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Özcan B, Güner M, Ceylan S, Öztürk Y, Girgin S, Okyar Baş A, Koca M, Balcı C, Doğu BB, Cankurtaran M, Yıldırım T, Halil MG. Calf circumference predicts sarcopenia in maintenance hemodialysis. Nutr Clin Pract 2024; 39:193-201. [PMID: 37933421 DOI: 10.1002/ncp.11089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD. METHODS This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface. RESULTS Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m2 [18.9-24.6] vs 24.7 kg/m2 [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765). CONCLUSIONS Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.
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Affiliation(s)
- Berşan Özcan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Güner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Ceylan
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Öztürk
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Girgin
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ukai T, Yokoyama K, Watanabe M. Preoperative Body Composition Correlates with Postoperative Muscle Volume and Degeneration after Total Hip Arthroplasty. Nutrients 2024; 16:386. [PMID: 38337672 PMCID: PMC10857396 DOI: 10.3390/nu16030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Impaired muscle recovery after total hip arthroplasty (THA) may affect gait and activities of daily living. Bioelectrical impedance analysis (BIA) can assess body composition and muscle volume, and computed tomography (CT) can assess muscle volume and the fatty degeneration of muscle. This study aimed to explore the effectiveness of BIA, and the correlation between preoperative body composition and postoperative muscle volume and degeneration after THA using BIA and CT. Thirty-eight patients who underwent THA and had BIA and CT performed pre- and postoperatively were retrospectively assessed. The BIA-derived measurements of preoperative body composition (fat mass index, fat-free mass index, and phase angle) were correlated with the CT-derived measurements (pre- and postoperative muscle volume and gluteus maximus and quadriceps Hounsfield Units of the affected hip). The preoperative fat mass index negatively correlated with the postoperative muscle volume of the gluteus maximus (p = 0.02) and quadriceps (p < 0.001) and the Hounsfield Units of the gluteus maximus (p = 0.03) and quadriceps (p = 0.03). The preoperative fat-free mass index positively correlated with the postoperative muscle volume of the quadriceps (p = 0.02). The preoperative phase angle positively correlated with the postoperative muscle volume of the quadriceps (p = 0.001) and the Hounsfield Units of the gluteus maximus (p = 0.03) and quadriceps (p = 0.001). In patients who underwent THA, preoperative body composition correlated with postoperative muscle volume and the fatty degeneration of the affected lower limb. Preoperative body composition may help predict postoperative muscle volume and fatty degeneration and thus, postoperative recovery.
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Affiliation(s)
- Taku Ukai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Katsuya Yokoyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine Oiso Hospital, 21-1 Gekkyo, Oiso 259-0198, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
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Comparisons between Bioelectrical Impedance Variables, Functional Tests and Blood Markers Based on BMI in Older Women and Their Association with Phase Angle. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116851. [PMID: 35682434 PMCID: PMC9180009 DOI: 10.3390/ijerph19116851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to compare electrical bioimpedance variables, blood markers and functional tests based on Body Mass Index (BMI) in older women. Associations between Phase Angle (PhA) with functional tests and blood markers were also analyzed. A total of 46 independent elderly people participated in the study, and they were divided into four groups according to BMI values: Group 1 (G1, BMI < 25 kg/m2); Group 2 (G2, BMI > 25−30 kg/m2); Group 3 (G3, BMI > 30−35 kg/m2); Group 4 (G4, BMI > 35 kg/m2). In addition to the weight and height used to calculate the BMI, the following body composition variables were collected: fat mass (FM), fat-free mass, intracellular water (ICW), extracellular water (ECW), total body water (TBW) and PhA (50 kHz) through InBody S10 equipment. Functional capacity was assessed using the Fullerton battery of tests: arm-curl; chair-stand; 6 min walking test (6MWT); time up-and-go test (TUG); standing on one leg (SOOL) and take 10 foot-lines (10FL). The main results showed differences between groups in the tests: 6MWT, SOOL and 10FL between G1 vs. G3 and G2 vs. G3 (p < 0.05); ACT, AIC and AEC between G1 vs. G4 (p < 0.05); FM among all groups (p < 0.05). Negative correlations were found between PhA and the agility test in G1 (r = −0.848; p = 0.008) and G4 (r = −0.909; p = 0.005); PhA and chair-stand in G3 (r = 0.527; p = 0.044); PhA and forearm flexion in G3 (r = 0.641; p = 0.010) and G4 (r = 0.943; p = 0.001); PhA and 6MWT in G4 (r = 0.771; p = 0.042). This study found that there is a clear trend towards better functional capacities with better parameters of body composition. Although there were no differences between groups in PhA, associations were found between different functional tests with PhA, which reveals the importance of this variable as a marker of health status.
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Brunani A, Perna S, Soranna D, Rondanelli M, Zambon A, Bertoli S, Vinci C, Capodaglio P, Lukaski H, Cancello R. Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity. Clin Nutr 2021; 40:3973-3981. [PMID: 34139470 DOI: 10.1016/j.clnu.2021.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population. METHODS The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes. RESULTS A total of 8303 patients with obesity, aged 18 to 90 y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m2) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p < 0.0001) in women while FFM index (FFMI) was higher in men (p < 0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p < 0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both. CONCLUSIONS The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity.
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Affiliation(s)
- Amelia Brunani
- IRCCS Istituto Auxologico Italiano, Division of Rehabilitation Medicine, Research Lab in Biomechanics and Rehabilitation, San Giuseppe Hospital, Piancavallo (VB), Italy.
| | - Simone Perna
- University of Bahrain, Department of Mathematics, College of Science, Sakhir Campus P. O. Box 32038, Kingdom of Bahrain.
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milano, Italy.
| | - Mariangela Rondanelli
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Pavia, Italy.
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milano, Italy; University of Milan-Bicocca, Department of Statistics and Quantitative Methods, Milan, Italy
| | - Simona Bertoli
- IRCCS Istituto Auxologico Italiano, Obesity Unit, Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, Milan, Italy; University of Milan, International Center for the Assessment of Nutritional Status (ICANS), Department of Food,Environmental and Nutritional Sciences (DeFENS), Milan, Italy.
| | - Calogero Vinci
- IRCCS Istituto Auxologico Italiano, Obesity Unit, Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, Milan, Italy.
| | - Paolo Capodaglio
- IRCCS Istituto Auxologico Italiano, Division of Rehabilitation Medicine, Research Lab in Biomechanics and Rehabilitation, San Giuseppe Hospital, Piancavallo (VB), Italy
| | - Henry Lukaski
- University of North Dakota, Department of Kinesiology and Public Health Education, Grand Forks, 58202, ND, USA.
| | - Raffaella Cancello
- IRCCS Istituto Auxologico Italiano, Obesity Unit, Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, Milan, Italy.
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Fernandes SA, Leonhardt LR, Silva DMD, Alves FD, Marroni CA. Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients. World J Hepatol 2020; 12:1276-1288. [PMID: 33442454 PMCID: PMC7772738 DOI: 10.4254/wjh.v12.i12.1276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition in cirrhotic patients is correlated with mortality and a better response to liver transplantation. However, recovery of the nutritional status in these patients is a challenge due to the difficulty in establishing a reliable nutritional diagnosis. The bioelectrical impedance vector analysis (BIVA) method appears as a feasible tool in clinical practice to define the physiological state of cirrhotic patients by assessing hydration and body cellularity.
AIM To evaluate body composition in cirrhotic patients using BIVA.
METHODS This retrospective cross-sectional study was carried out by following cirrhotic outpatients at a hospital in Porto Alegre, Brazil. A tetrapolar bioelectrical impedance analysis device was used to evaluate cellularity and hydration and to perform the BIVA. The BIVA graphic was elaborated by software and for statistical analysis a significance level of 5% (P ≤ 0.05) was considered.
RESULTS One hundred and ninety patients, 61.1% males, with a mean age of 56.6 ± 11.0 years, were evaluated. Of these, 56.3% had Child-Turcotte-Pugh (CTP) A score, and the prevalent etiology was hepatitis C virus (47.4%). The patients were classified according to cellularity and hydration by the quadrants and ellipses of the BIVA method, quadrant 1 (47.9%); quadrant 2 (18.9%); quadrant 3 (14.2%); and quadrant 4 (18.9%). Those classified in quadrant 1 and 2 had a higher phase angle compared to those in quadrants 3 and 4 (P < 0.001). Quadrant 2 patients had a lower average age than the other groups. The association with CTP score showed that patients in quadrant 2 had a higher proportion of CTP A, and those in quadrant 4 had a higher proportion of CTP C (P < 0.052).
CONCLUSION The BIVA method allows identification of the cellularity and hydration status of cirrhotic patients, and its association with clinical factors determines the disease severity, age and prognostic index.
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Affiliation(s)
- Sabrina Alves Fernandes
- Department of Nutrition, Centro Universitário Metodista IPA, Porto Alegre 90420-060, RS, Brazil
| | - Lara Rigon Leonhardt
- Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760-470, RS, Brazil
| | - Daniella Miranda da Silva
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Fernanda Donner Alves
- Department of Nutrition, Centro Universitário Ritter dos Reis - Uniritter, Porto Alegre 90840-440, Rio Grande do Sul, Brazil
| | - Cláudio Augusto Marroni
- Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760-470, RS, Brazil
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Matias C, Nunes C, Francisco S, Tomeleri C, Cyrino E, Sardinha L, Silva A. Phase angle predicts physical function in older adults. Arch Gerontol Geriatr 2020; 90:104151. [PMID: 32563736 DOI: 10.1016/j.archger.2020.104151] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
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Kamimura MA, Majchrzak KM, Cuppari L, Pupim LB. Protein and Energy Depletion in Chronic Hemodialysis Patients: Clinical Applicability of Diagnostic Tools. Nutr Clin Pract 2017; 20:162-75. [PMID: 16207654 DOI: 10.1177/0115426505020002162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Protein and energy depletion states are common and associated with increased morbidity and mortality in chronic hemodialysis (CHD) patients. Therefore, proper use of diagnostic tools to assess depleted states in CHD patients is critical. Assessment of protein and energy status can be done by an array of methodologies that include simple estimates of the visceral and somatic pools of protein to more refined techniques to measure protein and energy balance. The nutritional and metabolic derangements in the CHD population are highly complex and can be confounded by multiple comorbidities and fluid shifts between body compartments. Therefore, assessment of protein and energy status in CHD patients requires a wide range of methodologies that not only identify depleted states but also monitor nutrition therapy and predict clinical outcome. Most important, these methods require cautious and individualized interpretation in order to minimize the interference of comorbid conditions frequently observed in the CHD population. Currently, there is not a single method that can be considered the gold standard for assessment of protein and energy status in CHD patients. Therefore, a combination of methods is recommended. In this review, we describe available methods to assess protein and energy status, with special considerations pertaining to CHD patients.
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Affiliation(s)
- M A Kamimura
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
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Bosy-Westphal A, Danielzik S, Dörhöfer RP, Later W, Wiese S, Müller MJ. Phase Angle From Bioelectrical Impedance Analysis: Population Reference Values by Age, Sex, and Body Mass Index. JPEN J Parenter Enteral Nutr 2017; 30:309-16. [PMID: 16804128 DOI: 10.1177/0148607106030004309] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of bioelectrical impedance phase angle has been recommended as a prognostic tool in the clinical setting, but published reference data bases are discrepant and incomplete (eg, they do not consider body mass index [BMI], and data are lacking for children). METHODS Phase angle reference values stratified by age, sex, and BMI were generated in a large German data base of 15,605 children and adolescents and 214,732 adults, and the determinants of phase angle values were assessed. The reference values were applied to 3 groups of patients and compared with previously published reference values from the United States and Switzerland. RESULTS Gender and age were the main determinants of phase angle in adults, with men and younger subjects having higher phase angles. In children and adolescents, age and BMI were the main determinants of phase angle. In normal and overweight adults, phase angle increased with increasing BMI, but there was an inverse association at a BMI >40 kg/m2. In cirrhosis, the prevalence of a low phase angle increased with the state of disease, whereas it was not different between patients with the metabolic syndrome and controls. There are considerable differences between phase angle reference values from different populations. These differences are not explained by age or BMI and may be due to differences between impedance analyzers. CONCLUSION The determinants of phase angle differ between adults and children. In adults, the influence of BMI on phase angle depended on the BMI range. The prognostic value of phase angle may differ in different clinical settings. The use of population-specific and probably impedance-analyzer-specific reference values for phase angle is recommended.
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Affiliation(s)
- Anja Bosy-Westphal
- Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-University Kiel, Kiel, Germany
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Bakshi N, Singh K. Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant. Hepatobiliary Surg Nutr 2016; 5:358-71. [PMID: 27500148 PMCID: PMC4960422 DOI: 10.21037/hbsn.2016.03.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. METHODS We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. RESULTS Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). CONCLUSIONS The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.
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Affiliation(s)
- Neha Bakshi
- Department of Foods and Nutrition, Lady Irwin College, University of Delhi, New Delhi 110001, India
| | - Kalyani Singh
- Department of Foods and Nutrition, Lady Irwin College, University of Delhi, New Delhi 110001, India
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de França NA, Callegari A, Gondo FF, Corrente JE, Mclellan KC, Burini RC, de Oliveira EP. Higher dietary quality and muscle mass decrease the odds of low phase angle in bioelectrical impedance analysis in Brazilian individuals. Nutr Diet 2016. [DOI: 10.1111/1747-0080.12267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Natasha A.G. de França
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
- Department of Nutrition; School of Public Health, Sao Paulo University; Sao Paulo, Sao Paulo State Brazil
| | - Aliucha Callegari
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
| | - Fernanda F. Gondo
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
| | - José E. Corrente
- Department of Bioestatistic; Bioscience Institute (UNESP); Botucatu, Sao Paulo State Brazil
| | - Kátia C.P. Mclellan
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
| | - Roberto C. Burini
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
| | - Erick P. de Oliveira
- Centre for Exercise Metabolism and Nutrition (CeMENutri), Department of Public Health; Botucatu School of Medicine (UNESP); Botucatu, Sao Paulo State Brazil
- School of Medicine; Federal University of Uberlandia; Uberlandia, Minas Gerais State Brazil
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Fernandes SA, Bassani L, Nunes FF, Aydos MED, Alves AV, Marroni CA. Nutritional assessment in patients with cirrhosis. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:19-27. [PMID: 22481682 DOI: 10.1590/s0004-28032012000100005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 08/10/2011] [Indexed: 12/15/2022]
Abstract
CONTEXT Malnutrition in cirrhotic patients with end-stage disease is common, and the degree of nutritional debilitation can play an important role in the pathogenesis of complications and cause a negative impact on prognosis. However, it involves difficulties and controversies regarding the identification of the best nutritional assessment method. OBJECTIVE To identify a method that provides a safe and effective nutritional diagnosis. METHODS Cross-sectional study with 129 cirrhotic patients. Anthropometric measurements, subjective global assessment, hand grip strength and bioelectrical impedance. RESULTS Through phase angle of bioelectrical impedance analysis (BIA) method, significant associations with Child-Pugh (P = 0.008), age group and gender were observed. The ROC (receiver operator characteristic) curve was generated to determine the best cutoff point of the phase angle of cirrhotic patients, serving as one of the reference parameters for the nutritional assessment with bioimpedance in this study, considering the classification through Child-Pugh score as the reference standard for the clinical conditions of patients with cirrhosis. CONCLUSIONS The assessment through bioelectrical impedance presented a statistically significant correlation with Child-Pugh score. The identification of phase angle of 5.44º is the new parameter suggested for the classification of the nutritional conditions of cirrhotic patients.
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Affiliation(s)
- Sabrina Alves Fernandes
- Postgraduate Program of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brasil.
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Kahraman A, Hilsenbeck J, Nyga M, Ertle J, Wree A, Plauth M, Gerken G, Canbay AE. Bioelectrical impedance analysis in clinical practice: implications for hepatitis C therapy BIA and hepatitis C. Virol J 2010; 7:191. [PMID: 20712878 PMCID: PMC2930625 DOI: 10.1186/1743-422x-7-191] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 08/16/2010] [Indexed: 12/11/2022] Open
Abstract
Background Body composition analysis using phase angle (PA), determined by bioelectrical impedance analysis (BIA), reflects tissue electrical properties and has prognostic value in liver cirrhosis. Objective of this prospective study was to investigate clinical use and prognostic value of BIA-derived phase angle and alterations in body composition for hepatitis C infection (HCV) following antiviral therapy. Methods 37 consecutive patients with HCV infection were enrolled, BIA was performed, and PA was calculated from each pair of measurements. 22 HCV genotype 3 patients treated for 24 weeks and 15 genotype 1 patients treated for 48 weeks, were examined before and after antiviral treatment and compared to 10 untreated HCV patients at 0, 24, and 48 weeks. Basic laboratory data were correlated to body composition alterations. Results Significant reduction in body fat (BF: 24.2 ± 6.7 kg vs. 19.9 ± 6.6 kg, genotype1; 15.4 ± 10.9 kg vs. 13.2 ± 12.1 kg, genotype 3) and body cell mass (BCM: 27.3 ± 6.8 kg vs. 24.3 ± 7.2 kg, genotype1; 27.7 ± 8.8 kg vs. 24.6 ± 7.6 kg, genotype 3) was found following treatment. PA in genotype 3 patients was significantly lowered after antiviral treatment compared to initial measurements (5.9 ± 0.7° vs. 5.4 ± 0.8°). Total body water (TBW) was significantly decreased in treated patients with genotype 1 (41.4 ± 7.9 l vs. 40.8 ± 9.5 l). PA reduction was accompanied by flu-like syndromes, whereas TBW decline was more frequently associated with fatigue and cephalgia. Discussion BIA offers a sophisticated analysis of body composition including BF, BCM, and TBW for HCV patients following antiviral regimens. PA reduction was associated with increased adverse effects of the antiviral therapy allowing a more dynamic therapy application.
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Affiliation(s)
- Alisan Kahraman
- University Clinic Duisburg-Essen, Department of Gastroenterolgy and Hepatology, Essen, Germany
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Paiva SI, Borges LR, Halpern-Silveira D, Assunção MCF, Barros AJD, Gonzalez MC. Standardized phase angle from bioelectrical impedance analysis as prognostic factor for survival in patients with cancer. Support Care Cancer 2009; 19:187-92. [PMID: 20039074 DOI: 10.1007/s00520-009-0798-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 12/08/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE Phase angle (PA), determined by bioelectrical impedance analysis (BIA), has been considered as a prognostic factor in several clinical conditions. The purpose of this study is to investigate PA, after adjusting for sex and age (standardized phase angle; SPA) as a prognostic factor for survival in cancer patients. METHODS A prospective study was conducted in 195 patients before the first chemotherapy course. BIA was performed in all patients and SPA was calculated. The Kaplan-Meier method was used to calculate survival. The Cox regression method was used to evaluate the independent prognostic effect of PA after adjustment for other variables. RESULTS Patients with SPA < -1.65 had a smaller survival rate than those with SPA ≥ -1.65 (p < 0.001). Using Cox regression, the mortality rate was higher in patients with SPA < -1.65 (RR 3.12 CI: 2.03-4.79; p < 0.001). After multivariate analysis, patients with PA < -1.65 still presented a higher mortality rate (RR 2.35 CI: 1.41-3.90; p = 0.001). CONCLUSIONS The present study demonstrates that PA, used as SPA, is an independent prognostic indicator in this group of cancer patients receiving chemotherapy treatment even after adjustment for other prognostic variables.
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Affiliation(s)
- Silvana Iturriet Paiva
- Post-graduate Program, Health and Behaviour, Catholic University of Pelotas, Rua Porto Alegre 492, 96090-520 Pelotas, RS, Brazil.
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Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF, Lis CG. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer. BMC Cancer 2009; 9:37. [PMID: 19175932 PMCID: PMC2637288 DOI: 10.1186/1471-2407-9-37] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 01/28/2009] [Indexed: 01/05/2023] Open
Abstract
Background A frequent manifestation of advanced lung cancer is malnutrition, timely identification and treatment of which can lead to improved patient outcomes. Bioelectrical impedance analysis (BIA) is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated the prognostic role of BIA-derived phase angle in advanced non-small cell lung cancer (NSCLC). Methods A case series of 165 stages IIIB and IV NSCLC patients treated at our center. The Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle, independent of stage at diagnosis and prior treatment history. Results 93 were males and 72 females. 61 had stage IIIB disease at diagnosis while 104 had stage IV. The median phase angle was 5.3 degrees (range = 2.9 – 8). Patients with phase angle <= 5.3 had a median survival of 7.6 months (95% CI: 4.7 to 9.5; n = 81), while those with > 5.3 had 12.4 months (95% CI: 10.5 to 18.7; n = 84); (p = 0.02). After adjusting for age, stage at diagnosis and prior treatment history we found that every one degree increase in phase angle was associated with a relative risk of 0.79 (95% CI: 0.64 to 0.97, P = 0.02). Conclusion We found BIA-derived phase angle to be an independent prognostic indicator in patients with stage IIIB and IV NSCLC. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with advanced NSCLC.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, IL 60099, USA.
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Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF, Lis CG. Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer 2008; 8:249. [PMID: 18727837 PMCID: PMC2527613 DOI: 10.1186/1471-2407-8-249] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 08/27/2008] [Indexed: 12/21/2022] Open
Abstract
Background Bioelectrical impedance analysis (BIA) is an easy-to-use, non-invasive, and reproducible technique to evaluate changes in body composition and nutritional status. Phase angle, determined by bioelectrical impedance analysis (BIA), detects changes in tissue electrical properties and has been hypothesized to be a marker of malnutrition. Since malnutrition can be found in patients with breast cancer, we investigated the prognostic role of phase angle in breast cancer. Methods We evaluated a case series of 259 histologically confirmed breast cancer patients treated at Cancer Treatment Centers of America. Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle independent of stage at diagnosis and prior treatment history. Survival was calculated as the time interval between the date of first patient visit to the hospital and the date of death from any cause or date of last contact/last known to be alive. Results Of 259 patients, 81 were newly diagnosed at our hospital while 178 had received prior treatment elsewhere. 56 had stage I disease at diagnosis, 110 had stage II, 46 had stage III and 34 had stage IV. The median age at diagnosis was 49 years (range 25 – 74 years). The median phase angle score was 5.6 (range = 1.5 – 8.9). Patients with phase angle <= 5.6 had a median survival of 23.1 months (95% CI: 14.2 to 31.9; n = 129), while those > 5.6 had 49.9 months (95% CI: 35.6 to 77.8; n = 130); the difference being statistically significant (p = 0.031). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that every one unit increase in phase angle score was associated with a relative risk of 0.82 (95% CI: 0.68 to 0.99, P = 0.041). Stage at diagnosis (p = 0.006) and prior treatment history (p = 0.001) were also predictive of survival independent of each other and phase angle. Conclusion This study demonstrates that BIA-derived phase angle is an independent prognostic indicator in patients with breast cancer. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with breast cancer.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL, USA.
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LEE SEOUNGWOO, PARK GEUNHO, LEE SEUNGWON, UM WOOKHYUN, KWON SUHYUN, SONG JOONHO, KIM MOONJAE. Different pattern of fluid loss from the lower extremities in normohydrated and overhydrated stage 5 chronic-kidney-disease patients after haemodialysis. Nephrology (Carlton) 2008; 13:109-15. [DOI: 10.1111/j.1440-1797.2007.00832.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cigarran S, Barril G, Cirugeda A, Bernis C, Aguilera A, Sanz P, Herraez I, Alegre L, Selgas R. Hypoalbuminemia is Also a Marker of Fluid Excess Determined by Bioelectrical Impedance Parameters in Dialysis Patients. Ther Apher Dial 2007; 11:114-20. [PMID: 17381532 DOI: 10.1111/j.1744-9987.2007.00416.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypoalbuminemia may be secondary to volume expansion conditions and an independent risk factor for cardiovascular disease. Bioelectrical impedance analysis (BIA) is an accurate, non-invasive method to measure body composition, especially the water compartments in humans. The aim of this cross-sectional study is to evaluate the relationship between serum albumin concentration (SA) and hydration state measured by whole BIA. The study investigated 108 non-selected patients (73 on hemodialysis, 35 on peritoneal dialysis) with a mean age of 61.4 +/- 15.6 years, 42.7% of whom were female. The patients were allotted to groups according to their SA: Group 1, < or = 3.5 g/dL; Group 2, 3.6-4.0 g/dL; and Group 3, >4.0 g/dL. The BIA parameters used included: total body water, intracellular water (ICW), extracellular water (ECW), phase angle (PA), body cell mass (BCM), ICW/ECW ratio and ICW/ECW ratio patients/controls (fluid index). Seventy-five healthy volunteers formed the control group. A strong positive correlation was found between the PA and fluid index (r (2) = 0.993, P < 0.001), as well as between the PA and SA (r = 0.386, P < 0.001), and the ICW/ECW ratio and SA (r = 0.227, P < 0.001). The ECW was negatively correlated with SA (r = -0.330, P < 0.001). Every 0.1 g/dL decrease in SA was associated with a 0.33 L increase in ECW. Group 1 patients had lower reactance (P = 0.006), PA (P < 0.001), BCM (P = 0.012), fluid index (P < 0.001) and ICW/ECW ratio (P = 0.015), and an increased ECW (NS) than groups 2 and 3. We conclude that hypoalbuminemia is also a marker of fluid excess. The SA is associated to the fluid index and the PA allows assessment of the dry weight and its variations in an individualized manner in dialysis patients.
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Affiliation(s)
- Secundino Cigarran
- Nephrology Service, Princess University Hospital, Queen Sofia Institute for Nephrological Research, Madrid, Spain.
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ICHIKAWA Y, HIRAMATSU F, HAMADA H, SAKAI A, HARA K, KOGIRIMA M, KAWAHARA K, MINAKUCHI J, KAWASHIMA S, YAMAMOTO S. Effect of Protein and Energy Intakes on Body Composition in Non-Diabetic Maintenance-Hemodialysis Patients. J Nutr Sci Vitaminol (Tokyo) 2007; 53:410-8. [DOI: 10.3177/jnsv.53.410] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Coroas ASPS, Oliveira JGG, Sampaio S, Borges C, Tavares I, Pestana M, Almeida MDV. Body Composition Assessed by Impedance Changes Very Early with Declining Renal Graft Function. ACTA ACUST UNITED AC 2006; 104:p115-20. [PMID: 16940749 DOI: 10.1159/000095540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 05/03/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Kidney transplant (Tx) restores renal filtration, although it does not achieve the function of two native kidneys, and with time it may variably involute back to chronic renal failure. We hypothesized that bioelectrical impedance analysis (BIA) might highlight differences for body compartments among Tx with different filtration rates, and we compared them with healthy controls. METHODS 38 Tx patients (25 males, 13 females) were studied at 75.9 +/- 37.8 months postsurgery and divided into three groups: good creatinine clearance (CrCl, ml/min/1.73 m2; > 65.0), borderline (35.0 < CrCl < 60.0) and bad (CrCl < 35.0). BIA was assessed three times in a year. Total body water, extracellular water (ECW), intracellular water (ICW), Na:K exchange rate (Nae:Ke) and phase angle were studied. Healthy (n = 11) and hemodialysis (n = 11) groups were also studied. RESULTS BIA showed no differences between healthy controls and good Tx while both borderline and bad Tx presented a significantly higher ECW and lower ICW than either good Tx or normal controls. Only good CrCl was different from predialysis. CONCLUSIONS A good kidney graft manages to restore and maintain normal body composition, even with potential disturbances brought about by steroids and cyclosporine. With mild renal dysfunction a change in body compartments was observed, moving towards the composition of that with chronic renal failure patients.
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Sarkar SR, Kuhlmann MK, Khilnani R, Zhu F, Heymsfield SB, Kaysen GA, Levin NW. Assessment of body composition in long-term hemodialysis patients: rationale and methodology. J Ren Nutr 2006; 15:152-8. [PMID: 15648026 DOI: 10.1053/j.jrn.2004.09.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Protein-energy malnutrition is seen in patients with advanced stages of chronic kidney disease (CKD) and is even more pronounced in patients receiving long-term hemodialysis treatment. Both entities have great impact on patient morbidity and mortality. Analysis of body composition is an integral part of nutritional assessment and includes the estimation of muscle, fat, and fat-free mass, as well as the extracellular water compartment. Clinical assessment of these compartments is difficult, and gold-standard methods such as tracer dilution, magnetic resonance imaging, and dual-energy x-ray absorptiometry are expensive, cumbersome, and rarely available. We report an ongoing study of body composition in hemodialysis patients involving deuterium and sodium bromide dilution, total body potassium counting, magnetic resonance imaging, whole-body and segmental bioimpedance spectroscopy, and anthropometry. The goals of the study are (1) to validate bioimpedance technology against gold-standard methods for assessment of the various body compartments, (2) to directly quantify visceral adipose tissue mass, a potential source of cytokine production (adipokines) promoting chronic inflammation, and to study its relation to inflammatory markers, and (3) to directly quantify visceral organ mass and to study its relation to uremia toxin generation as assessed by protein catabolic rate and resting energy expenditure. Preliminary results based on up to 40 hemodialysis patients are reported.
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Barbosa-Silva MCG, Barros AJD. Bioelectric impedance and individual characteristics as prognostic factors for post-operative complications. Clin Nutr 2006; 24:830-8. [PMID: 15975694 DOI: 10.1016/j.clnu.2005.05.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Accepted: 05/10/2005] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Malnutrition increases morbidity and mortality in surgical patients, and for this reason, several nutritional markers have been used as prognostic tools to identify surgical patients under a higher risk to develop complications in post-operative period. Few studies show the impact of nutritional markers after controlling for others variables, such as age and severity of disease. A new method, bioelectric impedance analysis (BIA), and its parameter, phase angle, have been described as a prognostic tool in several clinical situations, but they have never been studied in surgical population. The objective of this work is to assess the importance of nutritional variables and parameters from BIA as predictors of post-operative complications in a multivariable regression model. METHODS The nutritional status of 225 adult patients scheduled to undergo gastrointestinal surgery was assessed by several methods, including bioelectric impedance analysis and subjective global assessment. Potential confounding factors were also studied. Patients were screened for post-operative complications until hospital discharge. RESULTS Weight loss greater than 10%, subjective global assessment, nutritional risk assessment, ECM/BCM ratio and phase angle (from BIA) were the prognostic factors significantly associated with post-operative complications in the crude analysis. After adjusting for sex, age, marital status, tumors and pre-operative infections, only phase angle remained as a prognostic factor (RR=4.3; CI95% 1.6-11.8 for phase angle <-0.8 sd), while the other nutritional variables lost their association with post-operative complications. CONCLUSION Phase angle remains as an important prognostic factor for postoperative complications, even after adjusting for other individual predictors and confounders. Its utility in the identification of patients eligible for nutritional therapy has now to be evaluated.
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Abstract
Nutritional and metabolic derangements are highly prevalent in patients with chronic kidney disease (CKD) and patients on renal replacement therapy. These derangements, which can be termed uremic malnutrition, significantly affect the high morbidity and mortality rates observed in this patient population. Uremic malnutrition clearly is related to multiple factors encountered during the predialysis stage and during chronic dialysis therapy. Several preliminary studies suggested that interventions to improve the nutritional status and metabolic status of uremic patients actually may improve the expected outcome in these patients, although their long-term efficacy is not well established. It therefore is important to emphasize that uremic malnutrition is a major comorbid condition in CKD and renal replacement therapy patients, and that all efforts should be made to try to understand better and treat these conditions effectively to improve not only mortality but also the quality of life of chronically uremic patients. In this article we review the current state of knowledge in the field of nutrition and metabolism in all stages of CKD and renal replacement therapy, including kidney transplant. We also address questions that face investigators in this field and suggest where future research might be headed.
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Affiliation(s)
- Lara B Pupim
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
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Barbosa-Silva MCG, Barros AJD, Wang J, Heymsfield SB, Pierson RN. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr 2005; 82:49-52. [PMID: 16002799 DOI: 10.1093/ajcn.82.1.49] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Phase angle is an indicator based on reactance and resistance obtained from bioelectrical impedance analysis (BIA). Although its biological meaning is still not clear, phase angle appears to have an important prognostic role. OBJECTIVE The aim of this study was to estimate population averages and SDs of phase angle that can be used as reference values. DESIGN BIA and other methods used to evaluate body composition, including hydrodensitometry and total body water, were completed in 1967 healthy adults aged 18-94 y. Phase angle was calculated directly from body resistance and reactance, and fat mass (FM) was estimated from the combination of weight, hydrodensitometry, and total body water by using the 3-compartment Siri equation. Phase angle values were compared across categories of sex, age, body mass index (BMI), and percentage FM. RESULTS Phase angle was significantly (P < 0.001) smaller in women than in men and was lower with greater age (P < 0.001). Phase angle increased with an increase in BMI and was significantly inversely associated with percentage fat in men. Phase angle was significantly predicted from sex, age, BMI, and percentage FM in multiple regression models. CONCLUSIONS Phase angle differs across categories of sex, age, BMI, and percentage fat. These reference values can serve as a basis for phase angle evaluations in the clinical setting.
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Barbosa-Silva MCG, Barros AJD, Wang J, Heymsfield SB, Pierson RN. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.1.49] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maria Cristina G Barbosa-Silva
- From the Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil (MCGB-S and AJDB), and the Obesity Research Center, St Luke’s–Roosevelt Hospital Center, Columbia University, New York, NY (JW, SBH, and RNP Jr)
| | - Aluísio JD Barros
- From the Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil (MCGB-S and AJDB), and the Obesity Research Center, St Luke’s–Roosevelt Hospital Center, Columbia University, New York, NY (JW, SBH, and RNP Jr)
| | - Jack Wang
- From the Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil (MCGB-S and AJDB), and the Obesity Research Center, St Luke’s–Roosevelt Hospital Center, Columbia University, New York, NY (JW, SBH, and RNP Jr)
| | - Steven B Heymsfield
- From the Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil (MCGB-S and AJDB), and the Obesity Research Center, St Luke’s–Roosevelt Hospital Center, Columbia University, New York, NY (JW, SBH, and RNP Jr)
| | - Richard N Pierson
- From the Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil (MCGB-S and AJDB), and the Obesity Research Center, St Luke’s–Roosevelt Hospital Center, Columbia University, New York, NY (JW, SBH, and RNP Jr)
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Coroas A, Oliveira JGG, Sampaio S, Borges C, Tavares I, Pestana M, Almeida MDV. Nutritional Status and Body Composition Evolution in Early Post–Renal Transplantation: Is There a Female Advantage? Transplant Proc 2005; 37:2765-70. [PMID: 16182805 DOI: 10.1016/j.transproceed.2005.05.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chronic renal failure is associated with metabolic derangements, affecting proteins, amino acids, and lipids. Usually these patients follow a restricted diet. Kidney transplant patients enjoy a recovery of renal function, but their therapeutics may entail significant changes in general metabolism. We compare the anthropometric results during the first 3 months after successful transplant for male and female patients versus a healthy group. METHODS Eighteen patients (11 men and 7 women) were studied. Anthropometry was assessed before and at month 1 and month 3 posttransplant including body weight (Wt), body mass index (BMI), triceps (TSF), biceps (BSF), subscapular (SCSF), and suprailiac skinfolds (SISF), midarm circumference (MAC), midarm muscle circumference (MAMC), corrected arm muscle area (CT.AMA), total body muscle mass (MM), body density (D), fat mass (FM), and fat-free mass (FFM). The healthy group was evaluated three times in the first year. RESULTS Pretransplant men showed lower Wt, BMI, TSF, BSF, SCSF, SISF, MAC, MAMC, CT.AMA, MM, FM and FFM than controls, while women displayed no differences from controls. By the third month, men showed only a partial recovery and women higher TSF and SCSF than controls. CONCLUSIONS Uremic men before transplant displayed undernutrition indices. During the first 3 months posttransplant men showed an incomplete recovery of anthropometric parameters. Quite differently, women started close to normal and had significantly increased body weight and fat content posttransplant. We suggest that nutritional requirements post-kidney grafting may be significantly different among male compared to female patients.
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Affiliation(s)
- A Coroas
- Nephrology Department, S João Hospital, Porto, Portugal.
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Coroas A, Oliveira J, Sampaio S, Borges C, Tavares I, Pestana M, Almeida M. Sequential body composition analysis by bioimpedance early post-kidney transplantation. Transpl Int 2005; 18:541-7. [PMID: 15819802 DOI: 10.1111/j.1432-2277.2005.00086.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND While chronic renal failure patients present disturbed body water composition, few studies have been done on its behavior following kidney grafting (Tx). We report the changes associated with a successful Tx on body composition evaluated by bioelectrical impedance analysis (BIA). METHODS Twelve Tx (seven males, five females) were studied. The BIA was assessed before Tx, at month 1 and at month 3 post-Tx. Total body water (TBW), extracellular water (ECW), intracellular water (ICW), Na:K exchange rate (Nae:Ke) and phase angle (PA) were studied. An healthy group and a HD group were evaluated three times in a year interval. RESULTS Comparing before Tx with month 1 post-Tx, TBW, ECW and Nae:Ke increased, while ICW and PA decreased significantly. Comparing month 1 with month 3 post-Tx, ECW decreased, while ICW and PA increased. On comparing month 1 post-Tx with the healthy group, Nae:Ke was greater and PA was lower at month 1. CONCLUSIONS The BIA showed that the different body water compartments of Tx recipients quickly match the constitution of normal individuals, overcoming drug therapy side effects.
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Affiliation(s)
- Andreia Coroas
- Nephrology Department, S João Hospital, Porto, Portugal.
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Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsch JF, Lammersfeld CA. Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer. Br J Nutr 2005; 92:957-62. [PMID: 15613258 DOI: 10.1079/bjn20041292] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bioelectrical impedance analysis (BIA) is an easy-to-use, non-invasive and reproducible technique to evaluate changes in body composition and nutritional status. Phase angle, determined by BIA, has been found to be a prognostic indicator in several chronic conditions, such as HIV, liver cirrhosis, chronic obstructive pulmonary disease and lung cancer, and in patients undergoing dialysis. The present study investigated the prognostic role of phase angle in advanced pancreatic cancer. We evaluated a case series of fifty-eight stage IV pancreatic cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center (Zion, IL, USA) between January 2000 and July 2003. BIA was conducted on all patients using a bioelectrical impedance analyser that operated at 50 kHz. The phase angle was calculated as capacitance (Xc)/resistance (R) and expressed in degrees. The Kaplan-Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle independent of other clinical and nutritional variables. The correlations between phase angle and traditional nutritional measures were evaluated using Pearson and Spearman coefficients. Patients with phase angle <5.0 degrees had a median survival time of 6.3 (95% CI 3.5, 9.2) months (n 29), while those with phase angle >5.0 degrees had a median survival time of 10.2 (95% CI 9.6, 10.8) months (n 29); this difference was statistically significant (P=0.02). The present study demonstrates that phase angle is a strong prognostic indicator in advanced pancreatic cancer. Similar studies in other cancer settings with larger sample sizes are needed to further validate the prognostic significance of the phase angle.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA.
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Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, Hoffman S, Lis CG. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 2004; 80:1634-8. [PMID: 15585779 DOI: 10.1093/ajcn/80.6.1634] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Phase angle, determined by bioelectrical impedance analysis (BIA), detects changes in tissue electrical properties and has been found to be a prognostic indicator in several chronic conditions-such as HIV, liver cirrhosis, chronic obstructive pulmonary disease, and lung cancer-and in patients receiving dialysis. OBJECTIVE This study was conducted to investigate the prognostic role of phase angle in advanced colorectal cancer. DESIGN We evaluated a case series of 52 patients with histologically confirmed stage IV colorectal cancer. BIA was conducted on all patients and phase angle was calculated. The Kaplan-Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle independent of other clinical and nutritional variables. RESULTS Patients with a phase angle < or =5.57 had a median survival of 8.6 mo (95% CI: 4.8, 12.4; n=26), whereas those with a phase angle >5.57 had a median survival of 40.4 mo (95% CI: 21.9, 58.8; n=26; P=0.0001). CONCLUSION Phase angle is a prognostic indicator in patients with advanced colorectal cancer. Similar studies of other cancer types with larger sample sizes are needed to further validate the prognostic significance of phase angle in cancer treatment settings.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL 60099, USA.
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Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004; 66:2054-60. [PMID: 15496179 DOI: 10.1111/j.1523-1755.2004.00978.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have pointed out the influence of nutritional parameters and/or indices of inflammation on morbidity and mortality. Often, these conditions coexist, and the relative importance of poor nutritional status and chronic inflammation in terms of predicting clinical outcomes in chronic hemodialysis (CHD) patients has not been clarified. METHODS We undertook a prospective cohort study analyzing time-dependent changes in several established nutritional and inflammatory markers, and their influence on mortality in 194 CHD patients (53% male, 36% white, 30% with diabetes mellitus, mean age 55.7 +/- 15.4 years) throughout a 57-month period. Serial measurements of serum concentrations of albumin, prealbumin, creatinine, transferrin, cholesterol, and C-reactive protein (CRP), as well as normalized protein catabolic rate, postdialysis weight, and phase angle and reactance by bioelectrical impedance analysis were performed every 3 months. Clinical outcomes were simultaneously assessed using indicators of mortality. RESULTS Serum albumin, serum prealbumin, serum creatinine, and phase angle were significant predictors of all-cause mortality, even after adjustment for serum CRP concentrations. Serum CRP concentrations were not significantly associated with mortality. Serum albumin concentrations and phase angle were also independent predictors of cardiovascular deaths in the multivariate model. CONCLUSION The nutritional status of CHD patients predicts mortality independent of concomitant presence or absence of inflammatory response. Prevention of, and timely intervention to treat uremic malnutrition by suitable means are necessary independent of the presence and/or therapy of inflammation in terms of improving clinical outcomes in CHD patients.
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Affiliation(s)
- Lara B Pupim
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2372, USA
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Coroas A, de Oliveira JGG, Sampaio S, Borges C, Tavares I, Pestana M, de Almeida MDV. Bioimpedance analysis highlights changes in body composition at the early stages of impairment of kidney transplant function. J Ren Nutr 2004; 14:157-63. [PMID: 15232794 DOI: 10.1053/j.jrn.2004.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Kidney transplantation restores renal filtration, although it does not achieve the function of 2 native kidneys, and with time it may involute back to chronic renal failure. We hypothesized that bioelectrical impedance analysis (BIA) might highlight differences for body compartments among kidney transplants (Tx) with different filtration rates. METHODS Thirty transplantation patients (19 male, 11 female) were studied at 62.4+/-26.6 months postsurgery and were divided into 3 groups: good creatinine clearance (crCl, mL/min/1.73 m2; >65.0), borderline (35.0<crCl<60.0), and bad (crCl <35.0). BIA was assessed 3 times in 1 year. Total body water, extracellular water (ECW), intracellular water (ICW), Na:K exchangeable ratio (Nae:Ke), and phase angle were studied. Healthy (n=11) and hemodialysis (n=11) groups were studied as well. RESULTS BIA showed no differences between healthy controls and good Tx, whereas both borderline and bad Tx presented a significantly higher ECW and lower ICW than either good Tx or normal controls. Only good crCl was different from predialysis. CONCLUSIONS A good graft kidney manages to restore and maintain normal body composition, whereas with mild renal dysfunction a change in body compartments was observed, moving toward the body water composition of chronic renal failure patients.
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Affiliation(s)
- Andreia Coroas
- Nephrology Department, S João Hospital, Porto, Portugal.
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Ikizler TA, Sezer MT, Flakoll PJ, Hariachar S, Kanagasundaram NS, Gritter N, Knights S, Shyr Y, Paganini E, Hakim RM, Himmelfarb J. Urea space and total body water measurements by stable isotopes in patients with acute renal failure. Kidney Int 2004; 65:725-32. [PMID: 14717948 DOI: 10.1111/j.1523-1755.2004.00439.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knowledge of urea volume of distribution (Vurea) in patients with acute renal failure (ARF) is critical in order to prescribe and monitor appropriate dialytic treatment. We have recently shown that in ARF patients, Vurea estimation by urea kinetic modeling is significantly higher than total body water (TBW) by anthropometric estimation. However, these estimates of Vurea and TBW have not been validated by isotopic methods, considered as reference measurement standards. METHODS In this study, we measured Vurea by [13C]urea and TBW by deuterium oxide (D2O) in 21 patients with ARF (14 males, 7 females, age 62.0 +/- 10.6 years old, 83% Caucasian, 17% African American) at three different centers. These measurements were compared to TBW estimates from anthropometric and bioelectrical impedance (BIA) measurements. RESULTS Our results show that Vurea by [13C]urea (51.0 +/- 11.7 L) is significantly higher than TBW estimated by all other methods (TBW by D2O: 38.3 +/- 9.8 L, P < 0.001; TBW by BIA: 45.7 +/- 15.7 L, P= 0.08; TBW by Watson formula: 38.3 +/- 7.3 L, P < 0.001; TBW by Chertow formula: 39.3 +/- 7.8 L, P= 0.002, all versus Vurea). Despite significant overestimation of the absolute value and considerable variation, Vurea significantly correlated with TBW by BIA (r= 0.66, P < 0.01) and TBW by D2O (r= 0.5, P= 0.04). There was also significant correlation between D2O and BIA determined TBW (r= 0.8, P < 0.001). CONCLUSION In terms of useful guidelines to prescribe a specific dose of dialysis in patients with ARF, conventional estimates of TBW as surrogates for Vurea should be used with caution. We propose that these conventional estimates of TBW should be increased by approximately 20% (a factor of 1.2) to avoid significant underdialysis.
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Affiliation(s)
- T Alp Ikizler
- Vanderbilt University Medical Center, Division of Nephrology, Nashville, Tennessee 37232-2372, USA.
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Abstract
Assessment and monitoring of protein and energy nutritional status are essential to prevent, diagnose, and treat uremic malnutrition, a condition highly prevalent and associated with increased morbidity and mortality in patients with advanced kidney failure. Comprehensive assessments of protein and energy nutritional status can be achieved by several measurements to quantitatively and qualitatively estimate protein content in visceral and somatic body compartments, in addition to measurements of energy balance. However, uremic malnutrition is a complex metabolic disorder in which not only net nutrient intake is lower than nutrient requirements, leading to decreased tissue function and loss of body mass, but it is also associated with many comorbid conditions. Therefore, a clinically meaningful assessment of uremic malnutrition should include methods that are able to assess clinical outcome, identify the underlying diseases, and determine whether there is potential of benefit from nutritional interventions. Such assessment usually requires using multiple measurements concomitantly, with no definitive single method that can be considered as a "gold standard." In this review, we describe the various types of methods to assess uremic malnutrition, expanding and updating data on the readily available methods, and discuss more precise techniques to estimate protein and energy homeostasis. Special considerations of specific methods related to their clinical and/or research applicability as they pertain to renal failure are also addressed.
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Affiliation(s)
- Lara B Pupim
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lee SW, Song JH, Kim GA, Lim HJ, Kim MJ. Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient. Am J Kidney Dis 2003; 41:1257-66. [PMID: 12776279 DOI: 10.1016/s0272-6386(03)00358-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is released into circulation in response to ventricular dilatation and pressure overload. Plasma BNP concentration correlates with left ventricular mass and dysfunction, which is prevalent in hemodialysis (HD) patients. METHODS To evaluate the potential of BNP level for determination of hydration status, we measured inferior vena caval diameter (IVCD) and BNP levels and performed bioimpedance analysis in 49 HD patients. RESULTS Pre-HD BNP levels remained unchanged after HD. Agreement between IVCD and pre-HD BNP level in overhydration was significant (kappa = 0.304). The area under the receiver operating characteristic (ROC) curve for overhydration was 0.819 for pre-HD BNP level. When extracellular fluid/total-body water (ECF/TBW) ratios of HD patients were compared with those of 723 controls, pre- and post-HD BNP levels were significantly greater in overhydrated patients. The area under the ROC curve for overhydration by ECF/TBW ratio was 0.781 for pre-HD BNP level. However, there was no significance for pre- or post-HD BNP levels on assessment of normohydration or underhydration. Pre-HD BNP level correlated significantly with post-HD BNP level, post-HD diastolic blood pressure, pulse pressure, and ECF/TBW ratio. IVCD correlated significantly with post-HD BNP level. CONCLUSION BNP level seems to have a limited potential for assessment of overhydration in HD patients.
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Affiliation(s)
- Seoung Woo Lee
- Kidney Center, Inha University Hospital, Inchon City, South Korea
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Barbosa-Silva MCG, Barros AJD, Post CLA, Waitzberg DL, Heymsfield SB. Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment? Nutrition 2003; 19:422-6. [PMID: 12714094 DOI: 10.1016/s0899-9007(02)00932-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Malnutrition is characterized by changes in cellular membrane integrity and alterations in fluid balance, both of which can be detected by bioelectrical impedance analysis (BIA). We investigated whether BIA-measured variables could detect malnutrition, as defined by the Subjective Global Assessment (SGA), in preoperative surgical patients. METHODS We prospectively evaluated 279 patients hospitalized for elective gastrointestinal surgery during the first 72 h after admission. BIA estimates were used to derive body cell mass, ratio of extracellular mass to body cell mass, and phase angle. Malnutrition diagnosed with these measures was compared with the SGA score. Receiver operating characteristic curves also were formulated to explore alternative cutoff points for one measure, phase angle. RESULTS A linear trend for means across SGA categories was found for all indicators used, except percentage of body cell mass. However, there was only fair overall agreement between SGA and BIA estimates. The receiver operating characteristic curves for phase angle suggested that the test was too sensitive or too specific. No alternative cutoff points resulted in suitable tests that could provide an alternative to SGA. CONCLUSIONS Although not in close agreement with SGA, the results suggested that there are some alterations in tissue electrical properties with malnutrition that can be detected by BIA. New cutoff points may be needed for application of BIA as a complementary method in the nutrition assessment of surgical patients.
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Kamimura MA, José Dos Santos NS, Avesani CM, Fernandes Canziani ME, Draibe SA, Cuppari L. Comparison of three methods for the determination of body fat in patients on long-term hemodialysis therapy. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2003; 103:195-9. [PMID: 12589325 DOI: 10.1053/jada.2003.50024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare three simple methods of body composition analysis for the assessment of body fat in patients on long-term hemodialysis therapy. DESIGN Cross-sectional study using the skinfold thickness, bioelectrical impedance analysis, and near-infrared interactance techniques after a hemodialysis session. SUBJECTS/SETTING Ninety clinically stable patients (57 male/33 female) undergoing hemodialysis at the Dialysis Unit of the Federal University of São Paulo. STATISTICAL ANALYSIS Analysis of variance, intraclass correlation coefficient, and Bland-Altman plot analysis were used for the comparative analysis between the methods. RESULTS Body fat measurements obtained by skinfold thickness (13.5+/-6.2 kg) and bioelectrical impedance analysis (13.7+/-6.7 kg) were similar, whereas those measured by near-infrared interactance (11.3+/-5.1 kg) were significantly lower in comparison with skinfold thickness and bioelectrical impedance analysis (P<.001). The strongest intraclass correlation coefficient was found between bioelectrical impedance analysis and skinfold thickness (r=0.87), and near-infrared interactance vs skinfold thickness and bioelectrical impedance analysis methods yielded r=0.78 and r=0.76, respectively. Near-infrared interactance showed a progressive underestimation of body fat values in comparison with the bioelectrical impedance analysis technique in patients with higher amount of adiposity. CONCLUSION In our study, we cannot consider that one method of body composition analysis is more accurate than the other because we did not apply a gold standard method. However, the most simple, long-established, and inexpensive method of skinfold thickness seems to be still very useful to the dietitians' routine for assessing body fat in patients on long-term hemodialysis therapy.
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Affiliation(s)
- Maria Ayako Kamimura
- Division of Nephrology and Nutrition Program, Federal University of São Paulo, Brazil
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Pupim LB, Kent P, Caglar K, Shyr Y, Hakim RM, Ikizler TA. Improvement in nutritional parameters after initiation of chronic hemodialysis. Am J Kidney Dis 2002; 40:143-51. [PMID: 12087572 DOI: 10.1053/ajkd.2002.33923] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Protein-calorie malnutrition is highly prevalent in patients with chronic renal failure and on chronic dialysis therapy. Longitudinal studies evaluating nutritional outcomes after the initiation of chronic dialysis therapy in incident dialysis patients are limited. METHODS This prospective cohort study evaluated time-dependent changes in several well-defined markers of nutritional status before and after initiation of chronic hemodialysis therapy. Fifty incident hemodialysis (HD) patients (60% men, 38% white, 32% with insulin-dependent diabetes mellitus) were studied. Multiple nutritional markers, including biochemical parameters and analysis of body composition, were assessed before the initial outpatient CHD treatment and every 3 months thereafter for 12 months. RESULTS At baseline, nutritional markers correlated well with each other. After the initiation of HD therapy, there were marked improvements in most nutritional parameters, including serum albumin, serum prealbumin, normalized protein catabolic rate, fat mass, reactance, and phase angle (P < 0.05 for all). Improvements in nutritional parameters were influenced by baseline nutritional status; ie, baseline nutritional parameters were predictors of their end-of-study value. CONCLUSION Initiation of CHD therapy is associated with improvements in most nutritional markers. Nutritional benefits of increased solute clearance provided by the initiation of chronic dialysis therapy prevail over its potential catabolic effects. However, the extent of improvement was dependent on nutritional status at the time of initiation of dialysis therapy, which remained an important determinant of subsequent nutritional improvements during the first year of treatment.
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Affiliation(s)
- Lara B Pupim
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA
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Cox-Reijven PL, Kooman JP, Soeters PB, van der Sande FM, Leunissen KM. Role of bioimpedance spectroscopy in assessment of body water compartments in hemodialysis patients. Am J Kidney Dis 2001; 38:832-8. [PMID: 11576887 DOI: 10.1053/ajkd.2001.27703] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bioimpedance spectroscopy (BIS) has been advocated as a tool to assess fluid status in hemodialysis (HD) patients. However, uncertainty remains about the reliability of BIS in patients with abnormalities in fluid status. Aims of the study are to assess the agreement between total-body water (TBW) and extracellular volume (ECW) measured by BIS and tracer dilution (deuterium oxide [D(2)O] and sodium bromide [NaBr]), the influence of the relative magnitude of water compartments (expressed as TBW(D(2)O) and ECW(NaBr):body weight) on the agreement between BIS and tracer dilution, and the ability of BIS to predict acute changes in fluid status. BIS and tracer dilution techniques were performed in 17 HD patients before a dialysis session. Moreover, the relation between BIS and gravimetric weight changes was assessed during both isolated ultrafiltration and HD. Correlation coefficients between TBW and ECW measured by BIS and tracer dilution were r = 0.71 and r = 0.71, respectively. Mean differences (tracer-BIS) were 6.9 L (limits of agreement, -1.5 to 21.6 L) for TBW and 2.3 L (limits of agreement, -1.7 to 9.7 L) for ECW. There was a significant relationship between the relative magnitude of TBW and ECW compartments and disagreement between BIS and tracer dilution (r = 0.65 and r = 0.77; P < 0.05). During both isolated ultrafiltration and HD, there was a significant relation between gravimetric changes and change in ECW(BIS) (r = 0.83 and r = 0.76; P < 0.05), but not with change in TBW(BIS). In conclusion, agreement between BIS and tracer dilution techniques in the assessment of TBW and ECW in HD patients is unsatisfactory. The discrepancy between BIS and dilution techniques is related to the relative magnitude of body water compartments. Nevertheless, BIS adequately predicted acute changes in ECW during isolated ultrafiltration and HD, in contrast to changes in TBW.
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Affiliation(s)
- P L Cox-Reijven
- Departments of Dietetics, Internal Medicine, and Surgery, University Hospital Maastricht, The Netherlands
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