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There is still some uncertainty towards the best method to diagnose the sarcopenic obesity, and specifically, altered body composition. A recent international consensus proposes the association of increased fat mass (FM) with reduced skeletal muscle mass adjusted by weight (SMM/W) (method 1). The ratio of fat mass index (FMI)/fat free mass index (FFMI) (method 2) has also been proposed. Aims: to determine and compare the prevalence of altered body composition by the two methods, and its associated factors, in obese patients referred to a specialized center. Anthropometry, single-frequency bioimpedance analysis (BIA), and risk factors for sarcopenia were collected. SMM, according to the Janssen equation, and the FMI/FFMI ratio, were calculated. The agreement between the two methods was determined by the kappa coefficient. Multivariable analysis identified the factors associated with altered body composition according to the two methods. 253 consecutive patients were retrospectively included: 81 % women, age 44.4 ± 13 yr, body mass index (BMI) 43.0 ± 6.8 kg/m2, severe obesity, 94 %. Altered body composition was reported in 90 % of the obese patients (n = 227/253) with method 1, and 35 % (83/253) with method 2. The agreement between the two methods was very low (kappa = 0.10). The factors associated with altered body composition were: method 1, age (odds ratio = 1.05 [95 % confidence interval, 1.01; 1.10], P = 0.02), arterial hypertension (0.18 [0.06; 0.57], P = 0.04), hip circumference (1.13 [1.07; 1.20], P < 0.0001), previous obesity follow-up (3.78 [1.30; 10.96], P = 0.002); method 2, female gender (3.12 [1.02; 9.5], P = 0.04), age (1.10 [1.06; 1.14], P < 0.0001), BMI (1.37 [1.26; 1.50], P < 0.0001), history of cancer (5.35 [1.20; 23.84], P < 0.028), phase angle (0.42 [0.27; 0.66], P < 0.001). Altered body composition is common in severely obese patients. The two methods are not comparable. Further work will aim at refining the methods of body composition measurements in the obese patients, and especially for the sarcopenic obesity diagnosis. [ABSTRACT FROM AUTHOR]

The most adequate amount of protein that should be administered to critically ill patients is still debated and diverging findings are recently accumulating. We hypothesized that the effect of protein administration might depend on the amount of muscle mass. A secondary analysis of a single-centre prospective observational study of body composition in critically ill patients. Mechanically-ventilated subjects with an expected intensive care unit (ICU) stay >72 h were enrolled. Within 24 h from ICU admission, bioimpedance-derived muscle mass (BIA MM) and rectus femoris cross-sectional area (RF CSA) were measured. The amount of proteins and calories administered on the 7th ICU day was recorded. We enrolled 94 subjects (65 males, actual body weight 72.9 ± 14.4 Kg, BMI 26.0 ± 4.8 kg/m2). Actual body weight was only weakly related to BIA MM (R = 0.478, p < 0.001) and not related to RF CSA (R = 0.114, p = 0.276). A higher protein intake was associated with a reduced mortality in the highest quartile of BIA MM (OR 0.68 [0.46; 0.99] per each 10 g of proteins administered) and in the third (OR 0.74 [0.57; 0.98]) and highest quartile of RF CSA (OR 0.68 [0.48; 0.96]). A higher protein intake was associated with lower ICU mortality only in patients admitted with a higher muscle mass, as either assessed by BIA or muscle ultrasound. [ABSTRACT FROM AUTHOR]

Phase angle (PhA) calculated from the resistance and reactance measured using a bioimpedance device was suggested to represent the degree of fat deposition in muscle (myosteatosis), though no direct evidence is available. We aimed to clarify the possible association between PhA and skeletal muscle myosteatosis in community-dwelling middle-aged to older adults. Participants consisted of 424 Japanese (aged ≥50 years). Leg PhA and skeletal muscle mass index (SMI) were obtained by bioelectrical impedance analysis. The mean attenuation values and cross-sectional area of the mid-thigh skeletal muscle were calculated from computed tomography images and considered as indexes of myosteatosis and skeletal muscle mass, respectively. Leg PhA was positively associated with SMI, and cross-sectional area and mean attenuation value at mid-thigh. Multiple regression analysis adjusted for possible covariates identified leg PhA (β = 0.214) and SMI (β = 0.260) as independent factors of mid-thigh muscle cross-sectional area (P < 0.001), while leg PhA (β = 0.349, P < 0.001) but not SMI (P = 0.645) was associated with mean attenuation value. Similar results were observed in the analysis in the older (≥65 years) subpopulation. The combination of low SMI and low leg PhA showed stepwise association with cross-sectional area, while only individuals with low leg PhA had lower mean attenuated value. Leg PhA was independently associated with mean attenuated value of the mid-thigh skeletal muscle, suggesting that the assessment of PhA in combination with SMI could provide additional information for the evaluation of muscle properties. [ABSTRACT FROM AUTHOR]

To report our data on the total body water (TBW), intracellular volume (ICV), extracellular volume (ECV), and fat-free mass (FFM) from studies using whole-body bioimpedance (BIA) with the aim of contrasting them to commonly cited reference values. Data were retrospectively retrieved from three single-center studies of adult healthy male volunteers and one study of women scheduled for abdominal hysterectomy where multifrequency BIA had been applied to obtain measurements of TBW, ICV, ECV, and FFM. Based on measurements performed in 44 males, the TBW, ICV, ECV, and FFM represented 49.1 (4.9)%, 23.32 (3.1)%, 25.8 (2.2)%, and 67.4 (7.4)% of the BW, respectively (mean, SD). In 15 females, these volumes were 40.4 (4.5)%, 18.0 (2.1)%, 22.4 (2.6)%, and 55.6 (6.1)% per kg BW, respectively. The deviation of these measurements from the reference values increased linearly with body weight and age. Body fluid volumes indicated by BIA showed that TBW amounted to 80% of the reference volume, which is 60% per kg BW in adult males. The ratio between the ICV and the ECV was approximately 1:1, while this ratio is traditionally reported to be 2:1. [ABSTRACT FROM AUTHOR]

Purpose: This study analyzed the relationship between degree of disability and edema index [extracellular water/total body water (ECW/TBW) ratio] values in a rural population of older adult patients with osteopenia, sarcopenia, or osteosarcopenia (OS). Materials and Methods: This study used data from the Namgaram-2 cohort. The degree of disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS) 12, and ECW/TBW ratio was calculated using bioelectrical impedance analysis. Based on ECW/TBW ratio, the participants were stratified into normal (<0.391) and abnormal (=0.391) groups, and the mean WHODAS 12 scores were compared between the two groups. Multiple regression analysis corrected for demographic factors, smoking history, hypertension, diabetes, and serological test results was also conducted. Results: Significant differences in mean WHODAS 12 scores were observed in the healthy group (5.8±7.4 vs. 9.2±9.7, p=0.008), the osteopenia only group (7.4±8.7 vs. 12.9±12.0, p<0.001), and the OS group (16.0±13.2 vs. 23.1±17.1, p=0.004). However, no significant difference in mean WHODAS 12 score was observed in the sarcopenia only group (14.9±13.4 vs. 20.7±14.8, p= 0.051). There were significant differences in ECW/TBW ratio values between the abnormal and normal groups in the osteopenia only group (B=4.646 and p=0.001), the sarcopenia only group (B=5.097 and p=0.016), and the OS group (B=5.653 and p=0.043). Conclusion: This study found that the degree of disability is related to the edema index in older patients with osteopenia, sarcopenia, or OS. Since the edema index indicates the nutritional status of an individual, proper nutrition and fluid intake are important to reduce disability. [ABSTRACT FROM AUTHOR]

Bioimpedance analysis-derived phase angle (PhA), as marker of body cell mass and cell integrity, might be altered in obesity, a condition which is characterized by alterations in muscle structure and function. The aim of this systematic review was to evaluate whether and to which extent PhA varies in individuals/patients with excess body weight focusing on: a) changes in PhA due to obesity; b) changes in PhA after bariatric interventions or training programs. According to PRISMA criteria, a systematic literature search until February 2021 using PubMed, Embase, Scopus, and Web of Science was performed. Selection criteria included studies on patients with obesity without comorbidities other than metabolic diseases. A total of 278 articles were first identified. After removing duplicates and excluding studies that did not fulfil the inclusion criteria, the full text of the remaining 80 potentially relevant studies was examined to finally retrieve 11 cross-sectional and 10 longitudinal studies. Few studies have shown that PhA is lower in individuals/patients with obesity than in controls. The only study on the matter showed a decrease with age after the fourth decade of life. Four out of five studies reported consistently greater mean values in men than in women. In two studies PhA was lower in patients with severe obesity; in addition, Patients with low PhA had higher BMI and PhA was inversely correlated with fat mass. Longitudinal studies showed that PhA markedly decreased after bariatric surgery and slightly increased after training programs. Thus, a relatively low number of studies have evaluated PhA in individuals/patients with obesity with sometimes contradictory and preliminary results. PhA might be useful to evaluate muscle quality in individuals/patients with obesity but further studies are needed to more accurately associate this variable with changes in muscle structure and strength, as well as in metabolic functions. [ABSTRACT FROM AUTHOR]

• Cardiac surgery patients are highly susceptible to malnutrition • Lean body tissue loss, phase angle attenuation and edema development could serve as potential surrogates to risk stratification • Nutritional status and body composition assessment could aim towards to prognosis refinement • Body composition assessment could be part of a patient-oriented multimodal approach in cardiac surgery. This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population. Prospective, cohort study. Tertiary university hospital. Patients undergoing cardiac surgery procedures. Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality. Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II. Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality. [ABSTRACT FROM AUTHOR]

The diagnostic accuracy of clinical-based body composition methods such as body mass index (BMI), waist circumference (WC), bioimpedance analysis (BIA), and dual energy X-ray absorptiometry (DXA) has yet to be evaluated in Hispanic adults. Moreover, it has also been suggested that previously established obesity cutoff values may need adjusting. Purpose: The primary aim of this study was to investigate the diagnostic accuracy of BMI, WC, BIA, and DXA for obesity classification in Hispanic adults. The secondary aim was to internally derive obesity cutoff values producing equal sensitivity and specificity for the respective tests. Methods: Hispanic females (n = 101) and males (n = 90) volunteered to participate in this study (18–45 years). Body fat percentage was estimated with BIA, DXA, and a 4-compartment (4C) model. Obesity-defined criteria was employed as follows: (Body fat percentage ≥ 25% and 35% and WC ≥ 102cm and 88cm for males and females, respectively; BMI ≥ 30 kg/m2). A 4C model was used as a criterion to evaluate BMI, WC, DXA, and BIA. Results: Sensitivity of DXA and BIA (74.1%–96.9%) was greater than BMI and WC (25.8%–51.9%) when using previously established standards. However, specificity was poor for DXA (<70%), but considered good to excellent for BMI, WC, and BIA (83.1%–96.6%) when using previously established standards. Internally derived cutoff values improved sensitivity for BMI and WC (74.2%–81.5%) and improved specificity for DXA (>80.0%). Conclusion: The internally derived cutoff values, producing identical sensitivity, and specificity, were developed and shown to improve the diagnostic performance of the body composition methods compared to previously established obesity cutoff standards. Consequently, the internally derived obesity cutoff values are recommended for use by allied health professionals in clinical practice when equal sensitivity and specificity is desired. [ABSTRACT FROM AUTHOR]

Obesity and low muscle mass are associated with worse outcomes of colorectal cancer patients. We conducted a controlled trial to study the impact of a ketogenic diet (KD) based on natural foods versus an unspecified standard diet (SD) on body composition in rectal cancer patients undergoing radiotherapy. Patients with non-metastasized rectal cancer were allocated to either the KD (N = 24) or the SD (N = 25) group during radiotherapy. Body composition was measured weekly by bioimpedance analysis and analyzed using linear mixed effects models. Pathologic response in patients undergoing neoadjuvant treatment was evaluated at the time of surgery. A total of 18 KD and 23 SD patients completed the study and were eligible for analysis. The SD group experienced no noteworthy changes in any body composition parameter. In contrast, patients in the KD group lost significant amounts of body weight and fat mass, averaging 0.5 and 0.65 kg/week (p < 0.0001). There was a rapid loss of intracellular water consistent with initial intramuscular glycogen and water depletion, but skeletal muscle tissue was conserved. Pathological tumor responses were somewhat greater in the KD group, with a larger mean Dworak regression grade (p = 0.072) and larger percentage of near-complete (yT0N0 or yT1N1) responses (43 versus 15%, p = 0.116) that almost reached statistical significance in intention-to-treat analysis (50% versus 14%, p = 0.018). In rectal cancer patients undergoing curative radiotherapy, a KD significantly reduced body weight and fat mass while preserving skeletal muscle mass. We could demonstrate a trend for KDs contributing synergistically to pathological tumor response, a finding in line with preclinical data that warrants future confirmation in larger studies. ClinicalTrials.gov identifier: NCT02516501, registered on August 06, 2015. [ABSTRACT FROM AUTHOR]

Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cut-offs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes. A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool. Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cut-off point values from 4.05 to 5.05° have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients. Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia. • Phase angle is decreased in sarcopenic subjects. • The prevalence of sarcopenia is higher in subjects with low phase angle. • Phase angle may help in detecting low muscle quality and identifying sarcopenia. • Different cut-off phase angle values have been derived for identifying sarcopenia. [ABSTRACT FROM AUTHOR]

It is crucial to assess age-related muscle mass changes and derived indices differences in geriatric medicine. We aimed to develop and validate four bioimpedance analysis (BIA) prediction equations against dual-energy X-ray absorptiometry (DEXA) and magnetic resonance image (MRI) in estimating skeletal muscle mass and to compare the differences among skeletal muscle mass indices, cutoff values, and corresponding prevalence rates of low muscle mass for assessing sarcopenia in Chinese adults. We measured the height (Ht), weight (Wt), appendicular lean mass (ALM) or skeletal muscle mass (ASM), total lean body mass (LBM) or skeletal muscle mass (TSM) obtained using DEXA or MRI, and a multi-frequency BIA (BCA II ;50, 250 kHz), in 371 adults aged 18.0–87.0 years. We also collected gender, age, Ht, Wt, and impedance indexes (Ht 2 /R 50 , Ht 2 /R 250 , R 50 /Ht 2 , R 250 /Ht 2 ) from 30,500 adults aged 18–96 years living in China. Multiple regression analyses were used to derive four prediction equations by BIA, and double cross-validation techniques and Bland-Altman analyses were used to test agreement. Various muscle mass indices and prevalence rates were depicted by line plots in regard to age trends. Satisfactory results were found in the four prediction models as they had the larger R2 (0.833–0.930) values and low SEE (1.409–2.335 kg) values. The predictive variables included impedance indexes (Ht 2 /R 50 , R 50 /Ht 2 , R 250 /Ht 2 ), gender, age, Wt, and Ht. The corresponding prevalence rates of low muscle mass exhibited significant differences according to the various muscle mass indices adjusted for Ht, Wt, or body mass index (BMI), in addition to the cutoff values based on two standard deviations (2SD) of young people or the lower 20% of the study group. The BIA equations have the potential to be applied as a practical method of quantifying skeletal muscle mass in Chinese adults. However, the operational methods that are most appropriate for determining the degree of low muscle mass that actually contributes to sarcopenia remains inconclusive. [ABSTRACT FROM AUTHOR]

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Background: Despite differences between the studies regarding methods for estimating low muscle mass, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends use of two standard deviations (SDs) below the reference sex-specific means of healthy young adults. Aims: The aim of this study was to determine the cutoff points of skeletal muscle mass index (SMI) and handgrip strength (HS) in Turkish population and to compare the power of different cutoff points to predict comprehensive geriatric assessment (CGA) parameters. Methods: Two hundred and eight young healthy volunteers (104 women, 104 men) were included in the study to define SMI, HS cutoff values. 1150 older adults (784 women, 366 men) underwent CGA, including physical performance, activities of daily living (ADL), HS and frailty. Body composition was obtained from every participant by bioimpedance analysis (BIA). CGA parameters of sarcopenic patients according to EWGSOP and new Turkish cutoff points were compared. Results: SMI cutoff points were defined 5.70 kg/m2 for women, 8.33 kg/m2 for men. HS thresholds were calculated as 14 kg for women, 28 kg for men using measurements of healthy young adult reference. Considering the new threshold values, the prevalence of sarcopenia was 10% (7% women, 17% men). When new sarcopenia criteria were applied and covariates were adjusted, sarcopenia was found to be more closely related to ADL impairment, balance, frailty in men, and balance, slow walking speed, ADL impairment, frailty in women (p < 0.05). Discussion: Muscle mass and strength may vary between populations because of ethnicity and other related discrepancies. The evaluation of sarcopenia according to the present guidelines may cause overdiagnosis in some populations. Conclusion: Cutoff points specific to populations should be determined. [ABSTRACT FROM AUTHOR]

The assessment of body composition (BC) can be used to identify malnutrition in patients with Crohn's disease (CD). The aim of this study was to evaluate the nutritional status of CD patients by assessing BC, phase angle (PhA) and muscle strength. Differences in disease duration and medications were also considered. Consecutive adult CD patients aged 18–65 years were enrolled in this cross-sectional study. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in the active and quiescent phases. All participants underwent anthropometry, BC and handgrip-strength (HGS) measurements; additionally, blood samples were taken. Data from CD patients were also compared with age-, sex- and BMI-matched healthy people. A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and a mean body weight of 64.9 ± 12 kg were recruited and compared to controls. The findings showed that all nutritional parameters, especially PhA and HGS, were lower in CD patients than in controls, and these parameters were substantially impaired as disease activity increased. Active CD patients had a lower body weight and fat mass than both the quiescent and control groups. PhA was negatively correlated with age (r = −0.362; p = 0.000) and CDAI (r = −0.135; p = 0.001) but was positively associated with fat free mass (FFM) (r = 0.443; p = 0.000) and HGS (r = 0.539; p = 0.000). Similarly, serum protein markers were lower in the active CD group than in the quiescent group (p < 0.05). Disease duration and medications did not significantly affect nutritional status. BIA-derived PhA is a valid indicator of nutritional status in CD patients, and its values decreased with increasing disease activity. Additionally, small alterations in BC, such as low FFM, and reduced HGS values can be considered markers of nutritional deficiency. Therefore, the assessment of BC should be recommended in clinical practice for screening and monitoring the nutritional status of CD patients. • The assessment of body composition should be used for identifying malnutrition in patients with Crohn's Disease. • Bioelectrical phase angle provides crucial information on cellular health and soft tissue hydration. • Phase angle values decreased with increasing disease activity, resulting a valid indicator of nutritional status. [ABSTRACT FROM AUTHOR]

Abstract Objective To identify the threshold of total body fat percentage (TBF%) required for the resumption of menses (ROM) in hospitalized female adolescents with anorexia nervosa (AN) using bioimpedance analysis (BIA). Methods All female adolescents hospitalized with AN in our medical center were evaluated in a longitudinal prospective study during the years of 2012–2017. Anthropometric data, body fat measured by BIA, and hormonal determinants were collected periodically, in addition to routine medical and gynecological assessments. Results Sixty-two participants presented with secondary amenorrhea, of which 20 remained with amenorrhea and 42 had ROM during hospitalization. At discharge, participants with ROM regained significantly more weight, and had higher mean body mass index (BMI), BMI standard deviation scores, and TBF% than those who remained with amenorrhea. Receiver operating characteristic analysis identified that a TBF% of 21.2% had the highest discriminative ability for ROM (sensitivity = 88%, specificity = 85%, positive predictive value = 93%). Compared with the anthropometric parameters, TBF% had the highest area under curve (AUC =.895), which significantly differed from that of BMI standard deviation scores (AUC =.643, p =.007) and body weight (AUC =.678, p =.03). Conclusions BIA is a safe and relatively simple method to assess the TBF% required for the return of balanced menstrual cycles in female adolescents with AN. The TBF% with the highest discriminative ability for menstrual resumption as assessed by BIA is 21.2%. [ABSTRACT FROM AUTHOR]

Summary Background & aims There is an increase in the number of patients worldwide with cardiac implantable electronic devices (CIEDs). Current medical practice guidelines warn against performing bioimpedance analysis (BIA) in this group of patients in order to avoid any electromagnetic interference. These recommendations restrict using the BIA in patients undergoing heart failure or with nutrition disorders in whom BIA could be of major interest in detecting peripheral congestion and to help guide treatment. The present study was conducted to evaluate whether BIA caused electromagnetic interference in patients having CIEDs. Methods Patient enrollment was conducted during routine face-to-face consultations for scheduled CIEDs interrogations. Device battery voltage, lead impedance, pacing thresholds and device electrograms were recorded before and after each BIA measurement to detect any electromagnetic interference or oversensing. Results A total of 200 patients were enrolled. During BIA, no significant changes in battery voltage, lead impedance or pacing thresholds were detected, nor were there any inappropriate over- or undersensing observed in intracardiac electrograms. Furthermore, 6- and 12-month follow-up did not reveal any changes in CIEDs. Conclusions This study shows no interference in patients equipped with CIEDs and suggests that BIA can be securely performed in these patients. Trial registered under the identifier NCT03045822. [ABSTRACT FROM AUTHOR]

Background: Prolongation of survival in patients with breast cancer due to early diagnosis and modern methods of treatment has turned the attention on lymphedema, which is the most important morbidity secondary to the treatment of the disease. Determination of lymphedema and related risk factors in patients before a surgical intervention may provide protection for patients and early treatment. The aim of this study was to determine the presence of lymphedema before surgery by bioimpedance analysis in patients with breast cancer and to establish risk factors associated with lymphedema. Patients and Methods: A total of 277 patients who were diagnosed as having breast cancer, were planned to undergo a surgical intervention, and had no clinical lymphedema were included in the study. The presence of lymphedema was evaluated with clinical examination, measurement of arm circumference, and bioimpedance analysis. Results: Lymphedema was found in 59 (21.3%) patients with no detected differences in arm circumferences. A significant relationship was found between the presence of lymphedema and body mass index (BMI), number of positive lymph nodes, and capsule invasion of the tumor ( p = 0.001, p = 0.003, p = 0.002, respectively). Multiple regression analysis revealed that BMI and the number of positive lymph nodes were independent variables ( p = 0.024, p = 0.002). ROC curve analysis resulted in an increased risk of preoperative lymphedema when the number of positive lymph nodes was ≥8. Correlation analysis revealed a positive correlation between the number of positive lymph nodes and L-dex score ( p = 0.001, r = 0.219). Conclusion: Preoperative bioimpedance analysis demonstrated that ∼1/5 of the patients had subclinical lymphedema. Preoperative subclinical lymphedema is associated with obesity and the number of positive lymph nodes, and thus, treatment of the axilla in patients who are preoperatively detected to have subclinical lymphedema should be revised. [ABSTRACT FROM AUTHOR]

Background: We evaluated a modified L-Dex score by using the right arm as a reference (LDS rarm), to determine whether it could be used for the assessment of leg edema in place of the usual L-Dex score calculated by using the contralateral normal leg as a reference (LDS cont). Methods: Bioimpedance analysis was performed in the legs and right arms of 38 patients with unilateral leg edema and in 42 healthy volunteers by using a standard equipotential electrode arrangement. Results: The impedance ratio in the right arms of patients (2.6 ± 0.4) was lower than that in their contralateral normal legs (3.0 ± 0.8, p < 0.05), but it was similar to that in the legs (right: 2.4 ± 0.7, left 2.5 ± 0.8) of normal subjects. There was a significant correlation between LDS cont and LDS rarm in legs with edema (right: r = 0.80, left: r = 0.93). No such correlation was found in the legs of normal subjects, but the mean ± 2 standard deviation of their LDS rarm ranged from −3 to 37, which was similar to LDS rarm values in legs with edema corresponding to the normal range of LDS cont (−10 to 10), that is, from 1 to 34. Conclusions: LDS rarm could be used as an alternative for LDS cont in the assessment of leg edema. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if heat exposure alters the measures of total body water (TBW), extracellular water (ECW), and intracellular water (ICW) in both single-frequency bioelectrical impedance analysis (BIA) and bioimpedance spectroscopy (BIS). Additionally, we sought to determine if any differences exist between the BIA and BIS techniques before and after brief exposure to heat. Body water was evaluated for twenty men (age=24±4 years) in a thermoneutral environment (22°C) before (PRE) and immediately after (POST) 15 min of passive heating (35°C) in an environmental chamber. The mean difference and 95% limits of agreement at PRE demonstrated that BIS yielded significantly higher body water values than BIA (all p<0.05; TBW=1.8kg; ECW=0.6±1.3kg; ICW=1.2±3.7kg). However, the effect size (ES) of the mean differences at PRE were small and the r-values were high (r≥0.97). TBW and ICW remained significantly higher at POST for BIS (both p<0.05; 1.4±3.2kg and 1.1±3.7kg, respectively) whereas ECW was not different (p>0.05; 0.2±1.5kg). Additionally, the ES of the mean differences at POST were trivial to small and the r-values were high (r≥0.96). When analyzing the changes in body water before and after heat exposure, POST values for BIS were significantly higher than PRE (all p<0.001; TBW=0.6±0.8kg; ECW=0.4±0.3kg; ICW=0.3±0.6kg). Similarly, POST values for BIA were significantly higher than PRE (all p<0.001; TBW=1.0±0.6kg; ECW=0.7±0.4kg; ICW=0.4±0.4kg). BIA and BIS provide similar body water estimates. However, the increase in POST body water values indicate more research is needed before either method can be used for estimating body water after heat exposure. [ABSTRACT FROM AUTHOR]

People perceive different levels of pain at the same stimulus intensity, hence overburdening objective nociception assessment. In the context of recently developed pain monitors, this work presents the analysis of the complex bioimpedance measured during cold-induced cutaneous nociception. Using the Anspec-PRO device, this analysis results in a more complex characterization of the acquired signal (i.e., 3-dimensional or image-based representations), rather than evaluations of one/multiple single-dimension signals (i.e., time-based index). The experimental protocol consists of thermal testing the nociception response of 13 participants, in terms of impedance changes. Several study cases are performed to evaluate the bioimpedance variability over one day, day to day, and at different stimulus intensities. The measured bioimpedance fluctuations in time were validated against the self-reported pain level of the test subjects. Moreover, the bioimpedance, acting as the frequency response of cold-induced nociception, demonstrated the pain memory effect and the influence on the impedance of the liquid/fat in the body. The impedance analysis can delineate cold-induced nociception effects from nominal states, the impedance spectroscopy proving the potential to monitor the evoked pain. The implications of this work rely on advancing the state of art for pain detection by using time–frequency analysis and image-based information. Moreover, in closed-loop anesthesia control, the nociception surrogate monitoring provides direct feedback for analgesia and an input–output model to opioids. • Bioimpedance methodology was validated during cold-induced cutaneous nociception. • Time–frequency analysis offers a more complex characterization of the nociception. • Impedance spectroscopy can delineate cold-induced nociception effects from nominal. • Frequency response matrix can be used for pain classification or analgesia modelling. • The great significance is the emerging individualized and objective pain assessment. [ABSTRACT FROM AUTHOR]

Background While laparoscopic gastric plication (LGP) results in a rapid weight loss in the first postoperative months, changes in body composition after LGP have not been studied previously. Objective To evaluate the body composition after LGP. Setting A tertiary referral hospital. Method This is a consecutive case series. Body composition was measured using bioimpedance analysis with a Tanita BC-418 by 1 nutritionist. Weight, fat mass (FM), fat-free mass (FFM), and total body water (TBW) were measured at baseline and at 1, 3, and 6 months postoperative. Results Sixteen consecutive patients underwent LGP. No intraoperative or major postoperative complications occurred during the follow-up period. No patient was lost to follow-up at any point during the study period. Mean postoperative total weight loss was 31 kg after 6 months, of which 25.5 kg (83%) was due to FM reduction. %FM was decreased by 15% after 6 months, whereas %TBW increased by 11%. Conclusions Most of the weight loss caused by LGP is attributable to FM loss, and FFM loss is minimal after LGP. Therefore, LGP shifts body composition toward normal. [ABSTRACT FROM AUTHOR]

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Summary: Background & aims: There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations. Methods: Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years). Results: The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p < 0.001), but all equations were highly correlated. Conclusions: The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation. [Copyright &y& Elsevier]

Abstract: This study wants to investigate if multi-frequency bioimpedance analysis; which is non-invasive, quick and mobile; and its indicators can be used like a tool for helping technical staff to improve performance, by optimizing training load, specific hydration and specific nutrition of an elite male runner. The principal results of this study are that BIA monitoring allowed to explain body weight variations, to optimize hydration state and to check fatigue state during the season. To conclude, BIA might be use in sport routine in order to monitor training load, hydration and nutrition during all the season. [Copyright &y& Elsevier]

Abstract: The aim of this study is to investigate whether multi-frequency bioimpedance analysis, which is non-invasive, quick and mobile, may be able to optimize training, nutrition and hydration for 9 elite skiers in view to Winter Olympic Games 2010. The principal results of this study is that BIA method may be used in sportive routine on elite skiers in order to estimate Fat Mass, Muscle Mass, Hydration state, Fatigue state and their variations. BIA showed a real interest, for technical and medical staff, because it permitted to optimize and orientate physical training, nutrition and hydration. [Copyright &y& Elsevier]

Although various physiological and psychological causes of fatigue in HIV-positive persons have been proposed, it is still not well understood. Bioimpedance analysis has proved to be an easily used, noninvasive measurement of body composition and cellular integrity. This study, looking at whether body composition as measured by bioimpedance analysis is associated with fatigue, is part of a pilot study looking for physiological and psychological biomarkers that could be factors in the fatigue experienced by HIV-positive people. Twenty-nine men and eleven women were measured for height, weight, and bioimpedance analysis. Correlations were examined between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, extracellular mass, and phase angle. Because of the fat redistribution that has occurred with some people taking protease inhibitors, we also examined differences in weight, body mass index, body cell mass, fat-free mass, and fatigue intensity between those taking and those not taking protease inhibitors. There was no association between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, or phase angle, nor were there differences between those taking and those not taking protease inhibitors. However, it was noted that both the phase angle and the ratio of extracellular mass to body cell mass (extracellular mass:body cell mass) were below their respective normal ranges, indicating that the participants were somewhat compromised nutritionally and with regard to cell membrane integrity. Although fatigue was not shown to be related to body composition measurement in this study, further work is needed on the causes of fatigue, because its effects on the lives of HIV-positive people can be devastating. [ABSTRACT FROM AUTHOR]

Summary: Background: No study targeting the impact of silicone breast implants on body composition measured by bioimpedance analysis was identified. Objective: Aiming to clarify this question a prospective clinical study was designed. Methods: Adult candidates were submitted to conventional analysis at baseline and two months after the surgical intervention. In addition, unwrapped prostheses were positioned in the axillary cavity before operation and bioimpedance was measured, both with and without application of ultrasound gel for improved conductivity (sham implantation). Results: Patients (N = 20) were young and healthy (26.8 ± 3.6 years old, BMI 22.1 ± 3.7 kg/m2). In comparison with preoperative results, sham procedures pointed out increased body fat and body resistance (13.2 ± 5.6 vs 13.6 ± 5.4 kg, P = 0.017 and 523 ± 54 vs 569 ± 53 Ω, P = 0.003, respectively). Two-month follow-up confirmed the same pattern after surgical intervention, with minor discrepancies (13.2 ± 5.6 vs 13.8 ± 5.7 kg, P = 0.011 and 523 ± 54 vs 549 ± 62 Ω, P = 0.032, respectively). BMI remained stable and did not correlate with bioimpedance changes. Conclusions: Silicone was recognized as adipose tissue. Difference in total body fat (approximately 600 g) was consistent with used amount. [Copyright &y& Elsevier]