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Kojima S, Usui N, Uehata A, Inatsu A, Tsubaki A. Associations between bioelectrical impedance analysis-derived phase angle, protein-energy wasting and all-cause mortality in older patients undergoing haemodialysis. Nephrology (Carlton) 2024. [PMID: 38858748 DOI: 10.1111/nep.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/03/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024]
Abstract
AIM Protein-energy wasting (PEW) is a common syndrome in patients undergoing haemodialysis (HD) and is associated with poor prognosis. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is useful for predicting PEW, but sex and age need to be considered. We aimed to reveal sex-specific cut-off values of PA predicting PEW in HD patients aged ≥65. METHODS This two-centre retrospective cohort study included patients on HD who underwent BIA. PEW was detected using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria as a reference. The PA was measured using a multifrequency bioimpedance device. Sex-specific cut-off values of PA predicting PEW were detected by receiver-operator characteristic analysis. We investigated the association between PEW determined using sex-specific cut-off values for PA and all-cause mortality. RESULTS This study included 274 patients undergoing HD, with a median age of 75 (70-80) years, mean PA of 3.8 ± 1.1° and PEW of 43%. Over a median follow-up duration of 1095 (400-1095) days, 111 patients died. Cut-off values of PA predicting PEW were as follows: female, 3.00° (sensitivity, 87.3%; specificity, 77.5%), and male, 3.84° (sensitivity, 77.6%; specificity, 71.4%). The kappa coefficient between sex-specific cut-off values of the PA and ISRNM criteria had a moderate coincidence level of 0.55. PEW detected by PA was independently associated with all-cause mortality (hazard ratio: 2.40; 95% confidence interval: 1.51-3.85; p < .001). CONCLUSIONS Sex-specific cut-off values for PA in older HD patients may be useful as a screening tool for predicting PEW and mortality.
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Affiliation(s)
- Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Tokyo, Japan
| | | | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Shi R, Zhu JX, Zhu L, Zhao WM, Li H, Chen QC, Pan HF, Wang DG. Exploring the nexus between fatigue, body composition, and muscle strength in hemodialysis patients. Eur J Med Res 2024; 29:266. [PMID: 38698469 PMCID: PMC11067273 DOI: 10.1186/s40001-024-01852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Fatigue is a relatively prevalent condition among hemodialysis patients, resulting in diminished health-related quality of life and decreased survival rates. The purpose of this study was to investigate the relationship between fatigue and body composition in hemodialysis patients. METHODS This cross-sectional study included 92 patients in total. Fatigue was measured by Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) (cut-off ≤ 34). Body composition was measured based on quantitative computed tomography (QCT), parameters including skeletal muscle index (SMI), intermuscular adipose tissue (IMAT), and bone mineral density (BMD). Handgrip strength was also collected. To explore the relationship between fatigue and body composition parameters, we conducted correlation analyses and binary logistic regression. RESULTS The prevalence of fatigue was 37% (n = 34), abnormal bone density was 43.4% (n = 40). There was a positive correlation between handgrip strength and FACIT-F score (r = 0.448, p < 0.001). Age (r = - 0.411, p < 0.001), IMAT % (r = - 0.424, p < 0.001), negatively associated with FACIT-F score. Multivariate logistic regression analysis shows that older age, lower serum phosphorus, higher IMAT% are associated with a high risk of fatigue. CONCLUSION The significantly increased incidence and degree of fatigue in hemodialysis patients is associated with more intermuscular adipose tissue in paraspinal muscle.
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Affiliation(s)
- Rui Shi
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Jia-Xin Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Li Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Wen-Man Zhao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Huai Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Qi-Chun Chen
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Hai-Feng Pan
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China.
| | - De-Guang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
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Lonardo MS, Cacciapuoti N, Chiurazzi M, Di Lauro M, Guida B, Damiano S, Cataldi M. Combined use of handgrip strength and hemoglobin as markers of undernutrition in patients with stage 3-5 chronic kidney disease. Nutr Metab Cardiovasc Dis 2023; 33:2169-2178. [PMID: 37544868 DOI: 10.1016/j.numecd.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS The early identification of undernourished patients with CKD could help instating appropriate nutritional intervention before the full development of the threatening condition known as Protein Energy Wasting (PEW). Handgrip strength (HGS) and blood hemoglobin (Hb) concentration are two parameters considered representative of nutritional status but not included among the criteria for PEW diagnosis. In the present work we investigated whether they could help identifying CKD patients at risk of undernutrition. METHODS AND RESULTS We performed a two-step cluster analysis to classify a cohort of 71 stage 3-5 CKD patients, none of which with PEW, according to their Hb concentration and dominant-hand HGS. Two clusters were finely separated using this method. When we compared the two groups for main body composition and nutritional variables by using t-test statistics or Mann-Whitney test, as appropriate, we found significant differences in PhA, ECW/TBW, ASMI, serum iron. Then we stratified our population by gender and performed cluster analysis as well. PhA, ECW/TBW were still significantly different in the two clusters both in M and in F, while serum iron concentration only in males and ASMI only in females. CONCLUSION These results suggest that either in male than in female Hb concentration and HGS may distinguish two subgroups of CKD patients with different nutritional status and disease severity. Patient belonging to either of these cluster can be easily identified by using the HGS/Hb ratio which represents the HGS normalized per gr Hb.
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Affiliation(s)
- Maria Serena Lonardo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
| | - Nunzia Cacciapuoti
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Martina Chiurazzi
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mariastella Di Lauro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Simona Damiano
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy
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Kwon YE, Lee JS, Kim J, Baeg SI, Choi HM, Kim H, Yang JY, Oh D. Impact of sarcopenia and phase angle on mortality of the very elderly. J Cachexia Sarcopenia Muscle 2023; 14:279-287. [PMID: 36394098 PMCID: PMC9891944 DOI: 10.1002/jcsm.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sarcopenia is a major component of geriatric syndrome and associated with poor clinical outcomes and mortality. However, diagnosing sarcopenia in the very elderly is difficult, and data on its epidemiology and devastating effects in this group are scarce. Phase angle (PA) is measured using bioimpedance spectroscopy and known to reflect cellular integrity and health. This study aimed to clarify the impact of sarcopenia and PA on mortality risk in very elderly people living in long-term care facilities. METHODS This prospective cohort study enrolled elderly residents living in nine long-term care facilities. We collected the participants' data, such as body mass index (BMI), comorbidities and laboratory data, from September to October 2017 and mortality data until October 2019. Nutritional status was evaluated using the Mini Nutritional Assessment (MNA) score, and multifrequency bioimpedance spectroscopy was used to assess body composition including PA. Appendicular skeletal muscle mass was calculated using the body composition monitor-derived equation of Taiwan's researchers. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) definition (sarcopenia vs. normal group). We divided the participants into two groups according to the median PA value of 3.65° (high vs. low group) and performed multivariate regression analyses to verify the association with mortality risk according to sarcopenia diagnosis or PA group. RESULTS A total of 279 elderly participants were enrolled; of them, 238 (85.3%) were diagnosed with sarcopenia according to EWGSOP2 guidelines. The median patient age was 83 years, 211 (75.6%) were female and the median BMI was 20.4 kg/m2 . The sarcopenia group was older than the normal group (84 vs. 81 years; P = 0.002), had a lower mean BMI (19.8 vs. 26.6 kg/m2 , P < 0.001) and had a lower MNA score (9 vs. 12 points, P < 0.001). Sarcopenia was associated with a higher mortality risk after the adjustment for age, sex and diabetes mellitus (hazard ratio [HR], 3.744; 95% confidence interval [CI], 1.155-12.134; P = 0.028). A low PA was associated with sarcopenia, older age, female sex, low MNA score and overhydration volume; it was also a significant predictor of mortality after the adjustment for age, sex, diabetes mellitus and MNA score (HR, 0.593; 95% CI, 0.420-0.837; P = 0.003). CONCLUSIONS Sarcopenia is prevalent among the very elderly patients in long-term care facilities. Sarcopenia and low PA are significantly associated with higher mortality risk.
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Affiliation(s)
- Young Eun Kwon
- Department of Internal MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Jung Sun Lee
- Department of Internal MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Jee‐young Kim
- Gerontology and Geriatric Medical CenterMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Song In Baeg
- Department of Internal MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Hye Min Choi
- Department of Internal MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Hong‐Bae Kim
- Gerontology and Geriatric Medical CenterMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
- Department of Family MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Joon Young Yang
- Gerontology and Geriatric Medical CenterMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
| | - Dong‐Jin Oh
- Department of Internal MedicineMyongji Hospital, Hanyang University College of MedicineGoyang‐siSouth Korea
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Lukachan GA, Chung F, Yadollahi A, Auckley D, Eissa M, Rahman N, McCluskey S, Singh M. Perioperative trends in neck and leg fluid volume in surgical patients: a prospective observational proof-of-concept study. Can J Anaesth 2023; 70:191-201. [PMID: 36450944 DOI: 10.1007/s12630-022-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The severity of obstructive sleep apnea (OSA) may increase postoperatively. The changes in segmental fluid volume, especially neck fluid volume, may be related to increasing airway collapsibility and thus worsening of OSA in the postoperative period. Our objective was to evaluate the feasibility of performing bioelectrical impedance analysis (BIA) and to describe the trend and predictors of changes in segmental fluid volumes in patients receiving general anesthesia for noncardiac surgery. METHODS We conducted a prospective observational proof-of-concept cohort study of adult patients undergoing elective inpatient noncardiac surgery. Patients underwent a portable sleep study before surgery, and segmental fluid volumes (neck fluid volume [NFV], NFV phase angle, and leg fluid volume [LFV]) were measured using BIA at set time points: preoperative period (preop), in the postanesthesia care unit (PACU), the night following surgery at 10 pm (N 0), and the following day at 10 am (POD 1). Linear regression models were constructed to evaluate for significant predictors of overall segmental fluid changes. The variables included in the models were sex, preoperative apnea-hypopnea index (AHI), fluid balance, body mass index (BMI), cumulative opioids, and the timepoint of measurement. RESULTS Thirty-five adult patients (20/35 females, 57%) were included. For the feasibility outcome, measure of recruitment was 50/66 (76%) and two measures of protocol adherence were fluid measurements (34/39, 87%) and preoperative sleep study (35/39, 90%). There was a significant increase in NFV from preop to N 0 and in LFV from preop to PACU. Neck fluid volume also increased from PACU to N 0 and PACU to POD 1, while LFV decreased during the same intervals. The overall changes in NFV were associated with the preop AHI, BMI, and opioids after adjusting for body position and pneumoperitoneum. CONCLUSIONS This proof-of-concept study showed the feasibility and variability of segmental fluid volumes in the perioperative period using BIA. We found an increase in NFV and LFV in the immediate postoperative period in both males and females, followed by the continued rise in NFV and a simultaneous decrease in LFV, which suggest the occurrence of rostral fluid shift. Preoperative AHI, BMI, and opioids predicted the NFV changes. STUDY REGISTRATION ClinicalTrials.gov; NCT02666781, registered 25 January 2016; NCT03850041, registered 20 February 2019.
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Affiliation(s)
- Gincy A Lukachan
- Department of Anesthesia, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Frances Chung
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Azadeh Yadollahi
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mohamed Eissa
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
- Department of Anesthesiology and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nayeemur Rahman
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Stuart McCluskey
- Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mandeep Singh
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
- Department of Anesthesiology and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
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Nutritional Predictors of Mortality after 10 Years of Follow-Up in Patients with Chronic Kidney Disease at a Multidisciplinary Unit of Advanced Chronic Kidney Disease. Nutrients 2022; 14:nu14183848. [PMID: 36145223 PMCID: PMC9504469 DOI: 10.3390/nu14183848] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Nutritional monitoring in advanced chronic kidney disease (ACKD) units provides personalized care and improves clinical outcomes. This study aimed to identify mortality risk factors in chronic kidney disease (CKD) patients on nutritional follow-up in the multidisciplinary ACKD unit. A retrospective cross-sectional observational study was conducted in 307 CKD patients’ stage 3b, 4−5 followed-up for 10 years. Clinical and nutritional monitoring was performed by malnutrition-inflammation score (MIS), biochemical parameters (s-albumin, s-prealbumin, and serum C-reactive protein (s-CRP), body composition measured by bioelectrical impedance analysis (BIA), anthropometry, and handgrip strength measurements. The sample was classified into non-survivors, survivors, and censored groups. Of the 307 CKD patients, the prevalence of protein-energy wasting (PEW) was 27.0% using MIS > 5 points, s-CRP > 1 mg/dL was 19.20%, and 27.18% died. Survivors had higher significant body cell mass (BCM%) and phase angle (PA). Survival analyses significantly showed that age > 72 years, MIS > 5 points, s-prealbumin ≤ 30 mg/dL, PA ≤ 4°, and gender-adjusted handgrip strength (HGS) were associated with an increased risk of mortality. By univariate and multivariate Cox regression, time on follow-up (HR:0.97), s-prealbumin (HR:0.94), and right handgrip strength (HR:0.96) were independent predictors of mortality risk at 10 years of follow-up in the ACKD unit. Nutritional monitoring in patients with stage 3b, 4−5 CKD helps to identify and treat nutritional risk early and improve adverse mortality prognosis.
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Ruperto M, Barril G. The Extracellular Mass to Body Cell Mass Ratio as a Predictor of Mortality Risk in Hemodialysis Patients. Nutrients 2022; 14:nu14081659. [PMID: 35458220 PMCID: PMC9029814 DOI: 10.3390/nu14081659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/10/2022] Open
Abstract
The extracellular mass/body cell mass ratio (ECM/BCM ratio) is a novel indicator of nutritional and hydration status in hemodialysis (HD) patients. This study aimed to explore the ECM/BCM ratio as a predictor of mortality risk with nutritional-inflammatory markers in HD patients. A prospective observational study was conducted in 90 HD patients (male: 52.2%; DM: 25.60%). Clinical and biochemical parameters [serum albumin, serum C-reactive protein (s-CRP), interleukine-6 (IL-6)] were analysed and bioelectrical impedance analysis (BIA) was performed. Protein-energy wasting syndrome (PEW) was diagnosed using malnutrition-inflammation score (MIS). Based on BIA-derived measurements, the ECM/BCM ratio with a cut-off point of 1.20 was used as a PEW-fluid overload indicator. Comorbidity by Charlson index and hospital admissions were measured. Out of 90 HD patients followed up for 36 months, 20 patients (22.22%) died. PEW was observed in 24 survivors (34.28%) and all non-survivors. The ECM/BCM ratio was directly correlated with MIS, s-CRP, Charlson index and hospital admissions but was negatively correlated with phase angle and s-albumin (all, p < 0.001). Values of the ECM/BCM ratio ≥ 1.20 were associated with higher probability of all-cause mortality (p = 0.002). The ECM/BCM ratio ≥ 1.20, IL-6 ≥ 3.1 pg/mL, s-CRP and s-albumin ≥ 3.8 g/dL and Charlson index were significantly associated with all-cause mortality risk in multivariate adjusted analysis. This study demonstrates that the ECM/BCM ratio ≥ 1.20 as a nutritional marker and/or fluid overload indicator had a significant prognostic value of death risk in HD patients.
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Affiliation(s)
- Mar Ruperto
- Department of Pharmaceutical & Health Sciences, Faculty of Pharmacy, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain
- Grupo USP-CEU de Excelencia “Nutrición para la vida (Nutrition for Life)”, Ref: E02/0720, Alcorcón, 28925 Madrid, Spain
- Correspondence: ; Tel.: +34-91-372-52-10
| | - Guillermina Barril
- Nephrology Department, Hospital Universitario La Princesa, 28006 Madrid, Spain;
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Ou Q, Zhou C, Tian M, Yang X, Zha Y. Study on Correlation between Body Cell Mass Index and Cognitive Impairment in Hemodialysis Maintaining Patients: A Cross-Sectional Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9023562. [PMID: 35281528 PMCID: PMC8913052 DOI: 10.1155/2022/9023562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the relationship between body cell mass index (BCMI) and cognitive impairment in maintaining hemodialysis (MHD) patients. Methods We collected the general materials, laboratory indexes, and physical measurement indexes of patients undergoing maintenance hemodialysis in hemodialysis centers of 20 tertiary and tertiary general hospitals in Guizhou Province from June to September 2020. The body composition was measured by bioelectrical impedance method, and the BCMI value was calculated. The subjects were divided into normal cognitive function group (score ≥27), mild cognitive impairment group (score 23-26), and severe cognitive impairment group (score <23). Two groups of people with normal cognitive function and cognitive impairment with similar baseline data (gender, age, and education) were obtained by propensity score matching (PSM). Results A total of 2008 subjects were included in this study, including 467 cases (23.3%) in the cognitive impairment group. A total of 814 cases were accurately matched after PSM. Multivariate logistic regression analysis showed that the incidence risk of the BCMI Q1 group was 8.99 times higher than that of the Q4 group (95% CI: 5.74 ∼ 14.09, P < 0.001). ROC curve analysis showed that the best threshold of BCMI for predicting cognitive impairment in MHD patients was 9.05, the sensitivity and specificity were 71.5% and 62.7%, respectively, and the area under the curve was 0.713 (95% CI: 0.678 ∼ 0.748, P < 0.001). Conclusions BCMI is related to cognitive impairment in MHD patients and has predictive value for the onset of cognitive impairment in MHD patients.
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Affiliation(s)
- Qinqin Ou
- Zunyi Medical University, Zunyi 563000, China
| | - Chaomin Zhou
- Department of Nephrology, Guizhou Provincial People′s Hospital, Guiyang 550002, China
| | - Maolu Tian
- Department of Nephrology, Guizhou Provincial People′s Hospital, Guiyang 550002, China
| | | | - Yan Zha
- Zunyi Medical University, Zunyi 563000, China
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Impedance-derived phase angle is associated with muscle mass, strength, quality of life, and clinical outcomes in maintenance hemodialysis patients. PLoS One 2022; 17:e0261070. [PMID: 35020730 PMCID: PMC8754345 DOI: 10.1371/journal.pone.0261070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the association between the phase angle and muscle mass, muscle strength, physical performance tests, quality-of-life scales, mood scales, or patient and hospitalization-free survival rates in hemodialysis (HD) patients. METHODS We included 83 HD patients. The patients were divided into tertiles based on phase angle value. The phase angle was measured using a bioimpedance analysis machine. Thigh muscle area per height squared (TMA/Ht2), handgrip strength (HGS), nutritional indicators, physical performance, quality-of-life, depression or anxiety status, and the presence of hospitalization or death regardless of cause were evaluated. RESULTS In our study, no significant differences were observed in the serum albumin level and body mass index according to tertiles of phase angle. The phase angle tertiles were associated with TMA/Ht2 and HGS. The phase angle was also associated with physical performance measurements and depression or anxiety status. Subgroup analyses according to sex, age, and diabetes mellitus showed similar trends to those of the total cohort. Furthermore, the hospitalization-free survival rate and patient survival rate were favorable in patients with high values for the phase angle. CONCLUSION The present study demonstrated that the phase angle is associated with muscle mass, strength, physical performance, quality-of-life scale, and hospitalization-free survival in maintenance HD patients.
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Marini ACB, Carneiro BS, Macedo M, Lobo PCB, Pimentel GD. Fatigue Is Not Associated with Phase Angle in Hemodialysis Patients. J Nutr Health Aging 2022; 26:187-189. [PMID: 35166313 DOI: 10.1007/s12603-022-1738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the association between fatigue and phase angle (PA) in patients with chronic kidney disease (CKD) on hemodialysis (HD). METHODS A cross-sectional study with older patients than 18 years diagnosed with CKD undergoing HD. From 160 (58.36±15.05 years) patients, (n=96; 60%) are men. Body mass and height were assessed using a portable scale and stadiometer, followed by body mass index (BMI) calculus. The bioimpedance electrical analysis was performed using the Bodystat QuadScan 4000. The sample size was dichotomized in two groups, using the median of our sample, either normal when PA ≥5.4º, or low when the PA <5.4º. The Chalder fatigue questionnaire was used the assess the fatigue. The multiple regression was applied to assess the association between fatigue questionnaire and PA. RESULTS Were considered normal PA≥5.4º (n=78, 48.8%) and low PA<5.4º (n=82, 51.2%). The patients of the PA<5.4º group are older compared to the PA≥5.4º group (63.1±15.1 vs. 53.3±13.4 years, p<0.001). There was no association between PA and fatigue score in the crude model (OR: 1.02, 95%CI: 0.96-1.08, p=0.47) and after confounding variables (OR: 1.03, CI: 0.95-1.12, p=0.43). CONCLUSIONS In HD patients, we found that patients with lower PA values are older. In addition, we did not find association between fatigue and PA.
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Affiliation(s)
- A C B Marini
- Gustavo Duarte Pimentel, Universidade Federal de Goiás, Goiânia, Goiás, MA: 74605-080, Brasil. E-mail: , Phone: +55 62 32096270
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Sciacchitano S, Capalbo C, Napoli C, Negro A, De Biase L, Marcolongo A, Anibaldi P, Salvati V, Petrella L, Merlo L, Alampi D, Alessandri E, Loffredo C, Ulivieri A, Lavra L, Magi F, Morgante A, Salehi LB, De Vitis C, Mancini R, Coluzzi F, Rocco M. Nonthyroidal illness syndrome (NTIS) in severe COVID-19 patients: role of T3 on the Na/K pump gene expression and on hydroelectrolytic equilibrium. J Transl Med 2021; 19:491. [PMID: 34861865 PMCID: PMC8640710 DOI: 10.1186/s12967-021-03163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
Background Nonthyroidal Illness Syndrome (NTIS) can be detected in many critical illnesses. Recently, we demonstrated that this condition is frequently observed in COVID-19 patients too and it is correlated with the severity the disease. However, the exact mechanism through which thyroid hormones influence the course of COVID-19, as well as that of many other critical illnesses, is not clear yet and treatment with T4, T3 or a combination of both is still controversial. Aim of this study was to analyze body composition in COVID-19 patients in search of possible correlation with the thyroid function. Methods and findings We report here our experience performed in 74 critically ill COVID-19 patients hospitalized in the intensive care unit (ICU) of our University Hospital in Rome. In these patients, we evaluated the thyroid hormone function and body composition by Bioelectrical Impedance Analysis (BIA) during the acute phase of the disease at admission in the ICU. To examine the effects of thyroid function on BIA parameters we analyzed also 96 outpatients, affected by thyroid diseases in different functional conditions. We demonstrated that COVID-19 patients with low FT3 serum values exhibited increased values of the Total Body Water/Free Fat Mass (TBW/FFM) ratio. Patients with the lowest FT3 serum values had also the highest level of TBW/FFM ratio. This ratio is an indicator of the fraction of FFM as water and represents one of the best-known body-composition constants in mammals. We found an inverse correlation between FT3 serum values and this constant. Reduced FT3 serum values in COVID-19 patients were correlated with the increase in the total body water (TBW), the extracellular water (ECW) and the sodium/potassium exchangeable ratio (Nae:Ke), and with the reduction of the intracellular water (ICW). No specific correlation was observed in thyroid patients at different functional conditions between any BIA parameters and FT3 serum values, except for the patient with myxedema, that showed a picture similar to that seen in COVID-19 patients with NTIS. Since the Na+/K+ pump is a well-known T3 target, we measured the mRNA expression levels of the two genes coding for the two major isoforms of this pump. We demonstrated that COVID-19 patients with NTIS had lower levels of mRNA of both genes in the peripheral blood mononuclear cells (PBMC)s obtained from our patients during the acute phase of the disease. In addition, we retrieved data from transcriptome analysis, performed on human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM)s treated with T3 and we demonstrated that in these cells T3 is able to stimulate the expression of these two genes in a dose-dependent manner. Conclusions In conclusion, we demonstrated that measurement of BIA parameters is a useful method to analyze water and salt retention in COVID-19 patients hospitalized in ICU and, in particular, in those that develop NTIS. Our results indicate that NTIS has peculiar similarities with myxedema seen in severe hypothyroid patients, albeit it occurs more rapidly. The Na+/K+ pump is a possible target of T3 action, involved in the pathogenesis of the anasarcatic condition observed in our COVID-19 patients with NTIS. Finally, measurement of BIA parameters may represent good endpoints to evaluate the benefit of future clinical interventional trials, based on the administration of T3 in patients with NTIS.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy. .,Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy.
| | - Carlo Capalbo
- Department of Medical Oncology, Sant'Andrea University Hospital, 00189, Rome, Italy.,Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Christian Napoli
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Luciano De Biase
- Heart Failure Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paolo Anibaldi
- Health Management Director, Sant'Andrea Hospital, Rome, Italy
| | - Valentina Salvati
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lea Petrella
- Department of Methods and Models for Economics, Territory and Finance (MEMOTEF), Sapienza University of Rome, Rome, Italy
| | - Luca Merlo
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Alampi
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Elisa Alessandri
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Loffredo
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandra Ulivieri
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Luca Lavra
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Fiorenza Magi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Alessandra Morgante
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy
| | - Leila B Salehi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Rome, Italy.,U.O.C. of Medical Genetics, Policlinic of Tor Vergata, Rome, Italy
| | - Claudia De Vitis
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Flaminia Coluzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
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Assessment of total and regional bone mineral density using bioelectrical impedance vector analysis in elderly population. Sci Rep 2021; 11:21161. [PMID: 34707125 PMCID: PMC8551151 DOI: 10.1038/s41598-021-00575-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the relationship between bone mineral density (BMD) and height-adjusted resistance (R/H), reactance (Xc/H) and phase angle (PhA). A total of 61 male and 64 female subjects aged over 60 years were recruited from middle Taiwan. The R and Xc were measured using Bodystat Quadscan 4000 at a frequency of 50 kHz. BMD at the whole body, L2–L4 spine, and dual femur neck (DFN), denoted as BMDTotal, BMDL2–L4, and BMDDFN, were calculated using a Hologic DXA scanner. The R-Xc graph was used to assess vector shift among different levels of BMD. BMD was positively correlated with Xc/H and negatively correlated with R/H (p < 0.001). The General Linear Model (GLM) regression results were as follows: BMDTotal = 1.473–0.002 R/H + 0.007 Xc/H, r = 0.684; BMDL2–L4 = 1.526–0.002 R/H + 0.012 Xc/H, r = 0.655; BMDDFN = 1.304–0.002 R/H + Xc/H, r = 0.680; p < 0.0001. Distribution of vector in the R-Xc graph was significantly different for different levels of BMDTotal, BMDL2–L4 and BMDDFN. R/H and Xc/H were correlated with BMD in the elderly. The linear combination of R/H and Xc/H can effectively predict the BMD of the whole body, spine and proximal femur, indicating that BIVA may be used in clinical and home-use monitoring tool for screening BMD in the elderly in the future.
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13
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Yang Y, Qin X, Chen J, Wang Q, Kong Y, Wan Q, Tao H, Liu A, Li Y, Lin Z, Huang Y, He Y, Lei Z, Liang M. The Effects of Oral Energy-Dense Supplements on Nutritional Status in Nondiabetic Maintenance Hemodialysis Patients: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2021; 16:1228-1236. [PMID: 34155082 PMCID: PMC8455049 DOI: 10.2215/cjn.16821020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Fat-based energy-dense nutritional supplements may offer benefits over protein- or carbohydrate-dense supplements for patients receiving dialysis because of the adverse metabolic consequences of the latter. We conducted a randomized controlled trial to assess the effects of the short-term use of a fat-based nutritional supplement on various measures of nutritional status in patients receiving maintenance hemodialysis who have low dietary energy intake. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled nondiabetic patients receiving hemodialysis for >3 months who had inadequate dietary energy intake (<30 kcal/kg per day). The participants were randomly assigned in a 1:1 ratio to receive an oral fat-based energy-dense supplement (300 kcal daily) or routine care for 12 weeks (n=120 per group). The primary outcome was the change in phase angle measured by bioelectrical impedance analysis, a marker of cell integrity and body cell mass, from the baseline to week 12. The secondary outcomes were changes in quality of life. Other outcomes included laboratory nutritional indicators and physical examinations. RESULTS The average age of the total population was 47 (SD: 12) years, and 55% were men. The median of dialysis vintage was 43.4 (22.5-76.3) months; 240 participants were randomly assigned to the intervention (n=120) or control group (n=120). In total, 228 (95%) participants completed the trial. The change in phase angle did not differ significantly between the intervention and control groups (estimate, 0.0; 95% confidence interval, -0.1 to 0.1 versus estimate, 0.0; 95% confidence interval, -0.1 to 0.1; estimated difference, 0.0; 95% confidence interval -0.2 to 0.2; P=0.99). None of the 19 domains of quality of life differed between the groups. Adverse events were reported in 23 (19%) participants in the control group and 40 (33%) participants in the intervention group. CONCLUSIONS In nondiabetic patients on maintenance hemodialysis, short-term administration of fat-based energy-dense nutritional supplement has no clinically significant effect on nutritional status as measured by phase angle. PODCAST This article contains a podcast at https://https://www.asn-online.org/media/podcast/CJASN/2021_08_03_CJN16821020.mp3.
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Affiliation(s)
- Yaya Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junzhi Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Wang
- Division of Nephrology, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Yaozhong Kong
- Division of Nephrology, The First People’s Hospital of Foshan, Foshan, China
| | - Qijun Wan
- Division of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Huiqin Tao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aiqun Liu
- Division of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhuan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihan Lei
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Kim DH, Oh DJ. Phase angle values, a good indicator of nutritional status, are associated with median value of hemoglobin rather than hemoglobin variability in hemodialysis patients. Ren Fail 2021; 43:327-334. [PMID: 33567950 PMCID: PMC7889140 DOI: 10.1080/0886022x.2020.1870137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Our aim was to elucidate whether Hb variability affects nutritional status in HD patients. Methods This study included chronic HD patients (n = 76) with available monthly Hb levels up to 24 months prior to the body composition monitoring (BCM) measurement. The parameters obtained in the BCM included body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), overhydration/extracellular water ratio (OH), and phase angle (PhA). The coefficient of variation (Hb-CV), standard deviation (Hb-SD), and range of Hb (Hb-RAN) were used as indexes of Hb variability. In addition, minimum (Hb-Min), maximum (Hb-Max), average (Hb-Avg), and median (Hb-Med) Hb levels (g/dL) were analyzed. Results There were no significant differences in clinical, biochemical, and nutritional indexes based on the Hb-CV level. Compared to patients with an Hb-Med ≤ 10.77, those with an Hb-Med >10.77 had higher albumin levels, total iron-binding capacity (TIBC), and PhA and lower average weekly prescribed darbepoetin. Age, female sex, OH, and darbepoetin dosage were negatively correlated with PhA. Serum albumin, phosphorus, TIBC, Hb-Med, and Hb-Avg were positively correlated with PhA. In multiple linear regression analysis, PhA was positively associated with Hb-Med and serum albumin level, whereas PhA was negatively associated with age and female sex. The area under the curve (AUC) of Hb-Med was 0.665 (p = 0.040) in predicting PhA >5.00° Conclusions PhA was not affected by indexes of Hb variability, whereas PhA was associated with Hb-Med in chronic HD patients.
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Affiliation(s)
- Do Hyoung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Dong-Jin Oh
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
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15
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Kim WJ, Jo GY, Park JH, Do HK. Feasibility of segmental bioelectrical impedance analysis for mild- to moderate-degree breast cancer-related lymphedema: Correlation with circumferential volume measurement and phase angle. Medicine (Baltimore) 2021; 100:e23722. [PMID: 33530173 PMCID: PMC7850733 DOI: 10.1097/md.0000000000023722] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Segmental multi-frequency bioelectrical impedance analysis (s-MFBIA) has been adopted recently to evaluate the volume of breast cancer-related lymphedema (BCRL). This procedure uses the segmental phase angle (s-PhA) as an indicator of cellular integrity. In the smaller-built Asian population, the BCRL often has a small volume difference and can be overlooked by tape circumference volume measurement (TVM). This study aimed to investigate the clinical feasibility of s-MFBIA for the assessment of lymphedema severity compared with TVM and evaluate the association between lymphedema severity and cellular integrity of the affected arm based on s-PhA values for a patient with mild- to moderate-degree BCRL.Segmental PhA and extracellular water (ECW)/total body water (TBW) ratio of bilateral arms were measured using InBody S10, an s-MFBIA device, in 128 BCRL patients. Inter-limb volume ratio was measured using TVM. The inter-limb ECW/TBW ratio was correlated with inter-limb volume ratio. Inter-limb ECW/TBW ratio and inter-limb volume ratio were then correlated with inter-limb PhA ratio to demonstrate the association between lymphedema severity and arm cellular integrity.The inter-limb ECW/TBW ratio and inter-limb volume ratio were positively correlated (r = 0.654, P < .001). The same result was obtained after adjusting for age, body mass index, postoperative survival, and duration of lymphedema (r = 0.636, 0.653, 0.652, and 0.648, P < .001). The inter-limb PhA ratio demonstrated significant negative correlation with inter-limb ECW/TBW ratio and inter-limb volume ratio (r = -0.896, -0.562, P < .001).s-MFBIA has high consistency with the conventional TVM method, and its relation to cellular integrity by segmental PhA enables better understanding of the cellular state of the affected limb in mild- to moderate-degree BCRL. Therefore, it is clinically feasible for severity assessment and monitoring of mild- to moderate-degree BCRL in smaller-built Asian patients.
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Affiliation(s)
- Woo-Jin Kim
- Epworth Rehabilitation and Mental Health, Epworth Healthcare, Brighton, Victoria, Australia
| | - Geun-Yeol Jo
- Department of Physical Medicine and Rehabilitation, Haeundae–Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji-Ho Park
- Department of Physical Medicine and Rehabilitation, Haeundae–Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae–Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Toida T, Toida R, Ebihara S, Takahashi R, Komatsu H, Uezono S, Sato Y, Fujimoto S. Association between Serum Zinc Levels and Clinical Index or the Body Composition in Incident Hemodialysis Patients. Nutrients 2020; 12:nu12103187. [PMID: 33086501 PMCID: PMC7603268 DOI: 10.3390/nu12103187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The relationships between serum zinc levels and body composition or clinical outcomes of incident hemodialysis (HD) patients remain unclear. Methods: This prospective observational study examined the relationships between serum zinc levels and clinical indexes, including body composition, in 142 incident HD patients using a bioelectrical impedance analysis. Patients were divided into three groups according to baseline serum zinc levels: tertile, <45, 45–59, and ≥60 µg/dL. The reference group was set as ≥60 µg/dL. Cox’s regression analysis was performed to investigate the relationships between serum zinc categories and cardiovascular events and all-cause mortality after adjustments for potential confounders. Results: Serum zinc levels positively correlated with the nutritional index and negatively correlated with fluid volume markers. In a mean follow-up of 2.5 years, there were 20 cases of cardiovascular events and 15 of all-cause mortality. In the Cox’s regression analysis for cardiovascular events and all-cause mortality, the hazard ratio increased with a decrease in serum zinc levels, but was not significant. Conclusion: Serum zinc levels were associated with nutritional and fluid volume markers in incident HD patients. To clarify the relationship between serum zinc levels and cardiovascular events or mortality, further studies with a larger number of cases will be necessary.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka 882-0835, Japan;
- Correspondence: ; Tel.: +83-985-85-1510
| | - Reiko Toida
- Department of Internal Medicine, Chiyoda Hospital, Hyuga 883-0064, Japan; (R.T.); (S.U.)
| | - Shou Ebihara
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
| | - Risa Takahashi
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka 882-0835, Japan;
| | - Hiroyuki Komatsu
- Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
| | - Shigehiro Uezono
- Department of Internal Medicine, Chiyoda Hospital, Hyuga 883-0064, Japan; (R.T.); (S.U.)
| | - Yuji Sato
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Takachiho Town Hospital, Takachiho 882-1101, Japan;
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
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Malnutrition as a risk factor for cardiac valve calcification in patients under maintenance dialysis: a cross-sectional study. Int Urol Nephrol 2020; 52:2205-2212. [PMID: 32964341 DOI: 10.1007/s11255-020-02590-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Cardiac valve calcification (CVC) is a significant risk factor for cardiovascular morbidity and mortality in patients with chronic kidney disease on maintenance hemodialysis. The aim of this study was to investigate the association of several risk factors and particularly of malnutrition on CVC. METHODS In this cross-sectional cohort study, we included stable adult patients on maintenance hemodialysis. Calcification of cardiac valves was evaluated using two-dimensional echocardiography. Nutritional assessment and body composition measurements were performed using the MQSGA clinical tool and bioelectrical impedance analysis, respectively. Biochemical parameters such as serum calcium, phosphorus, iPTH, 1.25 hydroxy-vitamin-D, triglycerides, total cholesterol, HDL-C, LDL-C, total proteins, albumin, creatinine and CRP were assessed as potentially risk factors. The receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic ability of the aforementioned variables on severe degree CVC. Binary logistic regression analysis was also performed to identify independent variables of severe CVC. RESULTS Overall, 42 patients were included in the study with half of them exhibiting mitral calcification, 38% aortic valve calcification, and 16.7% calcification in both valves. ROC analysis indicated that aging (p = 0.011), increased CRP (p = 0.038) and decreased value of serum albumin to total proteins ratio (p = 0.012) were positive prognostic factors for moderate to severe degree cardiac valve calcification. Low phase angle was also associated with CVC, although with moderate specificity. CONCLUSION Aging, inflammation, low serum albumin to total proteins ratio and low phase angle values as indicators of malnutrition are predictors of severe CVC in end-stage renal disease patients on hemodialysis.
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Devarasu N, Sudha GF. Dual-frequency bioelectrical phase angle to estimate the platelet count for the prognosis of dengue fever in Indian children. BIOMED ENG-BIOMED TE 2020; 65:417-428. [DOI: 10.1515/bmt-2018-0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
A noninvasive investigation to ascertain the platelet (PLT) count was conducted on 44 hospitalized dengue hemorrhagic fever (DHF) subjects, male and female aged between 3 and 14 years using bioelectrical phase angle (BPhA). Among the 44 subjects, 30 subjects were confirmed to be non-structural protein-1 (NS1) positive at the time of admission, whose blood investigations such as hematocrit (HCT) level, PLT count, aspartate aminotransferase (AST) level and alanine aminotransferase (ALT) level were performed for the classification of risk as low-risk (LR) and high-risk (HR) DHF. It was found that the BPhA of the body reflects a linear correlation with the PLT count. To provide a better and more accurate estimate of PLT, a dual-frequency method is proposed to calculate the phase angle of the total body. The resistance at 5 kHz and reactance at 100 kHz were used to estimate the phase angle of the total body. The statistical analysis identified that the PLT count estimated using the proposed dual-frequency method shows a good correlation with the blood investigation results. In addition, statistical analysis of the proposed method on other fever subjects indicated a significant difference with DHF.
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Affiliation(s)
- Neelamegam Devarasu
- Department of Electronics and Communication Engineering , Pondicherry Engineering College , Puducherry 605014 , India
| | - Gnanou Florence Sudha
- Department of Electronics and Communication Engineering , Pondicherry Engineering College , Puducherry 605014 , India
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Hirose S, Nakajima T, Nozawa N, Katayanagi S, Ishizaka H, Mizushima Y, Matsumoto K, Nishikawa K, Toyama Y, Takahashi R, Arakawa T, Yasuda T, Haruyama A, Yazawa H, Yamaguchi S, Toyoda S, Shibasaki I, Mizushima T, Fukuda H, Inoue T. Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases. J Clin Med 2020; 9:jcm9082554. [PMID: 32781732 PMCID: PMC7463846 DOI: 10.3390/jcm9082554] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.
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Affiliation(s)
- Suguru Hirose
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
- Correspondence:
| | - Naohiro Nozawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kazuhisa Matsumoto
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kaori Nishikawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yohei Toyama
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Reiko Takahashi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomoe Arakawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan;
| | - Akiko Haruyama
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Suomi Yamaguchi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Takashi Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
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Comparative Performance of Body Composition Parameters in Prediction of Death in Hospitalized Patients on Maintenance Hemodialysis: A Cohort Study. Sci Rep 2020; 10:10199. [PMID: 32576950 PMCID: PMC7311464 DOI: 10.1038/s41598-020-67019-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/29/2020] [Indexed: 01/01/2023] Open
Abstract
We compared the prognostic value of nutritional or volumetric parameters measured by body composition in hospitalized patients on maintenance hemodialysis. We conducted a cohort study to assess the association of different parameters of body composition with all-cause mortality in inpatients admitted to our nephrology department from January 2014 to December 2016. Of the 704 study patients, 160 (22.7%) died during a median follow-up of 33 months. In multivariate adjusted Cox models, higher ratio of extracellular water to body cell mass (ECW/BCM) (adjusted HR per 1-SD, 1.49; 95% CI, 1.19 to 1.85), lower lean tissue index (LTI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.57 to 0.86) and lower body cell mass index (BCMI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.58 to 0.85) were associated with a significantly greater risk of death. When these parameters were added to the fully adjusted model, BCMI performed best in improving the predictability for all-cause mortality (integrated discrimination improvement = 0.02, P = 0.04; net reclassification index = 0.11, P = 0.04). Among body composition indexes, ECW/BCM was the most relevant fluid volume indices to mortality and BCMI and LTI were the most relevant nutritional status indices to mortality in maintenance hemodialysis patients.
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Battaglia Y, Ullo I, Massarenti S, Esposito P, Prencipe M, Ciancio G, Provenzano M, Fiorini F, Andreucci M, Storari A, Sabatino A, Fiaccadori E, Granata A. Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients. Nutrients 2020; 12:nu12051388. [PMID: 32408709 PMCID: PMC7285004 DOI: 10.3390/nu12051388] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-393-432-0061
| | - Ines Ullo
- Division of Nephrology, ASST Sette Laghi, 21100 Varese, Italy;
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Prencipe
- Division of Nephrology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71100 Foggia, Italy;
| | - Giovanni Ciancio
- Division of Rheumatology, University of Ferrara, 44121 Ferrara, Italy;
| | - Michele Provenzano
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Fulvio Fiorini
- Division of Nephrology and Dialysis, “Santa Maria della Misericordia” Hospital, 45100 Rovigo, Italy;
| | - Michele Andreucci
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
| | - Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Antonio Granata
- Division of Nephrology, San Giovanni di Dio Hospital, 92100 Agrigento, Italy;
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Mizuiri S, Nishizawa Y, Yamashita K, Ono K, Usui K, Arita M, Naito T, Doi S, Masaki T, Shigemoto K. Relationship of serum magnesium level with body composition and survival in hemodialysis patients. Hemodial Int 2019; 24:99-107. [DOI: 10.1111/hdi.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Sonoo Mizuiri
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Yoshiko Nishizawa
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Kazuomi Yamashita
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Kyoka Ono
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic10‐3 Asahien, Saeki‐ku Hiroshima 731‐5133 Japan
| | - Michiko Arita
- Iciyokai East Clinic1‐3‐53 Danbaraminami Minami‐ku Hiroshima 732‐0814 Japan
| | - Takayuki Naito
- Ichiyokai Yokogawa Clinic2‐7‐9 Yokogawacho Nishi‐ku Hiroshima 733‐0011 Japan
| | - Shigehiro Doi
- Department of NephrologyHiroshima University, 1‐2‐3 Kasumi Minami‐ku Hiroshima 734‐8551 Japan
| | - Takao Masaki
- Department of NephrologyHiroshima University, 1‐2‐3 Kasumi Minami‐ku Hiroshima 734‐8551 Japan
| | - Kenichiro Shigemoto
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
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Bordoni L, Smerilli V, Nasuti C, Gabbianelli R. Mitochondrial DNA methylation and copy number predict body composition in a young female population. J Transl Med 2019; 17:399. [PMID: 31779622 PMCID: PMC6883616 DOI: 10.1186/s12967-019-02150-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Since both genomic and environmental factors are involved in obesity etiology, several studies about the influence of adiposity on both nuclear DNA and mitochondrial DNA methylation patterns have been carried out. Nevertheless, few evidences exploring the usage of buccal swab samples to study mitochondrial DNA epigenetics can be found in literature. Methods In this study, mitochondrial DNA from buccal swabs collected from a young Caucasian population (n = 69) have been used to examine potential correlation between mitochondrial DNA copy number and methylation with body composition (BMI, WHtR and bioimpedance measurements). Results A negative correlation between mitochondrial DNA copy number and BMI was measured in females (p = 0.028), but not in males. The mean percentage of D-loop methylation is significantly higher in overweight than in lean female subjects (p = 0.003), and a specific CpG located in the D-loop shows per se an association with impaired body composition (p = 0.004). Body composition impairment is predicted by a combined variable including mtDNA copy number and the D-loop methylation (AUC = 0.785; p = 0.009). Conclusions This study corroborates the hypothesis that mitochondrial DNA carries relevant information about body composition. However, wider investigations able to validate the usage of mtDNA methylation from buccal swabs as a biomarker are warranted.
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Affiliation(s)
- Laura Bordoni
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032, Camerino, MC, Italy
| | - Vanessa Smerilli
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032, Camerino, MC, Italy
| | - Cinzia Nasuti
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032, Camerino, MC, Italy
| | - Rosita Gabbianelli
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032, Camerino, MC, Italy.
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Yu B, Park KB, Park JY, Lee SS, Kwon OK, Chung HY. Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis. J Gastric Cancer 2019; 19:278-289. [PMID: 31598371 PMCID: PMC6769372 DOI: 10.5230/jgc.2019.19.e22] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose Phase angle obtained using bioelectrical impedance analysis (BIA) provides a relatively precise assessment of the nutritional status of elderly patients. This study aimed to evaluate the significance of phase angle as a risk factor for complications after gastrectomy in elderly patients. Materials and Methods We evaluated 210 elderly patients (aged ≥65 years) who had undergone gastrectomy for gastric cancer between August 2016 and August 2017. The phase angle cutoff value was calculated using receiver operating characteristic curve analysis according to sex. A retrospective analysis regarding the correlation between early postoperative complications and well-known risk factors, including the phase angle, was performed. Results Multivariate analysis revealed that the presence of two or more comorbidities (odds ratio [OR], 3.675) and hypoalbuminemia (OR, 4.059) were independent risk factors for overall complications, and female sex (OR, 2.993) was independent risk factor for severe complications. A low phase angle (OR, 2.901 and 4.348, respectively) and total gastrectomy (OR, 4.718 and 3.473, respectively) were independent risk factors for both overall and severe complications. Conclusions Our findings show that preoperative low phase angle predicts the risk of overall and severe complications. Our findings suggest that BIA should be performed to assess the risk of postoperative complications in elderly patients with gastric cancer.
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Affiliation(s)
- Byunghyuk Yu
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Yeon Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Low Bioelectrical Impedance Phase Angle Is a Significant Risk Factor for Frailty. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6283153. [PMID: 31281842 PMCID: PMC6590642 DOI: 10.1155/2019/6283153] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
Abstract
The phase angle, which is measured via bioelectrical impedance analysis (BIA), is a clinically important bioimpedance parameter used for nutritional assessment and evaluating the risk of various diseases, such as locomotive syndrome (LS). It remains unclear if the phase angle is associated with frailty (fragile state of physical and mental health). We therefore examined this association in a large prospective sample. Of 1081 individuals receiving health checkups, 550 (male; 235, female; 365) were enrolled in this study. We applied the Japanese version of the Cardiovascular Health Study criteria to evaluate frailty and administered the 25-Item Geriatric Locomotive Function Scale to diagnose LS. The phase angle was measured via BIA. Multiple logistic regression analysis was used to evaluate the relationship between the phase angle and frailty. For all participants and for each sex, the phase angle was significantly lower among individuals with frailty. After controlling for age, sex, and body mass index, we found that a low phase angle was a significant risk factor of frailty. As a result of multiple regression analysis including other confounding factors, among male participants, a low phase angle was significantly related with both frailty (P = 0.015) and LS (P < 0.001), whereas among female participants, the low phase angle had a stronger association with frailty (P = 0.001) than with LS (P = 0.52). Our findings suggest that a low angle is a risk factor of frailty. Furthermore, among female participants, frailty has a stronger relation with the phase angle than does LS. Therefore, the phase angle may be considered a useful indicator of frailty that does not require lengthy or costly assessment.
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Valente A, Caetano C, Oliveira T, Garagarza C. Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index? Nephrology (Carlton) 2018; 24:967-974. [PMID: 30414231 DOI: 10.1111/nep.13527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluate which of two combinations of parameters based on International Society of Renal Nutrition and Metabolism recommendations could better identify patients with protein-energy wasting (PEW) and to compare the relationship of these two combinations with other clinical and body composition parameters. METHODS This was a multicentre longitudinal study with 24 months of follow-up. The PEW patients were characterized by: Group A (GA ) - normalized protein catabolic rate (nPCR) < 1.0 g/kg per day, albumin <3.8 g/dL and body cell mass index (BCMI) < 6.4 kg/m2 (n = 203); Group B (GB ) - nPCR <1.0 g/kg per day, albumin <3.8 g/dL and body mass index (BMI) <23 kg/m2 (n = 109). All the patients who did not meet these requirements were considered "well-nourished" (GA : n = 1818; GB : n = 3292). RESULTS When compared to the well-nourished patients, PEW patients in the GA presented higher age, Kt/V, C-reactive protein, relative overhydration, fat tissue index (FTI); lower creatinine, albumin, nPCR, PTH, haemoglobin, phosphorus, calcium X phosphorus product, potassium, dry weight, BMI, BCMI, lean tissue index, %IDWG . In the GB , well-nourished patients FTI was significantly higher. In Cox analysis, the combination with BCMI was a strong independent predictor of mortality in these patients (hazard ratio: 1.48; confidence interval: 1.00-2.19; P = 0.048), even after adjustment. Although GB combination seemed to be also a predictor of death (hazard ratio: 2.67; confidence interval: 1.92-3.71; P < 0.001), when adjusted, the association remained no longer significant. CONCLUSION A new combination of parameters including protein intake, albumin and BCMI demonstrated significant associations with other nutrition and inflammation parameters as well as with mortality.
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Tanaka S, Ando K, Kobayashi K, Hida T, Seki T, Hamada T, Ito K, Tsushima M, Morozumi M, Machino M, Ota K, Ishiguro N, Hasegawa Y, Imagama S. The decrease in phase angle measured by bioelectrical impedance analysis reflects the increased locomotive syndrome risk in community-dwelling people: The Yakumo study. Mod Rheumatol 2018; 29:496-502. [PMID: 29694263 DOI: 10.1080/14397595.2018.1469582] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The locomotive syndrome (LS) risk test has recently been advocated for the evaluation of physical ability. Phase angle measurement by bioelectrical impedance analysis (BIA) is an indicator of cellular health and muscle mass. We aimed to investigate how muscle mass and phase angle are related to LS risk stage. METHODS A prospective cohort study was conducted in 311 patients who were undergoing a health checkup. All participants performed the two-step test, stand-up test, and 25-question geriatric locomotive function scale components of the LS risk test. Muscle mass and phase angle were measured using BIA. A comparison study was conducted among the three LS risk stages. RESULTS In the trend test, phase angle decreased significantly as the LS risk stage progressed, whereas muscle mass did not show a significant difference. After adjusting for age and sex, phase angle showed a significant difference among all LS risk stages. Muscle mass did not show a significant difference between no risk and stage 1. CONCLUSION Compared to muscle mass, phase angle more strongly reflects LS risk and becomes significantly reduced at later LS risk stages. Phase angle can be a useful screening tool for LS risk.
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Affiliation(s)
- Satoshi Tanaka
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kei Ando
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazuyoshi Kobayashi
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Tetsuro Hida
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Taisuke Seki
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Takashi Hamada
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kenyu Ito
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Mikito Tsushima
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Masayoshi Morozumi
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Masaaki Machino
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kyotaro Ota
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Naoki Ishiguro
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yukiharu Hasegawa
- b Department of Rehabilitation , Kansai University of Welfare Science , Osaka , Japan
| | - Shiro Imagama
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
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Urbano APS, Sassaki LY, Dorna MDS, Presti PT, Carvalhaes MADBL, Martini LA, Ferreira ALA. Associations among body composition, inflammatory profile and disease extent in ulcerative colitis patients. ACTA ACUST UNITED AC 2018; 64:133-139. [PMID: 29641662 DOI: 10.1590/1806-9282.64.02.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/06/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to assess body composition status and its association with inflammatory profile and extent of intestinal damage in ulcerative colitis patients during clinical remission. METHOD This is a cross-sectional study in which body composition data (phase angle [PhA], fat mass [FM], triceps skin fold thickness [TSFt], mid-arm circumference [MAC], mid-arm muscle circumference [MAMC], adductor pollicis muscle thickness [APMt]), inflammatory profile (C-reactive protein [CRP], a1-acid glycoprotein, erythrocyte sedimentation rate [ESR]) and disease extent were recorded. RESULTS The mean age of the 59 patients was 48.1 years; 53.3% were women. Most patients were in clinical remission (94.9%) and 3.4% was malnourished according to body mass index. PhA was inversely correlated with inflammatory markers such as CRP (R=-0.59; p<0.001) and ESR (R=-0.46; p<0.001) and directly correlated with lean mass: MAMC (R=0.31; p=0.01) and APMt (R=0.47; p<0.001). Lean mass was inversely correlated with non-specific inflammation marker (APMt vs. ESR) and directly correlated with hemoglobin values (MAMC vs. hemoglobin). Logistic regression analysis revealed that body cell mass was associated with disease extent (OR 0.92; 95CI 0.87-0.97; p<0.01). CONCLUSION PhA was inversely correlated with inflammatory markers and directly correlated with lean mass. Acute inflammatory markers were correlated with disease extent. Body cell mass was associated with disease extent.
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Affiliation(s)
- Ana Paula Signori Urbano
- Department of Internal Medicine, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Mariana de Souza Dorna
- Department of Internal Medicine, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Paula Torres Presti
- Department of Internal Medicine, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | | | - Ligia Araújo Martini
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Lucia Anjos Ferreira
- Department of Internal Medicine, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Tanaka S, Ando K, Kobayashi K, Hida T, Ito K, Tsushima M, Morozumi M, Machino M, Ota K, Seki T, Ishiguro N, Hasegawa Y, Imagama S. A low phase angle measured with bioelectrical impedance analysis is associated with osteoporosis and is a risk factor for osteoporosis in community-dwelling people: the Yakumo study. Arch Osteoporos 2018; 13:39. [PMID: 29623499 DOI: 10.1007/s11657-018-0450-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/27/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although the phase angle has been reported to be related to predictive factors and therapeutic effects in various diseases, its relation with osteoporosis is unclear. In our large prospective survey of community-dwelling people, a low phase angle was related with osteoporosis, and it could be a predictor of osteoporosis. PURPOSE The phase angle measured with bioelectrical impedance analysis (BIA) is one of the clinically important impedance parameters, and it is a predictor of prognosis and mortality for several diseases. The present cross-sectional study aimed to elucidate the association between osteoporosis and variables measured with BIA, including the phase angle. METHODS The study included 307 participants from an annual health checkup. All participants underwent measurement of bone status by quantitative ultrasound and body composition by BIA. Osteoporosis was diagnosed according to the WHO classification, and statistical comparisons were conducted between normal individuals and osteoporosis patients. RESULTS Age, proteins, minerals, and the phase angle were significantly different between normal individuals and osteoporosis patients (p < 0.001). Furthermore, after controlling for age and sex, proteins, minerals, and the phase angle were significantly lower in osteoporosis patients than those in normal individuals (p < 0.001). In multivariate logistic regression analysis, older age and a low phase angle were risk factors for osteoporosis. Additionally, multiple regression analysis showed that age, sex, proteins, minerals, and the appendicular skeletal muscle index were significantly related to the phase angle. CONCLUSIONS The phase angle is a predictor of osteoporosis, which is unaffected by age and sex, and a lower phase angle is associated with greater probability of osteoporosis. The phase angle can be easily measured, and osteoporosis can be confirmed even at home. This may facilitate early diagnosis and treatment, which may be useful for preventing diseases related to osteoporosis.
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Affiliation(s)
- Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kenyu Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kyotaro Ota
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan.
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30
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Saad MAN, Jorge AJL, de Andrade Martins W, Cardoso GP, dos Santos MMS, Rosa MLG, Lima GAB, de Moraes RQ, da Cruz Filho RA. Phase angle measured by electrical bioimpedance and global cardiovascular risk in older adults. Geriatr Gerontol Int 2018; 18:732-737. [DOI: 10.1111/ggi.13241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Maria AN Saad
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
| | - Antonio JL Jorge
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Cardiovascular Sciences from the Fluminense Federal University; Niterói Brazil
| | - Wolney de Andrade Martins
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Cardiovascular Sciences from the Fluminense Federal University; Niterói Brazil
| | - Gilberto P Cardoso
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
| | - Marcia MS dos Santos
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
| | - Maria LG Rosa
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Cardiovascular Sciences from the Fluminense Federal University; Niterói Brazil
| | - Giovanna AB Lima
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
| | - Rafaela Q de Moraes
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
| | - Rubens A da Cruz Filho
- Department of Clinical Medicine - Universidade Federal Fluminense, Post Graduation Program in Medical Sciences from the Fluminense Federal University; Niterói Brazil
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31
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Bellafronte NT, Batistuti MR, dos Santos NZ, Holland H, Romão EA, G. Chiarello P. Estimation of Body Composition and Water Data Depends on the Bioelectrical Impedance Device. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2018; 9:96-105. [PMID: 33584925 PMCID: PMC7852023 DOI: 10.2478/joeb-2018-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 06/12/2023]
Abstract
Overweight, obese and chronic kidney disease patients have an altered and negative body composition being its assessment important. Bioelectrical impedance analysis is an easy-to-operate and low-cost method for this purpose. This study aimed to compare and correlate data from single- and multi-frequency bioelectrical impedance spectroscopy applied in subjects with different body sizes, adiposity, and hydration status. It was a cross-sectional study with 386 non-chronic kidney disease volunteers (body mass index from 17 to 40 kg/m2), 30 patients in peritoneal dialysis, and 95 in hemodialysis. Bioelectrical impedance, body composition, and body water data were assessed with single- and multi-frequency bioelectrical impedance spectroscopy. Differences (95% confidence interval) and agreements (Bland-Atman analyze) between devices were evaluated. The intraclass correlation coefficient was used to measure the strength of agreement and Pearson's correlation to measure the association. Regression analyze was performed to test the association between device difference with body mass index and overhydration. The limits of agreement between devices were very large. Fat mass showed the greatest difference and the lowest intraclass and Pearson's correlation coefficients. Pearson's correlation varied from moderate to strong and the intraclass correlation coefficient from weak to substantial. The difference between devices were greater as body mass index increased and was worse in the extremes of water imbalance. In conclusion, data obtained with single- and multi-frequency bioelectrical impedance spectroscopy were highly correlated with poor agreement; the devices cannot be used interchangeably and the agreement between the devices was worse as body mass index and fat mass increased and in the extremes of overhydration.
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Affiliation(s)
- Natália T. Bellafronte
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina R. Batistuti
- Department of Physics and Chemistry, Faculty of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | - Nathália Z. dos Santos
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Héric Holland
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elen A. Romão
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula G. Chiarello
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Wong Vega M, Srivaths PR. Air Displacement Plethysmography Versus Bioelectrical Impedance to Determine Body Composition in Pediatric Hemodialysis Patients. J Ren Nutr 2017; 27:439-444. [DOI: 10.1053/j.jrn.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022] Open
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Jo IY, Kim WJ, Park HC, Choi HY, Lee JE, Lee SM. Effect of Personalized Nutritional Counseling on the Nutritional Status of Hemodialysis Patients. Clin Nutr Res 2017; 6:285-295. [PMID: 29124049 PMCID: PMC5665750 DOI: 10.7762/cnr.2017.6.4.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 01/01/2023] Open
Abstract
This study set out to evaluate the impact of personalized nutritional counseling (PNC) on the nutritional status of hemodialysis (HD) patients. This was an intervention study for 10 months at 2 hospitals. Anthropometric, biochemical, dietary, and body composition parameters were measured at baseline and after 3 and 6 months of PNC. A total of 42 patients (23 men and 19 women) were included. Intake of dietary protein, serum albumin, and cholesterol levels had increased significantly from baseline to month 6 (p < 0.05). Among the bioelectrical impedance analysis (BIA) parameters, both the body cell mass (BCM) and the fat free mass (FFM) had significantly reduced at month 3 compared to baseline (p < 0.05). However, there was no difference between baseline and month 6. We assessed the nutritional status of the subjects using the malnutrition inflammation score (MIS), and divided them into an adequately nourished (AN) and a malnourished (MN) group at baseline. In the subgroup analysis, serum levels of albumin and cholesterol had increased significantly, particularly from baseline to month 6 in the MN group (p < 0.05). This study suggests that consecutive PNC contributed to the improvement of the protein intake, serum levels of albumin, cholesterol and to the delay of muscle wasting, which could also have a positive impact on the nutritional status, particularly in malnourished patients receiving HD treatment.
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Affiliation(s)
- In-Young Jo
- Department of Nutrition Care, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Woo Jeong Kim
- Department of Nutrition Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hyeong Cheon Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hoon Young Choi
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jung Eun Lee
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 17046, Korea
| | - Song Mi Lee
- Department of Nutrition Care, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
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Clinical utility of bioelectrical impedance analysis in patients with locoregional muscle invasive or metastatic urothelial carcinoma: a subanalysis of changes in body composition during neoadjuvant systemic chemotherapy. Support Care Cancer 2017; 26:1077-1086. [DOI: 10.1007/s00520-017-3924-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/02/2017] [Indexed: 01/13/2023]
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Shin JH, Kim CR, Park KH, Hwang JH, Kim SH. Predicting clinical outcomes using phase angle as assessed by bioelectrical impedance analysis in maintenance hemodialysis patients. Nutrition 2017; 41:7-13. [PMID: 28760431 DOI: 10.1016/j.nut.2017.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/28/2016] [Accepted: 02/21/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Protein-energy wasting is common in patients on hemodialysis and is an independent risk factor for adverse events. The aim of this study was to retrospectively investigate whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in patients with end-stage renal disease (ESRD) who are receiving hemodialysis. METHODS Using bioelectrical impedance analysis (BIA), PA was obtained every 6 mo, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, and group B included patients with PA <4.5°. RESULTS We followed 142 patients for a median of 29 mo (12-42 mo). We found that a decrease in PA was associated with an increased risk for death that persisted after adjusting for age, sex, and comorbidities (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.33-0.97). Cardiovascular events were not associated with PA (P = 0.685). We found that PA predicted the occurrence of infection, independent of age, sex, and comorbidities (HR, 0.65; 95% CI, 0.45-0.94). Although levels of hemoglobin did not differ between groups during the study period, patients in group B received higher doses of erythropoiesis-stimulating agents and intravenous iron than those in group A (P = 0.004 and 0.044, respectively). In longitudinal analyses, we did not find increases in PA over time in patients who had a mean dialysis adequacy ≥1.4, daily protein catabolic rate ≥1.2 g/kg, or total carbon dioxide level ≥22 mmol/L. CONCLUSIONS PA assessed in a simple manner using BIA provides practical information to predict clinical outcomes in ESRD patients on maintenance hemodialysis.
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Affiliation(s)
- Jung-Ho Shin
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Chae Rim Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ki Hyun Park
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
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36
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Bordoni L, Napolioni V, Marchegiani F, Amadio E, Gabbianelli R. Angiotensin-Converting Enzyme Ins/Del Polymorphism and Body Composition: The Intermediary Role of Hydration Status. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2017; 10:1-8. [PMID: 28315876 DOI: 10.1159/000458154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The well-known insertion/deletion polymorphism (rs4646994) of the angiotensin-converting enzyme (ACE) gene has been previously associated with obesity, blood flow, muscular strength, and ACE enzyme activity. Despite the relevant role of ACE in homeostasis, few data are currently available on the relationship between rs4646994 and hydration status. Thus, we tested the association between the ACE Ins/Del polymorphism, body composition, and hydration status in a young Italian population. METHODS A total of 306 healthy children and adolescents who regularly practice sports were recruited. Anthropometric, bioimpedentiometric parameters, and urine samples were collected, while ACE rs4646994 genotyping was performed on DNA from buccal swabs. General linear models were used for association testing. RESULTS The ACE Ins/Del polymorphism was associated with body composition. Ins/Ins individuals had higher phase angle (PhA) and body cellular mass index (BCMI) values. A significant influence of the ACE rs4646994 according to hydration status on body composition was also identified. In particular, Ins/Ins individuals displayed higher PhA and BCMI values only if norm-hydrated, while they showed values similar to Del carriers if dehydrated. CONCLUSION Our results confirm the relationship between the ACE Ins/Del polymorphism and body composition and suggest a role for hydration status in modulating this relationship. These interesting preliminary results warrant further investigation to disentangle the genetic role of ACE on hydration homeostasis.
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Affiliation(s)
- Laura Bordoni
- School of Advanced Studies, University of Camerino, Camerino, Italy
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Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients. Aging Clin Exp Res 2016; 28:1121-1126. [PMID: 26786583 DOI: 10.1007/s40520-015-0528-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Phase angle (PhA) value determined by bioelectrical impedance analysis (BIA) is an indicator of cell membrane damage and body cell mass. Recent studies have shown that low PhA value is associated with increased nutritional risk in various group of patients. However, there have been only a few studies performed globally assessing the relationship between nutritional risk and PhA in hospitalized geriatric patients. The aim of the study is to evaluate the predictive value of the PhA for malnutrition risk in hospitalized geriatric patients. METHODS One hundred and twenty-two hospitalized geriatric patients were included in this cross-sectional study. Comprehensive geriatric assessment tests and BIA measurements were performed within the first 48 h after admission. Nutritional risk state of the patients was determined with NRS-2002. Phase angle values of the patients with malnutrition risk were compared with the patients that did not have the same risk. The independent variables for predicting malnutrition risk were determined. SPSS version 15 was utilized for the statistical analyzes. RESULTS The patients with malnutrition risk had significantly lower phase angle values than the patients without malnutrition risk (p = 0.003). ROC curve analysis suggested that the optimum PhA cut-off point for malnutrition risk was 4.7° with 79.6 % sensitivity, 64.6 % specificity, 73.9 % positive predictive value, and 73.9 % negative predictive value. BMI, prealbumin, PhA, and Mini Mental State Examination Test scores were the independent variables for predicting malnutrition risk. CONCLUSIONS PhA can be a useful, independent indicator for predicting malnutrition risk in hospitalized geriatric patients.
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Rimsevicius L, Gincaite A, Vicka V, Sukackiene D, Pavinic J, Miglinas M. Malnutrition Assessment in Hemodialysis Patients: Role of Bioelectrical Impedance Analysis Phase Angle. J Ren Nutr 2016; 26:391-395. [DOI: 10.1053/j.jrn.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/29/2016] [Indexed: 01/04/2023] Open
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Gavrilovic B, Bradley TD, Vena D, Lyons OD, Gabriel JM, Popovic MR, Yadollahi A. Factors predisposing to worsening of sleep apnea in response to fluid overload in men. Sleep Med 2016; 23:65-72. [PMID: 27692279 DOI: 10.1016/j.sleep.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/03/2016] [Accepted: 05/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is highly prevalent in patients with fluid-retaining conditions. Using bioimpedance measurements, previous studies have shown that the greater the amount of fluid redistributed from the legs to the neck overnight, the greater the severity of OSA. Our objective was to investigate factors that predispose the development or worsening of OSA in response to experimental fluid overload. METHODS Fifteen normotensive and non-obese adult men with and without OSA underwent polysomnography (PSG) during which normal saline was infused intravenously at a minimal rate to keep the vein open (control) or as a bolus of 22 ml/kg body weight (approximately 2 L) in a random order and crossed over after a week. RESULTS AND CONCLUSIONS Before and after sleep, neck circumference and bioimpedance were measured to calculate neck resistance, reactance, phase angle, and fluid volume. Subjects who experienced more than a twofold increase in apnea-hypopnea index (AHI) or obstructive AHI from control to intervention and had an AHI>10 during intervention were considered susceptible to the development or worsening of OSA. Baseline neck circumference and phase angle before saline infusion were independently associated with increased susceptibility to developing or worsening OSA in response to saline infusion. In non-obese men, a larger neck circumference and bioimpedance phase angle of the neck, which may be associated with larger pharyngeal tissue content, is associated with increased susceptibility for worsening of OSA in response to fluid overloading.
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Affiliation(s)
- Bojan Gavrilovic
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - T Douglas Bradley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Vena
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Owen D Lyons
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Joseph M Gabriel
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Milos R Popovic
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Azadeh Yadollahi
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
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Buscemi S, Batsis JA, Parrinello G, Massenti FM, Rosafio G, Sciascia V, Costa F, Pollina Addario S, Mendola S, Barile AM, Maniaci V, Rini N, Caimi G. Nutritional predictors of mortality after discharge in elderly patients on a medical ward. Eur J Clin Invest 2016; 46:609-18. [PMID: 27112375 DOI: 10.1111/eci.12637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/22/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. MATERIALS AND METHODS This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. RESULTS Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004). CONCLUSIONS The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.
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Affiliation(s)
- Silvio Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - John A Batsis
- Section of General Internal Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gaspare Parrinello
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Fatima M Massenti
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Giuseppe Rosafio
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Vittoria Sciascia
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Costa
- Servizio di Ingegneria Clinica, Policlinico 'P. Giaccone', Palermo, Italy
| | | | - Serena Mendola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Anna M Barile
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Vincenza Maniaci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Nadia Rini
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Gregorio Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
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Koefoed M, Kromann CB, Hvidtfeldt D, Juliussen SR, Andersen JR, Marckmann P. Historical Study (1986-2014): Improvements in Nutritional Status of Dialysis Patients. J Ren Nutr 2016; 26:320-4. [PMID: 27266624 DOI: 10.1053/j.jrn.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/02/2016] [Accepted: 04/26/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. DESIGN Historical study comparing results of two cross-sectional studies performed in 1986 and 2014. SETTING We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated at the dialysis center at Fredericia Hospital, Denmark, in April 1986. SUBJECTS Maintenance PD and HD patients (n = 64 in 2014 and n = 48 in 1986). METHODS We performed anthropometry (body weight, triceps skinfold, and midarm muscle circumferences [MAMCs]) and determined plasma transferrin. MAIN OUTCOME MEASURE Relative body weight, triceps skinfold, MAMC, body mass index, and prevalence of protein-caloric malnutrition as defined in the original study from 1986. RESULTS Average relative body weight, triceps skinfold, MAMC, and body mass index were significantly higher in 2014 compared with 1986. The prevalence of protein-caloric malnutrition was significantly lower in 2014 (18%) compared with 1986 (52%). CONCLUSIONS The nutritional status of maintenance dialysis patients has improved during the last 3 decades. The reason for this improvement could not be identified in the present study, but the most likely contributors are the higher prevalence of obesity in the general population, less predialytic malnutrition, and an improved focus on nutrition in maintenance dialysis patients.
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Affiliation(s)
- Mette Koefoed
- Department of Internal Medicine, Section of Nephrology, Holbæk Hospital, Denmark.
| | - Charles Boy Kromann
- Department of Internal Medicine, Section of Nephrology, Zealand University Hospital, Denmark
| | - Danni Hvidtfeldt
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Peter Marckmann
- Department of Internal Medicine, Section of Nephrology, Zealand University Hospital, Denmark
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Demirci C, Aşcı G, Demirci MS, Özkahya M, Töz H, Duman S, Sipahi S, Erten S, Tanrısev M, Ok E. Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients. Int Urol Nephrol 2016; 48:1155-62. [PMID: 27093965 DOI: 10.1007/s11255-016-1292-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Impedance ratio (Imp-R) obtained by multifrequency bioimpedance analysis (BIA) has been shown to be associated with volume and nutrition status. In this prospective study, the predictive role of Imp-R for mortality in hemodialysis (HD) patients was investigated. METHODS Multifrequency (5-50-100-200 kHz) BIA was applied to 493 prevalent HD patients in March-April 2006. Imp-R was defined as the ratio of 200-5 kHz impedance values. Demographical, clinical and laboratory data at the time of the analysis were recorded. All-cause and cardiovascular (CV) mortality were assessed during 3 years of follow-up. RESULTS Mean age was 57.7 ± 13.9 years, HD duration 52.1 ± 42.6 months and prevalence of diabetes 21.7 %. Imp-R was negatively correlated with nutritional markers including albumin, creatinine and hemoglobin levels. In addition, there was a positive correlation between Imp-R and age, ratio of extracellular water to total body water and high-sensitive C-reactive protein. Over a mean follow-up period of 27.9 ± 11.1 months, 93 deaths (52 from CV reasons) were observed. In the multivariate analysis, Imp-R was significantly associated with all-cause and CV mortality after adjustments [HR 1.13, 95 % CI (1.04-1.23); p = 0.004 and HR 1.15, 95 % CI (1.03-1.27); p = 0.01, respectively]. The risk of all-cause mortality was 3.4 times higher in the fourth quartile of Imp-R (>83.5 %) compared to the first Imp-R quartile (<78.8 %) as reference. Cutoff value of Imp-R for all-cause mortality was 82.0 % with a sensitivity of 65.5 % and specificity of 64 %. CONCLUSION Impedance ratio measured by multifrequency in standardized conditions BIA is an independent and powerful predictor of both all-cause and CV mortality in hemodialysis patients.
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Affiliation(s)
| | - G Aşcı
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - M S Demirci
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - M Özkahya
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - H Töz
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - S Duman
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - S Sipahi
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - S Erten
- FMC Turkey Clinics, Izmir, Turkey
| | - M Tanrısev
- Tepecik Training and Research Hospital, Izmir, Turkey
| | - E Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
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Ren H, Gong D, Jia F, Xu B, Liu Z. Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate, risk factors and its effect on survival risk. Ren Fail 2016; 38:364-71. [PMID: 26738817 DOI: 10.3109/0886022x.2015.1132173] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sarcopenia is a degenerative syndrome mainly characterized by the atrophy of skeletal muscle, along with the decrease of muscle strength and function. However, there are currently few studies concerning sarcopenia in patients undergoing maintenance hemodialysis dialysis (MHD). This study was aimed to investigate the incidence of sarcopenia in MHD patients and its influencing factors, as well as its impact on survival risk. METHOD All 131 MHD patients enrolled in our study were tested with bioelectrical impedance analysis (BIA) and grip strength. Demographic data was collected and anthropometric measurement and laboratory examination were conducted. RESULTS The total incidence of sarcopenia within the 131 MHD patients was 13.7% and the incidence of sarcopenia in patients over 60 years was 33.3%. The dialysis duration, with or without diabetes, serum phosphorus and pre-albumin levels of sarcopenic patients were significantly different from those of non-sarcopenicones; the modified quantitative subjective global assessment (MQSGA) scores of sarcopenic patients were higher than those without sarcopenia. Multivariate analysis showed that dialysis duration, diabetes and serum phosphorus level were independent risk factors for sarcopenia in MHD patients. Kaplan-Meier survival analysis showed a one-year survival of 88.9% in sarcopenic patients, which was significantly lower than non-sarcopenic patients. CONCLUSION The incidence of sarcopenia in MHD patients was high and increased gradually with age. Dialysis duration, diabetes, serum phosphorus level and malnutrition predisposed the patients to sarcopenia. One-year follow-up found that the mortality risk of sarcopenic patients was higher than that of non-sarcopenic patients.
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Affiliation(s)
- Hongqi Ren
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine , Nanjing , China
| | - Dehua Gong
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine , Nanjing , China
| | - Fengyu Jia
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine , Nanjing , China
| | - Bin Xu
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine , Nanjing , China
| | - Zhihong Liu
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine , Nanjing , China
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Caetano C, Valente A, Oliveira T, Garagarza C. Body Composition and Mortality Predictors in Hemodialysis Patients. J Ren Nutr 2015; 26:81-6. [PMID: 26632642 DOI: 10.1053/j.jrn.2015.10.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate how different compartments of body composition can affect survival in hemodialysis (HD) patients. DESIGN Multicenter longitudinal observational study of a cohort of patients in HD with 12 months of follow-up. SETTING Patients from 34 Nephrocare dialysis units in Portugal were included. SUBJECTS A total of 697 patients on maintenance HD during 4 hours 3 days per week were enrolled. INTERVENTION Dry weight, presence of diabetes, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), albumin and hydration status were recorded at baseline. In all patients, the assessment of body composition was carried out using the Body Composition Monitor (BCM; Fresenius Medical Care a Deutschland GmbH, Germany). MAIN OUTCOME MEASURE Survival during a 12-month period of follow-up. RESULTS Patient's mean (±standard deviation) age was 65.4 ± 14.3 years, and median (interquartile range) HD vintage was 41 (19-81) months. Patients who died during the study period, had higher age (P < .001), lower dry weight (P = .001), BMI (P < .001), albumin (P < .001), LTI (P = .015), and also lower BCMI (P = .046). Patients with diabetes (P = .045), BMI < 18.5 kg/m(2) (P < .001), albumin < 4.0 g/dL (P < .001), relative overhydration ≥ 15% (P = .001), low FTI (P = .019), and also those in the lowest tertile of BCMI (P = .022) displayed a significantly worse survival. In the Cox regression analysis, the overall mortality of patient was related to low FTI, relative overhydration, BMI < 18.5 kg/m(2), BCMI ≤ 5.2 kg/m(2), and albumin < 4.0 g/dL. CONCLUSIONS Several body composition parameters demonstrated to have an important role in predicting 1-year mortality in HD patients. Albumin, FTI, and BMI were useful predictors of mortality in these patients.
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Affiliation(s)
| | - Ana Valente
- Nutrition Department, Nephrocare, Lisbon, Portugal
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Mathias-Genovez MG, Oliveira CC, Camelo JS, Del Ciampo LA, Monteiro JP. Bioelectrical Impedance of Vectorial Analysis and Phase Angle in Adolescents. J Am Coll Nutr 2015; 35:262-70. [PMID: 26391733 DOI: 10.1080/07315724.2015.1027798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Bioelectrical impedance can be interpreted by vector analysis using direct measures of the impedance vector; thus, collecting information about resistance (R), reactance (Xc), and phase angle (PA) makes it possible to classify an individual's nutritional status. The aim of this study was to investigate these values and construct bioelectrical references for healthy Brazilian adolescents. METHODS This is a cross-sectional study that included 567 healthy adolescents, aged 10 to 18 years. The bioelectrical impedance was performed to collect data for R and Xc. In addition, weight and height were also collected. The PA was calculated, and thereby the tolerance and confidence ellipses were constructed using specific software. RESULTS For boys the mean vectors of 11 and 12 years, 12 and 13 years, 13 and 14 years, and 15 and 16 years were different from each other (p < 0.05). For girls the only mean vectors with significant differences were 11 and 12 years (p = 0.0071). The results differ from those in the literature, possibly due to ethnic differences in body composition. CONCLUSION The present study provides an important tool for monitoring the nutritional status of adolescents of different ages, without previous knowledge of some anthropometric measures such as body weight.
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Affiliation(s)
- Mariana G Mathias-Genovez
- a Department of Pediatrics , School of Medicine of Ribeirão Preto (M.G.M.-G., J.S.C., L.A.D.C., J.P.M.), University of São Paulo (C.C.O.) , Ribeirão Preto , São Paulo , BRAZIL
| | | | - José S Camelo
- a Department of Pediatrics , School of Medicine of Ribeirão Preto (M.G.M.-G., J.S.C., L.A.D.C., J.P.M.), University of São Paulo (C.C.O.) , Ribeirão Preto , São Paulo , BRAZIL
| | - Luiz A Del Ciampo
- a Department of Pediatrics , School of Medicine of Ribeirão Preto (M.G.M.-G., J.S.C., L.A.D.C., J.P.M.), University of São Paulo (C.C.O.) , Ribeirão Preto , São Paulo , BRAZIL
| | - Jacqueline P Monteiro
- a Department of Pediatrics , School of Medicine of Ribeirão Preto (M.G.M.-G., J.S.C., L.A.D.C., J.P.M.), University of São Paulo (C.C.O.) , Ribeirão Preto , São Paulo , BRAZIL
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Lee JE, Jo IY, Lee SM, Kim WJ, Choi HY, Ha SK, Kim HJ, Park HC. Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis. Clin Interv Aging 2015; 10:1327-34. [PMID: 26316728 PMCID: PMC4541557 DOI: 10.2147/cia.s86229] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The number of elderly people on dialysis is increasing rapidly. Fluid overload and malnutrition status are serious problems in elderly dialysis patients. We aimed to compare the hydration and nutritional status through bioimpedance analysis (BIA) between young and elderly hemodialysis (HD) patients and to analyze risk factors related to fluid overload and malnutrition status in these patients. Method We conducted a cross-sectional study, in which 82 HD (males 42, mean age 58.7±12.9 years) patients were enrolled. We collected different types of data: laboratory data, such as serum creatinine, albumin, total iron-binding capacity, hemoglobin, total cholesterol; anthropometric data, such as hand grip strength (HGS); BIA data, such as intracellular water, skeletal muscle mass, body cell mass, bone mineral content, phase angle (PhA), extra cellular water (ECW)/total body water (TBW) ratio; and malnutrition-inflammation score (MIS), which is a traditional nutritional parameter for dialysis patients. All patients were stratified into two groups according to their age: young (<65 years [n=54]) and elderly (≥65 years [n=28]). Results Total iron-binding capacity and HGS were significantly lower in elderly HD patients than in young HD patients (198.9±35.6 vs 221.4±52.1 mcg/dL; and 22.4±10.3 vs 36.4±23.2 kg, respectively) (P<0.05). Also, intracellular water and PhA measured by BIA were significantly lower (18.3±4.0 vs 20.3±4.2 L [P=0.043]; and 4.0±1.0 vs 4.9±1.2° [P=0.002], respectively), and ECW/TBW were higher in elderly HD patients (0.40±0.01 vs 0.39±0.01 [P=0.001]). ECW/TBW was positively associated with age (P<0.001) and the presence of diabetes (P<0.001) and was negatively associated with sex (P=0.001), albumin (P<0.001), urine volume (P=0.042), HGS (P<0.001), and PhA by BIA (P<0.001). MIS was negatively related to sex (P=0.001), albumin (P<0.001), HGS (P=0.001), and PhA (P<0.001) in HD patients. On multivariate analysis, older age (P=0.031), the presence of diabetes (P=0.035), and decreased PhA (P<0.001) were independent risk factors for increased ECW/TBW, representative of fluid overload status, whereas only decreased PhA (P=0.008) was a significant factor for MIS, representative of malnutrition status in these HD patients. Conclusion We found that fluid overload and malnutrition status were more common in elderly HD patients compared with young HD patients. PhA was a significant independent factor in fluid overload status and malnutrition in these HD patients. Thus, our results indicated that PhA assessed by BIA might be a clinically useful method for assessing nutritional and hydration status in elderly HD patients.
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Affiliation(s)
- Jung Eun Lee
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - In Young Jo
- Department of Nutrition Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Mi Lee
- Department of Nutrition Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jeong Kim
- Department of Nutrition Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Young Choi
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea ; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyu Ha
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jong Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyeong Cheon Park
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea ; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Soares V, Avelar ISD, Andrade SRDS, Vieira MF, Silva MS. Body composition of chronic renal patients: anthropometry and bioimpedance vector analysis. Rev Lat Am Enfermagem 2015; 21:1240-7. [PMID: 24402340 DOI: 10.1590/0104-1169.3060.2360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 08/21/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to compare the body composition of patients undergoing hemodialysis with that of healthy individuals using different methods. METHOD cross-sectional study assessing male individuals using anthropometric markers, electrical bioimpedance and vector analysis. RESULTS the healthy individuals presented larger triceps skinfold and arm circumference (p<0.001). The bioimpedance variables also presented significant higher values in this group. Significant difference was found in the confidence interval of the vector analysis performed for both the patients and healthy individuals (p<0.0001). The tolerance intervals showed that 55.20% of the patients were dehydrated, 10.30% presented visible edema, and 34.50% were within normal levels of hydration. Bioimpedance and vector analysis revealed that 52% of the patients presented decreased cell mass while 14.00% presented increased cell mass. CONCLUSIONS the differences in the body composition of patients and healthy individuals were revealed through bioimpedance and vector analysis but not through their measures of arm circumference and arm muscle area.
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Affiliation(s)
- Viviane Soares
- Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brazil
| | | | | | - Marcus Fraga Vieira
- Faculdade de Educação Física, Universidade Federal de Goiás, GoiâniaGO, Brazil
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Berbigier MC, Pasinato VF, Rubin BDA, Moraes RB, Perry IDS. Bioelectrical impedance phase angle in septic patients admitted to intensive care units. Rev Bras Ter Intensiva 2015; 25:25-31. [PMID: 23887756 PMCID: PMC4031866 DOI: 10.1590/s0103-507x2013000100006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/14/2013] [Indexed: 12/20/2022] Open
Abstract
Objective To calculate the values of the phase angle of septic patients using bioelectrical
impedance analysis, correlate the values with clinical and biochemical variables,
and compare them to reference values. Methods Cohort study conducted with 50 septic patients aged ≥18 years old, admitted to
intensive care units, and assessed according to prognostic indexes (APACHE II and
SOFA), clinical progression (mortality, severity of sepsis, length of stay in
intensive care unit), biochemical parameters (albumin and C-reactive protein), and
the phase angle. Results The average age of the sample was 65.6±16.5 years. Most patients were male (58%)
and suffering from septic shock (60%). The average APACHE II and SOFA scores were
22.98±7.1 and 7.5±3.4, respectively. The patients who survived stayed nine days on
average (five to 13) in the intensive care unit, and the mortality rate was 30%.
The average value of the phase angle was 5.4±2.6º in the total sample and was
smaller among the females compared with the males (p=0.01). The phase angle
measures did not exhibit an association with the severity of the sepsis,
mortality, gender, and age or correlate with the length of hospitalization or the
biochemical parameters. The participants' phase angle values adjusted per gender
and age were 1.1 to 1.9 times lower compared with the values for a normal
population. Conclusion The average value of the phase angle of septic patients was lower compared with
the reference values for a healthy population. The phase angle measures did not
exhibit association with the clinical and biochemical variables, which might be
explained by the sample homogeneity.
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da Silva TK, Berbigier MC, Rubin BDA, Moraes RB, Corrêa Souza G, Schweigert Perry ID. Phase Angle as a Prognostic Marker in Patients With Critical Illness. Nutr Clin Pract 2015; 30:261-5. [DOI: 10.1177/0884533615572150] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Taís Kereski da Silva
- Multiprofessional Integrated Residency Program in Health, with emphasis on Critical Adults, Hospital de Clínicas de Porto Alegre, Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Marina Carvalho Berbigier
- Multiprofessional Integrated Residency Program in Health, with emphasis on Critical Adults, Hospital de Clínicas de Porto Alegre, Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bibiana de Almeida Rubin
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Gabriela Corrêa Souza
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Intensive Medicine Department, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Ingrid Dalira Schweigert Perry
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Health Unit, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
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Toshikuni N, Arisawa T, Tsutsumi M. Nutrition and exercise in the management of liver cirrhosis. World J Gastroenterol 2014; 20:7286-7297. [PMID: 24966599 PMCID: PMC4064074 DOI: 10.3748/wjg.v20.i23.7286] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/22/2014] [Accepted: 05/05/2014] [Indexed: 02/07/2023] Open
Abstract
Liver cirrhosis (LC) patients often have protein-energy malnutrition (PEM) and decreased physical activity. These conditions often lead to sarcopenia, which is the loss of skeletal muscle volume and increased muscle weakness. Recent studies have demonstrated that PEM and sarcopenia are predictors for poor survival in LC patients. Nutrition and exercise management can improve PEM and sarcopenia in those patients. Nutrition management includes sufficient dietary intake and improved nutrient metabolism. With the current high prevalence of obesity, the number of obese LC patients has increased, and restriction of excessive caloric intake without the exacerbation of impaired nutrient metabolism is required for such patients. Branched chain amino acids are good candidates for supplemental nutrients for both obese and non-obese LC patients. Exercise management can increase skeletal muscle volume and strength and improve insulin resistance; however, nutritional status and LC complications should be assessed before an exercise management regimen is implemented in LC patients. The establishment of optimal exercise regimens for LC patients is currently required. In this review, we describe nutritional status and its clinical impact on the outcomes of LC patients and discuss general nutrition and exercise management in LC patients.
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