Determination of Total Body Water and Solids With Isotopes

High Hydration Factor in Older Hispanic-American Adults: Possible Implications for Accurate Body Composition Estimates

Age- and obesity-related body composition changes could influence the hydration factor (HF) and, as a result, body composition estimates derived from hydrometry. The aim of the present study was to compare the HF in older Hispanic-American adults to some published values. This cross-sectional study included a sample of 412 subjects, men and women, aged ≥60 years from northern Mexico. HF values were calculated based on the ratio of total body water-using the deuterium dilution technique-to fat-free mass, derived from the four-compartment model. The mean HF value for the total sample (0.748 ± 0.034) was statistically (p ≤ 0.01) higher than the traditionally assumed value of 0.732 derived from chemical analysis, the "grand mean'' value of 0.725 derived from in vivo methods, and the 0.734 value calculated for older French adults via the three-compartment model. The HF of the older women did not differ across the fat mass index categories, but in men the obese group was lower than the normal and excess fat groups. The hydration factor calculated for the total sample of older Hispanic-American people is higher than the HF values reported in the literature. Therefore, the indiscriminate use of these assumed values could produce inaccurate body composition estimates in older Hispanic-American people.

Deuterium MR in Vivo Imaging of the Rat Eye Using 2H2O

In vivo euterium MR imaging (2H MR) was investigated in rats after intraperitoneal administration of deuterated saline, and a dynamic study of the water movement in rat eyes was performed. Deuterium MR imaging was carried out by means of a gradient-echo (GRE) and a spin-echo (SE) pulse sequence. The rat eye was imaged in 2H MR more selectively by SE than by GRE, but a lower signal-to-noise ratio was obtained in 2H MR imaging using the SE sequence. The MR signal intensity of the rat eye was followed by a 3-compartment model, which enabled determination of the flow rate constant of the water in the eye (0.359/min). Deuterium MR imaging is useful to visualize the dynamic change of water in rat eyes using 2H MR at the same magnetic field (2 T) that can also be used for conventional MR imaging in humans.

A Temperature-Based Bioimpedance Correction for Water Loss Estimation During Sports

The amount of total body water (TBW) can be estimated based on bioimpedance measurements of the human body. In sports, TBW estimations are of importance because mild water losses can impair muscular strength and aerobic endurance. Severe water losses can even be life threatening. TBW estimations based on bioimpedance, however, fail during sports because the increased body temperature corrupts bioimpedance measurements. Therefore, this paper proposes a machine learning method that eliminates the effects of increased temperature on bioimpedance and, consequently, reveals the changes in bioimpedance that are due to TBW loss. This is facilitated by utilizing changes in skin and core temperature. The method was evaluated in a study in which bioimpedance, temperature, and TBW loss were recorded every 15 min during a 2-h running workout. The evaluation demonstrated that the proposed method is able to reduce the error of TBW loss estimation by up to 71%, compared to the state of art. In the future, the proposed method in combination with portable bioimpedance devices might facilitate the development of wearable systems for continuous and noninvasive TBW loss monitoring during sports.

Imaging complex protein metabolism in live organisms by stimulated Raman scattering microscopy with isotope labeling

Protein metabolism, consisting of both synthesis and degradation, is highly complex, playing an indispensable regulatory role throughout physiological and pathological processes. Over recent decades, extensive efforts, using approaches such as autoradiography, mass spectrometry, and fluorescence microscopy, have been devoted to the study of protein metabolism. However, noninvasive and global visualization of protein metabolism has proven to be highly challenging, especially in live systems. Recently, stimulated Raman scattering (SRS) microscopy coupled with metabolic labeling of deuterated amino acids (D-AAs) was demonstrated for use in imaging newly synthesized proteins in cultured cell lines. Herein, we significantly generalize this notion to develop a comprehensive labeling and imaging platform for live visualization of complex protein metabolism, including synthesis, degradation, and pulse-chase analysis of two temporally defined populations. First, the deuterium labeling efficiency was optimized, allowing time-lapse imaging of protein synthesis dynamics within individual live cells with high spatial-temporal resolution. Second, by tracking the methyl group (CH3) distribution attributed to pre-existing proteins, this platform also enables us to map protein degradation inside live cells. Third, using two subsets of structurally and spectroscopically distinct D-AAs, we achieved two-color pulse-chase imaging, as demonstrated by observing aggregate formation of mutant hungtingtin proteins. Finally, going beyond simple cell lines, we demonstrated the imaging ability of protein synthesis in brain tissues, zebrafish, and mice in vivo. Hence, the presented labeling and imaging platform would be a valuable tool to study complex protein metabolism with high sensitivity, resolution, and biocompatibility for a broad spectrum of systems ranging from cells to model animals and possibly to humans.

Dehydration: physiology, assessment, and performance effects

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).

Direct analysis of δ2H and δ18O in natural and enriched human urine using laser-based, off-axis integrated cavity output spectroscopy

The stable isotopes of hydrogen (δ(2)H) and oxygen (δ(18)O) in human urine are measured during studies of total energy expenditure by the doubly labeled water method, measurement of total body water, and measurement of insulin resistance by glucose disposal among other applications. An ultrasensitive laser absorption spectrometer based on off-axis integrated cavity output spectroscopy was demonstrated for simple and inexpensive measurement of stable isotopes in natural isotopic abundance and isotopically enriched human urine. Preparation of urine for analysis was simple and rapid (approximately 25 samples per hour), requiring no decolorizing or distillation steps. Analysis schemes were demonstrated to address sample-to-sample memory while still allowing analysis of 45 natural or 30 enriched urine samples per day. The instrument was linear over a wide range of water isotopes (δ(2)H = -454 to +1702 ‰ and δ(18)O = -58.3 to +265 ‰). Measurements of human urine were precise to better than 0.65 ‰ 1σ for δ(2)H and 0.09 ‰ 1σ for δ(18)O for natural urines, 1.1 ‰ 1σ for δ(2)H and 0.13 ‰ 1σ for δ(18)O for low enriched urines, and 1.0 ‰ 1σ for δ(2)H and 0.08 ‰ 1σ for δ(18)O for high enriched urines. Furthermore, the accuracy of the isotope measurements of human urines was verified to better than ±0.81 ‰ in δ(2)H and ±0.13 ‰ in δ(18)O (average deviation) against three independent isotope-ratio mass spectrometry laboratories. The ability to immediately and inexpensively measure the stable isotopes of water in human urine is expected to increase the number and variety of experiments which can be undertaken.

Diversity of Insulin Resistance in Monkeys with Normal Glucose Tolerance

Insulin resistance has been proposed as a critical factor in the development of Type II diabetes, hypertension, dyslipidemia, and coronary artery disease. However, even in normal healthy individuals, a wide range of in vivo insulin action has been found. In the present study we sought to examine this heterogeneity in insulin action in both normal and spontaneously obese nonhuman primates. Maximal insulin responsiveness as measured by a hyperinsulinemic euglycemic clamp, fasting plasma glucose, and insulin levels, beta-cell insulin response to glucose, glucose tolerance, and adiposity were measured in 22 male rhesus monkeys. Results showed that lean animals (body fat < or = 22%) had higher insulin-stimulated glucose uptake (M rate: 14.42+/-1.8 mg/kg FFM/min) compared to obese (8.08+/-0.8). The obese monkeys, with 23-49% body fat, had a wide range of M values (5.32-14.29 mg/kg FFM/min) which showed no relationship to degree of adiposity. In all monkeys, M values had a strong inverse correlation with fasting plasma insulin levels (r=-0.76; p<0.001), but not with fasting glucose or glucose disappearance rate. We conclude that neither degree of obesity above a critical threshold nor range of glucose tolerance is related to insulin resistance; however, in individuals with normal glucose tolerance an early reliable indicator of defective insulin action appears to be fasting insulin concentration. Longitudinal determination of basal insulin levels obtained under standardized conditions so as to minimize extraneous variability is likely to strengthen the ability to predict insulin resistance and possible later development of overt Type II diabetes.

Comparison between surrogate indexes of insulin sensitivity/resistance and hyperinsulinemic euglycemic glucose clamps in rhesus monkeys

The euglycemic glucose clamp is the reference method for assessing insulin sensitivity in humans and animals. However, clamps are ill-suited for large studies because of extensive requirements for cost, time, labor, and technical expertise. Simple surrogate indexes of insulin sensitivity/resistance including quantitative insulin-sensitivity check index (QUICKI) and homeostasis model assessment (HOMA) have been developed and validated in humans. However, validation studies of QUICKI and HOMA in both rats and mice suggest that differences in metabolic physiology between rodents and humans limit their value in rodents. Rhesus monkeys are a species more similar to humans than rodents. Therefore, in the present study, we evaluated data from 199 glucose clamp studies obtained from a large cohort of 86 monkeys with a broad range of insulin sensitivity. Data were used to evaluate simple surrogate indexes of insulin sensitivity/resistance (QUICKI, HOMA, Log HOMA, 1/HOMA, and 1/Fasting insulin) with respect to linear regression, predictive accuracy using a calibration model, and diagnostic performance using receiver operating characteristic. Most surrogates had modest linear correlations with SI(Clamp) (r ≈ 0.4-0.64) with comparable correlation coefficients. Predictive accuracy determined by calibration model analysis demonstrated better predictive accuracy of QUICKI than HOMA and Log HOMA. Receiver operating characteristic analysis showed equivalent sensitivity and specificity of most surrogate indexes to detect insulin resistance. Thus, unlike in rodents but similar to humans, surrogate indexes of insulin sensitivity/resistance including QUICKI and log HOMA may be reasonable to use in large studies of rhesus monkeys where it may be impractical to conduct glucose clamp studies.

Effect of somatostatin on duodenal glucose absorption in man

OBJECTIVE

The hyperglycemic hyperinsulinemic clamp technique using intraduodenally infused glucose is an attractive tool for studying postprandial glucose metabolism under strictly controlled conditions. Because it requires the use of somatostatin (SST), we examined, in this study, the effect of SST on intestinal glucose absorption.

CONTEXT

Twenty-six normal volunteers were given a constant 3-h intraduodenal infusion of glucose (6 mg.kg(-1).min(-1)) labeled with [2-(3)H]glucose for glucose absorption measurement. During glucose infusion, 19 subjects received iv SST at doses of 10-100 ng.kg(-1).min(-1) plus insulin and glucagon, and seven subjects were studied under control conditions. In the controls, glucose was absorbed at a rate that, after a 20-min lag period, equaled the infusion rate.

RESULTS

With all the doses of SST tested, absorption was considerably delayed but equaled the rate of infusion after 3 h. At that time, only 5 +/- 2% of the total amount of infused glucose was unabsorbed in the control subjects vs. 36 +/- 2% (P < 0.001) in the SST-infused subjects. In the latter, the intraluminal residue was almost totally absorbed within 40 min of the cessation of SST infusion. At the lowest dose of SST tested (10 ng.kg(-1).min(-1)), suppression of insulin secretion was incomplete.

CONCLUSION

These properties of SST hamper the use of intraduodenal hyperglycemic hyperinsulinemic clamps as a tool for exploring postprandial glucose metabolism.

Dual-energy X-ray absorptiometry lean soft tissue hydration: independent contributions of intra- and extracellular water

Dual-energy X-ray absorptiometry (DEXA) provides a measure of lean soft tissue (LST). LST hydration, often assumed to be constant, is relevant to several aspects of DEXA body composition estimates. The aims of this study were to develop a theoretical model of LST total body water (TBW) content and to examine hydration effects with empirically derived model coefficients and then to experimentally test the model's prediction that, in healthy adults, LST hydration is not constant but varies as a function of extra- and intracellular water distribution (E/I). The initial phase involved TBW/LST model development and application with empirically derived model coefficients. Model predictions were then tested in a cross-sectional study of 215 healthy adults. LST was measured by DEXA, extracellular water (ECW) by NaBr dilution, intracellular water (ICW) by whole body (40)K counting, and TBW by (2)H(2)O dilution. TBW estimates, calculated as ECW + ICW, were highly correlated with (r = 0.97, SEE = 2.1 kg, P < 0.001) and showed no significant bias compared with TBW measured by (2)H(2)O. Model-predicted TBW/LST was almost identical to experimentally derived values (means +/- SD) in the total group (0.767 vs. 0.764 +/- 0.028). LST hydration was significantly correlated with E/I (total group, r = 0.30, SEE = 0.027, P < 0.001). Although E/I increased with age (men, r = 0.48; women, r = 0.37; both P < 0.001), the association between TBW/LST and age was nonsignificant. Hydration of the DEXA-derived LST compartment is thus not constant but varies predictably with ECW and ICW distribution. This observation has implications for the accuracy of body fat measurements by DEXA and the use of TBW as a means of checking DEXA system calibration.

History of the study of human body composition: A brief review

This review assembles a chronology of human body composition research with the goal of exposing historical roots and identifying future potential trends. Body composition research has emerged over the past several decades as a distinct field, and for many scientists body composition is their primary investigative focus. Technological advances will likely move the field forward and, ultimately, help to expand knowledge of human body composition variability in health and disease. Am. J. Hum. Biol. 11:157-165, 1999. Copyright 1999 Wiley-Liss, Inc.

Techniques of body composition assessment: a review of laboratory and field methods

Body composition is one of the major health-related components of fitness. Thus, it is important for health and fitness professionals to have a general understanding of the most commonly used techniques for assessing body composition. This review presents the developmental background and underlying principles and theory of four laboratory (hydrodensitometry, air displacement plethysmography, isotope dilution, and dual-energy x-ray absorptiometry) and four field (bioelectrical impedance analysis, near-infrared interactance, skinfolds, and anthropometry) methods of body composition assessment. In addition to a description of the methods, the validity, and reliability, strengths, and limitations of each measurement tool are examined. Highlights of the laboratory methods include the relatively new Bod Pod air displacement device, which is a promising assessment tool more convenient than hydrodensitometry but still lacking substantial validity testing and the ability of dual-energy x-ray absorptiometry to measure regional composition making it an attractive method for clinicians. Advancements in segmental and multifrequency bioelectrical impedance for compartmental analysis have enhanced the value of this field method, but research continues to show that commercially available near-infrared interactance units are invalid. With this knowledge, the clinician and researcher should be able to make an informed decision regarding the most appropriate measurement device for their body composition assessments.

Hydration of fat-free body mass: review and critique of a classic body-composition constant

The assumed "constancy" of fat-free body mass hydration is a cornerstone in the body-composition research field. Hydration, the observed ratio of total body water to fat-free body mass, is stable at approximately 0.73 in mammals and this constancy provides a means of estimating total body fat in vivo. This review examines both in vitro and in vivo data that support the hydration constancy hypothesis and provides a critique of applied methodology. Biological topics of interest are then examined and critical areas in need of future research are identified. These are important issues because water dilution is the only method currently available for estimating body fat in all mammals, which range in body mass by a factor of 10(4).

Adjuvant arthritis as a model of inflammatory cachexia

OBJECTIVE

To determine whether adjuvant arthritis (AA) leads to changes in body composition and cytokine production similar to those seen in patients with rheumatoid arthritis.

METHODS

AA was induced in Lewis rats using Freund's complete adjuvant. Body cell mass was measured by determining the concentration of total exchangeable potassium using 42K gavage. Splenocyte production of interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) was measured by bioassay. Weight and food intake were also measured.

RESULTS

Animals that developed AA lost 6% of their body weight by the onset of clinically evident arthritis (day 14; P < 0.01) and lost 20% by the end of the inflammatory phase of AA (day 28; P < 0.0001). Body cell mass fell 24.7 +/- 8.6% (mean +/- SEM) in animals with AA, but did not change significantly in controls (increase of 6.3 +/- 7.9%) (P < 0.03). Pair-fed animals lost one-fourth of the weight lost by the animals with AA (P < 0.01), indicating that anorexia alone does not explain inflammatory cachexia. Weight loss was correlated with TNF alpha production by spleen mononuclear cells (r = 0.68, P < 0.007), and a weaker correlation was seen with IL-1 production (r = 0.45, P < 0.04).

CONCLUSION

AA in rats is a useful model of inflammatory cachexia that mimics the human pathophysiology in important ways, and is consistent with cytokine-driven cachexia in chronic inflammatory arthritis.

Noninvasive analysis of water movement in rat testis using deuterium magnetic resonance imaging

To measure water movement in the testis without the effects from the blood-testis barrier, we performed in vivo deuterium magnetic resonance imaging (2H MRI) of rats administered with deuterated saline. Alcohol was injected into one testis of each animal and the other was administered with normal saline as a control. Dynamic 2H MRI was obtained at 2 T by FLASH pulse sequence (TR, 300 ms; TE, 10 ms; alpha = 90 degrees) using a surface coil (3 cm in diameter). The variation in 2H signal intensity between the two testes as a function of time after deuterated saline injection was examined every 1.1 min up to 20 min. The signal intensity in the testis receiving the alcohol treatment was lower than that in the normal control. Thus, deuterium MRI can be used to analyze functional disorders of the testis.

Effects of Acipimox on the metabolism of free fatty acids and very low lipoprotein triglyceride

The mechanism of triglyceride lowering by Acipimox, a nicotine acid analogue, was examined in a group of five moderately hypertriglyceridemic male rhesus monkeys. Two experiments were designed to examine the effect of the drug on lipid and glucose metabolism in nondiabetic, insulin-resistant animals. A single dose of Acipimox (8 mg/kg) given with a meal lowered the plasma free fatty acids (FFA) significantly at 4 h (0.102 +/- 0.008 vs 0.154 +/- 0.020 g/l; mean +/- SEM; P < 0.03); however, FFA concentrations returned to control levels at 6 h. Chronic administration of Acipimox (16 mg/kg q. i. d.) for 2 months produced a 31% reduction in triglyceride concentration (P < 0.05) and a significant decrease in low density lipoprotein (LDL)-cholesterol (P < 0.04), without changes in insulin action as measured by the hyperinsulinemic euglycemic clamp. Fasting FFA concentrations were not significantly altered by chronic treatment (0.163 +/- 0.013 versus 0.140 +/- 0.034 g/l). Fatty acid metabolic studies indicated increases in FFA transport (203.7 +/- 59.1 versus 136.1 +/- 26.6 microEq/min; P < 0.05), while FFA fractional clearance rate (FCR) was unchanged. Very low density lipoprotein triglyceride (VLDL-Tg) metabolic experiments, using [3H]glycerol, showed increases in production and FCR with the drug. Increased VLDL-Tg clearance, in spite of increased production of VLDL, appears to be the mechanism by which triglycerides are lowered upon chronic Acipimox administration.

Measurement of body fat in individuals with tetraplegia: a comparison of eight clinical methods

Spinal cord injury (SCI) is a unique condition that markedly alters body composition, raising the possibility of having undefined effects on the traditional assumptions for body composition. In order to determine appropriate methods for the analysis of body composition in this population, 12 subjects with tetraplegia were studied for absolute weight as fat and percent fat by the following methods; bioelectrical impedance (BIA), dual energy X-ray absorptiometry (DEXA), total body potassium (TBK), total body water (TBW), and four anthropometric methods: Durnin and Womersley (DUR), Jackson and Pollack (J and P), Sloan (SLN) and Steinkamp et al (STK). The eight methods were compared with the mean of all means (24.4 +/- 2.2% fat), which was assumed to be the best estimate of percent fat. Four methods: BIA, DEXA, TBW and STK were not significantly different, while TBK, DUR, J&P and SLN were significantly (P < 0.009) different from the mean of the means. Using only the non-significantly different methods, repeat computation revealed TBW to have the smallest difference from the mean (0.1 +/- 2.8%), and DEXA to have the strongest correlation with the line of identity (r = 0.96, P < 0.0001). In conclusion, BIA, DEXA, TBW, and STK are equally valuable for estimating fat in those with tetraplegia.

Deuterium magnetic resonance imaging of rabbit eye in vivo

We used deuterium magnetic resonance imaging (2H MRI) to visualize water movement in the rabbit eye. Dynamic 2H MRI was obtained every 3.5 min at 2 tesla by FLASH pulse sequence (TR, 300 ms; TE, 10 ms; alpha = 90 degrees) with a slice thickness of 10 mm using a surface coil (4 cm in diameter). After topical administration (0.2 ml D2O), only the aqueous chamber was imaged, and the signals decreased mono-exponentially. The flow rate was 0.113/min, in agreement with that already reported. After intravenous administration of deuterated saline (3 ml/kg), the aqueous chamber became visible first during imaging, then by the vitreous body. The signals around the lens were only faintly detected. Thus, deuterium MRI was determined to be useful for visualizing water movement in the eye.

Deuterium dilution as a method for determining total body water: effect of test protocol and sampling time

Deuterium dilution for the measurement of total body water (TBW) has been conducted using varying protocols for equilibration. We measured TBW from deuterium dilution in urine samples in twenty-eight subjects using three protocols: (1) early morning dosage without breakfast, measuring deuterium in a second voiding at 4 h and 6 h; (2) early morning dosage with breakfast with the same measurement times; (3) dosage as last consumption before overnight sleep, measuring deuterium in a second voiding at 10 h. Results were compared with TBW estimates from underwater weighing (UWW). Because UWW is an indirect measure of TBW, it is used as an independent reference method in order to compare only relative discrepancies between the two methods. TBW values in the fasted state were not significantly different from those obtained in the fed state. The urinary deuterium enrichment was higher at 4 h than at 6 h (resulting TBW differences: 0.6 (SD 0.4) l). At 4 h and 6 h, differences in TBW measurements from deuterium and densitometry were positively related to the amount of TBW, indicating incomplete equilibration in larger water compartments. At 10 h no such relationship existed, indicating complete mixing of deuterium. It is concluded that 10 h equilibration is preferable to the shorter 4 h and 6 h, for the determination of TBW.

Body composition: research and clinical advances--1993 A.S.P.E.N. research workshop

The 1993 ASPEN Research Workshop examined research and clinical advances in the study of human body composition. The workshop had two themes: (1) compartments of the body and their measurement, and (2) clinical applications of body composition measurements. There were 12 speakers of varied backgrounds who gave short lectures followed by panel discussions. Speakers explored the validity and potential uses of new body composition methodologies, including dual-energy x-ray absorptiometry, multiple frequency bioimpedance analysis, computerized axial tomography, magnetic resonance imaging, nuclear magnetic resonance spectroscopy, neutron inelastic scattering, and gamma-ray resonance. The application of these methods to chronically and acutely ill hospitalized patients was described. The study of body composition is an emerging distinct research area within the broad study of human biology. This conference provided an overview of important new advances in the study of human body composition.

Comparison of different measurements of lean body mass in normal individuals and in chronic peritoneal dialysis patients

To evaluate different methods of measuring lean body mass (LBM) in chronic peritoneal dialysis (CPD) patients, we first made comparisons in seven normal subjects. Seven methods (total body potassium [TBK] counting, bioelectrical impedance with calculations according to Segal and Deurenberg, near-infrared interactance with and without exercise level included as a variable, anthropometric measurements, and creatinine kinetics) were compared with the standard method of underwater weighing (UW) for measuring LBM. Significant correlations with LBM measured by UW (r > 0.938) were found with LBM measured by all other methods. Compared with UW, the best result in normals was found with TBK as it had high r values, small y-intercepts, and slopes of regression lines close to unity in both measurements of LBM and %LBM; in addition, fat-free mass index by TBK best approximated that by UW and TBK had the lowest mean prediction error with UW. In 11 patients on CPD, LBM was measured by all the above methods except UW. Significant correlations of all methods with LBM measured by TBK used as the reference standard were noted (all r > 0.76) in the CPD population. The LBM measured by creatinine kinetics correlated best (by kilograms or percentage of body weight [%BW]) with LBM from TBK compared with the other methods in which values tended to be higher. The fat-free mass index by creatinine output was nearest to the fat-free mass index by TBK. The root mean square prediction error was lowest between LBM by creatinine output and that by TBK. The findings support the concept of measuring creatinine outputs in CPD patients for estimates of LBM as an index of nutritional status as well as for creatinine clearances as an index of adequacy. Total body potassium and creatinine output measurements of LBM reflect the LBM at normal body fluid volumes ("dry weight") and may be better indices of nutrition in dialysis patients than the other techniques, which include excess fluid in the LBM.

Water turnover of healthy children measured by deuterated water elimination

For healthy children up to 15 years of age, no data exist regarding water turnover as directly measured using stable isotope techniques. Water turnover was measured in 171 healthy children (88 girls, 83 boys, age: 6 weeks-15 years) whilst living in their normal environment. Water turnover was calculated from the equilibrium of 2H2O concentration reached in the urine 2-3 h after an oral test load of 2 ml 2H2O/kg and the subsequent elimination rate of 2H2O. Daily water turnover decreased from 160 ml/kg (3 months), 100 ml/kg (12 months), 65 ml/kg (3 years) to 40 ml/kg at 15 years of age. Fluid intake was then calculated by subtracting the estimated metabolic water production from water turnover and this data was compared with recommended values. Our calculation of spontaneous daily fluid intake for these healthy children is within the recommended range during the 1st year of life, whereas for older children the recommendations exceed the spontaneous intake by a factor of 1.2-2.