北京市城区858例中老年体检人群体成分和静息代谢率分析

目的 了解北京市城区中老年人超重/肥胖率,分析体成分和静息代谢率随年龄改变的趋势。方法 对2014年11月至2015年12月在北京医院体检的51～99岁的858例（男性760例,女性98例）进行体成分和静息代谢率检测。结果 超重率为51.4%,肥胖率为16.9%,且女性超重/肥胖率明显低于男性（P<0.001）;骨骼肌量、肌肉指数、体脂百分比、内脏脂肪面积和静息代谢率在不同年龄段的分布有差异（均P<0.001）。在体重正常组,≥80岁年龄段的骨骼肌量、肌肉指数、静息代谢率显著减少（P<0.05）,体脂百分比和内脏脂肪面积明显增多（P<0.05）;在超重/肥胖组,70～岁年龄段的骨骼肌量、肌肉指数、静息代谢率开始显著减少（P<0.05）,≥80岁年龄段减少更加显著,而70～岁年龄段体脂百分比和内脏脂肪面积明显增多（P<0.05）。结论 北京市城区中老年人超重/肥胖率较高,且男性高于女性;随年龄增长,骨骼肌量、肌肉指数、静息代谢率逐渐减少,而体脂百分比、内脏脂肪面积增加。超重/肥胖人群更早出现体成分和静息代谢率的改变。     

应用双能源X线吸收法测定 营养不良病人机体组成

目的应用双能源X线吸收法(DEXA),检测营养不良病人的机体组成改变。　方法中等程度以上营养不良住院病人56例,其中男32例,女24例,年龄为39～66(平均51±14)岁作为研究对象。72例健康志愿者(男34例,女38例)为对照者,年龄为41～64(平均54±11)岁。机体组成测定应用HologicQDR—2000双能源X线测定仪。　结果营养不良病人实际平均体重是理想体重的72.5%,其体重指数、肱三头肌皮褶厚度、上臂肌围、白蛋白、转铁蛋白、前白蛋白及淋巴细胞总数均明显低于正常值,属中、重度营养不良范围。营养不良病人的体脂及瘦组织群含量明显低于健康志愿者,尤以体脂含量下降最为明显,差异极显著(P＜0.01)。两组矿物质含量无统计学差异(P＞0.05)。　结论营养不良时机体体脂和瘦组织群存在不同程度的消耗,其中以体脂的丢失尤为明显。DEXA是临床上测定机体组成的一种准确、可靠方法,可有效地检测营养不良病人的机体组成改变。     

双能X线吸收法和生物电阻抗法测量成年超重/肥胖人群体脂率一致性分析

目的 分析生物电阻抗(MF-BIA)法和双能X线吸收(DXA)法测量成年超重/肥胖人群体脂率的一致性,并建立MF-BIA法校正预测模型。方法 招募志愿成年超重/肥胖者1 323人,分别采用MF-BIA法和DXA法测定受试者的体脂率,分析两方法测量结果的一致性,并建立MF-BIA法校正预测模型。结果 成年男女性超重/肥胖的MF-BIA法与DXA法测量体脂率差值分别为-6.5%、-4.3%和-2.5%、0.5%,差异均有统计学意义(均P<0.01),其体脂率的组内相关系数分别为0.746、0.807和0.628、0.674,差异均有统计学意义(均P<0.01)。MF-BIA法校正预测模型包括超重男性人群:体脂率(DXA法)=13.425+0.719×体脂率(MF-BIA法);肥胖男性人群:体脂率(DXA法)=12.572+0.741×体脂率(MF-BIA法);超重女性人群:体脂率(DXA法)=9.785+0.802×体脂率(MF-BIA法);肥胖女性人群:体脂率(DXA法)=20.348+0.532×体脂率(MF-BIA法)。结论 MF-BIA法和DXA法测量我国成年超重/肥胖人群体脂率一致性较差,使用MF-BIA法测量体脂率需进行校正。     

Body composition assessment in adults with cystic fibrosis: comparison of dual-energy X-ray absorptiometry with skinfolds and bioelectrical impedance analysis

OBJECTIVE: We compared body composition measurement in adults with cystic fibrosis (CF) by using non-invasive methods (skinfold thicknesses and bioelectrical impedance analysis [BIA]) with dual-energy X-ray absorptiometry (DXA). METHODS: Seventy-six adults with CF (mean age 29.9 +/- 7.9 y, mean body mass index 21.5 +/- 2.5 kg/m(2)) were studied. Body composition was measured to calculate fat-free mass (FFM) using DXA, the sum of four skinfold thicknesses, and BIA (predictive equations of Lukaski and of Segal). RESULTS: Mean FFM values +/- standard deviation measured using DXA were 54.8 +/- 7.3 kg in men and 41.2 +/- 3.9 kg in women. Mean FFM values measured using BIA/Lukaski were 51.5 +/- 7.8 kg in men and 40.4 +/- 4.9 kg in women (P < 0.0005 for men, not significant for women for comparison with DXA). Mean FFM values measured using BIA/Segal were 54.2 +/- 7.5 kg for men and 44.1 +/- 5.9 kg for women (not significant for men, P < 0.0005 for women for comparison with DXA). Mean FFM values measured using skinfolds were significantly higher than those for FFM with DXA (57.2 +/- 7.2 kg in men, 43.3 +/- 4.3 kg in women, P < 0.0005 for comparison with DXA). The 95% limits of agreement with FFM using DXA were, for men and women, respectively, -8.3 to 1.7 kg and -6.4 to 4.8 kg for BIA/Lukaski, -4.8 to 3.6 kg and -3.1 to 8.9 kg for BIA/Segal, and -2.8 to 7.3 kg and -1.5 to 5.7 kg for skinfolds. CONCLUSION: This study suggests that skinfold thickness measurements and BIA will incorrectly estimate FFM in many adults with CF compared with DXA measurements of FFM. These methods have limited application in the assessment of body composition in individual adult patients with CF.     

External cross-validation of bioelectrical impedance analysis for the assessment of body composition in Korean adults

Bioelectrical impedance analysis (BIA) models must be validated against a reference method in a representative population sample before they can be accepted as accurate and applicable. The purpose of this study was to compare the eight-electrode BIA method with DEXA as a reference method in the assessment of body composition in Korean adults and to investigate the predictive accuracy and applicability of the eight-electrode BIA model. A total of 174 apparently healthy adults participated. The study was designed as a cross-sectional study. FM, %fat, and FFM were estimated by an eight-electrode BIA model and were measured by DEXA. Correlations between BIA_%fat and DEXA_%fat were 0.956 for men and 0.960 for women with a total error of 2.1%fat in men and 2.3%fat in women. The mean difference between BIA_%fat and DEXA_%fat was small but significant (P < 0.05), which resulted in an overestimation of 1.2 ± 2.2%fat (95% CI: -3.2-6.2%fat) in men and an underestimation of -2.0 ± 2.4%fat (95% CI: -2.3-7.1%fat) in women. In the Bland-Altman analysis, the %fat of 86.3% of men was accurately estimated and the %fat of 66.0% of women was accurately estimated to within 3.5%fat. The BIA had good agreement for prediction of %fat in Korean adults. However, the eight-electrode BIA had small, but systemic, errors of %fat in the predictive accuracy for individual estimation. The total errors led to an overestimation of %fat in lean men and an underestimation of %fat in obese women.     

Underweight patients with anorexia nervosa: comparison of bioelectrical impedance analysis using five equations to dual X-ray absorptiometry

Background & aims

Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM.This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients.

Methods

Fifty female patients with AN (BMI = 14.3 ± 1.49, age = 19.98 ± 5.68 yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland–Altman plots.

Results

The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM_dxa = 35.80 kg versus FFM_deurenberg = 36.36 kg) and very close estimates of FM (FM_dxa = 9.16 kg and FM_deurenberg = 9.57 kg) The Kushner equation showed slightly better estimates for FM (FM_kushner = 9.0 kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA.

Conclusion

The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8–21.0, and for ages between 13.4 and up to 36.9 years.     

急性白血病患儿治疗期人体组成成分的变化

目的 探讨不同治疗阶段的急性白血病患儿人体组成成分变化的特点,为其营养支持提供依据.方法 前瞻性观察2009年1月至2010年4月在上海儿童医学中心住院接受化疗的急性白血病患儿56例,同时选择同年龄同性别健康儿童56名作为正常对照组.使用节段多频生物电阻抗分析法对正常对照组儿童及在各个治疗期的第1个疗程结束时的白血病患儿进行人体组成成分测定.人体各组成成分的分布情况使用各成分占体重的百分比表示.结果 56例急性白血病患儿中,急性淋巴细胞性白血病41例,急性非淋巴细胞性白血病15例;处于诱导缓解期23例,巩固强化期15例,维持治疗期18例.56例白血病患儿与正常对照组儿童人体组成成分比较后发现,白血病患儿细胞内液(P=0.000)、细胞外液(P=0.005)、蛋白质(P=0.000)、无机盐(P=0.001)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童,而体脂肪含量高于对照组[(26.2±8.3)%比(20.3 ±3.8)%,P=0.000].诱导缓解期患儿的人体组成与正常对照组儿童相比,表现为体重下降(P=0.001),细胞内液(P=0.005)、蛋白质(P=0.004)、体细胞群(P=0.001)和活动细胞群(P=0.020)明显减少.进入巩固强化期的患儿,细胞内液(P=0.000)、细胞外液(P=0.000)、蛋白质(P=0.000)、无机盐(P=0.001)、体脂肪(P=0.000)、去脂体重(P=0.000)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童.而维持治疗期的患儿与正常对照组儿童相比,除体重指数(P=0.127)和细胞外液占体重的百分比(P=0.097)差异无统计学意义外,其余各项指标差异仍具有统计学意义(P均<0.05).结论 急性白血病患儿经化疗后人体组成成分发生明显改变.应尽早监测白血病患儿营养状况变化,及时予以营养支持,以改善患儿预后.

Abstract：

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

生物电阻抗技术在肝病病人人体成分测量中的应用

该文介绍了生物电阻抗技术在肝病中应用的现状,重点介绍了多频节段电阻抗技术的应用.多频节段电阻抗技术可以克服因水肿、腹水而造成的体重对人体组成结果的影响,还可能判定腹水量.相比单频电阻抗技术,其在肝病病人中可能存在较好的应用前景,有助于客观地评价肝病病人的营养状况及能量代谢,但仍需临床进一步研究.     

人体成分分析及其应用

传统上使用体重指数(BMI)判断体型和营养状况具有其局限性.利用生物电阻抗法(BIA)人体成分分析技术可获得脂肪率、去脂体重指数等数据.我们认为,合适的脂肪率是男性12％ ～22％、女性20％ ～ 30％,中等的去脂体重指数是男性17.0～21.0、女性14.5 ～18.0.人体成分分析较BMI能更好地用于体型判断、营养评估、某些疾病的预后判断和调整用药剂量等.     

Body composition following stem cell transplant: Comparison of bioimpedance and air-displacement plethysmography

ObjectiveThe aim of this study was to assess the agreement between detected changes in body composition determined by bioimpedance spectroscopy (BIS) and air-displacement plethysmography (ADP) among patients with cancer undergoing peripheral blood stem cell transplantation (PBSCT); and to assess the agreement of absolute values of BIS with ADP and dual energy x-ray (DXA).MethodsForty-four adult hematologic cancer patients undergoing PBSCT completed both BIS and ADP assessment at preadmission and at 3 mo after transplantation. A subsample (n = 11) was assessed by DXA at 3 mo after transplantation. Results were examined for the BIS instrument’s default setting and three alternative predictive equations from the literature. Agreement was assessed by the Bland-Altman limits of agreement analysis while correlation was examined using the Lin’s concordance correlation.ResultsChanges in body composition parameters assessed by BIS were comparable with those determined by ADP regardless of the predictive equations used. Bias of change in fat-free mass was clinically acceptable (all <1 kg), although limits of agreement were wide (more than ±6 kg). Overall, the BIS predictive equation accounting for body mass index performed the best. Absolute body composition parameters predicted by the alternative predictive equations agreed with DXA and ADP better than the BIS instrument’s default setting.ConclusionChanges predicted by BIS were similar to those determined by ADP on a group level; however, agreement of predicted changes at an individual level should be interpreted with caution due to wide limits of agreement.     

生物电阻抗法与双标水稀释法在人体成分测定中的应用比较

目的 用双标水稀释法验证目前在我国广泛应用的体成分测定方法--生物电阻抗法的准确性.方法 从白求恩军医学院某中队150名学员中根据体质指数(BMI)等指标筛选出16名学员作为受试对象,试验期为14 d,试验期间学员集中管理,统一食宿.试验第1天受试者服用双标水,收集服用前及服用后2 h、4 h、6 h、8 h及第2至第14天的尿液,用质谱分析的方法,得到受试者2H、18O的消除曲线,从而获得受试者的体成分数据.与此同时,从试验第1天开始,每天晚餐后3 h用生物电阻抗仪对每位受试者进行体成分的测定.最后,将2种方法获得的体成分数据加以比对.结果 经统计学分析,生物电阻抗法与双标水稀释法获得的体成分参数值差异无统计学意义,而且高度相关,两种方法测得的总体水、瘦体重、体脂及体脂百分比的相关系数分别为0.556,0.556,0.817,0.606,具有统计学意义.结论 应用生物电阻抗法测定中国人体成分具有较高的准确性.     

Effect of fluid and food intake on the body composition evaluation of elderly persons

Background  Several studies have shown that liquid and food intake interfere with the evaluation of body composition in adults. However, since there are no reports about this interference in the elderly population, the need to fast for this evaluation may be dispensable. Objectives  The objective of the present study was to assess the influence of liquid and solid food on the measurement of body composition by bioelectrical impedance analysis (BIA) and by dual energy X-ray absorptiometry (DXA). Design  Forty-one male volunteers aged 62 to 87 years participated in the study. The subjects were submitted to evaluation of body composition by DXA and BIA under fasting conditions and 1 hour after the ingestion of breakfast (500 ml of orange juice and one 50 g bread roll with butter). Results  There was no significant difference in the variables fat-free mass (FFM) or fat mass (FM) between the fasting condition and the evaluation performed 1 hour after the meal as measured by BIA or DXA. There was also no significant difference when the same variables were compared between methods. Conclusion  In the present study, the ingestion of 500 ml orange juice and of one bread roll with butter by elderly subjects did not affect the results of the parameters of body composition determined by BIA or DXA. Thus, these exams could be performed without the rigor of fasting, often poorly tolerated by the elderly.