Chronic cellular dehydration in the aged patient

BACKGROUND: As a reduction of water spaces is expected in the elderly because of fat-free mass loss, disease is often associated with increased hydration. The present study compared water spaces and cellular hydration in adults, healthy and diseased aged patients. METHODS: An open study was conducted in 6 geriatric wards and a nutrition laboratory involving 85 aged diseased persons, 68 healthy elderly adults, and 35 adults. Total body water (TBW, H(2)(18)O dilution), extracellular water (ECW, Bromide dilution), and fat-free mass (FFM, body density and Siri's equation) were measured directly whereas intracellular water (ICW = TBW - ECW) and body cell mass (FFM - ECW) were obtained by calculations. RESULTS: FFM, TBW, and ICW were higher in adults than in the 2 other groups and in the elderly than in aged patients. ECW was higher in aged patients than in healthy elderly participants. The proportion of TBW made of ECW or ICW was the same in adults and in healthy elderly persons. A higher proportion of TBW was composed of ECW, and a lower proportion of TBW was composed of ICW, in diseased patients compared with the 2 other groups. The proportion of ICW in body cell mass was also lower in diseased patients. CONCLUSIONS: Diseased elderly persons display reduced ICW and expanded ECW. A cellular dehydration is suggested.     

Bioelectrical impedance analysis and other hydration parameters as risk factors for delirium in rural nursing home residents

BACKGROUND: The study investigators conducted a vigorous screening protocol for delirium in rural long-term care (LTC) facilities for a period of 28 days focusing on Bioelectrical Impedance Analysis (BIA) and other hydration parameters as risk factors. METHODS: A two-stage cluster sampling procedure was used to randomly select participants (n = 313) from 13 LTC facilities located in southeastern Iowa, stratified on facility bed size. BIA was used to estimate intracellular water (ICW), extracellular water (ECW), and total body water (TBW) on four occasions--baseline and follow-up days 7, 14, and 28. Volume estimates were calculated as a percent of body weight (%WT). Serum electrolytes and hematology were also measured. Delirium was measured with four strict criteria: a NEECHAM Confusion Scale score < 25, Vigilance "A" score > 2, a Mini-Mental Status Examination < baseline, and a positive Confusion Assessment Method score. RESULTS: There were n = 69 delirium cases (22.0%). Blood urea nitrogen/creatinine ratios greater than 21:1 (odds ratio = 1.76, 95% confidence interval 1.02-3.06). No significant risk for delirium was associated with ICW, ECW, or TBW as a percent of body weight. CONCLUSIONS: Some changes were observed with a slight decrease in ICW between day 7 and day 14 of follow-up that tended to follow an increase in delirium events, but in general the BIA measures did not predict delirium events.     

Body composition during normal pregnancy: reference ranges

Maternal body composition undergoes a deep adaptative change during the course of pregnancy. Fat mass, fat-free mass, and total body water (TBW) increase in different ways and their effects on pregnancy outcome represent a field of major interest in perinatal medicine. The aim of this study was to evaluate the changes in maternal body composition [maternal weight, TBW, intracellular water (ICW) and extracellular water (ECW)] during healthy pregnancy by using bioimpedance analysis (BIA). A total of 170 healthy pregnant women, aged 22-44 years, volunteered to participate in our study. The BIA measurements were carried out with a Tefal BIA scale determining resistance and reactance. Lukaski's multiple-regression equation was used to estimate TBW and ICW and ECW were computed using the prediction formula of Segal. The evaluations were performed at 10-38 weeks' gestation, every 3-4 weeks, and hematocrit was determined at every time interval. Analysis of variance and multiple comparisons of Bonferroni were performed to compare variables among the different study intervals. Second-order polynomial interpolation was used to obtain percentile values for each bioimpedance parameter. Percentile bioimpedance values of the healthy population are provided at each study time, by showing the mean value and the 5th, 25th, 75th, 95th percentiles. Moreover, normal reference ranges for TBW are provided for each gestational age, in relation to maternal weight gain. Reactance, TBW, and ICW enhance slightly during the course of gestation. Tetrapolar BIA could be an easy and practical tool for evaluating changes of maternal body components during pregnancy. It could also provide indirect proof of the normal hemodilution occurring in normal pregnancies. Moreover, fat mass deposition, and not only fluid retention, seems to be responsible for the mother's gestational weight gain, since reactance is an indirect parameter in estimating fat mass amount.     

Perioperative hemodynamic study of patients undergoing abdominal surgery using pulse dye densitometry

BACKGROUND/AIMS: Pulse dye densitometry (PDD) using indocyanine-green (ICG) is a newly developed technique for monitoring cardiac output (CO), cardiac index (CI), circulating blood volume (BV) and ICG elimination rate (K-ICG). We measured hemodynamic changes during the perioperative period in patients undergoing digestive surgery to analyze relationships between hemodynamic changes and surgical procedures, blood loss, water balance and SIRS. METHODOLOGY: Eighty-seven patients who underwent gastrectomy (n=46) and colectomy (n=41) without postoperative complications were enrolled in this study. The corresponding data from 15 patients who underwent laparoscopic cholecystectomy were used as controls. CO, CI, BV and K-ICG were measured by PDD before operation, on the first postoperative day (POD 1), POD 3, POD 7 and POD 14. RESULTS: In all patients, CO and CI increased significantly until POD 3 compared with preoperative levels. BV on POD 1 decreased significantly compared to the preoperative level. K-ICG increased significantly until POD 14. Laparoscopic cholecystectomy resulted in less surgical stress than gastrectomy or colectomy as measured by hemodynamic changes. There were minimal differences in hemodynamics between the gastrectomy and colectomy groups. There were significant negative correlations between intraoperative blood loss and the [POD 1: preoperative values] ratios for CO, CI, BV or K-ICG. There was no correlation between changes in water balance from operation to POD 1 and [POD 1: preoperative value] BV ratio. CONCLUSIONS: An increase in CO and decrease in BV were observed at the early operative stage, especially in patients with systemic inflammatory response syndrome (SIRS). Interestingly, hepatic artery flow volume (K-ICG) remained high until POD 14. It is important to minimize intraoperative blood loss, since it markedly affects postoperative hemodynamics.     

Hypoalbuminemia is also a marker of fluid excess determined by bioelectrical impedance parameters in dialysis patients

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.     

Nutritional Status and Body Fluid Distribution in Chronic Alcoholics Compared With Controls

BACKGROUND: At present few data are available on the total body water (TBW) content and in particular on the distribution of water in the intra- and extracellular compartments (ICW and ECW) of alcoholics. The aim of this study was to evaluate TBW, ICW, and ECW in chronic alcoholic patients. METHODS: Thirty-six alcoholics meeting DSM-III-R criteria for diagnosis (20 men, 16 women; body mass index [BMI] 22.3+/-2.57 kg/m2) were enrolled. Fifty-four healthy social drinkers (31 men, 23 women; BMI 23.7+/-1.68 kg/m2) matched for age and height were used as controls. Systolic and diastolic blood pressure was measured for all cases. All patients were assessed using specific anthropometric measurements. The waist-to-hip ratio (WHR) was used as an indicator of body fat distribution. TBW was measured by isotopic dilution by giving 100 microCi of tritiated water. ICW and ECW were assessed by multifrequence bioelectric impedance analysis (BIA). Basal metabolic rate (BMR) was measured by indirect calorimetry. RESULTS: Body weight was lower in the alcoholics than in the controls (61.9+/-5.5 kg vs. 65.8+/-5.2 kg;p < 0.01), essentially due to a reduction in fat mass. Significantly higher WHR values were found in both male (p < 0.001) and female (p < 0.001) alcoholics than in healthy subjects. A higher ECW/TBW ratio was found in the alcoholics compared with the controls, both as a whole (0.53+/-0.04 vs. 0.41+/-0.03; p < 0.0001) and separated by gender (p < 0.001). CONCLUSIONS: The increased ECW could derive from an increase in cellular permeability related to endothelial damage linked to the vasoconstriction present in the alcoholics and/or to a direct toxic effect of ethanol on cellular membranes. In addition, because the high ECW volumes correlated positively with WHR in the alcoholics, a potential association of these two factors in determining an increased risk of liver disease, hypertension, and cardiovascular disease may exist. Finally, the lower TBW characteristic of women may be one of the reasons for the observed greater rate of toxic effects of ethanol that occur in women.     

BODY COMPOSITION IN ACROMEGALY

Total body water (TBW) and potassium (TBK) were measured in untreated acromegalic patients seen between 1956 and 1984 and the results were compared to values predicted from height (BH), weight (BW), age and sex, using data from a large number of healthy subjects (n = 476). Normal body weight for each patient (BWnorm) was predicted from BH and sex, the regression equations being derived from a representative population sample (n = 4017). The BH for each patient was compared with data on BH in 15,000 Swedes. The patients were significantly taller than the control population (P less than 0.001). In 107 (70%) of the 156 patients BH was above the median. Patients with an early onset of the disease were taller than those with a later onset. TBK and TBW were significantly higher than predicted from observed BW (P less than 0.001) and so was the quotient extracellular water (ECW)/intracellular water (ICW). Body fat (BF), on the other hand, was lower than predicted (P less than 0.001). Observed BW in male acromegalics was 8.1 kg higher than predicted from healthy subjects of the same BH (BWnorm), a difference explained by an average increase of 4.7 kg in body cell mass (BCM) (P less than 0.001) and 7.1 kg in extracellular water (P less than 0.001) simultaneously with a mean decrease of 3.7 kg in BF (P less than 0.01). Female acromegalics weighed on average 6.4 kg more than healthy women, a difference explained by an increase in BCM of 3.3 kg (P less than 0.001) and in ECW of 4.6 kg (P less than 0.001) concomitantly with a decrease in BF of 1.5 kg. Mean hGH concentration at diagnosis correlated inversely with the quotients observed/predicted BF (P less than 0.01) and BW/BWnorm (P less than 0.05) but not with the quotients observed/predicted TBK, TBW or ECW/ICW.     

Bioelectrical impedance analysis estimation of water compartments in elderly diseased patients: the source study

BACKGROUND: This study validates, in geriatric patients, bioelectrical impedance analysis (BIA) equations that had been derived to estimate total body water (TBW) and extracellular water (ECW) in healthy elderly subjects. METHODS: We performed a multicentric trial in six geriatric wards. We studied 169 patients with varying degrees of hydration: dehydrated, euvolemic, and overhydrated. BIA estimates of TBW and of ECW were compared with the measurement of TBW with (18)O dilution and of ECW with bromide (Br) dilution. RESULTS: BIA estimated TBW with a difference of 0.48 +/- 2.3 l (mean +/- SD) (50 kHz; p = .01) and 0.69 +/- 2.2 l (100 kHz; p < 0.001) compared with (18)O dilution. The difference was not affected by the hydration status. Estimates of ECW with BIA were systematically biased compared with Br dilution: 4.6 +/- 3.1 l (equation from Segal and colleagues; p < .001) and 3.4 +/- 2.9 l (equation from Visser and colleagues; p < .001). We propose a new, cross-validated equation. Conclusions. Body water spaces can be estimated accurately in geriatric patients with BIA.     

Total body water/fat-free mass ratio as a valuable predictive parameter for mortality in maintenance hemodialysis patients

Hydration of fat-free mass (FFM), defined as the ratio of total body water (TBW) to FFM (TBW/FFM), is stable at 0.739 in adult mammals. However, an increase in the TBW/FFM ratio is common in hemodialysis (HD) patients. This study aimed to evaluate the determinants of TBW/FFM and investigate its predictive value for the prognosis of all-cause mortality in HD patients.We enrolled patients undergoing maintenance HD between July 2020 and May 2021. All patients were prospectively followed until death, HD dropout, or until the end of the study (November 1, 2021). A forward stepwise multivariable linear regression analyses was performed to test the independent relationship between TBW/FMM and other clinical variables. Receiver operating characteristic (ROC) analysis was used to discriminate the TBW/FFM with respect to 180-day mortality.Of the 106 patients, 42 had elevated TBW/FFM levels. Multiple linear regression analysis revealed that the TBW/FFM ratio was significantly associated with extracellular water (ECW)/TBW (standardized regression coefficient [β = 1.131, P < .001], phase angle (PhA) [β = 0.453, P < .001], and sex (β = 0.440, P < .001). We calculated the ROC curve (AUC) of TBW/FFM, ECW, ECW/TBW, and intracellular water (ICW) to compare the discriminatory capacities of these parameters in predicting 180-day mortality. The AUC for TBW/FFM (AUC = 0.849; 95% CI, 0.745–0.953) exhibited better discriminatory potential than ECW (AUC = 0.562; 0.410–0.714), although it had a similar predictive potential as the ECW/TBW ratio (AUC = 0.831; 0.731–0.932). High TBW/FFM can be used as a valuable prognostic index for predicting all-cause mortality in patients on HD.     

Bioelectrical impedance analysis predicts outcome in patients with suspected bacteremia

Summary  Fluid shifts from intracellular to extracellular water (ICW to ECW) are a feature of sepsis, caused by increased vascular permeability and cell catabolism. Changes in ECW and total body water (TBW) were assessed in a prospective observational study of patients with bacteremia by a bedside technique, and its prognostic impact determined. In 78 hospital patients with fever, the resistance ratio (Rinf/RO) and estimated ECW/TBW ratio from multifrequency bioelectrical impedance analysis, and serum albumin concentration were measured. Rinf/RO and ECW/TBW ratios decreased from day 0 to 2 in patients with significant bacteremia (n=31), but not in patients with doubtful or negative blood cultures (n=22 and 25). Increased Rinf/RO at baseline, and further increase of ECW/TBW from day 0 to 2, were associated with lower rate of recovery after 1 week and with higher mortality. Baseline Rinf/RO above the media (0.75) had positive and negative predictive values of 0.31 and 0.95 for death. This prognostic effect was independent of underlying disease and blood culture result in a multivariate model. Hypoalbuminemia at baseline was predictive of outcome, but changes in albumin from day 0 to 2 were unrelated to blood culture results or outcome. In patients with bacteremia, fluid shifts from intracellular to extracellular water occur early, are rapidly reversible by antibiotic treatment but are associated with adverse prognosis. Bioelectrical impedance deserves further study as a tool for bedside monitoring of patients with bacteremia.     

The role of bioelectrical impedance analysis,NT-ProBNP and inferior vena cava sonography in the assessment of body fluid volume in children with nephrotic syndrome

Background

Assessment of volume status and differentiating “underfill” and “overfill” edema is essential in the management of patients with nephrotic syndrome (NS).

Preoperative volume assessment using bioelectrical impedance analysis for minimizing blood loss during hepatic resection

BackgroundMaintaining low central venous pressure (CVP) is an effective strategy to reduce blood loss during hepatic resection. As an alternative to measuring CVP, which requires the placement of a central venous catheter, bioelectrical impedance analysis (BIA) is a noninvasive method recently used for monitoring volume status in critically ill patients.MethodsWe investigated 192 patients who underwent hepatic resection from January 2017 to December 2020. The ratio of extracellular water:total body water (ECW/TBW), as an index of volume status, was measured using InBody S10 (Biospace, Seoul, Korea). The correlation between the ECW/TBW and CVP was determined, and their influences on operative outcomes were analyzed.ResultsECW/TBW and CVP showed a significant correlation; an ECW/TBW <0.378 correlated with a CVP <5 mmHg (R² = 0.839, P<0.001). Estimated blood loss (EBL) was significantly increased in patients with an ECW/TBW ≥0.378 compared to those with a ratio <0.378 (508 ± 321 vs. 324 ± 193, mL, P<0.001). Identified predictors for an EBL ≥500 mL were operative time (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.001–1.015; P = 0.021) and an ECW/TBW <0.378 (OR, 0.263; 95% CI, 0.121–0.572; P = 0.001).ConclusionsBIA can be utilized for preoperative volume assessment to minimize blood loss during hepatic resection.     

Validation of bio-impedance spectroscopy: effects of degree of obesity and ways of calculating volumes from measured resistance values

BACKGROUND: Bioelectrical-impedance spectroscopy (BIS) is a very attractive method for body composition measurements in a clinical setting. However, validation studies often yield different results. This can partly be explained by the different approaches used to transform measured resistance values into body compartments. OBJECTIVE: The aim of this study was to compare the linear regression (LR) method with the Hanai Mixture theory (HM). Secondly, the effect of degree of overweight on the accuracy of BIS was analysed. DESIGN: In 90 people (10 M, 80 F; body mass index (BMI) 23-62 kg/m2) total body water (TBW) and extracellular water (ECW) were measured by deuterium and NaBr dilution methods, respectively, and by BIS. Resistance values of ECW (R(ECW)) and TBW (R(TBW)) were used for volume calculations. Data of half the group were used for LR based on L2/R (L = length, R = resistance) to predict TBW and ECW and to calculate the constants used in the HM (kECW), k(p)). Prediction equations and constants were cross-validated in Group 2. RESULTS: Bland and Altman analysis showed that the LR method underestimated TBW by 1.1 l (P < 0.005) and ECW by 1.1 l (P < 0.005). The HM approach underestimated ECW by 0.8 l (P < 0.005). The correlations with the dilution methods and the SEEs for TBW and ECW were comparable for the two approaches. The prediction error of BIS for TBW and ECW correlated with BMI. The constant kECW, and the specific resistivities of the ECW and intracellular water (ICW) pECW and pICW were also correlated with BMI. CONCLUSIONS: The mixture approach is slightly more accurate than linear regression, but not sensitive enough for clinical use. The constants used in the HM model are not constants in a population with a wide variation in degree of overweight. The physical causes of the correlation between BMI and constants used in the model should be studied further in order to optimize the mixture model.     

Effect of whey protein supplementation combined with resistance training on cellular health in pre-conditioned older women: A randomized,double-blind,placebo-controlled trial

AimThe purpose of study was to analyze the effects of a combined whey protein (WP) and RT intervention on cellular health in pre-conditioned older women.MethodsThe protocol is a randomized controlled clinical trial with a sample of seventy older women, divided into 3 groups: WP-placebo (WP-PLA, n = 24), placebo-WP (PLA-WP, n = 23), and placebo-placebo (PLA-PLA, n = 23). Each group drank 35 g of product (placebo or WP) pre- and post- training. The RT program was carried out over 12 weeks (3x/week; 3 × 8–12 repetitions maximum). Total body water (TBW), intra (ICW) and extracellular (ECW) water, resistance (R), reactance (Xc), and phase angle (PhA) assessed by bioimpedance spectroscopy. Lean soft tissue (LST) was measured using dual energy X-ray absorptiometry; and food consumption was assessed by means of the average of two 24-hour recalls. ANCOVA for repeated measures was applied for comparisons, with baseline scores used as covariates.ResultsA group by time interaction (P < 0.05) was observed for LST, ICW and the ECW/ICW ratio. There was a time effect (P < 0.05) for TBW, Xc, and PhA. A reduction (P <0.05) in R was found only in the WP-PLA and PLA-WP groups.ConclusionWhey protein supplementation (pre- or post-) combined with RT promoted an increase in ICW and LST, and also a reduction in ECW/ICW ratio in pre-conditioned older women. Regardless of the supplementation intake, the RT regimen improved PhA in older adult women. This trial was registered at ClinicalTrials.gov: NCT03247192.     

Intra- and Extracellular Water Dynamics on Rehydration in Cholera and Noncholera Patients

To estimate the intra- and extracellular bodywater compartments during rehydration of patients withcholera and noncholera diarrhea by bioimpedanceanalyzer, we studied 30 patients with acute waterydiarrhea. Total body water (TBW), intracellular water(ICW), and extracellular water (ECW) of severelydehydrated adult patients were measured with a dualfrequency bioimpedance analyzer at different phases ofrehydration. Fluid compartments between cholera andnoncholera patients were compared. Cholera patientsgained more TBW than noncholera patients duringrecovery. Unlike patients with noncholera diarrhea, thegain in cholera patients was mainly contributed by theICW (1.5 ± 1.6 vs 3.0 ± 1.2 liters,respectively, P < 0.01). It was also observed thatthe recovery of the ICW compartment in cholera patientsoccurred rapidly within the first 2 hr after infusion.Differential dynamics of body water compartments incholera compared to noncholera patients as observed inthis study may contribute further to understanding the mechanism of dehydration in diarrhealdisease, which might help in improving casemanagement.     

Impedance vector distribution by body mass index and conventional bioelectrical impedance analysis in obese women

BACKGROUND AND AIM: To compare the body fluid status assessments provided by conventional bioelectrical impedance analysis (BIA) and vector BIA in moderate and severe obesity. METHODS AND RESULTS: We studied 516 normotensive Caucasian women (mean age: 48 +/- 9.2 years), who were age-matched and divided into four groups on the basis of their body mass index (BMI): 99 normal weight women with a BMI of 19-25 Kg/m2; 228 preobese overweight women with a BMI of 25-30 Kg/m2; 132 women with class I-II obesity (BMI: 30-35 Kg/m2), and 57 women with class III obesity (BMI: 40-64 Kg/m2). Single-frequency (50 kHz) tetrapolar (hand-foot) bioelectrical impedance measurements were made, and total body water (TBW) and extracellular water (ECW) were estimated using conventional BIA regression equations. The RXc graph method was used for vector BIA, with the set of 327 women with a BMI of 19-30 Kg/m2 being adopted as the reference population. Mean vector displacement followed a definite pattern, with progressive vector shortening as the BMI increased, and along a fixed phase angle. This pattern indicates more TBW due to a greater soft tissue mass with average normal hydration. Short and downsloping vectors indicating fluid overload were more frequent in the group with class III obesity than in the group with class I obesity (19 vs 5%). The absolute values of TBW and ECW were significantly higher in the obese and overweight subjects than in those with normal weight subjects. TBW as a percentage of body weight was significantly lower in the obese subjects. CONCLUSIONS: BMI influenced the impedance vector distribution pattern, which proved to be consistent up to a BMI of 64 Kg/m2. Obese women with an altered body composition can be identified and monitored using vector BIA.     

Relationship between locomotive syndrome and body composition among community-dwelling middle-age and elderly individuals in Japan: The Yakumo study

Abstract

Objectives: Locomotive syndrome (LS) is a condition requiring nursing care for musculoskeletal disorders. Our aim was to evaluate the correlation between body composition, measured by bioelectrical impedance analysis (BIA), and LS, measured using the 25-question Geriatric Locomotive Functional Scale (GLFS-25).

Methods: We enrolled 286 individuals who were undergoing regular health follow-up. All individuals completed the GLFS-25, body composition analysis by BIA, and five physical performance tests related to LS: timed up-and-go test, 10-m gait time, maximum stride length, back strength, and grip strength. Measured variables and demographic data were compared between individuals with and without LS.

Results: The extracellular water ratio, the extracellular water/total body water (ECW/TBW) ratio differentiated the LS and non-LS groups (p=.005), with all physical function measures being lower among individuals with a high, compared to low, ECW/TBW ratio. The risk ratio for LS among individuals with a high ECW/TBW ratio was 2.31, with an odds ratio of 2.67.

Conclusion: The ECW/TBW ratio is predictive of LS. Based on our results, we propose that BIA should routinely be performed, with follow-up and intervention, as needed, for individuals with a high ECW/TBW ratio, as they are at risk for developing LS.     

Higher extracellular water to total body water ratio was associated with chronic kidney disease progression in type 2 diabetes

AimWe studied the association between extracellular volume status and chronic kidney disease (CKD) progression; and the role of extracellular volume excess as a potential mediator in the relationship between matrix metalloproteinases (MMP)-2 and CKD progression in Type 2 diabetes mellitus (T2DM).MethodsWe conducted a prospective cohort study of 1079 T2DM patients. Bioelectrical impedance analysis (BIA) was performed to assess body fluid status.ResultsAfter up to 8.6 years of follow-up, 471 (43.7%) patients experienced CKD progression. In the fully adjusted model, extracellular water (ECW)/ total body water (TBW)ratios 0.39–0.40 and > 0.40 were associated with 45% and 78% higher risk of CKD progression respectively. Patients with an increase in ECW/TBW ratio had 40% higher risk of CKD progression compared to those with no change or reduction of ECW/TBW ratio. Higher ECW/TBW ratio accounted for 17.4% of the relationship between MMP-2 and CKD progression in T2DM (p = 0.026).ConclusionsExtracellular volume excess was independently associated with CKD progression in T2DM. Higher ECW/TBW ratio mediated the positive association between MMP-2 and CKD progression. Further studies are needed to elucidate the role of extracellular volume excess in deterioration of renal function.     

Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study

Introduction/objectives

To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA).

Methods

We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted.

Results

Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15–5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32–3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13–10.19 points).

Conclusions

Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA.

Alterations in body composition after gastroplasty for morbid obesity

Body compositional changes during rapid weight loss and after weight stabilization were prospectively studied in morbidly obese patients undergoing gastroplasty operations. Body composition was studied preoperatively and 6 and 24 months postoperatively in 23 patients by use of a total body counter (40K) and an isotope dilution technique. The mean fat mass, cell mass, and intracellular water (ICW) decreased during the first 6 months (p less than 0.001) and remained unchanged at the 24-month test. However, the mean liters of extracellular water (ECW) did not change. Consequently, the ECW/ICW ratio, high in states of malnutrition, rose above postoperative levels. A strong correlation was found between decreases in cell mass and increases in the ECW/ICW ratio.