Evaluation of foot-to-foot bioelectrical impedance analysis for the prediction of total body water in oncology outpatients receiving radiotherapy

Body composition changes during and after curative chemotherapy in patients with testicular cancer

BACKGROUND

Testicular cancer is associated with excellent prognosis and cure is achieved in most patients with advanced cancer treated with cisplatin-based chemotherapy. However, testicular cancer survivors are at increased risk of accelerated atherosclerosis, which significantly contributes to their late morbidity and mortality. Atherosclerosis is associated with a higher proportion of fat mass and especially with increased amount of visceral fat. We explored the effects of cisplatin-based chemotherapy on body composition during and after the treatment.

PATIENTS AND METHODS

We studied 30 testicular cancer patients before chemotherapy, after the second cycle of chemotherapy and three months after the end of chemotherapy. Body composition parameters were evaluated using bioelectrical impedance analysis (BIA).

RESULTS

Three months after the end of chemotherapy the fat mass had increased from 22.04±7.15% to 23.92±7.33% (P=0.026) and visceral fat volume had increased by 17% from 2.36±1.75l to 2.77±1.94l (P=0.013). In the whole sample there was a decrease in muscle mass after the second cycle of chemotherapy (-1.33 ± 2 kg on average; P=0.005). The changes in body composition varied according to distinct baseline fat mass.

CONCLUSION

Cisplatin-based chemotherapy was associated with increase of fat mass, visceral fat, and body mass index. We also observed decrease in muscle mass and total body water. Our results suggest that BIA could help to target preventative measures to avert the acceleration of atherosclerosis in patients treated with cisplatin-based chemotherapy.

Investigating Nutrition-Related Complications and Quality of Life in Patients With Gastroenteropancreatic Neuroendocrine Tumors: Protocol for a Mixed-Methods Prospective Study

Background

Gastroenteropancreatic neuroendocrine tumors (GEP NETs) are a heterogeneous group of tumors with distinct effects on the body due to their potential to secrete hormones and peptides. The incidence and prevalence of GEP NETs in Australia are rising. During 2000-2006, the annual incidence was approximately 3.3 per 100,000 population. To date, there has been development of clinical practice and consensus guidelines for NETs covering best practice for diagnosis, treatment, and medical management; however, the supportive care needs and optimal nutritional management of patients affected by NETs remains underresearched, and evidence to guide clinical practice is lacking. While there is emerging research describing the extent of morbidity in different types of GEP NET patients, little is known about the experience of people affected by these tumors and how nutritional status is impacted by either diagnosis or treatment.

Objective

The objective of this study was to explore nutrition-related complications and quality of life of patients diagnosed with a GEP NET and to generate evidence to inform future research and development of nutrition screening and management practices.

Methods

Patients diagnosed with a GEP NET at two metropolitan recruitment sites will be invited to participate in a 6-month, mixed-methods longitudinal study. Participants recruited to the study will receive usual care and participate in data collection for the study at 4 time points (at recruitment and 2, 4, and 6 months postrecruitment). Study data will include nutritional status, body weight, fat-free mass, and patient-reported outcome measures (dietitian contact, disease-related symptom presence and severity, dietary habits, health-related quality of life, psychological morbidity, and financial impact). At recruitment and 6 months postrecruitment, complete nutrient testing, including relevant plasma vitamin levels, will also be undertaken. A purposive sample of participants will be invited to take part in semistructured interviews to explore the experience of living with a GEP NET and associated nutrition complications.

Results

Ethics approval has been obtained, and study recruitment and data collection are underway.

Conclusions

This study will provide the first in-depth, comprehensive description of nutritional issues in patients with GEP NETs. Results will advance the knowledge of nutritional issues faced by patients with GEP NETs and help inform the development of screening tools and clinical practice guidelines.

International Registered Report Identifier (IRRID)

DERR1-10.2196/11228

A bioimpedance analysis of head-and-neck cancer patients undergoing radiotherapy

Malnutrition is a frequent manifestation in patients with head-and-neck cancer undergoing radiation therapy and a major contributor to morbidity and mortality. Thus, body composition is an important component of an overall evaluation of nutrition in cancer patients. Malnutrition is characterized by weight loss, loss of muscle mass, changes in cell membrane integrity, and alterations in fluid balance. Bioelectrical impedance analysis is a method to analyze body composition and includes parameters such as intracellular water content, extracellular water content, and cell membrane integrity in the form of a phase angle (Φ). Bioelectrical impedance analysis has consistently been shown to have prognostic value with respect to mortality and morbidity in patients undergoing chemotherapy. The goal of the present study was to evaluate the relationship between Φ, time, intracellular water content, and weight for head-and-neck cancer patients undergoing radiotherapy. The results demonstrate that Φ decreases with time and increases with intracellular water content and weight.

Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer

BACKGROUND

Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer.

METHODS

We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan-Meier method was used to calculate survival.

RESULTS

Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446).

CONCLUSIONS

Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.

Early and Intensive Dietary Counseling in Lung Cancer Patients Receiving (Chemo)Radiotherapy-A Pilot Randomized Controlled Trial

Malnutrition is prevalent in patients undergoing (chemo)radiotherapy (RT) for lung cancer. This pilot study tested the feasibility and acceptability of delivering an intensive nutrition intervention for lung cancer patients receiving RT. Twenty-four patients with lung cancer were randomized to receive the intervention which employed a care pathway to guide intensive dietary counseling from pretreatment until 6-wk posttreatment or usual care. Nutritional, fatigue, and functional outcomes were assessed using valid and reliable questionnaires before randomization, at the start and end of RT and 1- and 3-mo post-RT. Consent rate was 57% with an overall attrition of 37%. Subject compliance with the completion of study questionnaires was 100%. A clinically important mean difference indicated greater overall satisfaction with nutritional care in the intervention group (5.00, interquartile range [IQR] 4.50-5.00; 4.00, IQR 4.00-4.00). Clinically important differences favoring the intervention were observed for weight (3.0 kg; 95% confidence interval [CI] -0.8, 6.8), fat-free mass (0.6 kg; 95% CI -2.1, 3.3), physical well-being (2.1; 95% CI -2.3, 6.5), and functional well-being (5.1; 95% CI 1.6, 8.6), but all 95% CIs were wide and most included zero. Recruitment feasibility and acceptability of the intervention were demonstrated, which suggest larger trials using an intensive nutrition intervention would be achievable.

Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers

BACKGROUND

The ratio of extracellular mass to body cell mass (ecm/bcm), determined by bioelectrical impedance analysis, has been found to be a potentially useful indicator of nutrition status. Subjective global assessment (sga) is a subjective method of evaluating nutrition status in head-and-neck cancer. The present study was conducted to investigate the association between ecm/bcm and sga in head-and-neck cancer.

METHODS

Patients were classified as either well-nourished or malnourished by sga. Bioelectrical impedance analysis was conducted on a population of 75 patients with histologically confirmed head-and-neck cancer, and the ecm/bcm was calculated. Receiver operating characteristic curves were estimated using the nonparametric method to determine an optimal cut-off value of the ecm/bcm.

RESULTS

Compared with malnourished patients, those who were well-nourished had a statistically significantly lower ecm/bcm (1.11 vs. 1.28, p = 0.005). An ecm/bcm cut-off of 1.194 was 76% sensitive and 63% specific in detecting malnutrition.

CONCLUSIONS

The ecm/bcm can be an indicator that detects malnutrition in patients with head-and-neck cancer. Further observations are needed to validate the significance of the ecm/bcm and to monitor nutrition interventions.

Comparing measures of fat-free mass in overweight older adults using three different bioelectrical impedance devices and three prediction equations

OBJECTIVES

To compare measures of fat-free mass (FFM) by three different bioelectrical impedance analysis (BIA) devices and to assess the agreement between three different equations validated in older adult and/or overweight populations.

DESIGN

Cross-sectional study.

SETTING

Orthopaedics ward of Brisbane public hospital, Australia.

PARTICIPANTS

Twenty-two overweight, older Australians (72 yr ± 6.4, BMI 34 kg/m² ± 5.5) with knee osteoarthritis.

MEASUREMENTS

Body composition was measured using three BIA devices: Tanita 300-GS (foot-to-foot), Impedimed DF50 (hand-to-foot) and Impedimed SFB7 (bioelectrical impedance spectroscopy (BIS)). Three equations for predicting FFM were selected based on their ability to be applied to an older adult and/ or overweight population. Impedance values were extracted from the hand-to-foot BIA device and included in the equations to estimate FFM.

RESULTS

The mean FFM measured by BIS (57.6 kg ± 9.1) differed significantly from those measured by foot-to-foot (54.6 kg ± 8.7) and hand-to-foot BIA (53.2 kg ± 10.5) (P < 0.001). The mean ± SD FFM predicted by three equations using raw data from hand-to-foot BIA were 54.7 kg ± 8.9, 54.7 kg ± 7.9 and 52.9 kg ± 11.05 respectively. These results did not differ from the FFM predicted by the hand-to-foot device (F = 2.66, P = 0.118).

CONCLUSIONS

Our results suggest that foot-to-foot and hand-to-foot BIA may be used interchangeably in overweight older adults at the group level but due to the large limits of agreement may lead to unacceptable error in individuals. There was no difference between the three prediction equations however these results should be confirmed within a larger sample and against a reference standard.

Comparison of body composition assessment methods in breast cancer survivors

PURPOSE/OBJECTIVES

To examine and compare the reliability of four body composition methods commonly used in assessing breast cancer survivors.

DESIGN

Cross-sectional.

SETTING

A rehabilitation facility at a university-based comprehensive cancer center in the southeastern United States.

SAMPLE

14 breast cancer survivors aged 40-71 years.

METHODS

Body fat (BF) percentage was estimated via bioelectric impedance analysis (BIA), air displacement plethysmography (ADP), and skinfold thickness (SKF) using both three- and seven-site algorithms, where reliability of the methods was evaluated by conducting two tests for each method (test 1 and test 2), one immediately after the other. An analysis of variance was used to compare the results of BF percentage among the four methods. Intraclass correlation coefficient (ICC) was used to test the reliability of each method.

MAIN RESEARCH VARIABLE

BF percentage.

FINDINGS

Significant differences in BF percentage were observed between BIA and all other methods (three-site SKF, p<0.001; seven-site SKF, p<0.001; ADP, p=0.002). No significant differences (p>0.05) in BF percentage between three-site SKF, seven-site SKF, and ADP were observed. ICCs between test 1 and test 2 for each method were BIA=1, ADP=0.98, three-site SKF=0.99, and seven-site SKF=0.94.

CONCLUSIONS

ADP and both SKF methods produce similar estimates of BF percentage in all participants, whereas BIA overestimated BF percentage relative to the other measures. Caution is recommended when using BIA as the body composition method for breast cancer survivors who have completed treatment but are still undergoing adjuvant hormonal therapy.

IMPLICATIONS FOR NURSING

Measurements of body composition can be implemented very easily as part of usual care and should serve as an objective outcome measure for interventions designed to promote healthy behaviors among breast cancer survivors.

Changes in nutritional status and dietary intake during and after head and neck cancer treatment

BACKGROUND

The purpose of this study was to test whether nutritional status of patients with head and neck cancer changes during and after treatment.

METHODS

Nutritional status (including body weight, lean mass, and fat mass) and dietary intake were assessed in 29 patients with head and neck cancer. Patients were assessed 1 week before, and 1 and 4 months after treatment (radiotherapy, either alone or combined with chemotherapy or surgery).

RESULTS

During treatment, body weight (-3.6 ± 5.3 kg; p = .019) and lean mass (-2.43 ± 2.81 kg; p = .001) significantly declined. Patients with sufficient intake (≥35 kcal and ≥1.5 grams protein/kg body weight) lost less body weight and lean mass than patients with insufficient intake (mean difference, -4.0 ± 1.9 kg; p = 0.048 and -2.1 ± 1.0 kg; p = .054, respectively). After treatment, only patients with sufficient intake gained body weight (2.3 ± 2.3 kg) and lean mass (1.2 ± 1.3 kg).

CONCLUSION

Patients with head and neck cancer fail to maintain or improve nutritional status during treatment, despite sufficient intake.

A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care

Human body composition is important in numerous cancer research domains. Our objective was to evaluate clinically accessible methods to achieve practical and precise measures of body composition in cancer patients. Dual-energy X-ray absorptiometry (DXA)-based analysis of fat and fat-free mass was performed in 50 cancer patients and compared with bioelectrical impedance analysis (BIA) and with regional computed tomography (CT) images available in the patients' medical records. BIA overestimated or underestimated fat-free mass substantially compared with DXA as the method of reference (up to 9.3 kg difference). Significant changes in fat-free mass over time detected with DXA in a subset of 21 patients (+2.2 +/- 3.2%/100 days, p = 0.003), was beyond the limits of detection of BIA. Regional analysis of fat and fat-free tissue at the 3rd lumbar vertebra with either DXA or CT strongly predicted whole-body fat and fat-free mass (r = 0.86-0.94; p < 0.001). CT images provided detail on specific muscles, adipose tissues and organs, not provided by DXA or BIA. CT presents great practical significance due to the prevalence of these images in patient diagnosis and follow-up, thus marrying clinical accessibility with high precision to quantify specific tissues and to predict whole-body composition.

Body composition analysis by leg-to-leg bioelectrical impedance and dual-energy X-ray absorptiometry in non-obese and obese individuals

AIM

The aim of this study is to compare total weight, % body fat (% BF), fat mass (FM) and fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA).

METHODS

This cross-sectional study included 159 women (mean age: 49.1 +/- 10.0 years) and 124 men (mean age: 51.4 +/- 8.0 years) subdivided according to sex and body mass index (BMI): BMI < 30 kg/m(2) (66 women and 50 men); BMI 30-35 kg/m(2) (53 women and 44 men) and BMI > or = 35 kg/m(2) (40 women and 30 men). Bioelectrical impedance was performed in the fasting state on a Tanita TBF-215 leg-to-leg analyser (Tanita, Tokyo, Japan). Whole-body DXA scans were performed on a Hologic QDR 4500 A bone densitometer (Hologic, Bedford, MA, USA). Total weight, % BF, FM and FFM were tested for intermethod differences. Linear regression and correlation analysis was performed. Limits of agreement and Bland-Altman plots were built.

RESULTS

DXA-derived body composition parameters were not significantly different from BIA estimates and were highly correlated (e.g. for FFM, r = 0.82-0.95). In lean individuals, BIA tended to produce lower values for FM and % BF and higher ones for FFM in comparison with DXA. This trend was reversed at BMI > 35 kg/m(2). The correlations decreased with increasing BMI. The limits of agreement were much better in men than in women and increased with increasing BMI in both sexes.

CONCLUSIONS

Compared with DXA, the leg-to-leg Tanita TBF-215 analyser accurately assessed body composition in a heterogeneous group of both sexes. In the very obese women (BMI > 35 kg/m(2)), BIA measurements should be viewed with caution.

Implications of the variability in time to isotopic equilibrium in the deuterium dilution technique

OBJECTIVE

To investigate the variability in isotopic equilibrium time under field conditions, and the impact of this variability on estimates of total body water (TBW) and body composition.

DESIGN AND SETTING

Following collection of a fasting baseline urine sample, 10 women and 10 men were dosed with deuterium oxide (0.05 g/kg body weight). Urine samples were collected every hour for 8 h. The samples were analysed using isotope ratio mass spectrometry. Time to equilibration was determined using three commonly employed data analysis approaches.

RESULTS

Isotopic equilibrium was reached by 50, 80 and 100% of participants at 4, 6 and 8 h, respectively. The mean group equilibration determined using the three different plateau determination methods were 4.8+/-1.5, 3.8+/-0.8 and 4.9+/-1.4 h. Isotopic enrichment, TBW, and percent body fat estimates differed between early (3-5 h), but not later sampling times (5-8 h).

CONCLUSION

Although the three different plateau determination approaches resulted in differences in equilibration time, all suggest that sampling at 6 h or later will decrease the likelihood of error in body composition estimates resultant from incomplete isotopic equilibration in a small proportion of individuals.

Resting energy expenditure in patients with solid tumors undergoing anticancer therapy

OBJECTIVE

Few studies have investigated the resting energy expenditure (REE) of, or determined the individual predictive accuracy of prediction equations in, cancer patients undergoing anticancer therapy. This study compared the measured REE of patients with cancer undergoing anticancer therapy with (1) healthy subjects and (2) REE estimated from commonly used prediction methods.

METHODS

Resting energy expenditure was measured in 18 cancer patients and 17 healthy subjects by using indirect calorimetry under standard conditions and was estimated from seven prediction methods. Fat-free mass (FFM) was measured by bioelectrical impedance analysis. Data were analyzed with regression modeling to adjust REE for FFM. Agreement between measured and predicted REE values was analyzed using the Bland-Altman approach.

RESULTS

There was no significant difference in FFM-adjusted REE between cancer patients and healthy subjects (mean difference 10%). Limits of agreement were wide for all prediction methods in estimating REE as much as 40% below and up to 30% above measured REE.

CONCLUSIONS

REE in cancer patients undergoing anticancer therapies does not appear to be as high as commonly thought. None of the prediction equations examined were acceptable for predicting REE of individual cancer patients or healthy subjects.

Estimation of total body water from foot-to-foot bioelectrical impedance analysis in patients with cancer cachexia - agreement between three prediction methods and deuterium oxide dilution

INTRODUCTION

Bioelectrical impedance analysis (BIA) is a useful bedside measure to estimate total body water (TBW). The aim of this study was to determine the agreement between three equations for the prediction of TBW using BIA against the criterion method, deuterium oxide dilution, in patients with cancer cachexia.

METHODS

Eighteen measurements of TBW using foot-to-foot BIA in seven outpatients with cancer cachexia (five male and two female, age 56.4 +/- 6.7 years) at an Australian hospital. Three prediction formulae were used to estimate TBW - TBW(ca-radiotherapy) developed in patients with cancer undergoing radiotherapy, TBW(ca-underweight) and TBW(ca-normal weight) developed in underweight and normal weight patients with cachexia. TBW was measured using the deuterium oxide dilution technique as the gold standard.

RESULTS

Mean measured TBW was 39.5 +/- 6.0 L. There was no significant difference in measured TBW and estimates from prediction equations TBW(ca-underweight) and TBW(ca-radiotherapy). There was a significant difference in measured TBW and TBW(ca-normal weight). All prediction equations overestimated TBW in comparison with measured TBW. The smallest bias was observed with TBW(ca-underweight) (0.38 L). The limits of agreement are wide (>7.4 L) for each of the prediction equations compared with measured TBW.

CONCLUSIONS

At a group level, TBW(ca-underweight) is the best predictor of measured TBW in patients with cancer cachexia. For an individual however, the limits of agreement are wide for all prediction equations and are unsuitable for use. Practitioners need to be aware of the limitations of using TBW prediction equations for individuals.

Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area

Malnutrition occurs frequently in patients with cancer of the gastrointestinal (GI) or head and neck area and can lead to negative outcomes. The aim of this study is to determine the impact of early and intensive nutrition intervention (NI) on body weight, body composition, nutritional status, global quality of life (QoL) and physical function compared to usual practice in oncology outpatients receiving radiotherapy to the GI or head and neck area. Outpatients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were randomised to receive intensive, individualised nutrition counselling by a dietitian using a standard protocol and oral supplements if required, or the usual practice of the centre (general advice and nutrition booklet). Outcome parameters were measured at baseline and 4, 8 and 12 weeks after commencing radiotherapy using valid and reliable tools. A total of 60 patients (51M : 9F; mean age 61.9±14.0 years) were randomised to receive either NI (n=29) or usual care (UC) (n=31). The NI group had statistically smaller deteriorations in weight (P<0.001), nutritional status (P=0.020) and global QoL (P=0.009) compared with those receiving UC. Clinically, but not statistically significant differences in fat-free mass were observed between the groups (P=0.195). Early and intensive NI appears beneficial in terms of minimising weight loss, deterioration in nutritional status, global QoL and physical function in oncology outpatients receiving radiotherapy to the GI or head and neck area. Weight maintenance in this population leads to beneficial outcomes and suggests that this, rather than weight gain, may be a more appropriate aim of NI.