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Hong S, Coté G. Minimization of Parasitic Capacitance between Skin and Ag/AgCl Dry Electrodes. MICROMACHINES 2024; 15:907. [PMID: 39064418 PMCID: PMC11278634 DOI: 10.3390/mi15070907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Conventional dry electrodes often yield unstable results due to the presence of parasitic capacitance between the flat electrode surface and the non-uniform skin interface. To address this issue, a gel is typically placed between the electrodes to minimize parasitic capacitance. However, this approach has the drawbacks of being unsuitable for repeated use, limited lifetime due to gel evaporation, and the possibility of developing skin irritation. This is particularly problematic in underserved areas since, due to the cost of disposable wet electrodes, they often sterilize and reuse dry electrodes. In this study, we propose a method to neutralize the effects of parasitic capacitance by attaching high-value capacitors to the electrodes in parallel, specifically when applied to pulse wave monitoring through bioimpedance. Skin capacitance can also be mitigated due to the serial connection, enabling stable reception of arterial pulse signals through bioimpedance circuits. A high-frequency structure simulator (HFSS) was first used to simulate the capacitance when injection currents flow into the arteries through the bioimpedance circuits. We also used the simulation to investigate the effects of add-on capacitors. Lastly, we conducted preliminary comparative analyses between wet electrodes and dry electrodes in vivo with added capacitance values ranging from 100 pF to 1 μF, altering capacitance magnitudes by factors of 100. As a result, we obtained a signal-to-noise ratio (SNR) that was 8.2 dB higher than that of dry electrodes. Performance was also shown to be comparable to wet electrodes, with a reduction of only 0.4 dB using 1 μF. The comparative results demonstrate that the addition of capacitors to the electrodes has the potential to allow for performance similar to that of wet electrodes for bioimpedance pulse rate monitoring and could potentially be used for other applications of dry electrodes.
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Affiliation(s)
- Sungcheol Hong
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Gerard Coté
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA;
- Department of Electrical Engineering, Texas A&M University, College Station, TX 77843, USA
- Center for Remote Health Technologies and Systems, Texas A&M Engineering Experiment Station, Texas A&M University, College Station, TX 77843, USA
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Koelmeyer LA, Gaitatzis K, Thompson B, Ward LC. Effects of Body Positioning When Assessing Lymphedema of the Lower Limb Using Bioimpedance Spectroscopy. Lymphat Res Biol 2024; 22:43-54. [PMID: 37851985 DOI: 10.1089/lrb.2022.0108] [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: 10/20/2023] Open
Abstract
Background: Bioimpedance spectroscopy (BIS) measurements are conventionally performed in supine position with a lead device attached to gel-backed electrodes, and more recently, with a stand-on device that uses fixed stainless-steel electrodes under the hands and feet. The aim of this study was to assess and compare BIS measurements made in supine, sitting, and standing positions using lead and stand-on impedance devices in participants with and without unilateral leg lymphedema. Materials and Methods: Participants with self-ascribed unilateral leg lymphedema (n = 24) and healthy controls (n = 71) were recruited using a cross-sectional study design. Triplicate BIS measurements were taken for each device in each position. Results: Impedance measurements with either device were reliable with coefficient of variation of 0.6% or lower. The magnitude of mean differences in absolute impedance values between devices were between 1% and 6% dependent on condition. L-Dex scores between the two devices were highly correlated (r = 0.82) and ∼70% of participants in the lymphedema group were classified as having lymphedema using the recommended cut-off with either device. There was no significant interleg difference of controls using the lead device; however, small, but significant differences (p = 0.0001) were found when using the stand-on device. Conclusion: The findings demonstrate that reliable impedance measurements of the legs can be made with either device in lying, sitting, or standing positions. However, data between the devices were not directly interchangeable. Although the risk of misidentification was small, reference ranges appropriate to the device and measurement position should be used when converting data to L-Dex scores.
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Affiliation(s)
- Louise A Koelmeyer
- Australian Lymphoedema Education, Research and Treatment Centre, Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Katrina Gaitatzis
- Australian Lymphoedema Education, Research and Treatment Centre, Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Belinda Thompson
- Australian Lymphoedema Education, Research and Treatment Centre, Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leigh C Ward
- Australian Lymphoedema Education, Research and Treatment Centre, Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
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Verde L, Camajani E, Annunziata G, Sojat A, Marina LV, Colao A, Caprio M, Muscogiuri G, Barrea L. Ketogenic Diet: A Nutritional Therapeutic Tool for Lipedema? Curr Obes Rep 2023; 12:529-543. [PMID: 37924422 DOI: 10.1007/s13679-023-00536-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide an overview of the current evidence on the efficacy, also considering the anti-inflammatory properties and safety of very low-calorie ketogenic diet (VLCKD) as a potential treatment for lipedema, particularly in the context of obesity. RECENT FINDINGS Lipedema is a chronic disease characterized by abnormal and painful fat buildup on the legs and/or arms. It is often misdiagnosed as obesity or lymphedema. However, although lipedema and obesity can coexist, unlike obesity, lipedema usually affects the legs and thighs without affecting the feet or hands, and the abnormal deposition of adipose tissue in lipedema is painful. The current lifestyle interventions are often unsuccessful in the management of lipedema. There is no consensus on the most effective nutritional approach for managing lipedema. Recent studies have suggested that VLCKD may be an effective treatment for lipedema, demonstrating that it is also superior to other nutritional approaches such as Mediterranean diet or intermittent fasting. Lipedema is a chronic and debilitating disease characterized by abnormal and painful accumulation of adipose tissue in the legs. VLCKD has been shown to be an effective treatment for lipedema, especially in the context of obesity, due to its anti-inflammatory properties. However, further research is needed to determine the long-term safety and efficacy of VLCKD as a treatment for lipedema.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Giuseppe Annunziata
- Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antoanstefan Sojat
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ljiljana V Marina
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia ed Andrologia, Unità di Endocrinologia, Università Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia ed Andrologia, Unità di Endocrinologia, Università Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy.
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy
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Liu L, Zhang B, Luo J, Li Z, Liu D, Dou Y, Yang L, Xiao J, Zhao Z. The role of segmental bioelectrical impedance technique in the assessment of intraperitoneal ultrafiltration volume with peritoneal dialysis patients. Ren Fail 2023; 45:2255678. [PMID: 37724525 PMCID: PMC10512755 DOI: 10.1080/0886022x.2023.2255678] [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: 12/05/2022] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To investigate the role of segmental bioelectrical impedance technique (SBIA) in the assessment of intraperitoneal ultrafiltration volume with peritoneal dialysis patients. METHOD We selected the patients at the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University and measured the segmental bioelectrical impedance by a German Fresenius body composition analyzer (the Fresenius whole body composition measurement (BCM) machine was used as a segmental machine in this study). An alternating current (5 kHz, 0.05-0.7 mA) was continuously released during the measurement. The released current penetrated the peritoneal cavity on both sides of the body, from which the segmental resistance at a frequency of 5 kHz was obtained from the multifrequency data (R5/Ω). Baseline BIA measurements were initiated after the patient entered the supine position for 5-10 min, then dialysate was instilled into the peritoneal cavity. BIA measurements were performed at 10-min intervals during the retention of dialysate in the abdomen and finally ended when dialysate drainage was complete. Real-time intraperitoneal volume estimated by SBIA (IPVSBIA)and ultrafiltration volume estimated by SBIA(UFVSBIA) was calculated. At the same time, the actual ultrafiltration volume at the end of peritoneal dialysis was weighed and measured (UFVMEA). RESULTS A total of 30 patients were included in the study, 9 patients withdrew from the study due to subjective factors during the measurement process, and 21 patients completed the study. The correlation coefficient R2 of UFVSBIA and UFVMEA was 0.21 (p < 0.05). Bland-Altman analysis showed that the bias of UFVSBIA to the actual UFVMEA was 0.12 L, and the 95% agreement limit was between -0.5 L and 0.74 L, which confirmed that UFVSBIA measured by electrical impedance method and UFVMEA measured by weighing method were in good agreement. The time required to reach the maximum ultrafiltration volume (UFVSBIA) was 108 ± 68 min, and the mean value of the maximum ultrafiltration volume (Max UFVSBIA) was 1.16 ± 0.60 L. CONCLUSION The segmental bioelectrical impedance technique can be used to assess the intraperitoneal ultrafiltration volume of peritoneal dialysis patients in real-time and effectively. This method may guide the dialysis fluid retention time and the maximum ultrafiltration volume in PD patients.
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Affiliation(s)
- Lifen Liu
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Bei Zhang
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
- Nephrology Department, Nanyang Central Hospital, Nanyang, P.R. China
| | - Jing Luo
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Zhengyan Li
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Dong Liu
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yanna Dou
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Lin Yang
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R.China
| | - Jing Xiao
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Zhanzheng Zhao
- Nephrology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
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Avila ML, Bentley RF, Bastas D, Brandão LR, Schneiderman JE, Ward L, Wong G, Stephens S, Liu K, Thomas S. Unraveling the pathophysiology of lower-limb postthrombotic syndrome in adolescents: a proof-of-concept study. Blood Adv 2023; 7:2784-2793. [PMID: 36763520 PMCID: PMC10275697 DOI: 10.1182/bloodadvances.2022009599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
A better understanding of the pathophysiology of pediatric postthrombotic syndrome (PTS) is needed to develop strategies to treat this condition. We investigated calf pump function, exercise capacity, balance in power output, and changes in limb muscle oxygen saturation (SmO2) and fluid content during exercise in 10 pediatric patients with unilateral lower-limb PTS, and in age- and sex-matched controls (1:1-1:2 ratio). Outcomes were investigated using bioimpedance spectroscopy, torque-sensing pedals, and near-infrared spectroscopy during incremental- and constant-load cycling tests. The median age at participation was 17 years (25th-75th percentile, 15-18 years); 68% of participants were females. The median CAPTSure score in the affected leg of affected participants was 35 points (25th-75th percentile, 24-46 points), indicating moderate/severe PTS; 20% of patients had a history of central venous catheter-related thrombosis. Increasing PTS severity was associated with higher calf pump venous volume and higher ejection volume, leading to compensated calf pump performance. We found no evidence of PTS impact on exercise capacity. Leg contribution to power output was similar in affected and unaffected legs. However, the PTS-affected legs showed lower SmO2 during active cycling and recovery with increasing PTS severity, indicating impaired microvascular function in the muscle. These findings suggest that PTS severity is associated with impaired blood flow, presumably from elevated venous pressure during and after exercise. The fact that microvascular function is impaired in young patients with PTS underscores the relevance of developing strategies to mitigate the effects of this chronic vascular disease to minimize its deleterious effects as children grow older.
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Affiliation(s)
- M. Laura Avila
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert F. Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Denise Bastas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leonardo R. Brandão
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jane E. Schneiderman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leigh Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Gina Wong
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha Stephens
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kuan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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Nevin AN, Urquhart S, Atresh SS, Geraghty TJ, Walter E, Ryan EG, Vivanti A, Ward LC, Hickman IJ. A longitudinal analysis of resting energy expenditure and body composition in people with spinal cord injury undergoing surgical repair of pressure injuries: a pilot study. Eur J Clin Nutr 2023; 77:386-392. [PMID: 36477671 DOI: 10.1038/s41430-022-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data informing energy needs of people with spinal cord injury (SCI) and pressure injuries are scarce, the impact of surgical repair unknown, and the role of body composition in healing unexplored. The study aims were to investigate resting energy expenditure (REE) over the course of pressure injury surgical repair, compare with available energy prediction equations, and explore associations between body composition and wound healing. METHODS Indirect calorimetry measured REE pre-surgery, post-surgery, at suture removal and hospital discharge. A clinically significant change was defined as +/-10% difference from pre-surgery. Eight SCI-specific energy prediction equations were compared to pre-surgery REE. Wound breakdown (Yes/No), weight, waist circumference (WC), and body composition (fat mass [FM], fat-free mass [FFM], bioimpedance spectroscopy) were measured. RESULTS Twenty people underwent pressure injury surgical repair (95% male, mean age 56 ± 12 years, 70% paraplegia). Between pre-surgery and discharge, mean REE increased (+118 kcal/d, p = 0.005), but with <10% change at any timepoint. An energy prediction equation incorporating FFM showed greatest agreement (rc = 0.779, 95% CI: 0.437, 0.924). Those with wound breakdown (65%) had a higher weight (12.7 kg, 95% CI: -4.0, 29.3), WC (17.8 cm, 95% CI: -5.1, 40.7), and FM % (36.0% [IQR 31.8, 40.2] vs 26.0% [IQR 15.6, 41.3]) than those without wound breakdown, although statistical significance was not reached. CONCLUSION The presence of pressure injuries and subsequent surgical repair did not impact REE and energy prediction equations incorporating FFM performed best. While not statistically significant, clinically important differences in body composition were observed in those with wound breakdown.
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Affiliation(s)
- Amy N Nevin
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia. .,The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Susan Urquhart
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sridhar S Atresh
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Timothy J Geraghty
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth Walter
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Marcôndes DWC, Paterno AS, Bertemes-Filho P. Parasitic Effects on Electrical Bioimpedance Systems: Critical Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:8705. [PMID: 36433301 PMCID: PMC9693567 DOI: 10.3390/s22228705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Parasitic capacitance represents the main error source in measurement systems based on electrical impedance spectroscopy. The capacitive nature of electrodes' impedance in tetrapolar configuration can give origin to phase errors when electrodes are coupled to parasitic capacitances. Nevertheless, reactive charges in tissue excitation systems are susceptible to instability. Based on such a scenario, mitigating capacitive effects associated with the electrode is a requirement in order to reduce errors in the measurement system. A literature review about the main compensation techniques for parasitic capacitance was carried out. The selected studies were categorized into three groups: (i) compensation in electronic instrumentation; (ii) compensation in measurement processing, and (iii) compensation by negative impedance converters. The three analyzed methods emerged as effective against fixed capacitance. No method seemed capable of mitigating the effects of electrodes' capacitance, that changes in the frequency spectrum. The analysis has revealed the need for a method to compensate varying capacitances, since electrodes' impedance is unknown.
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8
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Mayrovitz HN. Measuring Breast Cancer-Related Lymphedema. Breast Cancer 2022. [DOI: 10.36255/exon-publications-breast-cancer-lymphedema] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Does electrical stimulation improve healing in acute minor burn injury, as measured by bioimpedance spectroscopy? A single center, randomized, controlled trial. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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10
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Assessment of Body Composition in Athletes: A Narrative Review of Available Methods with Special Reference to Quantitative and Qualitative Bioimpedance Analysis. Nutrients 2021; 13:nu13051620. [PMID: 34065984 PMCID: PMC8150618 DOI: 10.3390/nu13051620] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023] Open
Abstract
Body composition is acknowledged as a determinant of athletic health and performance. Its assessment is crucial in evaluating the efficiency of a diet or aspects related to the nutritional status of the athlete. Despite the methods traditionally used to assess body composition, bioelectric impedance analysis (BIA) and bioelectric impedance vector analysis (BIVA) have recently gained attention in sports, as well as in a research context. Only until recently have specific regression equations and reference tolerance ellipses for athletes become available, while specific recommendations for measurement procedures still remain scarce. Therefore, the present narrative review summarizes the current literature regarding body composition analysis, with a special focus on BIA and BIVA. The use of specific technologies and sampling frequencies is described, and recommendations for the assessment of body composition in athletes are provided. Additionally, the estimation of body composition parameters (i.e., quantitative analysis) and the interpretation of the raw bioelectrical data (i.e., qualitative analysis) are examined, highlighting the innovations now available in athletes. Lastly, it should be noted that, up until 2020, the use of BIA and BIVA in athletes failed to provide accurate results due to unspecific equations and references; however, new perspectives are now unfolding for researchers and practitioners. In light of this, BIA and especially BIVA can be utilized to monitor the nutritional status and the seasonal changes in body composition in athletes, as well as provide accurate within- and between-athlete comparisons.
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Making the choice between bioelectrical impedance measures for body hydration status assessment. Sci Rep 2021; 11:7685. [PMID: 33833322 PMCID: PMC8032770 DOI: 10.1038/s41598-021-87253-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Situational or persistent body fluid deficit (i.e., de- or hypo-hydration) is considered a significant health risk factor. Bioimpedance analysis (BIA) has been suggested as an alternative to less reliable subjective and biochemical indicators of hydration status. The present study aimed to compare various BIA models in the prediction of direct measures of body compartments associated with hydration/osmolality. Fish (n = 20) was selected as a biological model for physicochemically measuring proximate body compartments associated with hydration such as water, dissolved proteins, and non-osseous minerals as the references or criterion points. Whole-body and segmental/local impedance measures were used to investigate a pool of BIA models, which were compared by Akaike Information Criterion in their ability to accurately predict the body components. Statistical models showed that ‘volumetric-based’ BIA measures obtained in parallel, such as distance2/Rp, could be the best approach in predicting percent of body moisture, proteins, and minerals in the whole-body schema. However, serially-obtained BIA measures, such as the ratio of the reactance to resistance and the resistance adjusted for distance between electrodes, were the best fitting in predicting the compartments in the segmental schema. Validity of these results should be confirmed on humans before implementation in practice.
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Bloomquist K, Krustrup P, Fristrup B, Sørensen V, Helge JW, Helge EW, Soelberg Vadstrup E, Rørth M, Hayes SC, Uth J. Effects of football fitness training on lymphedema and upper-extremity function in women after treatment for breast cancer: a randomized trial. Acta Oncol 2021; 60:392-400. [PMID: 33423594 DOI: 10.1080/0284186x.2020.1868570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Breast cancer survivors are encouraged to be physically active. A recent review suggests that football training is an effective exercise modality for women across the lifespan, positively influencing health variables such as strength, fitness and social well-being. However, football is a contact sport, potentially posing an increased risk of trauma-related injury. Against this backdrop, breast cancer survivors are advised to avoid trauma or injury to the affected or at-risk arm in order to protect against lymphedema onset or exacerbation. The aim of this study was therefore to evaluate the feasibility and safety of Football Fitness training in relation to lymphedema and upper-extremity function after treatment for breast cancer. MATERIAL AND METHODS Sixty-eight women aged 18-75 years, who had received surgery for stage I-III breast cancer and completed (neo) adjuvant chemotherapy and/or radiotherapy within five years, were randomized (2:1) to a Football Fitness group (FFG, n = 46) or a control group (CON, n = 22) for twelve months. Secondary analyses using linear mixed models were performed to assess changes in upper-body morbidity, specifically arm lymphedema (inter-arm volume % difference, dual energy X-ray absorptiometry; extracellular fluid (L-Dex), bioimpedance spectroscopy), self-reported breast and arm symptoms (EORTC breast cancer-specific questionnaire (BR23) and upper-extremity function (DASH questionnaire) at baseline, six- and twelve-month follow-up. RESULTS We observed similar point prevalent cases of lymphedema between groups at all time points, irrespective of measurement method. At the six-month post-baseline assessment, reductions in L-Dex (extracellular fluid) were found in FFG versus CON. These significant findings were not maintained at the twelve-month assessment. No difference between groups was observed for inter-limb volume difference %, nor any of the remaining outcomes. CONCLUSION While superiority of Football Fitness was not observed, the results support that participation in Football Fitness training is feasible and suggests no negative effects on breast cancer-specific upper-body morbidity, including lymphedema. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov. NCT03284567.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Bjørn Fristrup
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Victor Sørensen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørn Wulff Helge
- Department of Biomedical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Eva Wulff Helge
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Mikael Rørth
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jacob Uth
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Alternate Electrode Positions for the Measurement of Hand Volumes Using Bioimpedance Spectroscopy. Lymphat Res Biol 2020; 18:560-571. [DOI: 10.1089/lrb.2019.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Dale O. Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Dana A. Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Jeremy M. Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Perth, Australia
| | - Fiona M. Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Unit, The University of Western Australia, Nedlands, Australia
| | - Dale W. Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
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14
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Dylke ES, Ward LC. Three Decades of Bioelectrical Impedance Spectroscopy in Lymphedema Assessment: An Historical Perspective. Lymphat Res Biol 2020; 19:206-214. [PMID: 33232645 DOI: 10.1089/lrb.2020.0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Bioelectrical impedance spectroscopy (BIS) is a technology that is widely used for the assessment of body composition. The method is based on the measurement of the electrical resistance of the body or a body region that can be quantitatively related to the amount of water in the tissues. Lymphedema is characterized, at least in its early stages, as an accumulation of lymph, an extracellular fluid. In the late 1980s, it was recognized that it might be possible to adapt BIS protocols to measure this increase in lymph volume. Subsequently, the use of BIS for the early detection of breast cancer-related lymphedema was demonstrated in the early 1990s, with BIS reference values indicative of lymphedema published in 2001. The subsequent two decades have seen BIS become a widely accepted method for lymphedema assessment. This review traces the evolution of the BIS technique since its inception and presents the current state of the art, with particular emphasis on utility in clinical practice.
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Affiliation(s)
- Elizabeth S Dylke
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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15
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Desneves KJ, Panisset MG, Galea MP, Kiss N, Daly RM, Ward LC. Comparison of segmental lean tissue mass in individuals with spinal cord injury measured by dual energy X-ray absorptiometry and predicted by bioimpedance spectroscopy. Spinal Cord 2020; 59:730-737. [PMID: 33077901 DOI: 10.1038/s41393-020-00568-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Observational. OBJECTIVES To compare two methods for predicting segmental (arms, legs, trunk) lean tissue mass (LTM: non-bone fat-free mass) from bioimpedance spectroscopy (BIS) against LTM measured from dual energy X-ray absorptiometry (DXA) in individuals with acute spinal cord injury (SCI). SETTING Austin Health Victorian Spinal Cord Service, Victoria, Australia. METHODS Fourteen participants (two female), within 8 weeks of traumatic SCI had BIS measured following an overnight fast and within 24 h of DXA scanning. Total body fat-free mass (FFM, body weight minus fat mass) and segmental LTM were predicted from BIS using manufacturer's proprietary software and a previously established SCI-specific prediction method. Appendicular LTM (ALM) was calculated from the sum of the LTM of the arms and legs. Agreement and strength of relationships with DXA for predicted LTM measures using both approaches were assessed using Lin's concordance coefficient and limits of agreement analysis (LOA). RESULTS The BIS proprietary method performed better than the SCI-specific prediction method in predicting DXA LTM, demonstrating substantial concordance for total body FFM (rc = 0.80), ALM (rc = 0.78), arm (rc = 0.76) and leg LTM (rc = 0.65) and a smaller bias and LOA for ALM (+0.8 vs. -3.4 kg; LOA -4.9-6.4 vs. -11.9-5.1 kg), arm (+0.02 vs. -0.3 kg; LOA -1.1-1.1 kg vs. -2.2-1.6 kg) and leg (+0.4 vs. -1.4 kg; LOA -2.0-2.8 vs. -5.6-2.8) LTM. CONCLUSIONS BIS can be used to accurately predict total body FFM, segmental LTM and ALM in individuals with acute SCI.
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Affiliation(s)
- Katherine J Desneves
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, VIC, Australia. .,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia.
| | - Maya G Panisset
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
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16
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Paramanandam VS, Daptardar AA, Kamat MV, Lee MJ, Ward LC, Kilbreath SL, Dylke ES. Interchangeability of Two Electrode Placement Protocols Used by Bioimpedance Spectroscopy Devices in the Detection of Breast Cancer-Related Lymphedema. Lymphat Res Biol 2020; 19:181-188. [PMID: 32986508 DOI: 10.1089/lrb.2020.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Bioimpedance spectroscopy (BIS) devices are routinely used in the assessment of breast cancer-related lymphedema (BCRL). The equipotential electrode placement is a commonly used protocol for the assessment of BCRL. However, the sternal notch electrode placement protocol is also in use. Whether these two protocols are interchangeable is not known. Methods and Results: Ethical approval was received from the institutional ethics committee at Tata Memorial Hospital, India. BIS measurements (whole-body right side and affected and unaffected arms) of 100 women with or at risk of BCRL were measured using equipotential and sternal notch protocols. Resistance at zero frequency (R0) was determined, and agreement of the absolute R0 values and the R0 ratio (unaffected/affected) between protocols was evaluated (Bland-Altman analysis and Passing-Bablok regression analysis). Mean absolute differences between protocols were very small for whole-body right side, affected arm, unaffected arm, and the interarm ratio at 0.23 ohms (95% confidence interval [CI]: -3.8 to 4.3), -5.7 ohms (95% CI: -7.5 to -3.9), -9.09 ohms (95% CI: -11.4 to -6.8), and -0.008 ohms (95% CI: -0.02 to 0.001), respectively. Limits of agreement (two standard deviation) between protocols were narrow for whole-body right side, affected arm, unaffected arm, and interarm ratio without any systematic or proportional differences for whole-body right side and the interarm ratio (5.8% to -5.6%, 3.7% to -7.4%, 3.5% to -8.2%, and 5.8% to -5.6%, respectively). Conclusion: The equipotential and sternal notch protocols could be used interchangeably in BCRL assessment. The Clinical Trial Registration number: CTRI/2017/12/010762.
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Affiliation(s)
- Vincent S Paramanandam
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Physiotherapy Department, Tata Memorial Hospital, Mumbai, India
| | | | - Manali V Kamat
- Physiotherapy Department, Tata Memorial Hospital, Mumbai, India
| | - Mi-Joung Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Sharon L Kilbreath
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Elizabeth S Dylke
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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Steele ML, Janda M, Vagenas D, Ward LC, Cornish BH, Box R, Gordon S, Matthews M, Poppitt SD, Plank LD, Yip W, Rowan A, Reul-Hirche H, Obermair A, Hayes SC. A Bioimpedance Spectroscopy-Based Method for Diagnosis of Lower-Limb Lymphedema. Lymphat Res Biol 2020; 18:101-109. [DOI: 10.1089/lrb.2018.0078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Bruce H. Cornish
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robyn Box
- Queensland Lymphedema & Breast Oncology Physiotherapy, Brisbane, Australia
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Melanie Matthews
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sally D. Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D. Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Wilson Yip
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Angela Rowan
- Fonterra Co-operative Group Limited, Auckland, New Zealand
| | | | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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18
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Koelmeyer LA, Ward LC, Dean C, Boyages J. Body Positional Effects on Bioimpedance Spectroscopy Measurements for Lymphedema Assessment of the Arm. Lymphat Res Biol 2020; 18:464-473. [PMID: 32027213 DOI: 10.1089/lrb.2019.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Bioimpedance spectroscopy (BIS) measurements have conventionally been performed using a device that uses gel-backed electrodes with the patient in a supine position. More recently, impedance devices that use stainless steel electrodes with the patient in a standing position have become available. The aim of this study was to assess and compare BIS measurements made in three different body positions using two different impedance devices (lead device and stand-on device) in women with and without arm lymphedema. Methods: A cross-sectional study design was used to recruit two cohorts of women, healthy controls (n = 47) and those who had been diagnosed with breast cancer (n = 53) and were either at risk of (n = 14) or with unilateral arm lymphedema (n = 39). BIS measurements were taken three times in each position for each device. Results: Impedance measurements were reliably made using either a lead or stand-on device with a coefficient of variation being 0.6% or lower. Absolute impedance measurements for the stand-on device were larger than the comparable lead device values due to the difference in electrode position, but were highly correlated (r = 0.92, p < 0.0001). Interarm impedance ratios and L-Dex scores were slightly (3.1% equivalence), but significantly different. Conclusion: The findings support impedance measurements being made reliably using either the lead or stand-on device, representing supine and upright measurement positions, respectively. Data between devices were, however, not directly interchangeable.
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Affiliation(s)
- Louise A Koelmeyer
- Australian Lymphoedema Education, Research and Treatment Program, Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Catherine Dean
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - John Boyages
- Australian Lymphoedema Education, Research and Treatment Program, Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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19
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Qin ES, Bowen MJ, James SL, Chen WF. Multi-segment bioimpedance can assess patients with bilateral lymphedema. J Plast Reconstr Aesthet Surg 2020; 73:328-336. [DOI: 10.1016/j.bjps.2019.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
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20
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Bloomquist K, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, Oturai P, Ejlertsen B, Tuxen MK, Møller T. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial. Acta Oncol 2019; 58:1667-1675. [PMID: 31354000 DOI: 10.1080/0284186x.2019.1643916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Due to long-standing concerns that heavy-load lifting could increase the risk of developing lymphedema, breast cancer survivors have been advised to refrain from resistance exercise with heavy loads. This study prospectively evaluated the effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer.Material and Methods: Physically inactive women receiving adjuvant chemotherapy for breast cancer (n = 153) were randomized to a HIGH (supervised, multimodal exercise including heavy-load resistance exercise: 85-90% 1 repetition maximum [RM], three sets of 5-8 repetitions) versus LOW (pedometer and one-on-one consultations) 12-week intervention. Outcomes (baseline, 12 and 39 weeks) included lymphedema status (extracellular fluid [bioimpedance spectroscopy] and inter-arm volume % difference [dual-energy X-ray absorptiometry], lymphedema symptoms [numeric rating scale 0-10]), upper-extremity strength (1 RM), and quality of life domains (EORTC- BR23). Linear mixed models were used to evaluate equivalence between groups for lymphedema outcomes (equivalence margins for L-Dex, % difference and symptoms scale: ±5, ±3% and ±1, respectively). Superiority analysis was conducted for muscle strength and quality of life domains.Results: Postintervention equivalence between groups was found for extracellular fluid (0.4; 90% CI -2.5 to 3.2) and symptoms of heaviness (-0.2; -0.6 to 0.2), tightness (-0.1; -0.8 to 0.6) and swelling (0.2; -0.4 to 0.8). Nonequivalence was found for inter-arm volume % difference (-3.5%; -17.3 to 10.3) and pain (-0.7; -1.3 to 0), favoring HIGH. Strength gains were superior in the HIGH versus LOW group (3 kg; 1 to 5, p < .05). Further, clinically relevant reductions in breast (-11; -15 to -7) and arm (-6; -10 to -1) symptoms were found in the HIGH group.Conclusion: Findings suggest that physically inactive breast cancer survivors can benefit from supervised heavy-load resistance exercise during chemotherapy without increasing lymphedema risk. Trial registration: ISRCTN13816000.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Christian Lillelund
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Karl Bang Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- DBCG, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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21
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Svensson BJ, Dylke ES, Ward LC, Black DA, Kilbreath SL. Screening for breast cancer–related lymphoedema: self-assessment of symptoms and signs. Support Care Cancer 2019; 28:3073-3080. [DOI: 10.1007/s00520-019-05083-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
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22
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Mayrovitz HN. Assessing Lower Extremity Lymphedema Using Upper and Lower Extremity Tissue Dielectric Constant Ratios: Method and Normal Reference Values. Lymphat Res Biol 2019; 17:457-464. [DOI: 10.1089/lrb.2018.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harvey N. Mayrovitz
- Department of Physiology, College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, Florida
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23
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Mayrovitz HN, Alvarez A, Labra M, Mikulka A, Woody D. Possible applications of normative lower to upper limb ratios of tissue dielectric constant to lower extremity edema. INT ANGIOL 2019; 38:70-75. [PMID: 30860343 DOI: 10.23736/s0392-9590.18.04088-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower extremity edema occurs in many conditions including congestive heart failure, lymphedema, diabetes-related, kidney and liver disease, chronic venous insufficiency with venous hypertension. Clinical edema assessment methods are often subjective and variable. Our goals were to introduce a simple noninvasive measurement procedure potentially useful to characterize lower extremity edema by providing normative values from which edema thresholds might emerge. METHODS Tissue dielectric constant (TDC) values, as indices of skin-to-fat tissue water, were measured on foot dorsum, lower medial leg and anterior forearm of 88 adults (44 female) with ages ranging from 19-77 years with BMI ranging from 18.3-40.6 kg/m2. From these direct measurements lower-to-upper extremity TDC ratios (foot/arm and leg/arm) were determined for each gender. Possible edema threshold ratios were calculated as the mean lower-to-upper ratio to which was added two standard deviations of the overall ratio thereby providing initial thresholds for future testing. RESULTS Results showed that at each anatomical site absolute TDC values for males significantly exceed those of females (P<0.001). Male vs. female TDC values were 33.0±5.4 vs. 27.7±4.0 for the forearm, 34.8±6.5 vs. 27.5±4.6 for the leg, and 32.5±6.5 vs. 28.7±5.1 for the foot. In contrast, the foot/arm and leg/arm ratios were similar between genders ranging 0.990±0.144 to 1.063±0.170. Corresponding lower extremity to upper extremity threshold ratios ranged from 1.278 for foot/arm to 1.403 for leg/arm. The composite ratios considering both gender ration (N.=88) yielded a composite threshold foot/arm ratio of 1.387 and a leg/arm threshold ratio of 1.324. CONCLUSIONS This assessment method together with the normative ratios and calculated thresholds may aid in rapid detection of lower extremity edema in patients and possibly as a way to quantitatively track changes in edema status with time or treatment. However, the suitability of these thresholds is subject to future validation in persons with clearly defined lower extremity edema for which this report's findings serve as an initial quantitative starting point.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA -
| | - Andrea Alvarez
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Maria Labra
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Alexander Mikulka
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Don Woody
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
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Svensson BJ, Dylke ES, Ward LC, Kilbreath SL. Electrode Equivalence for Use in Bioimpedance Spectroscopy Assessment of Lymphedema. Lymphat Res Biol 2019; 17:51-59. [DOI: 10.1089/lrb.2018.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Brenda J. Svensson
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Occupational Therapy Department, Lourdes Hospital and Community Health Service, Dubbo, Australia
| | | | - Leigh C. Ward
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Steele ML, Janda M, Vagenas D, Ward LC, Cornish BH, Box R, Gordon S, Matthews M, Poppitt SD, Plank LD, Yip W, Rowan A, Reul-Hirche H, Obermair A, Hayes SC. Normative Interlimb Impedance Ratios: Implications for Early Diagnosis of Uni- and Bilateral, Upper and Lower Limb Lymphedema. Lymphat Res Biol 2018; 16:559-566. [DOI: 10.1089/lrb.2017.0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Bruce H. Cornish
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robyn Box
- Queensland Lymphoedema & Breast Oncology Physiotherapy, Brisbane, Australia
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Melanie Matthews
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sally D. Poppitt
- Human Nutrition Unit and School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D. Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Wilson Yip
- Human Nutrition Unit and School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Angela Rowan
- Fonterra Co-operative Group Limited, Auckland, New Zealand
| | - Hildegard Reul-Hirche
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Bloomquist K, Oturai P, Steele ML, Adamsen L, Møller T, Christensen KB, Ejlertsen B, Hayes SC. Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema. Med Sci Sports Exerc 2018; 50:187-195. [PMID: 28991039 PMCID: PMC5770105 DOI: 10.1249/mss.0000000000001443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer–related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy. Methods This is a randomized, crossover equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n = 21) participated in low-load (60%–65% 1-repetition maximum, two sets of 15–20 repetitions) and heavy-load (85%–90% 1-repetition maximum, three sets of 5–8 repetitions) upper-extremity resistance exercise separated by a 1-wk wash-out period. Swelling was determined by bioimpedance spectroscopy and dual-energy x-ray absorptiometry, with breast cancer–related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0–10). Order of low- versus heavy-load was randomized. All outcomes were assessed before, immediately after, and 24 and 72 h after exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion. Results The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72 h after exercise with less swelling after heavy loads (estimated mean difference, −1.00; 95% confidence interval, −3.17 to 1.17). Conclusions Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer–related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of repeated exposure to heavy-load resistance exercise.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Peter Oturai
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Megan L Steele
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Karl Bang Christensen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Bent Ejlertsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Sandra C Hayes
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
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Buendia R, Essex T, Kilbreath SL, Czerniec S, Dylke E, Ward LC. Estimation of Arm Adipose Tissue Quotient Using Segmental Bioimpedance Spectroscopy. Lymphat Res Biol 2018; 16:377-384. [DOI: 10.1089/lrb.2017.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ruben Buendia
- Department of Signals and Systems, Chalmers, Göteborg, Sweden
| | | | | | - Sharon Czerniec
- Faculty of Health Sciences, Australian Catholic University, North Sydney Campus, North Sydney, Australia
| | - Elizabeth Dylke
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Addressing the Barriers to Bioimpedance Spectroscopy Use in Major Burns: Alternate Electrode Placement. J Burn Care Res 2018; 38:e952-e959. [PMID: 28328660 DOI: 10.1097/bcr.0000000000000527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bioimpedance spectroscopy (BIS) is a method used to assess body composition and fluid distribution. As a technology for measurement of fluid shifts during acute burn resuscitation, there are potential barriers to its use due to the location of wounds. This study aimed to determine whether alternate electrode positions were a suitable alternative compared to standardized (manufacturer) positions in moderate to large size burns for the measurement of BIS resistance and fluid changes. BIS measurements were collected in standard and alternate electrode placements and in an open wound and Acticoat™ dressing condition. A percentage difference greater than 5% between each standard and alternate placement BIS measurements was deemed clinically significant. Chi-square tests determined there were no significant differences (P = .097-.96) between the standard and alternate electrode placements for whole body and limb segment BIS in both dressing conditions. Only whole body BIS resistance variables and extracellular fluid volumes were interchangeable in both dressing conditions and upper limb segmental measures were interchangeable in an open wound only. The differences between measurements of other BIS variables across the conditions were not acceptable or deemed not clinically acceptable without adjustment. The results showed that for moderate to large burn injuries clinicians can use whole body and upper limb segmental BIS variables to monitor changes in fluid shifts with alternate electrode placements where wounds preclude standardized placement within specified dressing conditions.
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Qin ES, Bowen MJ, Chen WF. Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis. J Plast Reconstr Aesthet Surg 2018; 71:1041-1050. [PMID: 29650264 DOI: 10.1016/j.bjps.2018.02.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bioimpedance spectroscopy (BIS) is used by healthcare specialists to diagnose lymphedema. BIS measures limb fluid content by assessing tissue resistance to the flow of electric current. However, there is debate regarding the validity of BIS in diagnosing early lymphedema. Indocyanine green (ICG) lymphography has been established as the most accurate diagnostic modality to date for lymphedema diagnosis. In this retrospective study, we test the sensitivity, specificity, and diagnostic accuracy of BIS in diagnosing lymphedema by referencing its results with ICG lymphography. METHODS Patients presented to the University of Iowa Lymphedema Center from 2015 to 2017 were evaluated with a standardized protocol that included history and physical examination, a validated lymphedema-specific quality-of-life assessment (LYMQOL), circumference -measurement-based index, BIS, and ICG lymphography. Diagnostic accuracy of BIS was assessed using ICG lymphography as a reference test. RESULTS Fifty-eight patients had positive ICG lymphography results, which confirmed the diagnosis of lymphedema. ICG lymphographic findings consistently correlated with clinical examination, LYMQOL evaluation, and lymphedema indices. By contrast, BIS demonstrated a false-negative rate of 36% - 21 out of 58 patients had normal BIS readings, but a positive ICG lymphography result. The 21 false-negative results occurred in patients with early-stage disease. Sensitivity and specificity for BIS were 0.64 and 1, respectively. CONCLUSION BIS carries an excessively high rate of false-negative results to be dependably used as a diagnostic modality for lymphedema. ICG lymphography highly correlates with other tracking modalities, and it remains the most reliable tool for diagnosing lymphedema.
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Affiliation(s)
- Evelyn S Qin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mindy J Bowen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Wei F Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Kenworthy P, Phillips M, Grisbrook TL, Gibson W, Wood FM, Edgar DW. An objective measure for the assessment and management of fluid shifts in acute major burns. BURNS & TRAUMA 2018; 6:3. [PMID: 30009191 PMCID: PMC6040607 DOI: 10.1186/s41038-017-0105-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/19/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major burns are life threatening. Fluid resuscitation is required for survival to maintain intravascular volumes and prevent hypovolemic shock. Bioimpedance spectroscopy (BIS) has been recognised as a potential method of monitoring fluid shifts after burn and in other disease states. The aims of this study were to examine the reliability of BIS across different dressing conditions and electrode positions, establish the influence of Acticoat™ on BIS variable measures and determine the validity of whole-body BIS to assess net fluid shift in the presence of moderate to major burns. METHODS An observational longitudinal cohort study was conducted from December 2014 to February 2016. Patients with over 15% total body surface area (TBSA) burns and injury less than 48 h were enrolled in the study. BIS triplicate measures were collected in an open wound and with an ActicoatTM dressing (at 5 half hour intervals). Standard and alternate electrode placements were utilised for the reliability analysis and standard placement only for determining the validity of BIS in moderate to major burns. The ImpediMde SFB7 was used to collect whole-body and segmental BIS measures. Stata statistical software, release 14 was utilised to analyse all results. Descriptive analyses were performed and were reported using the means and standard deviations (SD). RESULTS BIS-repeated measures established BIS raw resistance (R), and predicted volume variables were reliable in any condition (intra-class correlation coefficient (ICC) 0.996-0.999, 95% confidence intervals (CI) 0.996-0.999) without a systematic difference. Acticoat™ dressings significantly influenced all BIS-predicted volumes (p ≤ 0.01) as determined by multilevel mixed effects (MLME) linear regression analysis. Validity of BIS was demonstrated by resistance variables significantly decreasing with increasing net ionic fluid shift and increased TBSA (severity of injury) and calculated fluid volumes increasing with increasing net fluid shift and TBSA. BIS resistance also decreased with time as oedema reduced. For clinical use, a calculator was developed to adjust BIS variables when an Acticoat™ dressing is in situ, thus facilitating BIS variable change estimates in real time, with dressings intact. CONCLUSION BIS may be used clinically to monitor fluid volume change in major acute burns.
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Affiliation(s)
- Pippa Kenworthy
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
- School of Physiotherapy, Notre Dame University, Fremantle, Western Australia Australia
- Adult State Burns Service, Fiona Stanley Hospital, Murdoch Drive, Murdoch, Western Australia 6150 Australia
| | - Michael Phillips
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia Australia
| | - Tiffany L. Grisbrook
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia Australia
| | - William Gibson
- School of Physiotherapy, Notre Dame University, Fremantle, Western Australia Australia
| | - Fiona M. Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burn Injury Research Node, Notre Dame University, Fremantle, Western Australia Australia
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Bioimpedance spectroscopy: A technique to monitor interventions for swelling in minor burns. Burns 2017; 43:1725-1735. [DOI: 10.1016/j.burns.2017.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022]
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Svensson BJ, Dylke ES, Ward LC, Kilbreath SL. Segmental Bioimpedance Informs Diagnosis of Breast Cancer-Related Lymphedema. Lymphat Res Biol 2017; 15:349-355. [PMID: 28956701 DOI: 10.1089/lrb.2017.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detection of lymphedema, particularly its mild stage, is clinically challenging. The aim of this study was to determine whether segmental bioimpedance spectroscopy (BIS) provided additional information to whole arm BIS in assessing women with or at risk of lymphedema following breast cancer. METHODS AND RESULTS Participants (n = 66), aged 61.6 ± 10.5 years (mean ± standard deviation [SD]), were grouped according to lymphedema status: (1) at-risk (n = 24) had no indicators of lymphedema and (2) lymphedema (n = 42) were suspected to be developing lymphedema or had previously met lymphedema diagnostic criteria and undergone treatment. For each upper limb, impedance was measured for the whole arm, hand and four 10 cm segments of the arm, commencing at the ulnar styloid. Interlimb impedance ratios for corresponding locations were calculated and compared to previously determined, normatively based thresholds based on 2SD and 3SD above the mean. Segmental BIS classified 19% more women with lymphedema than 3SD whole arm thresholds and the same number as 2SD whole arm thresholds. Segmental BIS identified localized lymphedema and patterns in lymphedema distribution that were undetectable by whole arm BIS. Neither 3SD whole arm nor segmental BIS thresholds found lymphedema where it was not present; however, 2SD whole arm thresholds alone classified one woman in the at-risk group as having lymphedema. CONCLUSION Segmental BIS classified as many or more cases of lymphedema than whole arm BIS thresholds without finding lymphedema where it was likely not present while also providing additional information regarding the distribution of lymphedema within the limb.
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Affiliation(s)
- Brenda J Svensson
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia .,2 Occupational Therapy Department, Lourdes Hospital and Community Health Service , Dubbo, Australia
| | - Elizabeth S Dylke
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
| | - Leigh C Ward
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia .,3 School of Chemistry and Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - Sharon L Kilbreath
- 1 Faculty of Health Sciences, The University of Sydney , Sydney, Australia
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Wang H, Li D, Liuya J, Dylke ES, Ward LC, Jia J, Kilbreath SL. Reference Ranges Using Bioimpedance for Detection of Lymphedema in Chinese Women. Lymphat Res Biol 2017; 15:268-273. [PMID: 28880731 DOI: 10.1089/lrb.2017.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bioimpedance is a commonly used technique for detection of early lymphedema. The thresholds used for detection are based on impedance measurements obtained in Western populations. It is unknown whether these thresholds are applicable to a Chinese population. METHODS AND RESULTS Impedance measurements were obtained for both arms in 391 women, ranging in age from 20 to 84 years, using a standardized protocol. Frequency distributions of interlimb impedance arm ratios for both dominant:non-dominant and non-dominant:dominant were used to determine thresholds at two and three standard deviations (SDs) above the mean. Absolute impedance was significantly higher in the youngest group (20-39 years) compared to other age groups. However, there was no significant effect of age on impedance ratios. Similarly, there was no significant difference between impedance ratios determined in this study and those from recent studies in the Australia and the United States, which used similar protocols. New two and three SDs above the mean thresholds, using a weighted average from the pooled data of these studies are 1.108 and 1.153 for use when the dominant limb is at-risk and 1.072 and 1.116 when the non-dominant limb is at-risk. CONCLUSION There was no effect of ethnicity on impedance ratios. Consequently, the proposed pooled thresholds can be used, irrespective of ethnicity.
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Affiliation(s)
- Hewei Wang
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
| | - Ding Li
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
| | - Jiang Liuya
- 2 Rehabilitation Department, Jing' An District Centre Hospital of Shanghai , Shanghai, China
| | - Elizabeth S Dylke
- 3 Faculty of Health Sciences, University of Sydney , Sydney, Australia
| | - Leigh C Ward
- 3 Faculty of Health Sciences, University of Sydney , Sydney, Australia .,4 School of Chemistry and Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - Jie Jia
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
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Aristizábal JC, Giraldo A. Comparación de la composición corporal de mujeres jóvenes obtenida por hidrodensitometría y tres técnicas de bioimpedancia. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n3a01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Quantification of whole-body and segmental skeletal muscle mass using phase-sensitive 8-electrode medical bioelectrical impedance devices. Eur J Clin Nutr 2017; 71:1061-1067. [PMID: 28327564 PMCID: PMC5589975 DOI: 10.1038/ejcn.2017.27] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 11/29/2022]
Abstract
Background/Objectives: Bioelectrical impedance analysis (BIA) provides noninvasive measures of skeletal muscle mass (SMM) and visceral adipose tissue (VAT). This study (i) analyzes the impact of conventional wrist-ankle vs segmental technology and standing vs supine position on BIA equations and (ii) compares BIA validation against magnetic resonance imaging (MRI) and dual X-ray absorptiometry (DXA). Subjects/Methods: One hundred and thirty-six healthy Caucasian adults (70 men, 66 women; age 40±12 years) were measured by a phase-sensitive multifrequency BIA (seca medical body composition analyzers 515 and 525). Multiple stepwise regression analysis was used to generate prediction equations. Accuracy was tested vs MRI or DXA in an independent multiethnic population. Results: Variance explained by segmental BIA equations ranged between 97% for total SMMMRI, 91–94% for limb SMMMRI and 80–81% for VAT with no differences between supine and standing position. When compared with segmental measurements using conventional wrist-ankle technology. the relationship between measured and predicted SMM was slightly deteriorated (r=0.98 vs r=0.99, P<0.05). Although BIA results correctly identified ethnic differences in muscularity and visceral adiposity, the comparison of bias revealed some ethnical effects on the accuracy of BIA equations. The differences between LSTDXA and SMMMRI at the arms and legs were sizeable and increased with increasing body mass index. Conclusions: A high accuracy of phase-sensitive BIA was observed with no difference in goodness of fit between different positions but an improved prediction with segmental compared with conventional wrist-ankle measurement. A correction factor for certain ethnicities may be required. When compared with DXA MRI-based BIA equations are more accurate for predicting muscle mass.
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Cheng MF, Chen YY, Jang TR, Lin WL, Chen J, Hsieh KC. Total body composition estimated by standing-posture 8-electrode bioelectrical impedance analysis in male wrestlers. Biol Sport 2017; 33:399-405. [PMID: 28090145 PMCID: PMC5143775 DOI: 10.5604/20831862.1224097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/17/2016] [Accepted: 10/11/2016] [Indexed: 12/19/2022] Open
Abstract
Standing-posture 8-electrode bioelectrical impedance analysis is a fast and practical method for evaluating body composition in clinical settings, which can be used to estimate percentage body fat (BF%) and skeletal muscle mass in a subject’s total body and body segments. In this study, dual-energy X-ray absorptiometry (DXA) was used as a reference method for validating the standing 8-electrode bioelectrical impedance analysis device BC-418 (BIA8, Tanita Corp., Tokyo, Japan). Forty-eight Taiwanese male wrestlers aged from 17.9 to 22.3 years volunteered to participate in this study. The lean soft tissue (LST) and BF% in the total body and body segments were measured in each subject by the BIA8 and DXA. The correlation coefficients between total body, arm, leg segments impedance index (BI, ht2/Z) and lean soft tissue mass measured from DXA were r = 0.902, 0.453, 0.885, respectively (p < 0.01). In addition, the total body and segmental LST estimated by the BIA8 were highly correlated with the DXA data (r = 0.936, 0.466, 0.886, p < 0.01). The estimation of total body and segmental BF% measured by BIA8 and DXA also showed a significant correlation (r > 0.820, p < 0.01). The estimated LST and BF% from BIA8 in the total body and body segments were highly correlated with the DXA results, which indicated that the standing-posture 8-electrode bioelectrical impedance analysis may be used to derive reference measures of LST and BF% in Taiwanese male wrestlers.
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Affiliation(s)
- M-F Cheng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Histology and Clinical Pathology, Hualien Armed Forced General Hospital, Hualien, Taiwan; Institute of Oral Biology, School of Dentistry, National Yang-Ming University, Taipei, Taiwan; Department of Pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; These authors contributed equally
| | - Y-Y Chen
- Department of Combat Sports, National Taiwan University of Physical Education and Sport, Taichung, Taiwan; These authors contributed equally
| | - T-R Jang
- Department of Physical Education, National Taiwan University of Physical Education and Sport, Taichung, Taiwan
| | - W-L Lin
- Department of Sport Management, National Taiwan University of Physical Education and Sport, Taichung, Taiwan
| | - J Chen
- Department of laboratory medicine, Hualian Armed Forces General Hospital, Hualian, Taiwan
| | - K-C Hsieh
- Office of Physical Education and Sport, National Chung Hsing University, Taichung, Taiwan
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Ohta M, Midorikawa T, Hikihara Y, Masuo Y, Sakamoto S, Torii S, Kawakami Y, Fukunaga T, Kanehisa H. Validity of segmental bioelectrical impedance analysis for estimating fat-free mass in children including overweight individuals. Appl Physiol Nutr Metab 2016; 42:157-165. [PMID: 28112969 DOI: 10.1139/apnm-2016-0137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the validity of segmental bioelectrical impedance (BI) analysis for predicting the fat-free masses (FFMs) of whole-body and body segments in children including overweight individuals. The FFM and impedance (Z) values of arms, trunk, legs, and whole body were determined using a dual-energy X-ray absorptiometry and segmental BI analyses, respectively, in 149 boys and girls aged 6 to 12 years, who were divided into model-development (n = 74), cross-validation (n = 35), and overweight (n = 40) groups. Simple regression analysis was applied to (length)2/Z (BI index) for each of the whole-body and 3 segments to develop the prediction equations of the measured FFM of the related body part. In the model-development group, the BI index of each of the 3 segments and whole body was significantly correlated to the measured FFM (R2 = 0.867-0.932, standard error of estimation = 0.18-1.44 kg (5.9%-8.7%)). There was no significant difference between the measured and predicted FFM values without systematic error. The application of each equation derived in the model-development group to the cross-validation and overweight groups did not produce significant differences between the measured and predicted FFM values and systematic errors, with an exception that the arm FFM in the overweight group was overestimated. Segmental bioelectrical impedance analysis is useful for predicting the FFM of each of whole-body and body segments in children including overweight individuals, although the application for estimating arm FFM in overweight individuals requires a certain modification.
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Affiliation(s)
- Megumi Ohta
- a School of International Liberal Studies, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| | - Taishi Midorikawa
- b College of Health and Welfare, J.F. Oberlin University 3758 Tokiwa-machi, Machida-shi, Tokyo 194-0294, Japan
| | - Yuki Hikihara
- c Faculty of Engineering, Chiba Institute of Technology, 2-1-1 Shibazono, Narashino-shi, Chiba 275-0023, Japan
| | - Yoshihisa Masuo
- d National Institute of Fitness and Sports in Kanoya 1 Shiromizu, Kanoya-shi, Kagoshima 891-2311, Japan
| | - Shizuo Sakamoto
- e Faculty of Sport Sciences, Waseda University 2-579-15 Mikajima, Tokorozawa-shi, Saitama 359-1192, Japan
| | - Suguru Torii
- e Faculty of Sport Sciences, Waseda University 2-579-15 Mikajima, Tokorozawa-shi, Saitama 359-1192, Japan
| | - Yasuo Kawakami
- e Faculty of Sport Sciences, Waseda University 2-579-15 Mikajima, Tokorozawa-shi, Saitama 359-1192, Japan
| | - Tetsuo Fukunaga
- d National Institute of Fitness and Sports in Kanoya 1 Shiromizu, Kanoya-shi, Kagoshima 891-2311, Japan
| | - Hiroaki Kanehisa
- d National Institute of Fitness and Sports in Kanoya 1 Shiromizu, Kanoya-shi, Kagoshima 891-2311, Japan
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Brantlov S, Ward LC, Jødal L, Rittig S, Lange A. Critical factors and their impact on bioelectrical impedance analysis in children: a review. J Med Eng Technol 2016; 41:22-35. [DOI: 10.1080/03091902.2016.1209590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bloomquist K, Hayes S, Adamsen L, Møller T, Christensen KB, Ejlertsen B, Oturai P. A randomized cross-over trial to detect differences in arm volume after low- and heavy-load resistance exercise among patients receiving adjuvant chemotherapy for breast cancer at risk for arm lymphedema: study protocol. BMC Cancer 2016; 16:517. [PMID: 27449067 PMCID: PMC4957879 DOI: 10.1186/s12885-016-2548-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Background In an effort to reduce the risk of breast cancer-related arm lymphedema, patients are commonly advised to avoid heavy lifting, impacting activities of daily living and resistance exercise prescription. This advice lacks evidence, with no prospective studies investigating arm volume changes after resistance exercise with heavy loads in this population. The purpose of this study is to determine acute changes in arm volume after a session of low- and heavy-load resistance exercise among women undergoing adjuvant chemotherapy for breast cancer at risk for arm lymphedema. Methods/Design This is a randomized cross-over trial. Participants: Women receiving adjuvant chemotherapy for breast cancer who have undergone axillary lymph node dissection will be recruited from rehabilitation centers in the Copenhagen area. Intervention: Participants will be randomly assigned to engage in a low- (two sets of 15–20 repetition maximum) and heavy-load (three sets of 5–8 repetition maximum) upper-extremity resistance exercise session with a one week wash-out period between sessions. Outcome: Changes in extracellular fluid (L-Dex score) and arm volume (ml) will be assessed using bioimpedance spectroscopy and dual-energy x-ray absorptiometry, respectively. Symptom severity related to arm lymphedema will be determined using a visual analogue scale (heaviness, swelling, pain, tightness). Measurements will be taken immediately pre- and post-exercise, and 24- and 72-hours post-exercise. Sample size: A sample size of 20 participants was calculated based on changes in L-Dex scores between baseline and 72-hours post exercise sessions. Discussion Findings from this study are relevant for exercise prescription guidelines, as well as recommendations regarding participating in activities of daily living for women following surgery for breast cancer and who may be at risk of developing arm lymphedema. Trial registration Current Controlled Trials ISRCTN97332727. Registered 12 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2548-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Sandi Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove Urban Village, Kelvin Grove, Queensland, 4059, Australia
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Karl Bach Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Bent Ejlertsen
- DBCG, Afsnit 2501, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Bioimpedance spectroscopy in the infant: effect of milk intake and extracellular fluid reservoirs on resistance measurements in term breastfed infants. Eur J Clin Nutr 2016; 70:843-51. [PMID: 27026428 DOI: 10.1038/ejcn.2016.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Bioimpedance spectroscopy is an accurate non-invasive method for measuring body composition in adults, but in infants it requires further testing and validation. Of the few studies of bioimpedance conducted in infants, none have comprehensively investigated the effect of milk intake volume. This study assessed the effect of the milk intake, feed duration and the volume of the infant's stomach and bladder on the resistance values pre-/post-feed to establish the feasibility of using these values interchangeably during data collection. SUBJECTS/METHODS Forty-eight breastfeeding infants were measured at 2, 5, 9 and/or 12 months (n=62 sessions) within 1-2 min before the start and after the end of breastfeed. Median (IQR) time between measurements was 24 (20.0-30.0) min. Resistance measurements at 0 and 50 kHz, and infinite frequency (R0, R50 and Rinf) and resistance of intracellular water (Ricw) were analysed with customised infant settings. Milk intake was measured by test weights. Free-water volumes and free-water change were determined from stomach and bladder volumes calculated from ultrasound images. RESULTS Small pre-to-post-feed changes (median (IQR): R0 -3.7 (-14.8, 14.3); R50 0.3 (-10.4, 15.0); Rinf 2.8 (-13.3, 35.5); Ricw 20.8 (-98.1, 290.9)) were not significantly different from zero (R0: P=0.92; R50: P=0.48; Rinf: P=0.32; Ricw: P=0.097). No significant effect of milk intake or free-water change was detected. CONCLUSIONS The lack of consistent change in resistance across a breastfeed provides flexibility in the timing of measurements of infants in the research setting, such that typically pre- and post-feed measures of resistance can be used interchangeably.
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Grisbrook TL, Kenworthy P, Phillips M, Gittings PM, Wood FM, Edgar DW. Alternate electrode placement for whole body and segmental bioimpedance spectroscopy. Physiol Meas 2015; 36:2189-201. [PMID: 26365564 DOI: 10.1088/0967-3334/36/10/2189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Bioimpedance spectroscopy (BIS) is frequently used to monitor body fluid and body composition in healthy and clinical populations. BIS guidelines state that there should be no skin lesions at the site of electrodes, and if lesions are present, electrode positions should be changed. However, alternate electrode positions are yet to be reported. This study aimed to determine if ventral electrode placements were suitable alternatives for whole body and segmental BIS measurements. Three alternate electrode placements were assessed for whole body BIS using a combination of ventral hand and foot electrode placements. An alternate position was assessed for upper and lower body segmental BIS. The results demonstrated that for whole body BIS, if drive and sense electrodes on the hand are moved to ventral positions, but foot electrodes remain in standard positions, then whole body BIS variables were comparable to standard electrode positioning (percentage difference range = 0.01 to 1.65%, p = 0.211-0.937). The alternate electrode placement for upper limb segmental BIS, results in BIS variables that are comparable to that of the standard positioning (percentage difference range = 0.24-3.51%, p = 0.393-0.604). The alternate lower limb electrode position significantly altered all resistance and predicted BIS variables for whole body and lower limb segmental BIS (percentage difference range = 1.06-12.09%, p < 0.001). If wounds are present on the hands and/or wrist, then the alternate electrode position described in this study is valid, for whole body and upper limb segmental BIS.
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Affiliation(s)
- T L Grisbrook
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia. School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
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Lahtinen T, Seppälä J, Viren T, Johansson K. Experimental and Analytical Comparisons of Tissue Dielectric Constant (TDC) and Bioimpedance Spectroscopy (BIS) in Assessment of Early Arm Lymphedema in Breast Cancer Patients after Axillary Surgery and Radiotherapy. Lymphat Res Biol 2015; 13:176-85. [PMID: 26305554 DOI: 10.1089/lrb.2015.0019] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early diagnosis of breast cancer treatment-related lymphedema (BCRL) is of great importance for longstanding treatment results. Tissue dielectric constant (TDC) and bioimpedance spectroscopy (BIS) both have a potential for early diagnosis, but have not been compared. METHODS AND RESULTS One hundred women, treated for breast cancer with breast surgery, axillary dissection, and radiotherapy, were examined within one year after breast cancer treatment, as part of the follow-up procedure. Affected/at-risk and contralateral arms were measured with the TDC technique specific to localized skin water content and the BIS technique assessing arm extracellular fluid (ECF). Thirty-eight patients were clinically diagnosed for lymphedema (38.0%). The sensitivity and specificity for the TDC method were 65.8% and 83.9%, and for BIS method 42.1% and 93.5%, (p < 0.001 and NS), respectively. Of all lymphedema, 18.4% were detected only by TDC and 2.6% by BIS. Affected arm to contralateral arm TDC ratios for upper arm and forearm, 1.56 ± 0.49 and 1.28 ± 0.33, demonstrating the localized feature of the TDC measurements were significantly greater than the BIS arm ratio 1.12 ± 0.12 (both p < 0.001). CONCLUSIONS Discrepancies between TDC and BIS techniques in assessing lymphedema are related to different measurement techniques and assessed tissue water components. Independently of selected technique-specific threshold limit, the TDC technique was more sensitive than the BIS technique in the early assessment of BCRL and demonstrated that nearly 20% of early lymphedema are only superficially localized. The results further supported the complementary role of TDC and arm volume measurements as a highly diagnostic method for early lymphedema.
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Affiliation(s)
- Tapani Lahtinen
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Jan Seppälä
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Tuomas Viren
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Karin Johansson
- 2 Department of Health Sciences, Lund University , Lund, Sweden
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Ward LC, Isenring E, Dyer JM, Kagawa M, Essex T. Resistivity coefficients for body composition analysis using bioimpedance spectroscopy: effects of body dominance and mixture theory algorithm. Physiol Meas 2015; 36:1529-49. [PMID: 26034992 DOI: 10.1088/0967-3334/36/7/1529] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Body composition is commonly predicted from bioelectrical impedance spectroscopy using mixture theory algorithms. Mixture theory algorithms require the input of values for the resistivities of intra-and extracellular water of body tissues. Various derivations of these algorithms have been published, individually requiring resistivity values specific for each algorithm. This study determined apparent resistivity values in 85 healthy males and 66 healthy females for each of the four published mixture theory algorithms. The resistivity coefficients determined here are compared to published values and the inter-individual (biological) variation discussed with particular reference to consequential error in prediction of body fluid volumes. In addition, the relationships between the four algorithmic approaches are derived and methods for the inter-conversion of coefficients between algorithms presented.
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Affiliation(s)
- L C Ward
- School Chemistry and Molecular Biosciences, The University of Queensland, Australia
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Avila ML, Ward LC, Feldman BM, Montoya MI, Stinson J, Kiss A, Brandão LR. Normal values for segmental bioimpedance spectroscopy in pediatric patients. PLoS One 2015. [PMID: 25875618 DOI: 10.1371/hournal.pone.0126268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Localized limb edema is a clinically relevant sign in diseases such as post-thrombotic syndrome and lymphedema. Quantitative evaluation of localized edema in children is mainly done by measuring the absolute difference in limb circumference, which includes fat and fat-free mass. Bioimpedance spectroscopy (BIS) provides information on the fluid volume of a body segment. Our objective was to determine normal ranges for segmental (arm and leg) BIS measurements in healthy children. Additionally, we determined the normal ranges for the difference in arm and ankle circumference and explored the influence of handedness and the correlation between techniques. METHODS Healthy children aged 1-18 years were recruited. The ratio of extracellular fluid content between contralateral limbs (estimated as the inter-arm and inter-leg extracellular impedance ratio), and the ratio of extracellular to intracellular fluid content for each limb (estimated as the intracellular to extracellular impedance ratio) were determined with a bioimpedance spectrometer. Arm and ankle circumference was determined with a Gulick II tape. RESULTS We recruited 223 healthy children (48 infants, 54 preschoolers, 66 school-aged children, and 55 teenagers). Normal values for arm and leg BIS measurements, and for the difference in arm and ankle circumference were estimated for each age category. No influence of handedness was found. We found a statistically significant correlation between extracellular impedance ratio and circumference difference for arms among teenagers. CONCLUSION We determined normal BIS ranges for arms and legs and for the difference in circumference between arms and between ankles in children. There was no statistically significant correlation between extracellular impedance ratio and difference in circumference, except in the case of arms in adolescents. This may indicate that limb circumference measures quantities other than fluid, challenging the adequacy of this technique to determine the presence of localized edema in most age groups.
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Affiliation(s)
- Maria Laura Avila
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Brian M Feldman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Madeline I Montoya
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Leonardo R Brandão
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Normal values for segmental bioimpedance spectroscopy in pediatric patients. PLoS One 2015; 10:e0126268. [PMID: 25875618 PMCID: PMC4395226 DOI: 10.1371/journal.pone.0126268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/31/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Localized limb edema is a clinically relevant sign in diseases such as post-thrombotic syndrome and lymphedema. Quantitative evaluation of localized edema in children is mainly done by measuring the absolute difference in limb circumference, which includes fat and fat-free mass. Bioimpedance spectroscopy (BIS) provides information on the fluid volume of a body segment. Our objective was to determine normal ranges for segmental (arm and leg) BIS measurements in healthy children. Additionally, we determined the normal ranges for the difference in arm and ankle circumference and explored the influence of handedness and the correlation between techniques. Methods Healthy children aged 1-18 years were recruited. The ratio of extracellular fluid content between contralateral limbs (estimated as the inter-arm and inter-leg extracellular impedance ratio), and the ratio of extracellular to intracellular fluid content for each limb (estimated as the intracellular to extracellular impedance ratio) were determined with a bioimpedance spectrometer. Arm and ankle circumference was determined with a Gulick II tape. Results We recruited 223 healthy children (48 infants, 54 preschoolers, 66 school-aged children, and 55 teenagers). Normal values for arm and leg BIS measurements, and for the difference in arm and ankle circumference were estimated for each age category. No influence of handedness was found. We found a statistically significant correlation between extracellular impedance ratio and circumference difference for arms among teenagers. Conclusion We determined normal BIS ranges for arms and legs and for the difference in circumference between arms and between ankles in children. There was no statistically significant correlation between extracellular impedance ratio and difference in circumference, except in the case of arms in adolescents. This may indicate that limb circumference measures quantities other than fluid, challenging the adequacy of this technique to determine the presence of localized edema in most age groups.
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Lee MJ, Beith J, Ward L, Kilbreath S. Lymphedema Following Taxane-Based Chemotherapy in Women with Early Breast Cancer. Lymphat Res Biol 2014; 12:282-8. [DOI: 10.1089/lrb.2014.0030] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mi-Joung Lee
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Sydney, Australia
| | - Leigh Ward
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Sharon Kilbreath
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Svensson BJ, Dylke ES, Ward LC, Kilbreath SL. Segmental Impedance Thresholds for Early Detection of Unilateral Upper Limb Swelling. Lymphat Res Biol 2014; 13:253-9. [PMID: 24837521 DOI: 10.1089/lrb.2013.0050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Detection of early lymphedema is important for effective treatment outcome and reduction of disease burden. The aims of this study were to determine normal inter-limb variance in the hand and four segments of the arm using bioimpedance spectroscopy (BIS) to provide diagnostic thresholds for detection of early lymphedema development, to determine the intra-rater reliability of these measurements, and to compare the inter-limb BIS ratios to differences based on arm circumference measures. METHODS AND RESULTS One hundred women, aged 49.1 (SD 13.8) years without history of breast cancer or lymphedema participated. Impedance measures for the hand and four 10 cm length arm segments were used to determine the inter-limb segment BIS ratios. Circumference difference and segment volumes were calculated from circumference measures obtained with a tape measure. A subgroup of women was measured on two occasions, one week apart. Thresholds were determined for the dominant and nondominant limb, based on two and three standard deviations (SD) above the mean. The 2SD and 3SD thresholds for the dominant arm ranged from 1.121 to 1.150 and 1.172 to 1.209, respectively, and for the nondominant limb ranged from 1.057 to 1.107 and 1.103 to 1.169, respectively. Intra-rater reliability was high (ICC: 0.945-0.983). BIS ratio and circumference-based measures did not identify the same segments as being over threshold. CONCLUSIONS BIS diagnostic thresholds for the hand and four segments of the arm, based on normative data, taking into consideration arm dominance have been developed. Segmental BIS has been shown to be highly reliable.
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Affiliation(s)
- B J Svensson
- 1 Faculty of Health Sciences, University of Sydney , Sydney, Australia .,2 Lourdes Hospital and Community Health Service , Dubbo, Australia
| | - E S Dylke
- 1 Faculty of Health Sciences, University of Sydney , Sydney, Australia
| | - L C Ward
- 1 Faculty of Health Sciences, University of Sydney , Sydney, Australia .,3 School of Chemistry and Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - S L Kilbreath
- 1 Faculty of Health Sciences, University of Sydney , Sydney, Australia
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Development of a single-frequency bioimpedance prediction equation for fat-free mass in an adult Indigenous Australian population. Eur J Clin Nutr 2014; 69:28-33. [PMID: 24755929 DOI: 10.1038/ejcn.2014.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES To describe the development of a single-frequency bioimpedance prediction equation for fat-free mass (FFM) suitable for adult Aboriginal and Torres Strait Islander peoples with and without diabetes or indicators of chronic kidney disease (CKD). SUBJECTS/METHODS FFM was measured by whole-body dual-energy X-ray absorptiometry in 147 adult Indigenous Australians. Height, weight, body circumference and resistance were also measured. Adults with and without diabetes and indicators of CKD were examined. A random split sample with internal cross-validation approach was used to predict and subsequently validate FFM using resistance, height, weight, age and gender against measured FFM. RESULTS Among 147 adults with a median body mass index of 31 kg/m(2), the final model of FFM was FFM (kg)=0.432 (height, cm(2)/resistance, ohm)-0.086 (age, years)+0.269 (weight, kg)-6.422 (if female)+16.429. Adjusted R(2) was 0.94 and the root mean square error was 3.33 kg. The concordance was high (rc=0.97) between measured and predicted FFM across a wide range of FFM (31-85 kg). CONCLUSIONS In the context of the high burden of diabetes and CKD among adult Indigenous Australians, this new equation for FFM was both accurate and precise and based on easily acquired variables (height, weight, age, gender and resistance) among a heterogeneous adult cohort.
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THEME 2 RESPIRATORY AND NUTRITIONAL MANAGEMENT. Amyotroph Lateral Scler Frontotemporal Degener 2013. [DOI: 10.3109/21678421.2013.838416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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