HDL-cholesterol and triglyceride levels and blood pressure after adjusting for MetS-related confounders. The City-Rural cohort showed similar results. Total fat intake showed interactions with FADS1 and haplotype variants on MetS risk: MetS frequency was reduced in people consuming moderate fat diets as compared to low fat diets in FADS1 and haplotype of FADS1 and FADS2 major alleles.

CONCLUSION

Korean carriers of the FADS1 rs174547 and FADS2 rs2845573 minor alleles have a greater susceptibility to MetS and moderate fat intake protected against the risk of MetS in carriers of the FADS1 major alleles.

Effectiveness of Tai Chi on Cardiac Autonomic Function and Symptomatology in Women With Fibromyalgia: A Randomized Controlled Trial

The present study examined the effects of a 12-week Tai Chi (TC) training regimen on heart rate variability (HRV), symptomatology, muscle fitness and body composition in women with fibromyalgia. Participants were randomly assigned to either a TC training group (n = 18) or a control group (n = 19). HRV, symptomatology, muscle fitness and body composition were measured before and after 12 weeks. There were significant decreases (p < 0.05) in sympathovagal balance (LnLF/LnHF), sympathetic tone (LnLF, nLF), pain, and fatigue, and significant increases (p < 0.05) in parasympathetic tone (LnHF, nHF), strength and flexibility following TC compared with no changes after control. The changes in LnLF and LnLF/LnHF were correlated with changes in pain. There were no significant changes in HR, sleep quality and body composition after TC or control. TC may be an effective therapeutic intervention for improving sympathovagal balance, pain, fatigue, strength and flexibility in women with fibromyalgia.