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Hypervolemia and vitamin D deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular (LV) hypertrophy. The effect of bioelectrical impedance analysis (BIA)-guided volume management or vitamin D supplementation on LV mass among those receiving peritoneal dialysis is uncertain.Two-by-two factorial randomized controlled trial.Sixty-five patients receiving maintenance peritoneal dialysis.BIA-guided volume management versus usual care and oral cholecalciferol 50,000 U weekly for 8 weeks followed by 10,000 U weekly for 44 weeks or matching placebo.Change in LV mass at 1 year measured by cardiac magnetic resonance imaging.Total body water decreased by 0.9 + 2.4 (SD) L in the BIA group compared with a 1.5 ± 3.4 L increase in the usual care group (adjusted between-group difference: -2.4 [95% CI, -4.1 to -0.68] L, P = 0.01). LV mass increased by 1.3 ± 14.3 g in the BIA group and decreased by 2.4 ± 37.7 g in the usual care group (between-group difference: +2.2 [95% CI, -13.9 to 18.3] g, P = 0.8). Serum 25-hydroxyvitamin D concentration increased by a mean of 17.2 ± 30.8 nmol/L in the cholecalciferol group and declined by 8.2 ± 24.3 nmol/L in the placebo group (between-group difference: 28.3 [95% CI, 17.2-39.4] nmol/L, P 0.001). LV mass decreased by 3.0 ± 28.1 g in the cholecalciferol group and increased by 2.0 ± 31.2 g in the placebo group (between-group difference: -4.5 [95% CI, -20.4 to 11.5] g, P = 0.6).Relatively small sample size with larger than expected variation in change in LV mass.BIA-guided volume management had a modest impact on volume status with no effect on the change in LV mass. Vitamin D supplementation increased serum vitamin D concentration but had no effect on LV mass.Unrestricted Baxter International extramural grant and the Kidney Foundation of Canada.Registered at ClinicalTrials.gov with study number NCT01045980.

Context Accurate methods for predicting the percentage of body fat (%Fat) in female athletes are needed for those who lose weight before competition. Methods mandated by sport governing bodies for minimal weight determination in such athletes lack validation. Objective To (1) determine whether combining anthropometry using skinfold (SF) thicknesses and bioelectrical impedance analysis (BIA) in a 3-compartment (3C) model would improve the prediction of %Fat in female athletes and (2) evaluate the Slaughter SF equation. Design Cross-sectional study. Setting Laboratory-based study during the preseason for collegiate sports. Participants A total of 18 National Collegiate Athletic Association Division I female athletes were recruited from swim and gymnastics teams. Main Outcome Measure(s) We measured %Fat based on a 4-compartment (4C) criterion incorporating body density (air-displacement plethysmography), total body water (D2O dilution), and bone mineral mass (dual-energy x-ray absorptiometry) compared with predicted %Fat using SF alone (Slaughter equation), BIA (single frequency for total body water estimate), and combined SF and BIA (3C model). Results For the %Fat determined using the 4C criterion, the highest adjusted coefficient of determination and lowest prediction error (r2; ±standard error of estimate) were for the 3C model (r2 = 0.87; ±2.8%), followed by BIA (r2 = 0.80; ±3.5%) and SF (r2 = 0.76; ±3.8%; P values < .05 for all). Means differed for the %Fat determined using BIA (26.6% ± 7.5%) and the 3C (25.5% ± 7.2%) versus 4C model (23.5% ± 7.4%; analysis of variance and post hoc analyses: P values < .05). The SF estimate (24.0% ± 7.8%) did not differ from the 4C value. Conclusions Combining SF and BIA might improve the prediction and lower the prediction error for determining the %Fat in female athletes compared with using SF or BIA separately. Regardless, the Slaughter equation for SF appeared to be accurate for determining the mean %Fat in these female athletes.

The use of soap for skin cleansing is common among the population. However, it is possible that it causes damage to skin cells and disrupts the skin barrier.To determine the cytotoxic effect of soaps on in vitro-cultured keratinocytes and to correlate it with clinical irritation.A survey was conducted to find out the most widely used commercial soaps and their number. Subsequently, their cytotoxicity was evaluated in human keratinocyte cultures using the resazurin assay. The soaps with the highest and lowest cytotoxicity were applied to the skin of healthy volunteers to assess their effect on the skin barrier using colorimetry and transepidermal water loss (TEWL) assays.Of the analyzed soaps, 37 % were shown to be toxic to keratinocytes in vitro. The soap with the highest toxicity induced the highest rate of erythema and TEWL, in comparison with the least toxic soap and the vehicle used as the control solution.Soaps marketed for skin cleansing can contain chemical ingredients that damage human keratinocytes and cause skin barrier subclinical irritation. Their use can worsen preexisting dermatoses, generate xerotic or irritant contact dermatitis, and cause atrophy and dermatoporosis.El jabón para el aseo cutáneo es de empleo común entre la población, sin embargo, es posible que cause daño a las células de la piel y modifique la barrera cutánea.Determinar el efecto citotóxico de los jabones en queratinocitos cultivados in vitro y correlacionarlo con la irritación clínica.Se realizó una encuesta para conocer los jabones comerciales más utilizados y su cantidad; posteriormente, se evaluó su citotoxicidad en cultivos de queratinocitos humanos mediante el método de resazurina. Los jabones con mayor y menor citotoxicidad se aplicaron en piel de voluntarios sanos para evaluar su efecto en la barrera cutánea mediante ensayos de colorimetría y pérdida transepidérmica de agua.De los jabones analizados, 37 % demostró ser tóxico para los queratinocitos in vitro. El jabón con mayor toxicidad indujo el mayor índice de eritema y pérdida transepidérmica de agua, en comparación con el jabón menos tóxico y el vehículo empleado como solución control.Los jabones comercializados para el aseo cutáneo pueden incluir ingredientes químicos que dañan los queratinocitos humanos y causan irritación subclínica de la barrera cutánea. Su utilización puede agravar dermatosis preexistentes, generar dermatitis xerósica o de contacto irritativa y causar atrofia y dermatoporosis.

The purpose of this study was to compare relative adiposity (%Fat) derived from a 2-dimensional image-based 3-component (3C) model (%Fat(3C-IMAGE)) and dual-energy X-ray absorptiometry (DXA) (%Fat(DXA)) against a 5-component (5C) laboratory criterion (%Fat(5C)). 57 participants were included (63.2% male, 84.2% White/Caucasian, 22.5±4.7 yrs., 23.9±2.8 kg/m(2)). For each participant, body mass and standing height were measured to the nearest 0.1 kg and 0.1 cm, respectively. A digital image of each participant was taken using a 9.7 inch, 16g iPad Air 2 and analyzed using a commercially available application (version 1.1.2, made Health and Fitness, USA) for the estimation of body volume (BV) and inclusion in %Fat(3C-IMAGE) . %Fat(3C-IMAGE) and %Fat(5C) included measures of total body water derived from bioimpedance spectroscopy. The criterion %Fat(5C) included BV estimates derived from underwater weighing and bone mineral content measures via DXA. %Fat(DXA) estimates were calculated from a whole-body DXA scan. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. A strong correlation (r = 0.94, p

Background Testicular cancer is associated with excellent prognosis and cure is achieved in most patients with advanced cancer treated with cisplatin-based chemotherapy. However, testicular cancer survivors are at increased risk of accelerated atherosclerosis, which significantly contributes to their late morbidity and mortality. Atherosclerosis is associated with a higher proportion of fat mass and especially with increased amount of visceral fat. We explored the effects of cisplatin-based chemotherapy on body composition during and after the treatment. Patients and methods We studied 30 testicular cancer patients before chemotherapy, after the second cycle of chemotherapy and three months after the end of chemotherapy. Body composition parameters were evaluated using bioelectrical impedance analysis (BIA). Results Three months after the end of chemotherapy the fat mass had increased from 22.04±7.15% to 23.92±7.33% (P=0.026) and visceral fat volume had increased by 17% from 2.36±1.75l to 2.77±1.94l (P=0.013). In the whole sample there was a decrease in muscle mass after the second cycle of chemotherapy (-1.33 ± 2 kg on average; P=0.005). The changes in body composition varied according to distinct baseline fat mass. Conclusion Cisplatin-based chemotherapy was associated with increase of fat mass, visceral fat, and body mass index. We also observed decrease in muscle mass and total body water. Our results suggest that BIA could help to target preventative measures to avert the acceleration of atherosclerosis in patients treated with cisplatin-based chemotherapy.

The aim was to assess the validity of bioimpedance in the assessment of fat free mass (FFM) among women and to study if the validity differs between women with and without Rheumatoid Arthritis (RA).38 women with RA and 24 non-rheumatic controls were included. FFM was measured in the non-fasting state using DXA (Lunar Prodigy), multi-frequency bioelectrical impedance analysis (BIA) (MF-BIA [Tanita MC-180 MA]), single-frequency BIA (SF-BIA) and bioelectrical impedance spectroscopy (BIS) (both Impedimed SFB7). BIS raw data were also used to calculate FFM from equations by Matthie, Jaffrin and Moissl. Results were compared using correlation, Bland Altman analysis, Mann Whitney U test and Wilcoxon Signed Ranks Test.Women with RA had different body water distribution compared to women without RA (p 0.05). Median bias in FFM assessed by bioimpedance was 0.62-7.87 kg with wide limits of agreement for all methods. Median FFM differed significantly from DXA by all bioimpedance methods except for BIS by Jaffrin. Women with RA had significantly smaller biases compared to non-rheumatic controls using BIS equations by Matthie (p = 0.012) and Moissl (p = 0.025). Correlations between FFM measured by DXA and bioimpedance (r = 0.73-0.85, all p 0.001) did not differ between groups. The sensitivity of bioimpedance to detect low fat free mass index (FFMI) was 0-47%.The results of this study show that bioimpedance has similar validity in women with RA compared to non-rheumatic controls, despite differences in body water distribution. Agreement with DXA improved when applying specific equations, but the clinical utility of bioimpedance is questionable as all methods failed to identify low FFMI with acceptable precision.Clinicaltrials.org, NCT04247009.

Evaluating friction in human skin is important to assess its condition and the effects of skincare cosmetics. In this study, we evaluated the friction dynamics of moisturized skin to show the effects of moisturization on its mechanical properties.Friction force was evaluated using a sinusoidal motion friction evaluation system. The skin of the upper arm of 20 subjects was rubbed using a contact probe. The water content of the stratum corneum and the softness of the skin were measured using a Corneometer and a Cutometer, respectively.When human skin was treated with water or 10 wt% glycerol aqueous solution, the friction coefficients increased by 0.23 ± 0.01 and 0.17 ± 0.14, respectively, and the delay times (normalized by calculating the time interval from contact with the probe to the friction response divided by the friction time for one round trip) increased by 0.048 ± 0.034 and 0.055 ± 0.024, respectively. Three different friction profiles were observed: (a) a stable pattern, in which a smooth profile was observed during the sliding process; (b) an oscillation pattern, in which significant oscillation was obtained; and (c) a stick pattern, in which the friction coefficient increased even during the deceleration process. In the case of untreated skin, the oscillation pattern was observed for the majority of subjects. The appearance rate of the stick pattern increased by 80.3% ± 29.4% after treatment with 10 wt% glycerol aqueous solution. These characteristic friction profiles can be explained by a two-step friction model consisting of two modes: (a) friction at the skin surface and (b) the delayed response due to skin deformation.Moisturizing the skin with water or 10 wt% glycerol aqueous solution increased the friction coefficient and delay time, dramatically changing the friction profile. These changes were considered to be due to the swelling and softening of the stratum corneum and the increased true contact area between the contact probe and the skin surface.Une évaluation des effets de la friction sur la peau humaine demeure importante dans le but de juger de l'état de la peau ou de l'efficacité des produits cosmétiques pour les soins de la peau. Dans cette étude, nous avons évalué les propriétés d'une peau hydratée soumise à une friction afin d'identifier les effets de l'hydratation sur les propriétés mécaniques de la peau. MÉTHODE: Les forces de friction ont été évaluées grâce à un système d'évaluation du frottement par mouvement sinusoïdal. Une sonde de contact a été utilisée pour frotter la peau sur le haut du bras de 20 participants. La teneur en eau de la couche cornée et la souplesse de la peau ont été mesurées respectivement à l'aide d'un cornéomètre et d'un cutomètre. RÉSULTAT: Le traitement de la peau humaine avec de l'eau ou une solution de glycérol à 10% a entraîné une augmentation du coefficient de friction respectivement de 0.23 ± 0.01 et de 0.17 ± 0.14, ainsi que du délai de réaction (normalisé en divisant l'intervalle de temps entre le contact avec la sonde jusqu’à l'apparition de la réaction à la friction, par le temps de friction pour un aller-retour), de 0.048 ± 0.034 et de 0.055 ± 0.024. Trois profils de friction différents ont également été observés : (1) un modèle stable, (2) un modèle avec une grande oscillation, et (3) un modèle « collé-glissé » où le coefficient de friction augmente même pendant la décélération. Lorsque la peau est sèche, le modèle oscillant a été observé chez la majorité des participants. Le taux d'apparition du modèle « collé-glissé » a augmenté de 80.3 ± 29.4% dans le cas où la peau a été traitée avec une solution de glycérol à 10%. Ces profils caractéristiques de friction ont pu être expliqués à partir d'un modèle de friction composé de deux modes, (a) une friction à la surface de la peau et (b) un délai de réaction dû à la déformation de la peau.L'hydratation de la peau avec de l'eau ou une solution de glycérol à 10% a considérablement modifié le profil de friction en raison d'une augmentation du coefficient de friction et du délai de réaction. Nous avons estimé que ces changements sont relatifs au gonflement et à l'assouplissement de la couche cornée, engendrant une augmentation de la surface de contact réel entre la sonde de contact et la surface de la peau.

Purpose:This study aimed to determine the effects of an acute “train-low” nutritional protocol on markers of recovery optimization compared to standard recovery nutrition protocol.Methods:After completing a 2-hour high-intensity interval running protocol, 8 male endurance athletes consumed a standard dairy milk recovery beverage (CHO; 1.2 g/kg body mass [BM] of carbohydrate and 0.4 g/kg BM of protein) and a low-carbohydrate (L-CHO; isovolumetric with 0.35 g/kg BM of carbohydrate and 0.5 g/kg BM of protein) dairy milk beverage in a double-blind randomized crossover design. Venous blood and breath samples, nude BM, body water, and gastrointestinal symptom measurements were collected preexercise and during recovery. Muscle biopsy was performed at 0 hour and 2 hours of recovery. Participants returned to the laboratory the following morning to measure energy substrate oxidation and perform a 1-hour distance test.Results:The exercise protocol resulted in depletion of muscle glycogen stores (250 mmol/kg dry weight) and mild body-water losses (BM loss = 1.8%). Neither recovery beverage replenished muscle glycogen stores (279 mmol/kg dry weight) or prevented a decrease in bacterially stimulated neutrophil function (−21%). Both recovery beverages increased phosphorylation of mTORSer2448(main effect of time = P Ser9/total-GSK-3β occurred on CHO (P = .012). Blood glucose (P = .005) and insulin (P = .012) responses were significantly greater on CHO (618 mmol/L per 2 h and 3507 μIU/mL per 2 h, respectively) compared to L-CHO (559 mmol/L per 2 h and 1147 μIU/mL per 2 h, respectively). Rates of total fat oxidation were greater on CHO, but performance was not affected.Conclusion:A lower-carbohydrate recovery beverage consumed after exercise in a “train-low” nutritional protocol does not negatively impact recovery optimization outcomes.

Introduction Preeclampsia (PE) affects 2–8% of pregnancies and is one of the main causes of maternal morbidity and mortality worldwide. Early identification of pregnant women at higher risk for PE would allow the use of interventions to reduce adverse maternal and perinatal outcomes. Objective To assess the ability of bioelectrical impedance analysis (BIA) in pregnancy to predict the development of PE. Methods This prospective cohort involved healthy nulliparas who underwent BIA at 17–20 weekś gestation and were followed until delivery. We used univariate and multivariate logistic regression to assess the ability of BIA measures to predict the occurrence of PE. We used an adjusted regression model to estimate the probability of developing PE, the Hosmer-Lemeshow test to assess the adequacy of the final model, and ROC curves to assess the sensitivity and specificity of different BIA measures in the prediction of PE. Results Twelve (6.1%) of the 196 participants developed PE. In the final multivariate model, the following BIA measures were associated with the occurrence of PE: extracellular water/intracellular water ≤ 0.618, skeletal muscle mass ≥ 25 Kg, and body fat percentage ≥ 44%. The combination of these three measures had a predictive accuracy of 83.7%, a sensitivity of 83.3%, a specificity of 83.7%, and a negative predictive value of 98.7% for PE. Conclusion BIA done on nulliparous women at 17–20 weekś gestation has a good accuracy and high negative predictive value for the risk of developing PE.

Background: Bioelectrical impedance analysis (BIA) is a new and rapid technique to validate body composition. Several studies have used this technique to evaluate body compositions, such as muscle mass, in diabetic patients, but the results are very different. This may due the differences between diabetic patients and control group. Therefore, this study aimed to compare the muscle mass of diabetic patients with healthy matched adults using the BIA method. Methods: This descriptive cross-sectional study was conducted on 928 diabetic patients and 928 healthy individuals selected based on gender, age, height, weight, and closeness to demographic conditions. Body composition was measured by the BIA technique. Total body water, muscle mass in the trunk, legs, hands, and total body protein were measured by this method. The data were analyzed using t-test, paired t-test, and one-way ANOVA methods. Results: Diabetic women aged 50-60 years showed that their body weight, total protein, total muscle, right-hand muscle mass, left-hand muscle mass, right foot muscle mass, left foot muscle mass, and trunk muscle mass were higher than healthy matched women, and the differences were significant. Conclusion: Diabetic women aged 50-60 years showed the most significant difference compared to other age groups. It seems that diabetes along with the changes in humeral status in this age group due to menopause affected their body weight, total muscle mass, hand and leg muscles, and trunk muscles mass, and total body protein compared to healthy matched women. However, diabetic men showed no significant difference in the studied variables compared to healthy male subjects.

This study aimed to investigate the sex differences in short-term weight change and hydration status in judo athletes. Thirty-five men and 15 women judo athletes voluntarily participated in this descriptive and repeated measures design study. Body mass, urine-specific gravity (USG), and body composition of the athletes were measured at the official weigh-in and the competition day's morning. Body mass of the athletes increased during recovery time between official weigh-in and before the competition (time factor; F1-48 = 71.81, p

Aims In this study, we aimed to investigate whether body composition analysis (BCA) derived from bioelectrical impedance vector analysis (BIVA) could be used to monitor the hydration status of patients with acute heart failure (AHF) during intensified diuretic therapy. Methods and results This observational, single‐centre study involved a novel, validated eight‐electrode segmental body composition analyser to perform BCA derived from BIVA with an alternating current of 100 μA at frequencies of 5, 7.5, 50, and 75 kHz. The BCA‐derived and BIVA‐derived parameters were estimated and compared with daily body weight measurements in hospitalized patients with AHF. A total of 867 BCA and BIVA assessments were conducted in 142 patients (56.3% men; age 76.8 ± 10.7 years). Daily changes in total body water (TBW) and extracellular water (ECW) were significantly associated with changes in body weight in 62.2% and 89.1% of all measurements, respectively (range, ±1 kg). Repeated measures correlation coefficients between weight loss and TBW loss resulted with rho 0.43, P 0.01, CI [0.67, 0.75] for ECW loss. Between the first and last assessments, the mean weight loss was −2.5 kg, compared with the −2.6 L mean TBW loss and −1.7 L mean ECW loss. BIVA revealed an increase in mean Resistance R and mean Reactance Xc across all frequencies, with the subsequent reduction in body fluid (including corresponding body weight) between the first and last assessments. Conclusions Body composition analysis derived from BIVA with a focus on ECW is a promising approach to detect changes in hydration status in patients undergoing intensified diuretic therapy. Defining personalized BIVA reference values using bioelectrical impedance devices is a promising approach to monitor hydration status.

Background Few studies have evaluated the prevalence of post‐extubation dysphagia and associated factors in patients with coronavirus disease 2019 (COVID‐19) . Our study assessed the prevalence of post‐extubation dysphagia and body composition in patients with COVID‐19 discharged from an intensive care unit (ICU). Methods A prospective cohort study was performed in post‐ICU extubated patients with acute respiratory distress syndrome related to COVID‐19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (

Background and Purpose: Overnight shifts of fluid from lower to upper compartments exacerbate obstructive sleep apnea (OSA) in some OSA populations. Given the high prevalence of OSA after stroke, decreased mobility and use of IV fluids among hospitalized patients with stroke, and improvement in OSA in the months after stroke, we hypothesized that overnight fluid shifts occur and are associated with OSA among patients with subacute ischemic stroke. Methods: Within a population-based project, we performed overnight sleep apnea tests (ApneaLink Plus) during ischemic stroke hospitalizations. Before sleep that evening, and the following morning before rising from bed, we assessed neck and calf circumference, and leg fluid volume (bioimpedance spectroscopy). The average per subject overnight change in the 3 fluid shift measurements was calculated and compared with zero. Linear regression was used to test the crude association between each of the 3 fluid shift measurements and the respiratory event index (REI). Results: Among the 292 participants, mean REI was 24 (SD=18). Within individuals, calf circumference decreased on average by 0.66 cm (SD=0.75 cm, P P P =0.07). In men, when the overnight change of calf circumference was negative, an interquartile range (0.8 cm) decrease in calf circumference overnight was significantly associated with a 25.1% increase in REI ( P =0.02); the association was not significant in women. The relationship between overnight change in leg fluid volume and REI was U shaped. Conclusions: This population-based, multicenter, cross-sectional study showed that in hospitalized patients with ischemic stroke, nocturnal rostral fluid shifts occurred, and 2 of the 3 measures were associated with greater OSA severity. Interventions that limit overnight fluid shifts should be tested as potential treatments for OSA among patients with subacute ischemic stroke.

Background Although previous studies have made significant contributions to establishing animal traumatic brain injury (TBI) models for simulation of human TBI, the accuracy, controllability, and modeling efficiency of animal TBI models need to be further improved. This study established a novel high-efficiency graded mouse TBI model induced by shock wave. Methods A total of 125 mice were randomly divided into sham, 0.7 mm, 0.6 mm, and 0.5 mm groups according to the depth of the cross groove of the aluminum sheets. The stability and repeatability of apparatus were evaluated, and the integrity of the blood-brain barrier, cerebral edema, neuropathologic immunohistochemistry, apoptosis-related protein, and behavioral tests of neurologic function were used to validate this new model. Results The results showed that 4 mice were injured simultaneously in 1 experiment. They received the same intensity of shock waves. Moreover, the mortality rates caused by 3 different aluminum sheets were consistent with the mortality rates of mild TBI, moderate TBI, and severe TBI. Compared with the sham group, mice in different injured groups significantly increased brain water content, blood-brain barrier permeability, and neuronal apoptosis. And the mice in all injured groups showed poor motor ability, balancing, spatial learning, and memory abilities. Conclusions The novel TBI apparatus has advantages in its small size, simple operation, high repeatability, high efficiency, and graded severity. Our TBI apparatus provides a novel tool to investigate the neuropathologic changes and underlying mechanisms of TBI with various levels of severities.

Traumatic brain injury (TBI) is a major clinical and public health problem with few therapeutic interventions successfully translated to the clinic. Identifying imaging-based biomarkers characterizing injury severity and predicting long-term functional and cognitive outcomes in TBI patients is crucial for treatment. TBI results in white matter (WM) injuries, which can be detected using diffusion tensor imaging (DTI). Trauma-induced pathologies lead to accumulation of free water (FW) in brain tissue, and standard DTI is susceptible to the confounding effects of FW. In this study, we applied FW DTI to estimate free water volume fraction (FW-VF) in patients with moderate-to-severe TBI and demonstrated its association with injury severity and long-term outcomes. DTI scans and neuropsychological assessments were obtained longitudinally at 3, 6, and 12 months post-injury for 34 patients and once in 35 matched healthy controls. We observed significantly elevated FW-VF in 85 of 90 WM regions in patients compared to healthy controls (p

Background: Physical inactivity and muscle wasting potentiate each other and are highly prevalent among hemodialysis (HD) patients. The authors evaluated the association between physical activity (PA), clinical, nutritional, and body composition parameters in HD patients. Methods: Multicenter cross-sectional study with 581 HD patients. Clinical, body composition, dietary intake, and PA data were recorded. For the analysis, patients were divided into active (follow World Health Organization recommendations) and inactive groups. Results: A total of 20% of the patients followed World Health Organization recommendations on PA. Differences between physically active and physically inactive patients were observed in age, biochemical parameters and total body water, intracellular water, lean tissue index (LTI), body cell mass, energy, and protein intake. PA was a predictor of higher LTI, body cell mass, and energy intake independently of age, gender, presence of diabetes, dialysis adequacy, and dialysis vintage. Controlling for the effect of age, walking and vigorous PA were positively correlated with energy and protein intake. Vigorous PA was also positively correlated with LTI. Conclusion: The PA is a predictor of higher LTI, body cell mass, and energy intake. Vigorous PA is associated with an improved body composition and dietary pattern, whereas walking seems to be also associated with a favorable nutritional status.

Objective Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals.Methods Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution.Results TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P

Creatinine is distributed between the intracellular and extracellular compartments, and as a result, the measurement of its concentration is strongly related to the fluid status of the patient. An interest has been shown in correcting measured serum creatinine levels according to the fluid balance in order to better specify the degree of acute kidney injury (AKI).We conducted a retrospective observational study of 33 children, aged 0 to 5 years, admitted to the pediatric intensive care unit for acute respiratory distress syndrome treated by extracorporeal membrane oxygenation. We compared measured and corrected creatinine and assessed the degree of agreement between these values using both Cohen's kappa and Krippendorff's alpha coefficient.In our cohort, 37% of the classifications made according to measured creatinine levels were erroneous and, in the majority of cases, the degree of AKI was underestimated.Correction of the measured creatinine value according to the degree of fluid overload may result in more accurate diagnosis of AKI. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Increased microglial NADPH oxidase (NOX2) production may make an important contribution to the increased incidence and severity of ischemic stroke associated with diabetes. Imidazoline receptors are closely associated with neuroprotection, but the neuroprotective effects of the selective I2-imidazoline receptor ligand 2-(2-benzofuranyl)-2-imidazoline (2BFI) in diabetes has not been established. The effect of 2BFI on microglial NOX2 production was investigated using a co-culture of neurons and microglia, and the effect on cerebral ischemia-reperfusion (IR) injury was determined in diabetic rats. Garcia neurological scores, brain infarct volumes, brain water content, TUNEL staining, blood-brain barrier, and immunofluorescent labeling for microglia were evaluated. Western blots were used to determine gp91phox and Tyr1472 expression. Anti-inflammatory cytokine (IL-10) and inflammatory cytokine secretion was determined using ELISA kits. The brain infarct volumes, TUNEL-positive neurons, expression of microglia, brain water content, blood-brain barrier structure damage, and gp91phox and Tyr1472 expression were increased, the Garcia neurological scores were significantly decreased in the IR group, and 2BFI relieved these alterations. The IL-10 concentration was increased in the IR group; 2BFI significantly improved this increase. The neuron apoptosis and necrosis rates, and production of reactive oxygen species (ROS) and inflammatory cytokines, including IL-6, IL-8, TNF-α, and 8-iso-PGF2α, were significantly increased by high glucose stimulation combined with oxygen-glucose deprivation treatment, which were inhibited by 2BFI. The 2BFI ameliorated cerebral ischemia-reperfusion injury in diabetes and decreased neuron death in an in vitro model. The mechanism underlying these findings may be related to the decreased production of inflammatory factors and reactive oxygen species from microglia.

Summary Background & aims Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60–72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6–8 months old with data collection at 20–24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. Methods We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). Results Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60–72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60–72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60–72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. Conclusion In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition. Trial registration Clinical Trials (clinical trials.gov) ClinicalTrials.gov ID NCT 02098031.

Introduction: Isolated ultrafiltration (IUF) is an alternative treatment for diuretic-resistant patients with fluid retention. Although hemodialysis (HD) predominantly decreases extracellular water (ECW), the impact of IUF on fluid distribution compared with HD remains unclear. Methods: We compared the effect of HD (n = 22) and IUF (n = 10) sessions on the body fluid status using a bioimpedance analysis device (InBody S10). Results: The total ultrafiltration volume was similar between HD and IUF (HD 2.5 ± 0.3 vs. ICF 2.1 ± 0.3 L/session, p = 0.196). The reduction rate of ECW was significantly higher than that of intracellular water (ICW) after HD (ECW −7.9% ± 0.8% vs. ICW −3.0% ± 0.9%, p < 0.001) and IUF (ECW −5.8% ± 0.9% vs. ICW -3.6% ± 0.8%, p = 0.048). However, the change in the ratio of ECW to total body water in HD was significantly larger than that in IUF (HD −3.2% ± 0.3% vs. ICF −1.1% ± 0.4%, p < 0.001). The reduction rates in serum tonicity (effective osmolality) were higher after HD than after IUF (HD −1.8% ± 0.5% vs. IUF −0.6% ± 0.2%, p = 0.052). Among the components of effective osmolality, the reduction rates of serum K+ and glucose levels after HD were significantly higher than those after IUF (serum K+: HD −30.5% ± 1.6% vs. IUF −0.5% ± 3.8%, p < 0.001; serum glucose: HD −15.4% ± 5.0% vs. IUF 0.7% ± 4.8%, p = 0.026), while the serum Na+ level was slightly and similarly reduced (HD −0.8% ± 0.4% vs. IUF −0.8% ± 0.4%, p = 0.500). The reduction in the osmolal gap value (measured osmolality–calculated osmolarity) was significantly greater after HD sessions than after IUF sessions (HD −12.4 ± 1.4 vs. IUF 2.0 ± 1.0 mOsm/kg, p = 0.001). Conclusion: The extracellular fluid reduction effect of HD is stronger than that of IUF. The different changes in effective osmolality and osmolal gap after HD and IUF sessions may be related to the different effects of HD and IUF on fluid distribution.

Background Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60‐day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID‐19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan‐Meier curves. Results Sixty‐seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60‐day mortality. PhA

The beneficial effects of high-intensity interval training (HIIT) and chlorella vulgaris (CV) on body composition and mitochondrial biogenesis have been shown in some mechanistic studies. This study aimed to determine the effects of CV and/or HIIT on mitochondrial biogenesis, performance and body composition among overweight/obese women. There was a significant reduction in the fat mass (FM) of the CV + HIIT group, as compared with the placebo group (P = 0·005). A marginal significant increase in body water (P = 0·050) and PPAR-γ coactivator-1α (P = 0·050) was also found only in the CV + HIIT group, as compared with the placebo. Relative (P < 0·001) and absolute (P < 0·001) VO2max, as well as Bruce MET (P < 0·001), were significantly increased in the HIIT and HIIT + CV groups. Besides, the synergistic effect of CV and HIIT on the Bruce MET increment was found (interaction P-value = 0·029). No significant changes were observed in BMI, fat-free mass, visceral fat, silent information regulator 1 and fibroblast growth factor-21. In this randomised clinical trial, forty-six overweight/obese women were assigned to four groups including CV + HIIT and HIIT + placebo groups that received three capsules of CV (300 mg capsules, three times a day) or corn starch, in combination with three sessions/week of HIIT. CV and placebo groups only received 900 mg of CV or corn starch, daily, for 8 weeks. Biochemical assessments, performance assessment and body composition were obtained at the beginning and end of the intervention. HIIT may be, therefore, effective in improving mitochondrial biogenesis, performance and body composition in overweight/obese women.

Branched-chain amino acids (BCAA) are considered markers of insulin resistance (IR) in subjects with obesity. In this study, we evaluated whether the presence of the SNP of the branched-chain aminotransferase 2 (BCAT2) gene can modify the effect of a dietary intervention (DI) on the plasma concentration of BCAA in subjects with obesity and IR. A prospective cohort study of adult subjects with obesity, BMI ≥ 30 kg/m2, homeostatic model assessment-insulin resistance (HOMA-IR ≥ 2·5) no diagnosed chronic disease, underwent a DI with an energy restriction of 3140 kJ/d and nutritional education for 1 month. Anthropometric measurements, body composition, blood pressure, resting energy expenditure, oral glucose tolerance test results, serum biochemical parameters and the plasma amino acid profile were evaluated before and after the DI. SNP were assessed by the TaqMan SNP genotyping assay. A total of eighty-two subjects were included, and fifteen subjects with a BCAT2 SNP had a greater reduction in leucine, isoleucine, valine and the sum of BCAA. Those subjects also had a greater reduction in skeletal muscle mass, fat-free mass, total body water, blood pressure, muscle strength and biochemical parameters after 1 month of the DI and adjusting for age and sex. This study demonstrated that the presence of the BCAT2 SNP promotes a greater reduction in plasma BCAA concentration after adjusting for age and sex, in subjects with obesity and IR after a 1-month energy-restricted DI.

Aims Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study. Methods We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL−R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital. Results In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL−R; with RYGB and SG both BMI and FM slightly increased in the years 3–5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL−R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered. Conclusions All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3–5, while BPD and BPD + LCL−R showed a slight further decreases in the same time interval.

Background : A poor intrauterine environment is associated with increased risks of hypertension, chronic kidney disease, and/or diabetes. This study evaluated relationships between birth weight and body habitus in a representative sample of the general population. Methods : Adult participants were asked to complete a birth weight questionnaire. Associations between various current anthropometric and body composition measurements and birth weight were investigated. Results : Of 7,157 respondents, 4,502 reported their birth weight, which ranged from 0.4 to 7.0 kg with a mean and standard deviation of 3.37±0.7 kg; of these, 384 had low birth weights (LBWs

OBJECTIVE 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. DESIGN Prospective, cohort study. SETTING Tertiary university hospital. PARTICIPANTS Patients undergoing cardiac surgery procedures. INTERVENTIONS 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. RESULTS 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. CONCLUSIONS 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.

Disorders of fluid balance and electrolyte homeostasis are commonly observed in critically ill patients and in those who require emergency anaesthesia. Consequently, anaesthetists and intensive care physicians must understand the physiological principles that govern fluid balance. This article discusses the compartmentalization of total body water and describes methods by which the volume of the fluid compartments may be measured. The novel concept of the endothelial glycocalyx is discussed in addition to the conventional and contemporary models of capillary filtration dynamics. The core elements of fluid balance and cardiovascular homeostasis are also explored.

Background and aims Increased capillary filtration may paradoxically accelerate vascular refill of both fluid and albumin from the interstitial space, which is claimed to be edema-preventing. We characterized this proposed mechanism, called “interstitial washdown”, by kinetic analyses of the hemodilution induced by intravenous infusion of crystalloid fluid during 3 distinct physiological states. Methods Greater plasma dilution of hemoglobin as compared to albumin during fluid therapy indicated recruitment of albumin, which was compared to the flow of interstitial fluid to the plasma as indicated by population volume kinetic analysis. Data for the comparison were derived from 24 infusions of crystalloid fluid in conscious volunteers, 30 in anesthetized patients, and 31 in patients with ketoacidosis from hyperglycemia. Results “Interstitial washdown” increased the plasma albumin concentration by between 0.3 and 1.0 g/L in the three series of infusions. The initial albumin concentration in the interstitial fluid returning to the plasma was estimated to between 22 g/L and 29 g/L, which decreased to an average of 50–75% lower during the subsequent 2–3 h. Kinetic simulations show that pronounced washdown was associated with increased capillary filtration (high k12) and, in conscious subjects, with greater plasma and interstitial volume expansion and restricted urine flow. During anesthesia, the main effect was an increase in the non-exchangeable fluid volume (“third-spacing”). Conclusions Crystalloid fluid accelerates lymphatic flow that moderately increases plasma albumin, but more clearly helps to maintain the intravascular volume. This “interstitial washdown” mechanism becomes exhausted after a few hours.

Background Fasting prior to anesthesia is considered aspiration prophylaxis. However, prolonged food and drink restrictions may increase the risk of other complications. The aim of this study was to assess whether a carbohydrate-enriched drink (Nutricia™ preOp®), recommended by the enhanced recovery after surgery (ERAS) protocol, can improve body hydration in fasting healthy individuals. Methods Measurements were done with the bioelectric impedance analysis with a Fresenius body composition monitor. Body composition, total body water, water distribution, and hemodynamic parameters were measured at the beginning of the study and after 10 h and 12 h of fasting. Patients fasted for 10 h and then were divided into two groups: the control (n = 40) and the pre-op group (n = 41). The pre-op group received 400 mL of Nutricia™ preOp®, as suggested in the ERAS guidance. The two-tailed Student’s t test was used to compare two groups with normally distributed data and homogenous variances; if variances were heterogeneous, Welch’s test was used. The Mann-Whitney U test was used to compare two groups with non-normal data distribution. p Results We found no significant differences between the control and pre-op groups regarding body water distribution and body composition. We did not observe significant losses in the total body water after fasting. Also, blood pressure was not affected by fasting. Conclusion We have proven that pre-op did not impact either body composition or body water. Trial registration ClinicalTrials.gov, NCT04665349. Registered on 11 December 2020—retrospectively registered.

Background Cortisol is a steroid hormone acting as a stress hormone, which is crucial in regulating homeostasis. Previous studies have linked cortisol concentration to body mass and body composition. Methods The investigations were carried out in 2016–2017. A total of 176 children aged 6–13 years in primary schools in central Poland were investigated. Three types of measurements were performed: anthropometric (body weight and height, waist and hip circumferences), body composition (fat mass FM (%), muscle mass – MM (%), body cellular mass - BCM (%), total body water - TBW (%)), and cortisol concentration using saliva of the investigated individuals. Information about standard of living, type of feeding after birth, parental education and maternal trauma during pregnancy was obtained with questionnaires. Results The results of regression models after removing the environmental factors (parental education, standard of living, type of feeding after birth, and maternal trauma during pregnancy) indicate a statistically significant association between the cortisol concentration and fat mass and muscle mass. The cortisol concentration was negatively associated with FM (%) (Beta=-0.171; p = 0.026), explaining 2.32 % of the fat mass variability and positively associated with MM (%) (Beta = 0.192; p = 0.012) explaining 3.09 % of the muscle mass variability. Conclusions Cortisol concentration affects fat and muscle mass among Polish children. Trial registration The Ethical Commission at the University of Lodz (nr 19/KBBN-UŁ/II/2016).

Objective Hydration status after cardiac surgery can be difficult to assess, often requiring invasive measurements. Bioelectrical impedance vector analysis (BIVA) is based on patterns of resistance (R) and reactance (Xc), corrected by height, and has been used in various clinical scenarios to determine body composition and monitor its changes over time. The purpose of the present study was to apply this method in cardiac surgery patients to assess the variation in hydration status and to compare its changes according to the use of extracorporeal circulation. Design Single-center, observational, prospective study including patients older than 18 years undergoing elective or urgent cardiac surgery. Setting Intensive cardiac care unit of a tertiary center in a metropolitan area. Participants The study comprised 76 patients with a median age of 60 years and mostly undergoing coronary artery bypass grafting (CABG) (n = 47 [61.8%]) with extracorporeal circulation (n = 54 [73%]). Interventions Bioimpedance was measured with a standard tetrapolar single-frequency bioimpedance meter using a standardized procedure and plotted in an R–Xc graph. Measurements and Main Results The study demonstrated an increase in total body water immediately after surgery that was sustained until producing hyperhydration 24 hours later. Off-pump CABG was associated with a normal hydration status after surgery, whereas on-pump CABG produced a significant increase in total body water. Conclusions Fluid status assessment with BIVA in cardiac surgery showed an increase in total body water up to 24 hours after surgery. Off-pump surgery prevented overhydration, which partially could explain the reduction in some of the postoperative complications. BIVA could serve as a useful method for monitoring fluid status in the setting of goal-directed therapy to assist in maintaining euvolemia in cardiac surgical patients.

Introduction Maintaining flexibility, often defined as range of motion (ROM), is important. Recently, self-massage using a foam roller (FR) has been used in clinical and/or sports settings to effectively and immediately improve ROM. Many studies have found significant increases in ROM following the FR intervention; however, the mechanism of the effect is unclear. We aimed to clarify this mechanism regarding the ROM effects following the FR intervention by evaluating local tissue and autonomic nervous system responses. Method The study employed a crossover design that included a comparison between non-intervention (CON trial: left leg) and intervention (FR trial: right leg) groups. Fourteen volunteers participated. Nine outcomes (passive maximum ankle ROM [ROM with a specified and non-specified passive strength], tissue hardness, skin temperature, water contents, circumference, blood flow velocity, pressure pain threshold, autonomic nervous system, and heart rate) were investigated before (PRE) and 0 min (POST0), 20 min (POST20), 40 min (POST40), and 60 min (POST60) post intervention. Results Skin temperature, impedance, and circumference changed significantly following the intervention, and increased ROM with non-specified strength was observed. Discussion Although we found that the FR intervention influenced skin temperature, impedance, circumference, and ROM, adaptability to the intervention may differ depending on an individual's characteristics. Females and/or individuals with a high body water content could obtain greater positive ROM effects than males and/or individuals with a low body water content. Conclusion These findings suggest that the FR intervention may be an effective method to improve ROM, with alterations of skin temperature, impedance, and circumference.

Objectives Brain white matter (WM) microstructural changes evaluated by diffusion MRI are well documented in patients with SLE. Yet, the conventional diffusion tensor imaging technique fails to differentiate WM changes that originate from tissue alterations from those due to increased extracellular free water (FW) related to neuroinflammation, microvascular disruption, atrophy, or other extracellular processes. Here, we sought to delineate changes in WM tissue microstructure and extracellular FW volume and examine their relationships with neurocognitive function in SLE patients. Methods Twenty SLE patients [16 females, aged 36.0 (10.6)] without clinically overt neuropsychiatric manifestation and 61 healthy controls (HCs) [29 females, aged 29.2 (9.4)] underwent diffusion MRI and computerized neuropsychological assessments cross-sectionally. The FW imaging method was applied to compare microstructural tissue changes and extracellular FW volume of the brain WM between SLE patients and HCs. Association between extracellular FW changes and neurocognitive performance was studied. Results SLE patients had higher WM extracellular FW compared with HCs (family-wise-error-corrected P Conclusion The association between WM extracellular FW increases and reduced neurocognitive performance suggest possible microvascular degradation and/or neuroinflammation in SLE patients with clinically inactive disease. The mechanistic impact of cumulative glucocorticoids on WM FW deserves further evaluation.

The dialysis disequilibrium syndrome (DDS) results from osmotic shifts between the blood and the brain compartments. Patients at risk for DDS include those with very elevated blood urea nitrogen, concomitant hypernatremia, metabolic acidosis, and low total body water volumes. By understanding the underlying pathophysiology and applying urea kinetic modeling, it is possible to avoid the occurrence of this disorder. A urea reduction ratio (URR) of no more than 40%-45% over 2 h is recommended for the initial hemodialysis treatment. The relationship between the URR and Kt/V is useful when trying to model the dialysis treatment to a specific URR target. A simplified relationship between Kt/V and URR is provided by the equation: Kt/V = -ln (1 - URR). A URR of 40% is roughly equivalent to a Kt/V of 0.5. The required dialyzer urea clearance to achieve this goal URR in a 120-min treatment can simply be calculated by dividing half the patient's volume of distribution of urea by 120. The blood flow rate and dialyzer mass transfer coefficient (K0 A) required to achieve this clearance can then be plotted on a nomogram. Other methods to reduce the risk of DDS are reviewed, including the use of continuous renal replacement therapy.

There is an increasing need for suitable tools to evaluate body composition in paediatrics. The Body Composition Monitor (BCM) shows promise as a method, but reference values in children are lacking. Twenty children were included and measured twice by 4 different raters to asses inter- and intra-rater reproducibility of the BCM. Reliability was assessed using the Bland-Altman method and by calculating intraclass correlation coefficients (ICCs). The intra-rater ICCs were high (≥ 0.97) for all parameters measured by BCM as were the inter-rater ICCs for all parameters (≥ 0.98) except for overhydration (0.76). Consequently, a study was set up in which BCM measurements were performed in 2058 healthy children aged 3–18.5 years. The age- and gender-specific percentile values and reference curves for body composition (BMI, waist circumference, fat mass and lean tissue mass) and fluid status (extracellular and intracellular water and total body water) relative to age were produced using the GAMLSS method for growth curves.Conclusion: A high reproducibility of BCM measurements was found for fat mass, lean tissue mass, extracellular water and total body water. Reference values for these BCM parameters were calculated in over 2000 children and adolescents aged 3 to 18 years. What is Known• The 4-compartment model is regarded as the ‘gold standard’ of body composition methods, but is inappropriate for regular follow-up or screening of large groups, because of associated limitations. • Body Composition Monitor® is an inexpensive field method that has the potential to be an adequate monitoring tool.What is New• Good reproducibility of BCM measurements in children provides evidence to use the device in longitudinal follow-up, multicentre and comparative studies.• Paediatric reference values relative to age and sex for the various compartments of the body are provided.

Summary Background & aims The accuracy of estimating body composition compartments is critical in the clinical setting. Currently, there are different bioelectrical impedance analysis (BIA) devices available for obtaining raw BIA parameters. The aim of this study was to determine the level of agreement between multiple frequency (MF)-BIA and single frequency (SF)-BIA devices in obtaining raw BIA measurements (resistance (R), reactance (Xc), and phase angle (PhA)), as well as the agreement on the classification of hydration status and body cell mass by the bioelectrical impedance vector analysis (BIVA) method. Methods This cross-sectional study included 406 outpatients with stable chronic heart failure (HF). The raw BIA measurements at 50 kHz obtained by tetrapolar MF-BIA (Bodystat QuadScan 4000) were compared with those obtained by tetrapolar SF-BIA (RJL Quantum X). In addition, the patients were classified by their hydration status and body cell mass according to the BIVA method. Results Strong and significant correlations were observed between the two methods in all raw BIA variables (r ≥ 0.90). Lin's concordance correlation coefficient (CCC) values were almost perfect for R (CCC = 0.99; 95% CI 0.997 to 0.998), moderate for Xc (CCC = 0.93; 95% CI 0.92 to 0.94), and poor for PhA (CCC = 0.88; 95% CI 0.85 to 0.90). The agreement obtained in the two classifications (quadrants and hydration status) was >0.81. Conclusions MF-BIA and SF-BIA demonstrated good agreement for measurement of the R parameter; however, the Xc and PhA parameters must be used carefully due to the previously reported variability. Likewise, the agreement in all classifications by the BIVA method was almost perfect.

Summary Background & aims The complex nature of pancreatic operation makes it a high-risk and technically demanding major abdominal procedure, resulting in early pathophysiological alterations. This study aims to observe changes in body composition, muscle function and biochemical values in patients during the early postoperative days (PODs) following pancreaticoduodenectomy or total pancreatectomy. Methods Assessment of body composition by bioimpedance spectroscopy, muscle function by peak expiratory flow rate (PEFR) and maximum handgrip strength (HGS), and biochemical values were measured in patients the day before surgery and on PODs 3, 6 and 9. Results Significant changes occurred among 34 patients on POD 3 in body weight +2.3 (0.8–3.6) kg, total body water +2.8 (1.1–5.9) L, extracellular water +2.5 (1.2–3.7) L, intracellular water +1.1 (−0.4–1.9) L, phase angle −1.0 (−1.2 to −0.7)°, PEFR −250.0 (−407.5 to −125.0) L/m and HGS −4.8 (−7.3 to −3.0) kg, C-reactive protein +78.0 (41.0–102.8) mg/L, haemoglobin −34.5 (−45.8 to −26.0) g/L, albumin −12 (−16.5 to −10.0) g/L. Conclusions Changes in water distribution, phase angle, initial reduced muscle function and altered biochemical values were observed during the first 9 PODs.

Objective To investigate the ability of phase angle (PA) and body composition for predicting protein energy wasting (PEW) in renal replacement therapy (RRT) patients. Methods Renal replacement therapy (RRT) patients were enrolled in this study. Body composition was measured by direct segmental multi‐frequency biolectrical impedance analysis method (DSM‐BIA); phase angle (PA), fat‐free mass (FFM), fat mass (FM), mid‐arm circumference (MAC), WC (waist circumference), and ECW/TBW (extracellular water/total body water) were obtained. Biochemicals (serum albumin, triglyceride, and cholesterol) were tested. PEW patients were classified according to ISRNM (The International Society of Renal Nutrition and Metabolism) criteria. Cutoff value of PA and related variables was calculated by ROC analysis. The ability of body composition variables as indicators to predict PEW was evaluated. Results Sixty‐four patients were enrolled in this study. Thirty‐three patients (52.6%) were males, and forty (62.5%) patients were diagnosed with PEW. The ROC curve showed that the optimal cutoff values of PA, FFMI (fat‐free mass index), MAC, WC, and BMI for PEW risk were 4.45°, 16.71, 29.7 cm, 86.4 cm, and 21.1 kg/m2, respectively. These indicators showed significant association with PEW; meanwhile, the PA and MAC can be used as the predictors for PEW with OR 6.333 (95% CI, 1.956–20.505) and 3.267 (95% CI, 1.136–9.394), respectively. Both groups have a lower BUN/Cr ratio (, Protein energy wasting is prevalence in chronic kidney disease (CKD) patients on renal replacement therapy by the International Society of Renal Nutrition and Metabolism. Phase angle and mid‐arm circumference can be used as the independent and reliable indicators for the noninvasive predicting of protein energy wasting and evaluating nutrition status in CKD patients.

Background: Why is bodyweight not a predictor of lung function, while height, sex, race, and age are predictors of lung capacity and function? In this study, we want to investigate the association between body composition and pulmonary function. And, as much as possible, answer the question of why bodyweight is not predictive of lung function. Methods: This cross-sectional study was performed among 2967 employees of Tehran University of Medical Sciences (TUMS) who participated in the TUMS Employees Cohort (TEC) study. The body composition of the participants was measured using the Bioelectrical Impedance Analysis (BIA) method. Anthropometric variables were also measured as a confounder. The pulmonary function of participants was assessed by a forced spirometry test. Results: The correlation of BIA values including fat-free mass and total body water with a pulmonary function such as FEV1, FVC, and FEF25-75is higher than most anthropometric values such as weight, wrist circumference, and the waist to hip ratio. Also, in regression analysis, age and sex had an association with pulmonary function, but the weight did not show a significant relationship. On the other hand, fat-free mass and visceral fat were significantly associated with pulmonary function. One is direct and the other is inverse. Conclusion: We observed a negative association between visceral fat and pulmonary function tests and a direct association between Fat-free mass pulmonary function tests (FEV1 and FVC) adjusted for age, sex, and anthropometric indices.

Introduction: Serum cancer antigen 125(SeCA125) has been reported to be increased in patients with heart failure and correlate with both extracellular water (ECW) overload and poor prognosis. Ultrafiltration failure and ECW overload are a major cause of peritoneal dialysis (PD) technique failure. We wished to determine whether SeCA125 could also be a marker of volume status in PD patients. Methods: We contemporaneously measured SeCA125, serum N terminal brain natriuretic peptide (NTproBNP) and ECW by bioimpedance in adult PD patients attending for outpatient assessment of peritoneal membrane function. Results: The median SeCA125 was 19 (12–33) U/mL in 489 PD patients, 61.3% male, median age 61.5 (interquartile range 50–75) years. SeCA125 was positively associated with the ratio of ECW/total body water (TBW) ( r = 0.29, p Conclusion: Heart failure studies have reported SeCA125 is a marker of ECW overload. Our retrospective analysis suggests that SeCA125 is also associated with ECW volume in PD patients. Further studies are required to determine whether serial measurements of SeCA125 trend with changes in ECW status in PD patients and can be used to aid volume assessments.

The objectives of the study were to quantitatively evaluate leg edema in patients undergoing endovenous radiofrequency ablation (RFA) for saphenous varicose veins using bioelectrical impedance analysis (BIA) and to elucidate the time course of leg edema after RFA.The data of 87 patients with 128 limbs undergoing RFA for saphenous varicose veins in Eniwa Midorino Clinic from April 2018 to November 2019 were retrospectively analyzed. Saphenous vein reflux was evaluated by duplex scan. Extracellular water/total body water ratio (ECW/TBW) of the leg was measured by BIA. Moderate to severe leg edema (ECW/TBW ≥ 0.400) was defined as significant leg edema. Venous reflux was evaluated as a venous filling index (VFI) using air plethysmography.BIA revealed that 26 legs (20.3%) had significant edema and 102 legs (79.7%) did not before RFA. The proportion of patients with significant leg edema increased significantly from preoperative to 1 week after RFA (P 0.05) and decreased 1 month after RFA (P 0.01). The ECW/TBW increased significantly from preoperative (0.393 ± 0.008) to 1 week after RFA (0.394 ± 0.008, P 0.05), whereas it decreased significantly before or 1 week to 1 month after RFA (0.391 ± 0.008, P 0.05). There was a significant, moderate correlation between the decrease of the VFI and that of ECW/TBW (r = 0.34, P 0.001).This is the first study to quantitatively elucidate the time course of leg edema after RFA. Leg edema worsens one week after RFA, but it is improved one month after RFA, compared with that preoperatively.

Background Increasing number of peritoneal dialysis (PD) patients are reported to have increased left ventricular hypertrophy (LVH), a major risk factor for cardiovascular mortality. We wished to determine which factors were most associated with changes in left ventricular mass index (LVMI). Methods We reviewed patient and treatment factors in prevalent PD patients with repeat echocardiograms 18 to 24 months apart, with corresponding bioimpedance measurements of extracellular water (ECW) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP). Results We studied 60 patients (34 males, 35 with diabetes) who were treated with PD for a median of 14 months (2.5-26.3 months). All but one had LVH; on repeat echocardiography, there was no overall change in LVMI (106 [84-127] g/m2 vs. 108 [91-122] g/m2) despite a loss of residual renal function. Left ventricular mass increased in 34 (56.7%), and the percent change in LVMI was associated with percent change in NT-proBNP (r = 0.51, p = 0.017) and ECW/height (r = 0.32, p = 0.029), but not with ECW/total body water or changes in systolic or mean arterial pressure, urine output, 24-hour PD ultrafiltration, or net sodium balance. Only ECW/height remained independently associated with the percent change in LVMI in a multivariable model (odds ratio, 1.25; 95% confidence interval, 1.08-1.36; p = 0.007). Conclusion In this observational longitudinal report, a reduction in ECW/height was associated with regression of LVMI, whereas an increased ECW/height was associated with increased LVMI. As there was no corresponding association with systolic or mean arterial pressure, then volume expansion would appear to be a more significant factor in determining LVH than blood pressure.

BackgroundTotal body water (TBW) is one component of fat-free mass and changes in TBW are influenced by fluid shifts (especially during transition to postnatal life), electrolyte balance and nutritional status. Normal values for term-born neonates and preterm infants at birth have not been defined in large cohorts, limiting investigation into its monitoring and use in clinical practice.ObjectiveTo systematically review the evidence base for percentage of TBW in term-born infants, quantify the effect of prematurity on TBW at birth, and describe normal progression of TBW over time in preterm infants.MethodsSystematic review of Medline, Web of Science Core Collection and EBSCO-CINAHL (January 1946 to January 2020). Included articles used dilutional methods to assess TBW.ResultsSearches identified 2349 articles of which 22 included data suitable for analysis. Mean TBW in term-born newborns was 73.8% (95% CI 72.47% to 75.06%, 15 studies, 433 infants). Meta-regression showed that TBW was higher in preterm infants (up to 90% at 26 weeks gestation, dropping to 75% at 36 weeks corrected gestation) and was negatively correlated with gestation at birth, falling 1.44% per week (95% CI 0.63% to 2.24%, 9 studies, 179 infants). Analysis of TBW over time during the ex utero growth of preterm infants was not possible due to paucity of data.ConclusionThis review defines the normal TBW percentage in term-born infants and confirms and quantifies previous findings that preterm infants have a higher TBW percentage.

Background Cardiac bypass surgery patients have early postoperative interventions that elicit breakthrough pain. We evaluated the use of intranasal fentanyl for breakthrough pain management in these patients. Methods Multimodal analgesia (paracetamol 1 g three times a day, oxycodone 2–3 mg boluses with a patient-controlled intravenous pump) was used in 16 patients (age 49–70 years, weight 59–129 kg) after cardiac bypass surgery. Intranasal fentanyl 100 µg or 200 µg was used to manage breakthrough pain on the first and third postoperative mornings in a randomised order. Blood samples were collected for up to 3 h after fentanyl administration, pain was assessed with a numeric rating scale of 0–10. Plasma fentanyl concentration was assayed using liquid chromatography-mass spectrometry. Body composition was measured with a bioelectrical impedance device. Results Bioavailability of intranasal fentanyl was high (77%), absorption half-time short (< 2 min) and an analgesic plasma concentration ≥ 0.5 ng/mL was achieved in 31 of 32 administrations. Fentanyl exposure correlated inversely with skeletal muscle mass and total body water. Fentanyl analgesia was effective both on the first postoperative morning with chest pleural tube removal and during physiotherapy on the third postoperative morning. The median time of subsequent oxycodone administration was 1.1 h after intranasal fentanyl 100 µg and 2.1 h after intranasal fentanyl 200 µg, despite similar oxycodone concentrations (median 13.8, range 5.2–35 ng/mL) in both fentanyl dose groups. Conclusions Intranasal fentanyl 100 µg provided rapid-onset analgesia within 10 min and is an appropriate starting dose for incidental breakthrough pain in the first 3 postoperative days after cardiac bypass surgery. Clinical Trial Registration EudraCT Number: 2018-001280-22. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01002-4.

The human body is made up principally of water, two-thirds of which is intracellular and one-third extracellular. Dissolved in body water are a variety of mineral and organic salts and proteins. These components are quantified in millimoles and are electrochemically balanced in each compartment. The relative quantities of each cation and anion are different in each compartment. Fluid motion through the body is determined by hydrostatic, osmotic and oncotic forces. The rate of extravasation is determined by the Starling equation. In perioperative medicine and critical care, temporal fluid shifts occur based on the stress response. Fluid management, in terms of volume and tonicity, should follow this response. Tissue oedema, particularly in the lungs, results from excess intravascular fluid or high venous pressures (hydrostatic pulmonary oedema) or damage to the capillary endothelium (capillary leak).

Purpose:The influence of female sex hormones on body fluid regulation and metabolism homeostasis has been widely studied. However, it remains unclear whether hormone fluctuations throughout the menstrual cycle (MC) and with oral contraceptive (OC) use affect body composition (BC). Thus, the aim of this study was to investigate BC over the MC and OC cycle in well-trained females.Methods:A total of 52 eumenorrheic and 33 monophasic OC-taking well-trained females participated in this study. Several BC variables were measured through bioelectrical impedance analysis 3 times in the eumenorrheic group (early follicular phase, late follicular phase, and midluteal phase) and on 2 occasions in the OC group (withdrawal phase and active pill phase).Results:Mixed linear model tests reported no significant differences in the BC variables (body weight, body mass index, basal metabolism, fat mass, fat-free mass, and total body water) between the MC phases or between the OC phases (P > .05 for all comparisons). Trivial and small effect sizes were found for all BC variables when comparing the MC phases in eumenorrheic females, as well as for the OC cycle phases.Conclusions:According to the results, sex hormone fluctuations throughout the menstrual and OC cycle do not influence BC variables measured by bioelectrical impedance in well-trained females. Therefore, it seems that bioimpedance analysis can be conducted at any moment of the cycle, both for eumenorrheic women and women using OC.

Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in AHF's pathogenesis, which is also a predictor of mortality and rehospitalization in patients with AHF. Aim: Knowing the effect of adding a %Total body w ater (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019, with research subjects taken consecutively against all AHF patients hospitalized at UD dr.UD dr. Saiful Anwar Malang. The data taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination, then the outside seen is mortality rate and rehospitalization due to AHF within 90 days after exiting the hospital. Results : This study involved 65 subjects who were 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW predischarge than the survivor group. Based on statistical analysis, we found that NT-proBNP is a good predictor of mortality (HI: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly , %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW predischarge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00). Conclusion: The addition of predischarge %TBW examination detected by bioimpedance analysis tool against NT-proBNP increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of acute heart failure patients. Keywords: acute heart failure, NT-proBNP, bioimpedance analysis, total body water

Background The study objective was to examine if age and chronic environmental exposure affect the water content and the composition of the natural moisturizing factors (NMFs) of the stratum corneum (SC). Methods Forty healthy Caucasian women 18-70 years of age were recruited. Measurements were done on the cheek and on two skin sites on the arm (one relatively protected and one exposed to environmental factors). SC water content and NMF composition were measured by Raman confocal microspectroscopy. Results The SC water content was gradually reduced with age, reaching statistically significant levels only on the exposed arm site. The SC water content remained higher on the face than on the two arm sites throughout the ages tested. The age-dependent concentration changes of various amino acids were species-specific, potentially indicating different protein sources. Interestingly, on the arm sites, the sum of decreasing amino acid concentrations is compensated by the sum of those increasing, resulting in constant total amino acid content. However, on the face, the total amino acid content statistically increased with age potentially relating to the declining cell turnover rates. The lactate content was higher on the face for all ages and statistically decreased on both arm sites. Conclusion Both chronological aging and chronic exposure to environmental factors mildly affect SC hydration, while they have variable effects in the concentrations of NMF components. The dynamics of NMF composition may at least partially explain the age-related changes in SC hydration.