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Murray Hurtado M, Martín Rivada Á, Quintero Alemán C, Ruiz Alcántara MP, Ramallo Fariña Y. Body composition and nutritional status changes in adolescents with anorexia nervosa. An Pediatr (Barc) 2023; 99:162-169. [PMID: 37563070 DOI: 10.1016/j.anpede.2023.06.015] [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: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for the study of body composition is dual-energy X-ray absorptiometry (DEXA), although electrical bioimpedance (BIA) is a more accessible, cheaper and faster method that does not involve exposure to radiation. MATERIAL AND METHODS We recruited 33 female adolescents with AN (age, 11.7-16.3 years) by consecutive sampling. We collected data on clinical, anthropometric and laboratory variables. Patients were assessed with BIA and DEXA at inclusion in the study and at the end of the study, with a mean duration of follow-up of 1 year, during the nutritional rehabilitation phase. RESULTS There was significant improvement in nutritional status, reflected by the body composition obtained by anthropometric measurements and BIA. The phase angle increased significantly during the follow-up. Greater weight loss was associated with the presence of secondary amenorrhoea and decreased bone mineral density in the spine. CONCLUSIONS Electrical BIA is a useful tool for assessment and monitoring of nutritional status in paediatric patients with AN. Dual-energy X-ray absorptiometry continues to be essential to assess bone mineral density. The role of hormones such as leptin remains to be elucidated.
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Affiliation(s)
- Mercedes Murray Hurtado
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - Álvaro Martín Rivada
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Yolanda Ramallo Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Colegio Oficial de Médicos de Tenerife, Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Santa Cruz de Tenerife, Spain
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Abbaspour A, Reed KK, Hübel C, Bulik-Sullivan EC, Tang Q, Bulik CM, Carroll IM. Comparison of Dual-Energy X-ray Absorptiometry and Bioelectrical Impedance Analysis in the Assessment of Body Composition in Women with Anorexia Nervosa upon Admission and Discharge from an Inpatient Specialist Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111388. [PMID: 34769915 PMCID: PMC8583076 DOI: 10.3390/ijerph182111388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
Assessment of body composition is fundamental in diagnosis and treatment of anorexia nervosa (AN). The gold standard dual-energy X-ray absorptiometry (DXA) is expensive and not universally available. Bioelectrical impedance analysis (BIA) is a non-invasive, inexpensive method relative to DXA. We compared DXA and BIA in the assessment of fat-free mass (FFM), fat mass (FM), and body fat percentage (BF%) in women with AN upon admission (ANT1) and discharge (ANT2) from an inpatient specialist unit with a referent healthy control (HC) group. The study population consisted of 31 ANT1, 25 ANT2, and 52 HC women with median age of 21 years. Body composition was measured by DXA and Tanita foot-to-foot BIA. Comparison between the two methods was done using Bland–Altman analysis, Pearson’s correlation coefficient, Lin’s concordance correlation coefficient, and linear regression. The mean difference (bias) in FM and BF% values obtained by DXA and BIA in ANT1 (FM: +1.01 kg, BF%: +2.26%) and ANT2 (FM: +1.49 kg, BF%: +1.66%) were comparable to HC (FM: −1.32 kg, BF%: −2.29%) although in opposite directions. Less bias was observed in FFM values in ANT1 (−0.46 kg) and ANT2 (−0.86 kg) than in HC (+2.03 kg); however, the limits of agreement between the two methods were wider in ANT1 and ANT2 than in HC for all measurements. No association was observed between age, percentage of total body water, and the time spent on the inpatient specialist unit with the difference in estimates of body composition between DXA and BIA. Comparison of DXA and BIA suggests that DXA should remain the gold standard for measuring body composition; the development of more specific BIA equations is required to improve validity and precision of BIA in patients with AN. Despite ease and cost in both BIA access and operation, the suitability of BIA in a low bodyweight eating disorders population remains questionable.
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Affiliation(s)
- Afrouz Abbaspour
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden; (C.H.); (C.M.B.)
- Correspondence:
| | - Kylie K. Reed
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.K.R.); (E.C.B.-S.); (I.M.C.)
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden; (C.H.); (C.M.B.)
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE58AF, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London SE58AF, UK
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, 8000 Aarhus, Denmark
| | - Emily C. Bulik-Sullivan
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.K.R.); (E.C.B.-S.); (I.M.C.)
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Quyen Tang
- Graduate School of Professional Psychology, Morrison Family College of Health, University of St. Thomas, Minneapolis, MN 55403, USA;
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden; (C.H.); (C.M.B.)
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.K.R.); (E.C.B.-S.); (I.M.C.)
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ian M. Carroll
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.K.R.); (E.C.B.-S.); (I.M.C.)
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Popiołek-Kalisz J, Teter M, Kozak G, Powrózek T, Mlak R, Sobieszek G, Karakuła-Juchnowicz H, Małecka-Massalska T. Potential bioelectrical impedance analysis (BIA) parameters in prediction muscle strength in women with anorexia nervosa. World J Biol Psychiatry 2021; 22:203-213. [PMID: 32462960 DOI: 10.1080/15622975.2020.1774652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The role of physical activity in anorexia nervosa (AN) treatment has been investigated. Muscle strength (MS) reflects physical condition and can predict AN patients' response to this novel treatment approach. This study was intended to find bioelectrical impedance analysis (BIA) parameters that predict AN patients' MS. METHODS The study included 42 AN patients and 42 healthy ones in the control group. BIA parameters that predict MS were assessed by dividing AN patients into groups by their hand grip strength test score (higher/lower than 22.5 kg). RESULTS The highest accuracy for distinguishing AN subjects from the control group was achieved by cell membrane capacitance (AUC = 0.916), impedance at 200 kHz and 5 kHz ratio (AUC = 0.924), phase angle (PA) 5 kHz (AUC = 0.906) and PA 50 kHz (AUC = 0.919). The low MS group had significantly lower values of PA 50 kHz (mean: 4.03 ± 0.80° vs. 4.58 ± 0.65°; p = 0.032) and fat-free mass index (mean: 12.22 ± 1.41 kg/m2 vs. 13.14 ± 0.94 kg/m2; p = 0.026). In the univariate model, PA 50 kHz ≥4.037° was associated with the lowest chance of muscle weakness (OR = 0.230; p = 0.005). In the multivariate analysis, PA 50 kHz was the only significant factor of MS (OR = 0.01; p = 0.027). CONCLUSIONS PA 50 kHz is the best BIA parameter to predict MS in AN patients. It could be useful for assessment before physical activity treatment application.
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Affiliation(s)
| | - Mariusz Teter
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Gustaw Kozak
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Tomasz Powrózek
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Sobieszek
- Clinic of Cardiology and Internal Medicine, Department of Cardiology, Military Hospital, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
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Hübel C, Yilmaz Z, Schaumberg KE, Breithaupt L, Hunjan A, Horne E, García‐González J, O'Reilly PF, Bulik CM, Breen G. Body composition in anorexia nervosa: Meta-analysis and meta-regression of cross-sectional and longitudinal studies. Int J Eat Disord 2019; 52:1205-1223. [PMID: 31512774 PMCID: PMC6899925 DOI: 10.1002/eat.23158] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. METHOD In accordance with PRISMA guidelines, we conducted 94 meta-analyses on 62 samples published during 1996-2019, comparing up to 2,319 pretreatment, posttreatment, and weight-recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat-free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta-regressions examined relationships among those measures and moderators. RESULTS Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: -8.80 kg, 95% CI: -9.81, -7.79, Q = 1.01 × 10-63 ) and 4.98 kg (95% CI: -5.85, -4.12, Q = 1.99 × 10-28 ) lower fat-free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: -2.1, -6.2, Q = 2.30 × 10-4 ). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat-free mass (MD: -1.27 kg, 95% CI: -1.79, -0.75, Q = 5.49 × 10-6 ) and bone mineral density (MD: -0.10 kg, 95% CI: -0.18, -0.03, Q = 0.01) remained significantly altered. DISCUSSION Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long-term altered levels of fat-free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. RESUMENOBJETIVO Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. MÉTODO: De acuerdo con las pautas PRISMA, realizamos 94 meta-análisis en 62 muestras publicadas entre 1996-2019, comparando hasta 2,319 pacientes mujeres en pre-tratamiento, post-tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta-regresiones examinaron las relaciones entre esas medidas y moderadores. RESULTADOS Las pacientes femeninas con AN pre-tratamiento mostraron un 50% menos de masa grasa (MD: -8.80 kg, CI 95%: -9.81, -7.79, Q = 1.01 × 10-63 ) y 4.98 kg (CI 95%: -5.85, -4.12, Q = 1.99 × 10-28 ) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: -2.1, -6.2, Q = 2.30 × 10-4 ). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: -1.27 kg, CI 95%: -1.79, -0.75, Q = 5.49 × 10-6 ) y la densidad mineral ósea (MD: -0.10 kg, CI 95%: -0.18, -0.03, Q = 0.01) permanecieron significativamente alteradas. DISCUSIÓN: La composición corporal es marcadamente alterada en la AN, lo que garantiza la investigación en estos fenotipos como predictores de riesgo clínico o de recaída. Notablemente, la alteración a largo plazo de los niveles de masa libre de grasa y densidad mineral ósea sugieren que estos parámetros debe ser investigados como potenciales rasgos indicadores de AN.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Zeynep Yilmaz
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of GeneticsUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Katherine E. Schaumberg
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of PsychiatryUniversity of Wisconsin—MadisonMadisonWisconsin
| | - Lauren Breithaupt
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusetts
- Department of PsychiatryHarvard Medical SchoolBostonMassachusetts
| | - Avina Hunjan
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
| | - Eleanor Horne
- Department of Genetics, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | | | - Paul F. O'Reilly
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
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Anthropometrical and Bioelectrical Impedance Analysis Parameters in Anorexia Nervosa Patients' Nutritional Status Assessment. ACTA ACUST UNITED AC 2019; 55:medicina55100671. [PMID: 31623379 PMCID: PMC6843431 DOI: 10.3390/medicina55100671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Body mass index (BMI) is still the only recommended measurable nutritional status assessment parameter in anorexia nervosa (AN). The aim of this study was to measure other anthropometrical and bioelectrical impedance analysis (BIA) parameters in AN patients and to evaluate their nutritional status assessment value. Materials and Methods: The 46 AN female patients were examined at the beginning of hospitalization and followed-up in three measurements (in 6 ± 2 weeks’ intervals). Anthropometrical assessment was based on BMI, circumferences of arm, calf, thigh, hips, waist, their ratio (waist-to-hip ratio (WHR)), and a skinfold test over biceps and triceps muscle, under the scapula, over the hip, and 2 cm from the umbilicus. The BIA parameters included phase angle (PA), membrane capacitance (Cm), and impedance at 200 kHz, and a 5 kHz ratio (Z200/5). Results: In the 1st measurement, BMI correlated with all anthropometric and BIA parameters (p < 0.05). For BIA parameters, the correlation included arm circumference and WHR (p < 0.05). In the follow-up, significant changes were observed in BMI and all BIA parameters. The correlation between BMI and all BIA parameters was present in the 2nd and 3rd measurements (p < 0.05). In the 4th measurement, BMI correlated only with Cm (p = 0.0114). Comparison of BIA parameters according to the state of starvation (BMI < 16.0 kg/m2) revealed that all studied BIA parameters were characterized by statistically significant sensitivity and specificity in the detection of this condition (p < 0.05), except PA in the 4th measurement (p = 0.2099). Conclusions: Selected BIA and anthropometrical parameters could be used for AN patients’ assessment. The study confirmed dynamic changes of BIA parameters during the follow-up. They could be useful in the detection of the state of starvation.
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Marra M, Sammarco R, De Filippo E, Caldara A, Speranza E, Scalfi L, Contaldo F, Pasanisi F. Prediction of body composition in anorexia nervosa: Results from a retrospective study. Clin Nutr 2017; 37:1670-1674. [PMID: 28847608 DOI: 10.1016/j.clnu.2017.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/05/2017] [Accepted: 07/22/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The assessment of body composition is crucial in evaluating nutritional status in female subjects with anorexia nervosa (AN) and improving their clinical management. The aim of this retrospective study was to assess the accuracy of selected BIA (bioimpedance analysis) equations for fat-free mass (FFM) in female AN subjects and to formulate a specific equation for these subjects. METHODS Eighty-two restrictive female AN subjects (age 20.5 ± 3.7 yrs, BMI 15.7 ± 1.7 kg/m2) were studied. Body composition was determined with dual-energy X-ray absorptiometry (DXA) and estimated by BIA using five different equations. Linear correlation analysis was carried out to evaluate the association of FFM with selected variables. Multiple regression analysis was used to formulate specific equations to predict FFM in AN. RESULTS All predictive equations underestimated FFM at the population level with a bias from -5.6 to -11.7%, while the percentage of accurate predictions varied from 12.2% to 35.4%. More interestingly, multiple regression analysis clearly indicates that, in addition to weight, ZI100 or RI also emerged as independent predictors of DXA-derived FFM, increasing the prediction power of the equation well above that observed with anthropometric characteristics only. CONCLUSIONS This study shows that the selected predictive BIA equations considered exhibit an insufficient accuracy at the population and the individual level. Predictive formulas based on body weight plus BIA parameters such as RI and ZI100 offer a rather accurate prediction of FFM (with high R squared).
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Affiliation(s)
- Maurizio Marra
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Rosa Sammarco
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
| | - Emilia De Filippo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Annarita Caldara
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Enza Speranza
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University of Naples, Italy
| | - Franco Contaldo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Inter-University Centre for Obesity and Eating Disorders (CISRODCA), Federico II University of Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Inter-University Centre for Obesity and Eating Disorders (CISRODCA), Federico II University of Naples, Italy
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Fortunato F, Demartini B, Maffoni C, Apicella E, Leonardi V, Mendolicchio L. A disconnection between nutritional status (in terms of body mass index and phase angle) and psychopathology in anorexia nervosa. Psychiatry Res 2017; 252:196-200. [PMID: 28285245 DOI: 10.1016/j.psychres.2017.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 11/28/2022]
Abstract
The aim of our study was to investigate the relationship between nutritional status (body mass index and phase angle) and psychological symptoms at admission and discharge in a residential population of anorexic patients. We also aimed to determine the evolution of the above psychological symptoms and nutrition rehabilitation from admission to discharge. Thirty-six consecutive patients were included. The evaluation was performed using the following measures at admission and discharge: body mass index, phase angle, Eating Disorders Inventory-3, Multiphasic Personality Inventory-2 and Body Uneasiness. Admission and discharge nutritional status were not correlated with psychometric scores respectively at admission and at discharge. In addition, neither the improvement in the scores on the psychometric scales between admission and discharge was correlated to body mass index, phase angle improvement. For the group as a whole there were significant improvements from admission to discharge in nutritional status, Multiphasic Personality Inventory-2-Depression, Body Uneasiness-Global Score Index and in all the composites of Eating Disorders Inventory-3. Our data showed a disconnection between nutritional status and eating disorders psychopathology and/or psychiatric comorbidities.
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Affiliation(s)
| | - Benedetta Demartini
- Cattedra di Psichiatria, Dipartimento di Scienze della Salute, Universita` degli Studi di Milano, Italy.
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Evaluation of a new impedancemeter to independently measure extracellular, intracellular and total body water volumes: application to the measurement of hydration. Med Biol Eng Comput 2015; 53:989-99. [PMID: 26036775 DOI: 10.1007/s11517-015-1305-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to evaluate the accuracy of independent hydric data for the quantification of total body water (V t), extracellular water (V e) and intracellular water (V i), obtained by a multifrequency impedancemeter Z-Métrix(®) (ZM), in standing and lying position, with respect to the Xitron reference. In a second step, the aim was to consider whether it is possible to quantify daily hydration. The average repeatability error of the ZM impedancemeter is less than 0.5 %. For total body water (V t), we note a low R (2) dispersion with an average of 0.9 for men and 0.6 for women. The estimation of extracellular water is equivalent to a maximum error of 3.1 % in standing position for women against 2.97 % for men in the same position. The estimation of the total body water by direct measurement and by summing the volumes of extracellular and intracellular water obtained by the Z-Metrix(®) shows very low dispersions with R (2) = 0.89 and average error from 1.3 % for healthy women in lying position to 3.9 % for healthy women in standing position. Finally, despite the impact of events on the daily measurements, it is viable to track a subject's overall hydration.
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Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases. SENSORS 2014; 14:10895-928. [PMID: 24949644 PMCID: PMC4118362 DOI: 10.3390/s140610895] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/13/2022]
Abstract
Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases.
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Affiliation(s)
- Sami F Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Mas S Mohktar
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Fatimah Ibrahim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health 2013; 53:579-84. [PMID: 24054812 PMCID: PMC4452504 DOI: 10.1016/j.jadohealth.2013.07.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Current recommendations for refeeding in anorexia nervosa (AN) are conservative, beginning around 1,200 calories to avoid refeeding syndrome. We previously showed poor weight gain and long hospital stay using this approach and hypothesized that a higher calorie approach would improve outcomes. METHODS Adolescents hospitalized for malnutrition due to AN were included in this quasi-experimental study comparing lower and higher calories during refeeding. Participants enrolled between 2002 and 2012; higher calories were prescribed starting around 2008. Daily prospective measures included weight, heart rate, temperature, hydration markers and serum phosphorus. Participants received formula only to replace refused food. Percent Median Body Mass Index (%MBMI) was calculated using 50th percentile body mass index for age and sex. Unpaired t-tests compared two groups split at 1,200 calories. RESULTS Fifty-six adolescents with mean (±SEM) age 16.2 (±.3) years and admit %MBMI 79.2% (±1.5%) were hospitalized for 14.9 (±.9) days. The only significant difference between groups (N = 28 each) at baseline was starting calories (1,764 [±60] vs. 1,093 [±28], p < .001). Participants on higher calories had faster weight gain (.46 [±.04] vs. .26 [±.03] %MBMI/day, p < .001), greater daily calorie advances (122 [±8] vs. 98 [±6], p = .024), shorter hospital stay (11.9 [±1.0] vs. 17.6 [±1.2] days, p < .001), and a greater tendency to receive phosphate supplementation (12 vs. 8 participants, p = .273). CONCLUSIONS Higher calorie diets produced faster weight gain in hospitalized adolescents with AN as compared with the currently recommended lower calorie diets. No cases of the refeeding syndrome were seen using phosphate supplementation. These findings lend further support to the move toward more aggressive refeeding in AN.
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Bonaccorsi G, Bassetti A, Chiari S, Dirindelli P, Lorini C, Menicalli C, Santomauro F, Martinetti MG. Body composition in subjects with anorexia nervosa: bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Eat Weight Disord 2012; 17:e298-303. [PMID: 23152083 DOI: 10.3275/8722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the applicability and validity of bioelectrical impedance analysis (BIA) compared with dual-energy X-ray absorptiometry (DXA) in a population of girls with restrictive anorexia nervosa (AN). METHODS A total of 30 girls (11-19 years old) with AN were enrolled. DXA and BIA (BIA software and the Deurenberg equations) were used to estimate the body composition. The correlation between the methods was assessed by Pearson's correlation coefficient and the Bland-Altman method. RESULTS The mean FFM estimates were 33.2 kg (BIA software), 32.8 kg (BIA, Deurenberg equation) and 33.1 kg (DXA). The mean FM values were 5.6 kg (BIA software), 6.2 kg (BIA, Deurenberg equation) and 6.4 kg (DXA). There was a high correlation between the FFM values estimated with the two methods (BIA software vs DXA r=0.917, p<0.001; Deurenberg equation vs DXA r=0.931, p<0.001). For the FFM, the limits of agreement were equal to ±3.34 kg for the BIA software and ±2.96 kg for the Deurenberg equation. For the FM, the limits of agreement were equal to ±4.60 kg for the BIA software and ±3.82 kg for the Deurenberg equation. CONCLUSION The results show a good correlation between DXA and BIA. BIA seems to be a valid alternative for epidemiological and clinical evaluations.
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Affiliation(s)
- G Bonaccorsi
- Dipartimento di Sanità Pubblica, Università degli Studi di Firenze, Viale GB Morgagni 48, 50134 Firenze, Italy
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12
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Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health 2012; 50:24-9. [PMID: 22188830 PMCID: PMC4467563 DOI: 10.1016/j.jadohealth.2011.06.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 06/09/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol. METHODS Adolescents aged 13.1-20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day. RESULTS Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission. CONCLUSIONS Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome.
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Affiliation(s)
- Andrea K. Garber
- Division of Adolescent Medicine, University of California, San Francisco, California,Address correspondence to: Andrea K. Garber, Ph.D., R.D., Division of Adolescent Medicine, University of California, Suite 245, California Street, San Francisco, CA 94143. (A. K. Garber)
| | - Nobuaki Michihata
- Division of Adolescent Medicine, University of California, San Francisco, California,Division of Adolescent Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Katherine Hetnal
- Division of Adolescent Medicine, University of California, San Francisco, California
| | - Mary-Ann Shafer
- Division of Adolescent Medicine, University of California, San Francisco, California
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, University of California, San Francisco, California
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Mattar L, Huas C, Duclos J, Apfel A, Godart N. Relationship between malnutrition and depression or anxiety in Anorexia Nervosa: a critical review of the literature. J Affect Disord 2011; 132:311-8. [PMID: 20920829 DOI: 10.1016/j.jad.2010.09.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression, anxiety and obsessive-compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). Clinical consensus admits that depressive symptoms and anxiety are the sequelae of malnutrition in AN. This review presents a critical assessment of the literature that looked into the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment. METHODS We performed a systematic search of literature in Medline and PsychInfo for all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords "Anorexia Nervosa", "depression", "anxiety", "obsessive-compulsive disorder" and "malnutrition". Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept. This search was complemented by a manual search. We also checked the reference lists of the articles we found. RESULTS Seven papers were analyzed and critically reviewed for their methods and results. Results are contradictory and inconsistent at all levels of assessment. CONCLUSIONS Evidence based data is very rare. From the 7 reviewed studies, none of them draw the same conclusion. This is mainly due to the large differences in the samples' populations and the studies' protocols. Future studies are needed to focus on the relationship between depression/anxiety symptoms and malnutrition. A more critical nutritional assessment should be undertaken with multiple psychological assessment scales.
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Affiliation(s)
- Lama Mattar
- INSERM U669, Maison de Solenn, 97 Boulevard De Port Royal 75014 Paris, France
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14
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Mattar L, Godart N, Melchior JC, Falissard B, Kolta S, Ringuenet D, Vindreau C, Nordon C, Blanchet C, Pichard C. Underweight patients with anorexia nervosa: comparison of bioelectrical impedance analysis using five equations to dual X-ray absorptiometry. Clin Nutr 2011; 30:746-52. [PMID: 21802800 DOI: 10.1016/j.clnu.2011.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/15/2011] [Accepted: 05/22/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients. METHODS Fifty female patients with AN (BMI=14.3 ± 1.49, age=19.98 ± 5.68yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland-Altman plots. RESULTS The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM(dxa)=35.80 kg versus FFM(deurenberg)=36.36 kg) and very close estimates of FM (FM(dxa)=9.16 kg and FM(deurenberg)=9.57 kg) The Kushner equation showed slightly better estimates for FM (FM(kushner)=9. 0kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA. CONCLUSION The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8-21.0, and for ages between 13.4 and up to 36.9 years.
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Affiliation(s)
- Lama Mattar
- INSERM U669, PSIGIAM 'Paris Sud Innovation Group in Adolescent Mental Health', Maison des Adolescents, 97 Boulevard De Port Royal, 75014 Paris, France.
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15
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Anorexia nervosa and nutritional assessment: contribution of body composition measurements. Nutr Res Rev 2011; 24:39-45. [DOI: 10.1017/s0954422410000284] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from AN.
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16
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Body fluid retention and body weight change in anorexia nervosa patients during refeeding. Clin Nutr 2010; 29:749-55. [DOI: 10.1016/j.clnu.2010.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/26/2010] [Accepted: 05/28/2010] [Indexed: 11/20/2022]
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Andersen TB, Jødal L, Arveschoug A, Eskild-Jensen A, Frøkiær J, Brøchner-Mortensen J. Precision and within- and between-day variation of bioimpedance parameters in children aged 2-14 years. Clin Nutr 2010; 30:326-31. [PMID: 21074302 DOI: 10.1016/j.clnu.2010.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Bioimpedance spectroscopy (BIS) offers the possibility to perform rapid estimates of fluid distribution and body composition. Few studies, however, have addressed the precision and biological variation in a pediatric population. Our objectives were to evaluate precision, variation within- and between-days for the BIS-determined parameters total body fluid, extra-cellular fluid, intra-cellular fluid, body cell mass, fat-free mass, extra-cellular resistance, intra-cellular resistance and percentage body fat using a Xitron 4200. METHODS All 133 children (81 boys, 52 girls; 2.4-14.9 years) had one series measured on day one (precision population). Forty-four children had a second series on day one (within-day sub-population). Thirty-two children had a series measured on the next day (between-day sub-population). Each measurement series consisted of three repeated measurements. A linear mixed model was used for statistical analysis. RESULTS The precision was 0.3-0.8% in children ≥6 years and 0.5-2.4% in children <6 years with a statistically significant difference between the two age-groups (p<0.001). Within-day variation was 1.1-2.8% and between-day variation 2.4-5.7%. Total variation and reference change values are reported. CONCLUSION The Xitron 4200 has a very good but age-dependent precision. The median value of three repeated measurements is recommended in order to avoid incorrect measurements.
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Affiliation(s)
- Trine B Andersen
- Department of Nuclear Medicine, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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Abstract
PURPOSE OF REVIEW To review various methods for measuring body composition by bioimpedance and their limitations, as well as available impedance meters, including body fat analyzers for home use. RECENT FINDINGS Bioimpedance spectroscopy, which requires multifrequency impedance meters, is preferable for fluid volume measurements, especially extracellular fluid, whereas bioimpedance analysis at 50 kHz is more widely used for measuring fat-free mass. A method for using bioimpedance spectroscopy equations with 50 kHz impedance meters has been recently proposed and successfully tested. Low cost foot-to-foot impedance meters (body fat analyzers) with plantar electrodes on a body scale, that are easy and fast to use, have been compared with medical impedance meters and with dual X-ray absorptiometry measurements and found reasonably accurate, except for individuals with very low or high BMI. SUMMARY Body composition by bioimpedance is gaining acceptance in nutrition, hemodialysis, gerontology and sports medicine. Body fat analyzers that have been validated by comparison with dual x-ray absorptiometry could be useful to general practitioners, nutritionists and cardiologists.
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Affiliation(s)
- Michel Y Jaffrin
- Department of Biological Engineering, UMR CNRS 6600, University of Technology of Compiegne, Compiegne, France.
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