BIA on Patients in Various Disease States

Am J Clin Nutr. 2006 Jan;83(1):65-9.

Estimating body composition in children with Duchenne muscular dystrophy: comparison of bioelectrical impedance analysis and skinfold-thickness measurement.

Mok E, Béghin L, Gachon P, Daubrosse C, Fontan JE, Cuisset JM, Gottrand F, Hankard R.

INSERM Centre D’Investigation Clinique 9202, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.

BACKGROUND: Duchenne muscular dystrophy (DMD) is often associated with obesity, which worsens the handicap early in the course of the disease. Nutritional assessment, however, can be difficult and often misleading in DMD. OBJECTIVE: Two methods of estimating body composition in DMD, skinfold-thickness (ST) measurement and bioelectrical impedance analysis (BIA), were compared with a reference method, labeled water dilution (WD). DESIGN: Body composition was estimated by using ST measurements and BIA (50 kHz, 800 mAmp), as well as the WD method (1 mL H2(18)O/kg) in 11 DMD patients with a mean (+/-SD) age of 10.0 +/- 2.5 y. RESULTS: When compared with the WD method, ST measurement significantly (P < 0.01) overestimated fat-free mass (FFM) (mean +/- SD ST: 24.5 +/- 5.9 kg; mean +/- SD WD: 18.2 +/- 2.5 kg), which led to an underestimation of the percentage of fat mass (%FM) (ST: 23.3 +/- 10.4%; WD: 40.1 +/- 17.1%; P < 0.05). In contrast, estimates obtained with BIA (FFM: 21.5 +/- 4.5 kg; %FM: 31.3 +/- 13.9%) did not differ from those obtained with WD. The difference from the reference method was less for BIA (mean: 3.3 kg; 95% CI: 0.8, 4.9 kg) than for ST (6.3 kg; 2.2, 8.6 kg). WD and BIA defined 73% and 55%, respectively, of the children as obese (%FM associated with body mass index cutoffs for obesity), whereas ST measurements defined 9% as obese (P < 0.01). CONCLUSIONS: Body-composition estimates by BIA are closer to those by WD than are those by ST measurement. Early detection of fat accumulation and longitudinal monitoring of nutritional care are 2 relevant applications of BIA to prevent obesity and hence lessen the burden of DMD.

Am J Clin Nutr. 2000 Oct;72(4):1053-8.

Comparison of total body potassium with other techniques for measuring lean body mass in men and women with AIDS wasting.

Corcoran C, Anderson EJ, Burrows B, Stanley T, Walsh M, Poulos AM, Grinspoon S.

Neuroendocrine Unit and the General Clinical Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

BACKGROUND: Lean body mass is an important predictor of survival and functional status in patients with AIDS wasting. The bias between different techniques for assessing body composition in AIDS wasting is not known. DESIGN: We compared total body potassium (TBK) with fat-free mass (FFM) determined by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold-thickness measurement (SKF) in 132 patients (63 men, 69 women) with AIDS wasting (weight < 90% of ideal body weight, or weight loss > 10% of original, or both). None of the subjects exhibited clinical lipodystrophy. Comparisons were made by using different BIA equations. RESULTS: Lean body mass determined by DXA was highly correlated with TBK in men (r = 0.79, P: < 0.0001) and women (r = 0.84, P: < 0.0001). FFM(BIA) and FFM(DXA) were significantly different (P: < 0.01 in men and P: < 0.0001 in women). The difference between FFM(DXA) and FFM(BIA) was significantly greater with greater weight and body fat, particularly in HIV-infected women (r = -0.39, P: = 0.001 for weight; r = -0.60, P: < 0.0001 for fat). The comparability of FFM and fat mass determined by DXA and BIA was dependent on the specific BIA equation used. Among men, no single BIA equation was more highly predictive of fat mass and FFM in comparison with DXA. CONCLUSIONS: The differences between DXA, BIA, and SKF in the determination of fat mass and FFM are significant in patients with AIDS wasting. BIA overestimates FFM compared with DXA in those with greater body fat. Standard BIA equations may not accurately estimate FFM and fat mass in men and women with AIDS wasting.

Am J Physiol Endocrinol Metab. 2003 Jun;284(6):E1080-8. Epub 2003 Feb 25.

Body composition assessment in extreme obesity and after massive weight loss induced by gastric bypass surgery.

Das SK, Roberts SB, Kehayias JJ, Wang J, Hsu LK, Shikora SA, Saltzman E, McCrory MA.

Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston 02111, USA.

Body composition methods were examined in 20 women [body mass index (BMI) 48.7 +/- 8.8 kg/m(2)] before and after weight loss [-44.8 +/- 14.6 (SD) kg] after gastric bypass (GBP) surgery. The reference method, a three-compartment (3C) model using body density by air displacement plethysmography and total body water (TBW) by H(2)18O dilution (3C-H(2)18O), showed a decrease in percent body fat (%BF) from 51.4 to 34.6%. Fat-free mass hydration was significantly higher than the reference value (0.738) in extreme obesity (0.756; P < 0.001) but not after weight reduction (0.747; P = 0.16). %BF by H(2)18O dilution and air displacement plethysmography differed significantly from %BF by 3C-H(2)18O in extreme obesity (P < 0.05) and 3C models using (2)H(2)O or bioelectrical impedance analysis (BIA) to determine TBW improved mean %BF estimates over most other methods at both time points. BIA results varied with the equation used, but BIA better predicted %BF than did BMI at both time points. All methods except BIA using the Segal equation were comparable to the reference method for determining changes over time. A simple 3C model utilizing air displacement plethysmography and BIA is useful for clinical evaluation in this population.

Am J Clin Nutr. 2003 May;77(5):1179-85.

Validation of bioelectrical impedance analysis in patients with amyotrophic lateral sclerosis.

Desport JC, Preux PM, Bouteloup-Demange C, Clavelou P, Beaufrère B, Bonnet C, Couratier PP.

Nutrition Unit & Hepato-Gastroenterology Service, Dupuytren University Hospital, Limoges, France.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurologic disease with an unfavorable prognosis that may be accompanied by malnutrition or overweight. Nutritional status is difficult to evaluate in these patients because of their physical limitations and the asymmetry of their disease involvement. Bioelectrical impedance analysis (BIA), which enables bedside analysis of body compartments, has not been adequately validated for use in patients with ALS. OBJECTIVE: We compared reference measures of fat-free mass (FFM(a)), obtained by dual-energy X-ray absorptiometry, with FFM obtained by BIA and by the skinfold-thickness technique. DESIGN: We measured FFM(a) in 32 ALS patients. Anthropometric measures included weight, height, skinfold thickness, and arm and wrist circumferences. The fat mass obtained from the skinfold-thickness measures enabled us to calculate FFM. BIA was performed by measuring the bioimpedances at 5, 50, and 100 kHz of each side of the body and from one side to the other. FFM was calculated by using the instrument’s internal software and by using 3 standard equations. The concordance between the methods was evaluated by the Bland-Altman test. RESULTS: Two of the 16 measured FFM values were not significantly different from FFM(a). However, the risk of dispersion was too high to be acceptable in practice. An equation was then developed by using multivariate analysis, with impedance at 50 kHz. This equation was validated in a second population of 15 ALS patients and with the use of 2 successive measurements performed on 18 patients. CONCLUSION: BIA is a simple technique that is valid for use in ALS patients, both for a single exam measure and for longitudinal monitoring, with the use of an adapted equation and a frequency of 50 kHz.

J Am Soc Nephrol. 2006 Jan;17(1):285-93. Epub 2005 Nov 30.

Anthropometric prediction of total body water in children who are on pediatric peritoneal dialysis.

Morgenstern BZ, Wühl E, Nair KS, Warady BA, Schaefer F.

Division of Pediatric Nephrology, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.

Accurate estimation of total body water (TBW) is a critical component of dialysis prescription in peritoneal dialysis (PD). Gold-standard isotope dilution techniques are laborious and costly; therefore, anthropometric prediction equations that are based on height and weight are commonly used to estimate TBW. Equations have been established in healthy populations, but their validity is unclear in children who undergo PD, in whom altered states of hydration and other confounding alterations in normal physiology, particularly retarded growth and pubertal delay, may exist. TBW was measured by heavy water (H2O18 or D2O) dilution in 64 pediatric patients who were aged 1 mo to 23 yr and receiving chronic PD in the United States and Germany to establish and validate population-specific anthropometric TBW prediction equations and to compare the predictive power of these equations with formulas that have been established in healthy children. The best-fitting equations are as follows: For boys, TBW = 0.10 x (HtWt)0.68 – 0.37 x weight; for girls, TBW = 0.14 x (HtWt)0.64 – 0.35 x weight. The height x weight parameter also predicts body surface area (BSA). These equations can be simplified, with slightly less precision, to the following: For boys, TBW = 20.88 x BSA – 4.29; for girls, TBW = 16.92 x BSA – 1.81. TBW is predicted without systematic deviations and equally well in boys and girls, North American and European, obese and nonobese, growth-retarded and normally sized, and pre- and postpubertal children. In contrast, previous anthropometric equations that were derived from healthy children systematically overpredicted TBW and were less precise in this pediatric PD population. In summary, a new set of anthropometric TBW prediction equations that are suited specifically for use in pediatric PD patients have been provided.

Am J Physiol Endocrinol Metab. 2004 Jul;287(1):E142-9. Epub 2004 Feb 17.

Total branched-chain amino acids requirement in patients with maple syrup urine disease by use of indicator amino acid oxidation with L-[1-13C]phenylalanine.

Riazi R, Rafii M, Clarke JT, Wykes LJ, Ball RO, Pencharz PB.

Division of Gasteroentrology/Nutrition, The Hospital for Sick Children, 555 Univ. Ave., Toronto, Ontario M5G 1X8, Canada.

Maple syrup urine disease (MSUD) is an autosomal recessive disorder caused by defects in the mitochondrial multienzyme complex branched-chain alpha-keto acid dehydrogenase (BCKD; EC, responsible for the oxidative decarboxylation of the branched-chain ketoacids (BCKA) derived from the branched-chain amino acids (BCAA) leucine, valine, and isoleucine. Deficiency of the enzyme results in increased concentrations of the BCAA and BCKA in body cells and fluids. The treatment of the disease is aimed at keeping the concentration of BCAA below the toxic concentrations, primarily by dietary restriction of BCAA intake. The objective of this study was to determine the total BCAA requirements of patients with classical MSUD caused by marked deficiency of BCKD by use of the indicator amino acid oxidation (IAAO) technique. Five MSUD patients from the MSUD clinic of The Hospital for Sick Children participated in the study. Each was randomly assigned to different intakes of BCAA mixture (0, 20, 30, 50, 60, 70, 90, 110, and 130, in which the relative proportion of BCAA was the same as that in egg protein. Total BCAA requirement was determined by measuring the oxidation of l-[1-(13)C]phenylalanine to (13)CO(2). The mean total BCAA requirement was estimated using a two-phase linear regression crossover analysis, which showed that the mean total BCAA requirement was 45, with the safe level of intake (upper 95% confidence interval) at 62 This is the first time BCAA requirements in patients with MSUD have been determined directly.

Clin Nutr. 2003 Apr;22(2):167-74.

Erratum in:

Clin Nutr. 2004 Apr;23(2):285-6.

Improved assessment of body cell mass by segmental bioimpedance analysis in malnourished subjects and acromegaly.

Pirlich M, Schütz T, Ockenga J, Biering H, Gerl H, Schmidt B, Ertl S, Plauth M, Lochs H.

Medizinische Klinik und Poliklinik, Abteilung Gastroenterologie, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, Germany.

BACKGROUND: Estimation of body cell mass (BCM) has been regarded valuable for the assessment of malnutrition. AIM: To investigate the value of segmental bioelectrical impedance analysis (BIA) for BCM estimation in malnourished subjects and acromegaly. METHODS: Nineteen controls and 63 patients with either reduced (liver cirrhosis without and with ascites, Cushing’s disease) or increased BCM (acromegaly) were included. Whole-body and segmental BIA (separately measuring arm, trunk, leg) at 50 kHz was compared with BCM measured by total-body potassium. Multiple regression analysis was used to develop specific equations for BCM in each subgroup. RESULTS: Compared to whole-body BIA equations, the inclusion of arm resistance improved the specific equation in cirrhotic patients without ascites and in Cushing’s disease resulting in excellent prediction of BCM (R(2) = 0.93 and 0.92, respectively; both P<0.001). In acromegaly, inclusion of resistance and reactance of the trunk best described BCM (R(2) = 0.94, P<0.001). In controls and in cirrhotic patients with ascites, segmental impedance parameters did not improve BCM prediction (best values obtained by whole-body measurements: R(2)=0.88 and 0.60; P<0.001 and <0.003, respectively). CONCLUSION: Segmental BIA improves the assessment of BCM in malnourished patients and acromegaly, but not in patients with severe fluid overload. Copyright 2003 Elsevier Science Ltd.

Acta Diabetol. 2003 Oct;40 Suppl 1:S151-3.

Body composition assessment: an indispensable tool for disease management.

Battezzati A, Bertoli S, Testolin C, Testolin G.

International Center for the Assessment of Nutritional Status, University of Milan, Via Colombo 60, I-20133, Milan, Italy.

Recent conceptual and technology advancements fostered a rapid development in the field of body composition assessment and provided new and powerful investigative tools. Densitometry, isotopic dilution, bioelectrical impedance, whole-body counting, neutron activation, X-ray absorptiometry, computed tomography, magnetic resonance imaging, and spectroscopy have been the most widely employed methods. The result of this effort is the discovery that body composition at both molecular and cellular or tissue levels is affected by virtually all the pathologic conditions found in medical textbooks. The field is now mature for the clinical translation of this research. Some applications rely on a very solid base and their clinical use has been fully codified. Others still need reference values diversified on a regional and ethnic scale, consensus for interpretation of values, and guidelines for clinical indications. Only after these requirements are satisfied will it be possible to adopt specific practical guidelines, the most reasonable basis for acceptance and accreditation by care providers. Some applications are already being used in several settings. Therefore, establishing the guidelines for clinical application of body composition assessment methods is not only important for physicians and their patients, but is also urgent so as to prevent misuse and to ensure correct communication with the media in this field.

J Am Acad Nurse Pract. 2007 May;19(5):235-41.

Comment in:

J Am Acad Nurse Pract. 2007 Oct;19(10):499; discussion 499.

Use of bioelectrical impedance analysis in the evaluation, treatment, and prevention of overweight and obesity.

Ricciardi R, Talbot LA.

Walter Reed Army Medical Center, Washington, DC 20012, USA.

PURPOSE: To present an overview of bioelectrical impedance analysis (BIA) and to familiarize nurse practitioners (NPs) with the potential benefits of using BIA in prevention, monitoring, and long-term follow-up of healthy individuals and those with chronic conditions (e.g., obesity). DATA SOURCES: Original research articles and comprehensive review articles identified through Medline, CINAHL, OVID, and electrical engineering databases. CONCLUSIONS: Obtaining serial measurements of percent body fat using BIA can identify patients at greatest health risk and gives NPs an additional tool to assess treatment response in patients seeking to lose or maintain body weight and/or increase muscle mass. IMPLICATIONS FOR PRACTICE: Traditionally, height/weight tables and body mass index have been used to assess body composition and diagnose overweight and obesity. More recently, BIA has emerged as a portable and simple-to-operate instrument to evaluate body composition in the clinical setting.

J Am Soc Nephrol. 2006 May;17(5):1481-7. Epub 2006 Apr 12.

Early changes in bioelectrical estimates of body composition in chronic kidney disease.

Bellizzi V, Scalfi L, Terracciano V, De Nicola L, Minutolo R, Marra M, Guida B, Cianciaruso B, Conte G, Di Iorio BR.

Nephrology and Dialysis Unit, “A. Landolfi” Hospital, Via Melito, Solofra, 83029 Italy.

The aim of this study was to detect the potential occurrence of early abnormalities of body composition in patients with chronic kidney disease (CKD) at first referral to an outpatient nephrology clinic. Eighty-four patients with CKD (49 men and 35 women) were compared with 604 healthy control subjects (298 men and 306 women). Anthropometry and bioelectrical impedance analysis (BIA) were performed in all participants, whereas renal function, laboratory tests for nutritional status, and nutrient intake were assessed in the CKD group only. Creatinine clearance was 27.8 +/- 13.8 and 27.4 +/- 13.0 ml/min per 1.73 m(2) in male and female patients with CKD, respectively. No patient showed peripheral edema; frank malnutrition, defined by presence of serum albumin <3.5 g/dl plus body mass index <20 kg/m(2); or protein intake <0.6 g/kg per d. At the BIA, patients with CKD showed lower resistance (R) and abnormal mean impedance vectors for the bivariate normal distribution of R/height and reactance/height. Phase angle also was reduced (-22%), especially in patients with diabetes. When BIA-derived data were considered, total body water was slightly higher (+4.3% in men; +3.5% in women) and body cell mass was lower (-6.7% in men; -7.7% in women) in patients with CKD. No difference in either BIA parameters or nutritional indexes was observed among various CKD stages. Despite the absence of overt malnutrition, patients with CKD exhibit altered BIA variables from the early phases of renal disease. These alterations are related to the renal dysfunction, are more marked in the presence of diabetes, and mainly indicate the presence of overhydration in the absence of edema. Therefore, BIA represents an attractive clinical tool to detect impairment of body composition from the early stages of CKD.

Diabetes Care. 2003 Jan;26(1):172-8.

Rosiglitazone improves insulin sensitivity and lowers blood pressure in hypertensive patients.

Raji A, Seely EW, Bekins SA, Williams GH, Simonson DC.

Endocrine-Hypertension Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

OBJECTIVE: To examine the effect of rosiglitazone on insulin resistance and blood pressure in patients with essential hypertension, classified based on abnormalities of their renin-angiotensin system. RESEARCH DESIGN AND METHODS: A total of 24 hypertensive nondiabetic patients (age 58 +/- 6 years, BMI 30 +/- 5 kg/m2) were studied before and after rosiglitazone treatment. After 2 weeks off antihypertensive medication, subjects received a euglycemic-hyperinsulinemic clamp (40 mU. m(-2). min(-1)) with 6,6-[2H2]glucose infusion, ambulatory blood pressure monitoring, and blood tests for cardiovascular risk factors. Subjects were then placed on rosiglitazone (4 mg orally b.i.d.) and their usual antihypertensive medications (but not ACE inhibitors) for 16 weeks, and baseline tests were repeated. RESULTS: There was no change in fasting plasma glucose (83 +/- 2 vs. 82 +/- 2 mg/dl, P = 0.60), but fasting insulin decreased (16.1 +/- 1.4 vs. 12.5 +/- 0.9 micro U/ml, P < 0.01). Total glucose disposal during the clamp increased (5.0 +/- 0.4 vs. 5.9 +/- 0.5 mg. kg(-1). min(-1), P < 0.001), with no change in suppression of hepatic glucose output. There were significant decreases in mean 24-h systolic (138 +/- 2 vs. 134 +/- 2 mmHg, P < 0.02) and diastolic (85 +/- 2 vs. 80 +/- 2 mmHg, P < 0.0001) blood pressure, and the decline in systolic blood pressure was correlated with the improvement in insulin sensitivity (r = 0.59, P < 0.005). Triglycerides (135 +/- 16 vs. 89 +/- 8 mg/dl, P < 0.01), LDL cholesterol (129 +/- 6 vs. 122 +/- 8 mg/dl, P = 0.18), and HDL cholesterol (51 +/- 3 vs. 46 +/- 3 mg/dl, P < 0.02) all decreased, with no change in the LDL-to-HDL ratio. Plasminogen activator inhibitor-1 and C-reactive protein also declined significantly. CONCLUSIONS: Rosiglitazone treatment of nondiabetic hypertensive patients improves insulin sensitivity, reduces systolic and diastolic blood pressure, and induces favorable changes in markers of cardiovascular risk. Insulin sensitizers may provide cardiovascular benefits when used in the treatment of patients with hypertension.

Am J Clin Nutr. 1995 Apr;61(4):741-5.

The use of bioelectrical impedance analysis to predict total body water in patients with cancer cachexia.

Simons JP, Schols AM, Westerterp KR, ten Velde GP, Wouters EF.

Department of Pulmonology, University of Limburg, Maastricht, Netherlands.

The applicability of bioelectrical impedance analysis (BIA) to predict total body water (TBW) was assessed in 16 underweight [< 95% of ideal body weight (IBW)] and 25 normal-weight (> 95% of IBW) cancer patients. Although height2/resistance (ht2/R) proved to be a strong single predictor of TBW measured by deuterium dilution in both groups (normal-weight patients: r2 = 0.85, SEE 2.16 L; underweight patients: r2 = 0.86, SEE 2.24 L), TBW would be significantly overestimated in the underweight group if the prediction formula developed in the normal-weight group was used [bias 1.67 L (5%), 95% CI 0.20-3.15 L]. A systematic overestimation of TBW in the underweight patients was also found when TBW was predicted in our two patient groups by several previously published BIA formulas developed in normal-weight individuals. We conclude therefore, that although a similar relationship is found between ht2/R and TBW in normal-weight and underweight cancer patients, single-frequency BIA overestimates TBW in underweight patients when prediction formulas are used that have been developed in normal-weight subjects.

Arq Bras Endocrinol Metabol. 2004 Dec;48(6):885-9. Epub 2005 Mar 8.

[Body adiposity and its influence on clinical and metabolic parameters of patients with type 1 diabetes] [Article in Portuguese]

Andrade CR Jr, Clemente EL, Gomes MB.

Serviço de Diabetes e Metabologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, RJ.

We evaluated the influence of body adiposity (BA), which was measured by bioelectrical impedance, body mass index (BMI) and waist circumference (WC), in clinical and laboratorial parameters of 64 patients with type 1 diabetes (DM1), 33 females, matched for diabetes duration. Women had greater BA than men. Fourteen patients were overweight. In the whole group, we found correlations between BA and BMI (r= 0.50; p= 0.001), BA and WC (r= 0.30; p= 0.001) and BA and fasting glucose (r= 0.24; p= 0.048). There were 11 patients with abnormal BA; among them, there were 6 with overweight and abnormal WC. In those patients with abnormal BA, we found higher HbA1c, respectively [(9.8 +/- 2.4) vs. (8.1 +/- 1.5%); p= 0.03], WC [(82.9 +/- 11.4) vs. (72.9 +/- 8.3 cm); p = 0.01] and BMI [(26.1 +/- 2.7) vs. (22.1 +/- 2.5 Kg/m2); p= 0.0001]. We conclude that some DM1 patients can have some characteristics of the metabolic syndrome and the influence of these findings on clinical and laboratory control and on the cardiovascular risk must be analysed in prospectives studies.

Cancer Epidemiol Biomarkers Prev. 2004 Apr;13(4):553-9.

Body size and composition and colon cancer risk in men.

MacInnis RJ, English DR, Hopper JL, Haydon AM, Gertig DM, Giles GG.

Cancer Epidemiology Centre, The Cancer Council Victoria, 1 Rathdowne Street, Carlton South, Melbourne, Victoria 3053, Australia.

BACKGROUND: Several studies of male colon cancer have found positive associations with body size and composition. It is uncertain whether this relationship is due to non-adipose mass, adipose mass, distribution of adipose mass such as central adiposity, or all three. METHODS: In a prospective cohort study of men aged 27-75 at recruitment in 1990-1994, body measurements were taken by interviewers. Fat mass and fat-free mass (FFM) were estimated from bioelectrical impedance analysis. Waist circumference and waist-to-hips ratio (WHR) estimated central adiposity. Incident colon cancers were ascertained via the population cancer registry. Altogether, 16,556 men contributed 145,433 person-years and 153 colon cancers. RESULTS: Rate ratios (RRs) comparing men in the fourth quartile with those in the first quartile were as follows: FFM 2.3 [95% confidence interval (CI) 1.4-3.7]; height 1.9 (95% CI 1.1-3.1); waist circumference 2.1 (95% CI 1.3-3.5); WHR 2.1 (95% CI 1.3-3.4); fat mass 1.8 (95% CI 1.1-3.0); and body mass index 1.7 (95% CI 1.1-2.8). When continuous measures of FFM and WHR were modeled together, the RR for FFM per 10 kg was 1.37 (95% CI 1.04-1.80) and the RR for WHR per 0.1 unit was 1.65 (95% CI 1.28-2.13). After adjustment for FFM and WHR, the RRs for fat mass and body mass index were no longer statistically significant. CONCLUSION: Male colon cancer appears to be related to body size and composition by two different pathways, via central adiposity and via non-adipose mass.

J Clin Endocrinol Metab. 2006 Apr;91(4):1233-8. Epub 2006 Jan 24.

Cardiovascular risk factors in healthy women with previous gestational hypertension.

Paradisi G, Biaggi A, Savone R, Ianniello F, Tomei C, Caforio L, Caruso A.

Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Via Servilio IV 4, 00178 Rome, Italy.

CONTEXT: Epidemiological studies indicate that gestational hypertension (Gh) during pregnancy is associated with increased risk of cardiovascular disease in later life. However, it is unclear whether particular metabolic and hemodynamic characteristics are related to this risk. OBJECTIVE: The objective of this study was to investigate endothelial function and carbohydrate and lipid metabolism in healthy, normotensive women with previous pregnancy complicated by Gh. DESIGN, SETTING, AND PARTICIPANTS: Brachial artery flow-mediated dilatation (FMD; endothelium dependent) and nitroglycerin-induced dilatation (endothelium independent) were measured in 15 subjects with previous Gh and in 15 controls with previous normal pregnancies. Lipid panel, glucose, insulin, homocysteine, and androgens were also measured. RESULTS: FMD was significantly reduced in women with previous Gh compared with controls (P < 0.0001), whereas nitroglycerin-induced dilatation was comparable in both groups. Gh women showed increased fasting insulin (P = 0.011), insulin resistance measured by homeostasis model assessment (P = 0.018), free fatty acids (P = 0.0018), and testosterone (P = 0.0012) and decreased high-density lipoprotein cholesterol (P = 0.0017) compared with controls. Across all subjects, FMD showed a strong independent negative correlation with testosterone and homeostasis model assessment and a positive correlation with high-density lipoprotein cholesterol (r = -0.60, P = 0.0003; r = -0.43, P = 0.016; and r = 0.58, P = 0.0005, respectively). CONCLUSIONS: Endothelial dysfunction and early alteration of carbohydrate and lipid metabolism are present in otherwise healthy women with previous Gh. These abnormalities along with a relative hyperandrogenism could explain, at least in part, the increased risk for cardiovascular disease in later life in these women.

Am J Clin Nutr. 2003 Apr;77(4):868-74.

Response of whole-body protein and urea turnover to exercise differs between patients with chronic obstructive pulmonary disease with and without emphysema.

Engelen MP, Deutz NE, Mostert R, Wouters EF, Schols AM.

Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands.

BACKGROUND: Exercise is known to improve physical capacity and muscle mass in patients with chronic obstructive pulmonary disease (COPD). However, recent evidence suggests that exercise may also negatively influence metabolism in COPD. OBJECTIVE: The objective was to investigate whether exercise influences whole-body protein metabolism differently in COPD patients and control subjects and to elucidate the effect of the specific underlying lung disease. DESIGN: Whole-body protein synthesis and breakdown and urea synthesis were measured by using stable-isotope methods in 14 male patients with severe COPD (forced expiratory volume in 1 s: 37 +/- 12% of predicted) and in 8 male control subjects during and after 20 min of exercise. Subjects were normal weight [body mass index (in kg/m2) of COPD patients and control subjects: 25.8 +/- 3.9 and 25.7 +/- 4.4, respectively]. The COPD group was selected to include patients with (Emph+, n = 7) and without (Emph-, n = 7) emphysema. Absolute workload was 35 +/- 5 W, corresponding to 17 +/- 2%, 33 +/- 9%, and 52 +/- 14% of the maximal obtained workload in the control, Emph-, and Emph+ groups. RESULTS: Exercise induced a 9% increase in protein synthesis and breakdown in the Emph- and control groups, which normalized postexercise. In the Emph+ group, protein turnover did not change significantly during exercise but decreased postexercise (+/- 10%). Exercise did not change net protein breakdown (protein breakdown – synthesis) or urea synthesis, except in the Emph+ group, which showed a 14% reduction in urea synthesis postexercise (P < 0.05). CONCLUSION: Low-intensity exercise suppresses whole-body protein and urea turnover in COPD patients with emphysema and needs to be considered when maximal anabolism is targeted through a combination of exercise and nutrition.

Intensive Care Med. 1995 Feb;21(2):125-31.

Predictive value of tetrapolar body impedance measurements for hydration status in critically ill patients.

Roos AN, Westendorp RG, Brand R, Souverijn JH, Frölich M, Meinders AE.

Department of General Internal Medicine, University Hospital Leiden, The Netherlands.

OBJECTIVE: To design and evaluate a simple and rapid method to predict body hydration status in critically ill patients. DESIGN: Prospective, consecutive sample. SETTING: Medical intensive care unit of a university hospital. PATIENTS: 31 consecutive patients. METHODS: All patients were classified daily for hydration status by the attending physician based on clinical impression, weight changes and laboratory measurements. The hydration status was scored as ‘dehydrated’, ‘euvolemic’ or ‘edematous’. The total body impedance was measured daily by a tetrapolar impedance technique. RESULTS: Resistances > 700 omega were found in dehydrated subjects and resistances of < 400 omega in edematous patients. Weight gain was observed in dehydrated and weight loss in edematous patients. A discriminant analysis was used to create a predictive model for hydration using the daily impedance and weight measurements. If a cutoff point of 60% for the predicted classification was used to categorize the patient’s hydration as dehydrated, euvolemic and edematous, no false positive predictions were observed for the dehydrated or the edematous state. CONCLUSION: Impedance measurements are in close agreement with the clinical impression of hydration of critically ill patients. Future investigations must elucidate the clinical importance.

Hypertension. 2004 Mar;43(3):555-60. Epub 2004 Feb 2.

Comment in:

Hypertension. 2004 Sep;44(3):e6; author reply e6.

Association between blood pressure and resting energy expenditure independent of body size.

Luke A, Adeyemo A, Kramer H, Forrester T, Cooper RS.

Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, IL 60153, USA.

Obesity is an important risk factor for hypertension; however, the pathway through which it raises blood pressure (BP) is poorly understood. Body size is also the primary determinant of energy expenditure, and we therefore examined the joint relationship of energy expenditure and body size to blood pressure. Resting energy expenditure (REE) was measured using respiratory gas exchange in population-based samples of 997 Nigerians and 452 African Americans. In a third sample of 118 individuals, nonresting energy expenditure (ie, physical activity) was measured in addition to REE. The univariate correlation between REE and BP ranged from 0.10 to 0.22 in the 3 samples (P<0.001). In multivariate models, adiposity, whether defined by body mass, fat mass, or leptin, was no longer associated with BP, while REE remained highly significant (P<0.001). The REE-BP association also persisted after adjustment for physical activity measured with doubly labeled water. The odds ratio for hypertension among persons in the highest quartile versus the lowest quartile of REE, after adjustment for body size, was 1.7. This relationship was not the result of hypertension among the obese, because it did not vary across the range of BMI and was the same in lean Nigerians as in obese Americans. These data suggest that metabolic processes represented by REE may mediate the effect of body size on BP. The interrelationship of REE with sympathetic tone, transmembrane ion exchange, or other metabolic processes that determine energy costs at rest could provide physiological explanations for this observation.

Am J Physiol. 1999 Mar;276(3 Pt 1):E519-28.

Sympathetic nervous system activity and alpha-adrenergic responsiveness in older hypertensive humans.

Supiano MA, Hogikyan RV, Sidani MA, Galecki AT, Krueger JL.

Division of Geriatric Medicine, Department of Internal Medicine, and Institute of Gerontology, University of Michigan, Department of Veterans Affairs Medical Center, Ann Arbor, Michigan 48105, USA.

We have previously demonstrated in normotensive humans an age-associated increase in sympathetic nervous system (SNS) activity combined with appropriate downregulation of alpha-adrenergic responsiveness. Impaired downregulation of alpha-adrenergic responsiveness, despite a comparable level of SNS activity, could contribute to higher blood pressure in older hypertensive humans. We measured arterial plasma norepinephrine (NE) levels and the extravascular NE release rate (NE2) derived from [3H]NE kinetics (to assess systemic SNS activity), and platelet and forearm arterial adrenergic responsiveness in 20 normotensive (N) and in 24 hypertensive (H), otherwise healthy, older subjects (60-75 yr). Although plasma NE levels were similar (N 357 +/- 27 vs. H 322 +/- 22 pg/ml; P = 0.37), NE2 tended to be greater in the hypertensive group (H 2.23 +/- 0.21 vs. N 1.64 +/- 0.20 microgram. min-1. m-2; P = 0. 11), and the NE metabolic clearance rate was greater (H 1,100 +/- 30 vs. N 900 +/- 50 ml/m2; P = 0.004). In the hypertensive group, there was a greater alpha-agonist-mediated inhibition of platelet membrane adenylyl cyclase activity and a NE- but not ANG II-mediated decrease in forearm blood flow. Compared with normotensive subjects, in older hypertensive subjects 1) NE metabolic clearance rate is increased, 2) systemic SNS activity tends to be increased, and 3) arterial and platelet alpha-adrenergic responsiveness is enhanced. These results suggest that heightened SNS activity coupled with enhanced alpha-adrenergic responsiveness may contribute to elevated blood pressure in older hypertensive humans.

Am J Clin Nutr. 2004 Dec;80(6):1634-8.

Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer.

Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, Hoffman S, Lis CG.

Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, IL 60099, USA.

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.

Obes Res. 2005 Apr;13(4):717-28.

Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance.

Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW.

Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden.

OBJECTIVE: To evaluate the interplay among abdominal adipose tissue distribution, the cortisol axis, the autonomic nervous system, and insulin resistance. RESEARCH METHODS AND PROCEDURES: Two age-, sex-, and BMI-matched groups were studied. Fifteen subjects were first-degree relatives of patients with type 2 diabetes (R), and 15 had no family history of diabetes (controls, C). A hyperinsulinemic euglycemic clamp, cortisol measurements, and analysis of heart rate variability (HRV) were performed. Computed tomography was performed in a subgroup (n = 9 + 9) to determine abdominal adipose tissue distribution. RESULTS: R tended to be less insulin-sensitive than C (M value 9.2 +/- 1.0 vs 10.3 +/- 0.7 mg/kg per minute, not significant). Stimulation with tetracosactin or corticotropin releasing hormone yielded lower peak serum cortisol levels in R (p = 0.03 and p = 0.06, respectively). The amount of visceral abdominal fat (VAT) tended to be greater in R. In all subjects, VAT was negatively correlated to insulin sensitivity (r = -0.93, p < 0.001). There was a positive association between VAT and resting heart rate (r = 0.70, p = 0.003) and sympathetic/parasympathetic ratio in HRV assessment after tilt (r = 0.53, p = 0.03). Subcutaneous abdominal tissue was not associated with insulin sensitivity or any of the hormonal or HRV assessments. DISCUSSION: Subjects genetically predisposed for type 2 diabetes had a tendency toward a larger amount of VAT and to lower insulin sensitivity compared with control subjects. The amount of visceral fat was strongly associated with insulin resistance and signs of a high ratio of sympathetic vs. parasympathetic reactivity. A large amount of visceral fat may act in concert with sympathetic/parasympathetic imbalance to promote the development of insulin resistance, and this may be partly independent of genetic background.

Bull World Health Organ. 2001;79(6):541-5.

Coeliac disease: a potentially treatable health problem of Saharawi refugee children.

Rätsch IM, Catassi C.

Department of Paediatrics, University of Ancona, Via F. Corridoni 11, 60123 Ancona, Italy.

OBJECTIVE: To characterize the clinical and nutritional impact of coeliac disease (gluten-sensitive enteropathy) among Saharawi children living as refugees in Algeria. METHODS: A total of 65 Saharawi children with coeliac disease were compared with 71 age-matched non-coeliac controls. For each participant, the clinical history was taken and a clinical examination, non-quantitative 24-hour dietary recall, anthropometric and skinfold measurements, bioelectric impedance analysis (BIA) of body composition, and venous blood sampling for haemoglobin determination were performed. RESULTS: Gluten-containing food, especially bread, was the staple diet of Saharawi children. Abdominal pain and distension were significantly commoner among children with coeliac disease than in controls (P < 0.05). The mean height-for-age was significantly lower in such children than in controls (-2.5 +/- 1.4 units vs -1.8 +/- 1.3 units, respectively, P < 0.01). No significant differences were found for either skinfold or BIA measurements. Haemoglobin values tended to be lower in children with coeliac disease than in controls. CONCLUSIONS: Coeliac disease has a negative effect on the health status of Saharawi refugee children. Because of the high prevalence of the condition in the Saharawi, a specific programme for treating all affected individuals should be established. Further studies are required to quantify the impact of coeliac disease in other areas of the developing world.

Am J Clin Nutr. 2005 Oct;82(4):850-6.

Sex differences in the associations of HIV disease characteristics and body composition in antiretroviral-naive persons.

Visnegarwala F, Raghavan SS, Mullin CM, Bartsch G, Wang J, Kotler D, Gibert CL, Shlay J, Grunfeld C, Carr A, El-Sadr W.

Baylor College of Medicine and Houston AIDS Research Team, Houston, TX, USA.

BACKGROUND: Data on associations of body composition with HIV disease characteristics are limited. OBJECTIVE: We compared sex-specific associations between HIV disease characteristics and body composition in an racially-ethnically diverse cohort of antiretroviral-naive patients. DESIGN: The study was a cross-sectional analysis of participants enrolled in a metabolic substudy of a multicenter trial. Regional fat was measured, and total body fat (TBF) was derived by using the Durnin-Womersley formula (DWF) and bioelectrical impedance analysis (BIA). Body cell mass (BCM) was measured by BIA. RESULTS: Among 422 participants, 22% were women, 60% were African American, and 36% had prior AIDS-defining illnesses. Mean (+/-SD) age was 38.2 +/- 9.6 y, CD4+ count was 215 +/- 184 cells/mm3, and HIV RNA log10 was 5.0 +/- 0.8 copies/mL. On multivariate analysis, women with AIDS-defining illness had significantly (P < 0.005) lower regional body fat and TBF (BIA: -9.5 kg; DWF: -7.3 kg) but nonsignificantly lower BCM (-1.3 kg) than did women without such illnesses, whereas men with AIDS-defining illness had significantly (P < 0.005) lower BCM (-1.7 kg) but nonsignificantly lower TBF (BIA: -1.3 kg; DWF: -1.83 kg) than did men without such illnesses (P < 0.05 for sex differences in TBF). Significant negative associations of HIV RNA with BCM (-0.9 kg/log RNA; P = 0.03), TBF by BIA (-1.4 kg/log RNA; P = 0.05) and by DWF (-1.6 kg/log RNA; P = 0.01), and regional fat were observed in men only. CONCLUSIONS: The effect of prior AIDS illness on body fat differed significantly between the sexes: women with prior AIDS-defining illness had significantly less fat than did women without such illnesses. An independent effect of HIV viremia on BCM and fat was seen in men. These distinctions may be due to inherent biological differences between the sexes.

Am J Trop Med Hyg. 2005 Oct;73(4):815-9.

Body composition in adults infected with human immunodeficiency virus in Khon Kaen, Thailand.

Ludy MJ, Hendricks K, Houser R, Chetchotisakd P, Mootsikapun P, Anunnatsiri S, Price E, Wanke CA.

Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.

A cross-sectional study of 77 patients infected with human immunodeficiency virus (HIV) in Khon Kaen, Thailand examined association of nutritional status with active opportunistic infections (AOIs)/HIV status and assessed degree of correlation between bioelectrical impedance analysis (BIA) and anthropometry. Many patients (41.3%) were malnourished using World Health Organization criteria for underweight, and malnutrition was associated with AOI status. Unconditional odds ratios (P < 0.05) for AOI as opposed to no AOI were 4.57 for underweight, 9.87 for severe underweight, 2.55 for triceps < 10th percentile, and 5.22 for mid-arm circumference < 10th percentile. Body fat composition from BIA, anthropometry, and body mass index were moderate to highly correlated (P < 0.001), with the highest correlation between BIA and subscapular skinfold (r = 0.86) and the lowest between BIA and triceps skinfold (r = 0.54). Insights were gained about relative value of using various measurements to assess nutritional status of HIV-infected populations.

Am J Clin Nutr. 1999 Mar;69(3):432-9.

Relative influences of sex, race, environment, and HIV infection on body composition in adults.

Kotler DP, Thea DM, Heo M, Allison DB, Engelson ES, Wang J, Pierson RN Jr, St Louis M, Keusch GT.

Department of Medicine, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.

BACKGROUND: The factors that control body composition in disease are uncertain. OBJECTIVE: We planned to compare the relative influences of HIV infection, sex, race, and environment on body composition. METHODS: We analyzed results of body composition studies performed by bioelectrical impedance analysis in 1415 adults from 2 cohorts: white and African American men and women from the United States, and African men and women (279 HIV-infected and 1136 control). The effects of sex and HIV infection on weight, body cell mass, and fat-free mass were analyzed by using both unadjusted and age-, weight-, and height-adjusted data. RESULTS: Control men weighed more and had more body cell mass and fat-free mass than did control women, although control women had more fat. The strongest correlates with body composition were height and weight, followed by sex. HIV infection, age, environment, and race. Control men and women weighed more and had more body cell mass, fat-free mass, and fat than did HIV-infected men. However, differences in body composition between HIV-infected and control groups were strongly influenced by sex. Of the differences in weight between HIV-infected and uninfected subjects, fat-free mass accounted for 51% in men but only 18% in women, in whom the remainder was fat. Sex effects were similar in African and American groups. CONCLUSIONS: Sex has a marked effect on the changes in body composition during HIV infection, with women losing disproportionately more fat than men. Sex-related differences in body composition were narrower in the HIV-infected groups. Race and environment had smaller effects than sex and HIV infection.

These papers and abstracts of papers have been published in peer-reviewed journals. They may draw conclusions and discuss applications of Bioelectrical Impedance Analysis which have not been reviewed by the FDA. Statements made within them are the sole responsibility of the authors. Unless otherwise indicated, no material support was provided to the authors or study investigators by RJL Systems.