Sodium Selenite Alleviates Breast Cancer-Related Lymphedema Independent of Antioxidant Defense System

Long-term surveillance is necessary to identify patients at risk of developing secondary lymphedema after breast cancer surgery. We assessed how sodium selenite supplementation would affect breast cancer-related lymphedema (BCRL) symptoms and parameters in association with antioxidant effects. A randomized, double-blind, controlled trial was conducted on 26 participants with clinical stage II to III BCRL. The control group (CTRL, n = 12) and selenium group (SE, n = 14) underwent five sessions of 0.9% saline and 500 μg sodium selenite (Selenase^®) IV injections, respectively, within 2 weeks. All patients were educated on recommended behavior and self-administered manual lymphatic drainage. Clinical diagnosis on lymphedema by physicians, bioimpedance data, blood levels of oxidative markers, including glutathione (GSH), glutathione disulfide (GSSG), malondialdehyde (MDA), glutathione peroxidase activity (GSH-Px), and serum oxygen radical absorbance capacity (ORAC) levels, were investigated at timelines defined as baseline, 2-week, and follow-up. Sodium selenite increased whole blood selenium concentration in the SE group. Compared to the baseline, at 2 weeks, 75.0% of participants in clinical stage showed improvement, while there was no change in the CTRL group. At follow-up, 83.3% and 10.0% of the SE and CTRL, respectively, showed stage changes from III to II (p = 0.002). Extracellular water (ECW) ratios were significantly reduced at 2 weeks and follow-up, only in the SE group. Blood GSH, GSSG, GSH/GSSG ratio, MDA, and ORAC levels did not change by selenium supplementation. Sodium selenite improved diagnostic stages of BCRL along with ECW ratios, although the beneficial effect might not be related to its antioxidant activity. Selenite’s effect on lymphedema may be associated with non-antioxidant properties, such as anti-inflammation and immune function. Further mechanistic research using a larger population is needed.

Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population

BACKGROUND & AIMS

Body composition measurement is a valuable tool for assessing nutritional status and physical fitness in a variety of clinical settings. Although bioimpedance analysis (BIA) can easily assess body composition, its accuracy remains unclear. We examined the accuracy of direct segmental multi-frequency BIA technique (DSM-BIA) in assessing different body composition parameters, using dual energy X-ray absorptiometry (DEXA) as a reference standard.

METHODS

A total of 484 middle-aged participants from the Leiden Longevity Study were recruited. Agreements between DSM-BIA and DEXA for total and segmental body composition quantification were assessed using intraclass correlation coefficients and Bland-Altman plots.

RESULTS

Excellent agreements were observed between both techniques in whole body lean mass (ICC female = 0.95, ICC men = 0.96), fat mass (ICC female = 0.97, ICC male = 0.93) and percentage body fat (ICC female = 0.93, ICC male = 0.88) measurements. Similarly, Bland-Altman plots revealed narrow limits of agreements with small biases noted for the whole body lean mass quantification but relatively wider limits for fat mass and percentage body fat quantifications. In segmental lean muscle mass quantification, excellent agreements between methods were demonstrated for the upper limbs (ICC female≥0.91, ICC men≥0.87) and lower limbs (ICC female≥0.83, ICC male≥0.85), with good agreements shown for the trunk measurements (ICC female = 0.73, ICC male = 0.70).

CONCLUSIONS

DSM-BIA is a valid tool for the assessments of total body and segmental body composition in the general middle-aged population, particularly for the quantification of body lean mass.

Relationship between segmental and whole-body phase angle in peritoneal dialysis patients

The relation between the right-side (RS) electrical impedance phase angle (PA) and segmental PA in five configurations at 50 kHz was analyzed in 23 peritoneal dialysis male patients before complete drainage of the abdominal cavity. The impedance vector (Z/H) components were standardized by the height H of the subjects (R/H and Xc/H). BIVA software was used to analyze the individual RS vector. The Pearson correlation was used to analyze the correlation between RS and segmental configurations. Student's t test and Hotelling's T2 test were used to analyze the separation of groups obtained by BIVA. The highest significant Pearson correlation was between RS and right leg total (RLEGT) in a longitudinal direction (r=0.925, P<0.001). We obtained a significant difference (P<0.05) in R/H, Xc/H (for RS and RLEGT) using Hotelling's T2 test, and in PA using Student's t test. The transverse measurement in the leg (RTRLEG) showed the lowest correlation (r=0.261). In conclusion, we can obtain similar information through the phase angle, whether RS is measured or if we measure on RLEGT. The phase angle of the transverse measurements provides different information from the phase angle of the longitudinal measurements.

Hydration abnormalities in Nigerian patients on chronic hemodialysis

The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas. Predialysis and postdialysis values of body water did not differ between BIA and anthropometric estimates. However, only the BIA estimate of the change in body water during dialysis (-0.8+/-2.9 L) did not differ from the corresponding change in body weight (-1.3+/-3.0 kg), while anthropometric estimates of the change in body water were significantly lower, approximately one-third of the change in weight. Bioelectrical impedance analysis correctly detected the intradialytic change in body water content (the ratio V/Weight) in 79% of the cases, while anthropometric formula estimates of the same change were erroneous in each case. Compared with patients with clinical postdialysis euvolemia (n=7), those with postdialysis edema (n=5) had higher values of postdialysis BIA ratios V/FFM (0.77+/-0.01 vs. 0.72+/-0.03, p<0.01) and ECFV/V (0.53+/-0.02 vs. 0.47+/-0.06, p<0.05), respectively. Bioelectrical impedance analysis appeared to underestimate body water and extracellular volume in a patient with massive ascites and bilateral pleural effusions. Anthropometric formulas are not appropriate for evaluating the state of hydration in patients on chronic hemodialysis. In contrast, BIA provides estimates of hydration agreeing with clinical estimates in the same patients, although it tends to underestimate body water and extracellular volume in patients with large collections of fluid in central body cavities.

Whole-body and thoracic bioimpedance measurement: hypertension and hyperhydration in hemodialysis patients

Mono-frequency (50 kHz) and multi-frequency (3 kHz - 1 MHz) whole-body and thoracic segment bioimpedance measurement were doing before and after hemodialysis session in 20 patients. The patients were classified in hypertensive or non-hypertensive according to the mean blood pressure, BPmean. The relation between hyper-hydration in thorax segment through real part of impedance and mean blood pressure was analyzed. Also the bioelectrical impedance vector analysis method was used to analyze the displacement of Z/H vector in order to establish the relation with hyper-hydration (edema). Finally we made multi-frequency measurements with the objective to find a significative change in high and low frequency. We obtained a significant difference (P < 0.05) in impedance parameters before and after HD session. Some patients are located in hyper-hydration zone, below the inferior pole of the 75% tolerance ellipse, whereas others patients were within the tolerance ellipses. The real part of the impedance in thorax region can identify over-hydrated patients with an increased risk for cardiovascular disease associate to hypertension. Multi-frequency bioimpedance measurement show an important change at low and high frequency and indicate that is possible to obtain more information about extra-cellular or intra-cellular fluid status, to find the relation between fluid loads, bioimpedance parameters, extra-cellular water, and blood pressure.

Thoracic versus whole body bioimpedance measurements: the relation to hydration status and hypertension in peritoneal dialysis patients

The whole body bioimpedance technique is a highly promising non-invasive, reproducible, fast and inexpensive bed-side method for monitoring hydration status. Using segmental bioimpedance measurements, it is possible to obtain information about the fluid change in each body segment (Song, Lee, Kim and Kim 1999 Perit. Dial. Int. 19 386-90). In this pilot study we have measured 25 male patients (30-65 yr, BMI 20-32 kg m(-2)) undergoing continuous ambulatory peritoneal dialysis (CAPD). Tetrapolar impedance measurements were obtained using the right-side technique (whole body), and a segmental impedance method focused in the thorax region. Blood pressure (BP) measurements were taken manually with a sphygmomanometer. Patients were classified as either stable (group 0) or unstable (group 1) using clinical parameters of overall cardiovascular risk. The Mahalanobis distance (dM2) was calculated for the mean blood pressure (BP(mean)), and the impedance parameter R normalized by body height H for the right-side (R(RS)/H) and the thorax segment (R(TH)/H). Differences between groups were significant (p < 0.0001) for R(TH)/H and for BP(mean), and less significant (p = 0.016) for R(RS)/H. Group 1 patients showed a small dM2 as compared with a reference patient (a critical patient with acute lung edema) with high BP(mean) and low values of R(TH)/H and R(RS)/H. Moreover, Group 0 patients showed a larger dM2 with respect to the reference patient, with lower BP(mean) and higher values of R(TH)/H and R(RS)/H. All patients classified as unstable by clinical assessment were correctly classified using R(TH)/H in conjunction with BP(mean) using dM2. Segmental-monofrequency non-invasive bioimpedance of the thoracic region could provide a simple, objective non-invasive method of support for facilitating the clinical assessment of CAPD patients.

Treatment of Depression and Effect of Antidepression Treatment on Nutritional Status in Chronic Hemodialysis Patients

BACKGROUND

Depression, which is the most common psychological complication in patients with end-stage renal disease (ESRD), has an impact on the clinical outcome and is associated with malnutrition in chronic hemodialysis patients. This study evaluated the effect of antidepression treatment on nutritional status in depressed chronic hemodialysis patients.

METHODS

Sixty-two ESRD patients who underwent dialysis for more than 6 months were interviewed and completed a Beck Depression Inventory assessment. Thirty-four patients who had scores greater than 18 on the Beck Depression Inventory score and met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for major depressive disorder were selected to receive paroxetine 10 mg/day and psychotherapy for 8 weeks. The remaining 28 patients were assigned to the control group. Change in the severity of depressive symptoms was ascertained by administering the Hamilton Depression Rating Scale. Nutritional status was evaluated by normalized protein catabolic rate, serum albumin and blood urea nitrogen level.

RESULTS

All patients successfully completed 8 weeks of antidepression treatment. Antidepression treatment decreased the severity of depressive symptoms (Hamilton Depression Rating Scale score: 16.6 +/- 7.0 versus 15.1 +/- 6.6, P < 0.01) and increased normalized protein catabolic rate (1.04 +/- 0.24 versus 1.17 +/- 0.29 g/kg/day, P < 0.05), serum albumin (37.3 +/- 2.0 versus 38.7 +/- 3.2 g/l, P < 0.005), and prehemodialysis blood urea nitrogen level (24.3 +/- 5.6 versus 30.2 +/- 7.9 mmol/L, P < 0.001). In the control group, no change was noted during the study period.

CONCLUSION

This study suggests that antidepressant medication with supportive psychotherapy can successfully treat depression and improve nutritional status in chronic hemodialysis patients with depression.

Bioelectric impedance vector distribution in peritoneal dialysis patients with different hydration status

BACKGROUND

In continuous ambulatory peritoneal dialysis (CAPD), total body water (TBW) is estimated by functions of body weight, and by equations of bioelectric impedance analysis (BIA). These procedures may be biased with abnormal tissue hydration. We validated vector BIA (BIVA) patterns of hydration in CAPD patients, based on direct measurements of resistance (R) and reactance (Xc) (RXc graph) without knowledge of the body weight.

METHODS

Cross-sectional study in 200 adult CAPD patients from two groups: 149 patients (77 males and 72 females) without edema (BMI 24.3 kg/m2), and 51 (29 males and 22 females) with pitting edema (BMI 24.6 kg/m2). Single frequency (50 kHz), whole-body impedance vector was measured with both empty and filled peritoneal cavity. Vector distribution was compared with that from 726 healthy subjects, 1116 hemodialysis patients, and 50 nephrotic patients, all with a same BMI. The performance of BIVA was compared with indications of four anthropometry and four conventional BIA equations for TBW.

RESULTS

TBW estimates from anthropometry (Watson, Hume and Weyers, Chertow, and Johansson formulas) were misleading, indicating the same hydration in edema. TBW estimates from BIA equations indicated a 10% excess TBW in edema. BIVA were very sensitive to fluid overload, as both R (by 10%) and Xc (by 40%) were reduced in patients with edema (regardless of peritoneal filling). The vector distribution of individual CAPD patients without edema was superposable to that of the healthy, gender-specific, reference population (50%, 75%, and 95% tolerance ellipses, RXc graph) and close to the hemodialysis, presession distribution. Vectors from patients with edema were displaced downward on the RXc graph, out of the 75% ellipse (88% sensitivity and 87% specificity), and close to vectors from nephrotic patients.

CONCLUSION

CAPD prescription would keep or bring vectors of patients back into the 75% reference ellipse (border for progression from latent to apparent overhydration across the lower pole) regardless of body weight. Whether CAPD patients with vector within the target ellipse have better outcome needs longitudinal evaluation.

Use of multifrequency bioelectrical impedance analysis for estimation of total body water and extracellular and intracellular fluid volumes in horses

OBJECTIVE

To evaluate the use of multifrequency bioelectrical impedance analysis (MF-BIA) for estimating total body water (TBW), extracellular fluid volume (ECFV), and intracellular fluid volume (ICFV) in horses.

ANIMALS

9 healthy mares.

PROCEDURE

TBW and ECFV were measured by use of deuterium oxide and sodium bromide dilution techniques, respectively. Intracellular fluid volume was calculated as the difference between TBW and ECFV. Concurrently, MF-BIA recordings were obtained by use of 4 anatomic electrode positions and 3 measurements of length. Models for MF-BIA data were created for all combinations of length and anatomic electrode position. Models were evaluated to determine the position-length configuration that provided the most consistent estimates of TBW, ECFV, and ICFV, compared with values determined by use of the dilution techniques.

RESULTS

Positioning electrodes over the ipsilateral carpus and tarsus and use of height at the tuber sacrale for length provided the closest estimate between values for TBW, ECFV, and ICFV predicted by use of MF-BIA and measured values obtained by dilutional techniques. This model had the narrowest 95% limits of agreement.

CONCLUSIONS AND CLINICAL RELEVANCE

MF-BIA techniques have been used to predict changes in TBW, ECFV, and ICFV in healthy and diseased humans. Results reported in this study provide an equine-specific model to serve as the basis for further evaluation of MF-BIA in horses with altered fluid states. The MF-BIA techniques have a number of potential applications for use in horses, including evaluation of exercise physiology, pharmacologic studies, and critical-care management.

Estimates of body water, fat-free mass, and body fat in patients on peritoneal dialysis by anthropometric formulas

BACKGROUND

Anthropometric formulas that are used to estimate body water in peritoneal dialysis patients can also be used to estimate fat-free mass and body fat. Evaluation of body composition by the anthropometric formulas rests on two assumptions: (1) fat contains no water, and (2) the water content of the fat-free mass is constant (72%).

METHODS

We compared estimates of body water, fat-free mass, and body fat by anthropometric formulas to estimates employing dilution of tracer substances to measure body water and standard methods to analyze body composition in studies performed on peritoneal dialysis patients. We also analyzed the potential errors of the estimates of body composition by the formulas.

RESULTS

Estimates of the average body composition provided by the anthropometric formulas agreed with estimates provided by the standard methods. However, these formulas have the potential of introducing large errors when estimating body composition in individuals differing from the average subject, either because the anthropometric formulas do not account for major determinants of body composition, such as physical exercise, nutrition, and catabolic illness, or because these formulas systematically overestimate body water in subjects who are obese or experiencing volume excess.

CONCLUSION

Anthropometric formulas currently in existence can provide only approximations of body composition and may be the sources of large errors in evaluating body composition in peritoneal dialysis patients. The potential errors include estimates of body water. These errors may alter the interpretation of urea kinetic studies in certain categories of peritoneal dialysis patients (e.g., obese subjects).

Dynamic assessment of fat-free mass during catabolism and recovery

Catabolism of fat-free mass affects both the quality of life and survival of patients. Because of variations in fluid status during acute illness, changes in body weight are difficult to evaluate and interpret during treatment. Nutritional assessment should therefore evaluate fat-free and fat mass changes during metabolic stress and catabolism. We have chosen to discuss bioelectrical impedance analysis, including the various bioelectrical impedance analysis techniques (i.e. multi-frequency and bioimpedance spectroscopy), as an easy, non-invasive, portable bedside technique that is operator-independent for evaluating fat-free and fat mass compartments and their changes during treatment. Clinical examples of the determination of fat-free mass in healthy and ill individuals are also presented.