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Cacciatore C, Cangiano B, Carbone E, Spagnoli S, Cid Ramirez MP, Polli N, Bonomi M, Persani L. Body weight variation is not an independent factor in the determination of functional hypothalamic amenorrhea in anorexia nervosa. J Endocrinol Invest 2024; 47:903-911. [PMID: 37812282 DOI: 10.1007/s40618-023-02207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Functional hypothalamic amenorrhea (FHA) is one of the foremost manifestations in anorexia nervosa (AN), but a subset of patients have menses despite marked weight loss and underweight. The aim of our study was to investigate parameters potentially influencing FHA in AN. DESIGN AND METHODS In this observational retrospective study, we selected 114 female patients with AN who completed a 12 months semi-residential rehabilitation program and a subsequent 12 months outpatient follow-up. We divided our sample into three groups: "Group 0" patients who experienced FHA and recovered their menses, "Group 1" persistent FHA, "Group 2" never experienced FHA, and looked for clinical and hormonal correlations. RESULTS At the enrollment, the BMI was higher in Group 2 than in Group 1 (p = 0.0202), but the last follow-up weight was higher in Group 1 (p < 0.0001) despite persistent amenorrhea. At logistic regression, the higher BMI at which patients experienced amenorrhea was the main prediction factor for persistent FHA. Notwithstanding comparable leptin levels at admission, they improved significantly at discharge only in Groups 0 and 2 (p = 0.0054 and p = 0.0104, respectively). FT3 at admission was significantly higher in Group 2 than in Group 0 (p = 0.0249). CONCLUSIONS FHA does not correlate strictly with body weight variations in AN patients, indicating a multifactorial origin, likely including an individual predisposition. Higher FT3 levels identify patients who continue having menses at extremely low BMI. AN patients with persistent FHA constitute a subgroup in whom estroprogestins should be considered after significant weight recovery to prevent prolonged tissue hypoestrogenism.
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Affiliation(s)
- C Cacciatore
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - B Cangiano
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - E Carbone
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - S Spagnoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M P Cid Ramirez
- Secciòn Endocrinologia y Diabetes, Hospital Clìnico Universidad del Chile, Santiago, Chile
| | - N Polli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M Bonomi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - L Persani
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy.
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Alyami SH, Alhamdan A, Alebrahim HM, Almadani AH, Aljuraiban GS, Abulmeaty MMA. Gastric Myoelectric Activity and Body Composition in Women with Binge Eating Disorder and Bulimia Nervosa: A Preliminary Trial Study. J Clin Med 2023; 12:4563. [PMID: 37510678 PMCID: PMC10380395 DOI: 10.3390/jcm12144563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Women with eating disorders (EDs) often complain of abnormal gastric responses, which may impact their eating patterns and, consequently, their body composition. Binge eating disorder (BED) and bulimia nervosa (BN) have been shown to affect gastric myoelectric activity (GMA), which may provide a basis for the gastric response in this disease population. This study aimed to examine GMA and body composition in patients with an ED compared to age-body mass index (BMI) matched controls. This case-control study included 18 adults diagnosed with BED or BN compared to 19 age-gender-BMI-matched controls. The electrogastrography with water load test was used to measure GMA during fasting and after water loading to satiety. Body composition was measured using a bioelectric impedance analyzer. The results showed that the ED group had a significantly higher water load than the control group and increased percentages of tachygastria times. Comparing the BED and BN subgroups showed differences in body composition status between the subgroups in the form of less fat mass, muscle mass, and total body water in the BN subgroup. In the BN subgroup, fat mass was associated with the average dominant frequency in the EGG. Thus, measuring GMA may be a promising approach to understanding gastric abnormalities in patients with EDs. Therapies targeting improving body composition in women with BED and BN are recommended in future ED management strategies.
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Affiliation(s)
- Seham H Alyami
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Adel Alhamdan
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Hanan M Alebrahim
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ahmad H Almadani
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ghadeer S Aljuraiban
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mahmoud M A Abulmeaty
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Więch P, Wołoszyn F, Trojnar P, Skórka M, Bazaliński D. Does Body Position Influence Bioelectrical Impedance? An Observational Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9908. [PMID: 36011541 PMCID: PMC9408608 DOI: 10.3390/ijerph19169908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
As the availability of various bioelectric impedance analysis (BIA) tools is increasing, the patient's position during the test may be of significant importance for the comparability of the results. An observational pilot study was undertaken between March and May 2021 at the Center for Innovative Research in Medical and Natural Sciences at the University of Rzeszow, Rzeszów, Poland. All participants (n = 49: M: 21.05 y ± 1.12 vs. F: 21.34 y ± 2.06) were subjected to measurements of selected nutritional status indicators and body components in three positions: lying, sitting and standing. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101 Anniversary Sport Edition Analyzer (Akern SRL, Pontassieve, Florence, Italy). The results were analyzed using dedicated software (BodygramPlus 1.2.2.12 from AKERN 2016, Florence, Italy). Our observations indicate that there is a significant difference between lying and standing as well as sitting and standing with respect to anthropometric and nutritional indicators (resistance, reactance, phase angle, standardized phase angle, body cell mass index and fat-free mass index) and body composition components, with particular reference to intracellular and extracellular water. The described differences are significant for both sexes. This study showed that this significantly influenced the scores of components directly related to resistance, reactance and hydrated cell mass, while not affecting the percentages or absolute values of fat and fat-free mass.
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Affiliation(s)
- Paweł Więch
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
- Department of Nursing, Institute of Social Sciences and Health Protection, East European State Higher School in Przemysl, 37-700 Przemysl, Poland
| | - Filip Wołoszyn
- Department of Human Physiology, Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Patrycja Trojnar
- Medical College, University of Information Technology and Management, 35-225 Rzeszow, Poland
| | - Mateusz Skórka
- Orthopedics Department, St. Hedvig Clinical Provincial Hospital, 35-301 Rzeszow, Poland
| | - Dariusz Bazaliński
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
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Steward T, Martínez-Zalacaín I, Mestre-Bach G, Sánchez I, Riesco N, Jiménez-Murcia S, Fernández-Formoso JA, Veciana de Las Heras M, Custal N, Menchón JM, Soriano-Mas C, Fernandez-Aranda F. Dorsolateral prefrontal cortex and amygdala function during cognitive reappraisal predicts weight restoration and emotion regulation impairment in anorexia nervosa. Psychol Med 2022; 52:844-852. [PMID: 32698931 DOI: 10.1017/s0033291720002457] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes. METHODS We investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement. RESULTS Compared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWE<0.05, threshold-free cluster enhancement (TFCE) corrected]. Importantly, psycho-physiological interaction analysis revealed reduced functional connectivity between the dlPFC and the amygdala in AN patients during emotion regulation (pFWE<0.05, TFCE corrected), and dlPFC-amygdala uncoupling was associated with emotion regulation deficits (r = -0.511, p = 0.018) and eating disorder severity (r = -0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment. CONCLUSIONS Taken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity.
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Affiliation(s)
- Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jose A Fernández-Formoso
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
| | | | - Nuria Custal
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
| | - Jose M Menchón
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- Ciber Mental Health (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Ciber Mental Health (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Howe CA, Corrigan RJ, Djalali M, McManaway C, Grbcich A, Aidoo GS. Feasibility of Using Bioelectrical Impedance Analysis for Assessing Youth Weight and Health Status: Preliminary Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10094. [PMID: 34639395 PMCID: PMC8507857 DOI: 10.3390/ijerph181910094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
Background. This study assessed the accuracy of bioimpedance analysis (BIA) for measuring body composition and resting metabolic rate (RMR) in fasted and non-fasted state and the prospect of using phase angle (PA) to indicate cellular health in youth. Methods. BIA body composition, RMR, and hydration measures were compared to dual-energy x-ray absorptiometry (DXA), MedGem metabolic analyzer, and urine specific gravity, respectively, at baseline in a fasted state using one-way ANOVAs. Repeated BIAs at 0, 30, 60, 90, and 120 min post-prandial were compared to baseline using repeated-measures ANOVA. Correlations were used to assess the relationship among PA and health (blood lipids and glucose, resting BP) and fitness (grip strength and a 3 min step test) measures. Results. BIA scans (N = 58; 11.4 ± 2.9 y) measured lower body fat % (BF%) in healthy weight youth (BMI < 85th percentile; 16.4 ± 1.1 vs. 25.1 ± 1.0%) and lower visceral adipose tissue (VAT) in males (44.5 ± 2.9 vs. 34.1 ± 6.0 cm2) than DXA and higher RMR in all youth (1244 ± 41 vs. 1104 ± 39 kcals/day), healthy weight (1231 ± 48 vs. 1049 ± 44 kcals/day), and teens (1541 ± 62 vs. 1234 ± 72 kcals/day) than MedGem. Compared to baseline, immediate post-prandial values were significantly higher for BF% (21.4 ± 1.4 vs. 22.0 ± 1.4%) and VAT (45.4 ± 6.1 vs. 46.2 ± 6.2 cm2). PA was significantly correlated with BF% (r = -0.33; p = 0.01), fat-free mass (r = 0.59; p < 0.001), grip strength (r = 0.56; p < 0.001). Conclusions. While more data are needed to confirm these preliminary findings, the results suggest caution is necessary in using BIA to assess aspects of youth health and weight status, especially in males, healthy weight, and teens. However, these preliminary findings do indicate that phase angle maybe be a valuable, non-invasive tool for identifying youth who are heading towards obesity and/or obesity-related health consequences.
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Affiliation(s)
- Cheryl A. Howe
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Riley J. Corrigan
- Honors Tutorial College, Ohio University, Athens, OH 45701, USA; (R.J.C.); (M.D.)
| | - Maya Djalali
- Honors Tutorial College, Ohio University, Athens, OH 45701, USA; (R.J.C.); (M.D.)
| | - Chris McManaway
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Alexandra Grbcich
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Grace Sam Aidoo
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
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Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med 2019; 8:jcm8071042. [PMID: 31319585 PMCID: PMC6679071 DOI: 10.3390/jcm8071042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Anorexia Nervosa (AN) is a psychiatric disorder characterised by a physical and psychosocial deterioration due to an altered pattern on the intake and weight control. The severity of the disease is based on the degree of malnutrition. The objective of this article is to review the scientific evidence of the refeeding process of malnourished inpatients with AN; focusing on the clinical outcome. Methods: We conducted an extensive search in Medline and Cochrane; on April 22; 2019; using different search terms. After screening all abstracts; we identified 19 papers that corresponded to our inclusion criteria. Results: The article focuses on evidence on the characteristics of malnutrition and changes in body composition; energy and protein requirements; nutritional treatment; physical activity programmes; models of organisation of the nutritional treatment and nutritional support related outcomes in AN patients. Conclusion: Evidence-based standards for clinical practice with clear outcomes are needed to improve the management of these patients and standardise the healthcare process.
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Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA): A Critical Overview. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:3548284. [PMID: 31275083 PMCID: PMC6560329 DOI: 10.1155/2019/3548284] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/05/2019] [Indexed: 12/18/2022]
Abstract
The measurement of body composition (BC) represents a valuable tool to assess nutritional status in health and disease. The most used methods to evaluate BC in the clinical practice are based on bicompartment models and measure, directly or indirectly, fat mass (FM) and fat-free mass (FFM). Bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA) (nowadays considered as the reference technique in clinical practice) are extensively used in epidemiological (mainly BIA) and clinical (mainly DXA) settings to evaluate BC. DXA is primarily used for the measurements of bone mineral content (BMC) and density to assess bone health and diagnose osteoporosis in defined anatomical regions (femur and spine). However, total body DXA scans are used to derive a three-compartment BC model, including BMC, FM, and FFM. Both these methods feature some limitations: the accuracy of BIA measurements is reduced when specific predictive equations and standardized measurement protocols are not utilized whereas the limitations of DXA are the safety of repeated measurements (no more than two body scans per year are currently advised), cost, and technical expertise. This review aims to provide useful insights mostly into the use of BC methods in prevention and clinical practice (ambulatory or bedridden patients). We believe that it will stimulate a discussion on the topic and reinvigorate the crucial role of BC evaluation in diagnostic and clinical investigation protocols.
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Siddiqui NI, Khan SA, Shoeb M, Bose S. Anthropometric Predictors of Bio-Impedance Analysis (BIA) Phase Angle in Healthy Adults. J Clin Diagn Res 2016; 10:CC01-4. [PMID: 27504280 DOI: 10.7860/jcdr/2016/17229.7976] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/04/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Phase Angle (PhA) is a ratio of whole body reactance and resistance obtained from Bioelectrical Impedance Analysis (BIA). It indicates cellular health and integrity and is considered as prognostic tool in medical disorders. In spite of prognostic potentials of PhA, it has limited usefulness in clinical practice and in population studies because of non-availability of normal population reference limits for comparison. Moreover, it is influenced by various factors like age, sex, race and body composition (i.e. body fat, muscle mass, visceral fat, body cell mass, total body water, etc). AIM The aim of this study was to evaluate predictors of phase angle which will be useful in formulation of reference values for Indian population. MATERIALS AND METHODS BIA was performed by Tanita Body Composition Analyser on healthy adults aged 17-24 years. The inbuilt software measured the phase angle by the formula: Phase angle (PhA) = Reactance (xc)/Resistance (R)* (180/π). Phase angle values were compared across categories of age, sex, weight, height, Body Mass Index (BMI), total fat, visceral fat and muscle mass. RESULTS Mean value of phase angle was found to be 5.65. Phase angle was significantly (p< 0.001) higher in male than in female. Phase angle was significantly predicted from height (p< 0.001), weight (p< 0.002), muscle mass (p< 0.002) and visceral fat (p< 0.02) in multiple regression models. CONCLUSION Phase angle differs across anthropometric and body composition categories. Thus height, weight and muscle mass should also be taken into consideration while deriving population specific reference limits of phase angle.
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Affiliation(s)
- Nazeem Ishrat Siddiqui
- Professor, Department of Physiology, Sri Aurobindo Medical College and Post Graduate Institute , Indore, Madhya Pradesh, India
| | - Sarfaraz Alam Khan
- Associate Professor, Department of Pharmacology, CIMS Bilaspur, Chhattisgarh, India
| | - Mohammad Shoeb
- Assistant Professor, Department of Biotechnology, SSMV , Bhilai, Chhattisgarh, India
| | - Sukhwant Bose
- Director Professor, Department of Physiology and Director Medical Education, Sri Aurobindo Medical College and Post Graduate Institute , Indore, Madhya Pradesh, India
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Bera TK, Nagaraju J, Lubineau G. Electrical impedance spectroscopy (EIS)-based evaluation of biological tissue phantoms to study multifrequency electrical impedance tomography (Mf-EIT) systems. J Vis (Tokyo) 2016. [DOI: 10.1007/s12650-016-0351-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Agüera Z, Romero X, Arcelus J, Sánchez I, Riesco N, Jiménez-Murcia S, González-Gómez J, Granero R, Custal N, Montserrat-Gil de Bernabé M, Tárrega S, Baños RM, Botella C, de la Torre R, Fernández-García JC, Fernández-Real JM, Frühbeck G, Gómez-Ambrosi J, Tinahones FJ, Crujeiras AB, Casanueva FF, Menchón JM, Fernández-Aranda F. Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome. PLoS One 2015; 10:e0143012. [PMID: 26600309 PMCID: PMC4658117 DOI: 10.1371/journal.pone.0143012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022] Open
Abstract
The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.
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Affiliation(s)
- Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
| | - Xandra Romero
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jon Arcelus
- Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, United Kingdom
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jana González-Gómez
- Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV), Santander, Spain
| | - Roser Granero
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Custal
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Monica Montserrat-Gil de Bernabé
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Dietetics and Nutrition Unit, University Hospital of Bellvitge, Barcelona, Spain
| | - Salomé Tárrega
- Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa M. Baños
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Cristina Botella
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Basic Psychology, Clinic and Psychobiology, University Jaume I, Castelló, Spain
| | - Rafael de la Torre
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José C. Fernández-García
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - José M. Fernández-Real
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Ana B. Crujeiras
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela, Spain
| | - Felipe F. Casanueva
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela, Spain
| | - José M. Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- * E-mail:
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Mayr M, Imgart H, Skala K, Karwautz A. [Quality management in weight restitution in Anorexia nervosa--pathophysiology, evidence-based practice and prevention of the refeeding syndrome]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2015; 29:200-211. [PMID: 26596577 DOI: 10.1007/s40211-015-0165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
During refeeding syndrome-a well-known and dreaded complication of weight-restauration in anorexia nervosa-a shift of electrolytes and fluid can occur in malnourished patients and might therefore lead to-potentially fatal-cardiovascular, respiratory and neurological symptoms. Causes of this are metabolic and hormonal changes during re-establishment of a carbohydrate-rich diet. This syndrome is most commonly associated with hypophosphatemia, which can however be accompanied by other chemical laboratory abnormalities. Standardized guidelines for the prevention and management of the refeeding syndrome have not yet been established. In case and cohort studies different low- and high-calorie diet protocols led to comparable results with similar complication rates. A focus should be placed on prevention of serious complications by careful monitoring. The pathophysiology, the main constituents in the development of the refeeding syndrome, recommendations for risk assessment and treatment, and current evidence are discussed.
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Affiliation(s)
- Michael Mayr
- Eating Disorders Unit, Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Hartmut Imgart
- Kompetenzzentrum für Essstörungen und Adipositas, Parklandklinik, Bad Wildungen, Deutschland.
| | - Katrin Skala
- Eating Disorders Unit, Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Andreas Karwautz
- Eating Disorders Unit, Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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