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Purpose: The aims of this study were to explore the differences in total body water and hydration status among Chinese children aged 6–17 years. Methods: A cross-sectional study was implemented among children aged 6–17 years in China. The total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were determined by bioelectrical impedance analysis (BIA). The participants were divided according to age—age 6–8 years, age 9–11 years, age 12–14 years, age 15–17 years—and body mass index (BMI) of China—underweight, normal weight, overweight, and obese groups. The differences of variables of groups were compared using analysis of variance, Student's t-test, and Kruskal–Wallis test. Significance levels were set at 0.05 (p < 0.05). Results: A total of 59,643 participants (30,103 males and 29,540 females) completed the study. As children became older, the TBW, ICW, ECW, ICW/TBW, and TBW/FFM (TBW to fat free mass ratio) increased simultaneously (all p < 0.05); concurrently, the ECW/TBW decreased with age (all p < 0.05). Boys had higher TBW, ICW, ECW, ICW/TBW, TBW/BW, and TBW/FFM than those of girls at each age (all p < 0.05). For all BMI groups, increases in TBW, ICW, ECW were observed from the underweight group to the obese group, both in boys and girls (all p < 0.001). For the increase in BMI in all age groups, the values of TBW made a significantly lower percentage compared to BW. The higher BMI groups showed higher levels of TBW/FFM, both in girls and boys (all p < 0.001). Conclusions: The body water contents of children aged 6–17 years varied according to their age, sex, and BMI. Overweight and obese individuals may have inferior hydration status compared to those with normal weight. [ABSTRACT FROM AUTHOR]

Abstract Aims A high extracellular water (ECW) to intracellular water (ICW) ratio of skeletal muscle as assessed by bioelectrical impedance analysis is reportedly associated with loss of muscle strength. However, the validity of this index for heart failure (HF), which is likely associated with changes in the water distribution, is unclear. Methods and results This study involved 190 patients with HF. The total ECW and ICW of both upper and lower extremities were measured, and a high ECW/ICW ratio was defined as an ECW/ICW ratio higher than the median (≥0.636 for men, ≥0.652 for women). Low muscle strength was defined as reduced handgrip strength according to the criteria established by the Asian Working Group for Sarcopenia. Patients with a high ECW/ICW ratio had a lower handgrip strength (21.1 ± 8.1 kg vs. 27.6 ± 9.3 kg, P ≤ 0.05) and 6 min walk distance (329 ± 116 m vs. 440 ± 114 m) than those with a low ECW/ICW ratio. An increasing ECW and/or decreasing ICW was associated with a higher ECW/ICW ratio and a lower handgrip strength (P

Aims: A high extracellular water (ECW) to intracellular water (ICW) ratio of skeletal muscle as assessed by bioelectrical impedance analysis is reportedly associated with loss of muscle strength. However, the validity of this index for heart failure (HF), which is likely associated with changes in the water distribution, is unclear. Methods and results: This study involved 190 patients with HF. The total ECW and ICW of both upper and lower extremities were measured, and a high ECW/ICW ratio was defined as an ECW/ICW ratio higher than the median (≥0.636 for men, ≥0.652 for women). Low muscle strength was defined as reduced handgrip strength according to the criteria established by the Asian Working Group for Sarcopenia. Patients with a high ECW/ICW ratio had a lower handgrip strength (21.1 ± 8.1 kg vs. 27.6 ± 9.3 kg, P ≤ 0.05) and 6 min walk distance (329 ± 116 m vs. 440 ± 114 m) than those with a low ECW/ICW ratio. An increasing ECW and/or decreasing ICW was associated with a higher ECW/ICW ratio and a lower handgrip strength (P < 0.05). In the multivariate logistic regression analysis, a high ECW/ICW ratio and low skeletal muscle mass were independently associated with low muscle strength (P < 0.05). Conclusions: A high ECW/ICW ratio in limb muscles, that is, the water imbalance of increasing ECW and/or decreasing ICW, is useful in assessing muscle quality in patients with HF. [ABSTRACT FROM AUTHOR]

Introduction: Chronic heart failure (HF) represents a major global public health problem, and despite significant advances in diagnosis and management over the past two decades, HF patients still have a poor prognosis. The aim of the study was to evaluate the relationship between lung congestion, as assessed by lung ultrasonography (LUS), bioimpedance spectroscopy, body fluid compartments, and echocardiographic parameters, and to determine the effect of these associations on all-cause mortality in HF patients. Material and methods: Eligible patients with a left ventricular ejection fraction (LVEF) below 45% were identified via daily echocardiography assessments. Lung ultrasonography was performed with patients in the supine position, for a total of 28 sites per complete examination. The extracellular water (ECW) was determined using a BIS device. Results: Our study included 122 patients (67.2% males) with a mean age of 67.2 years. In the multivariable linear regression analysis, including all the univariable predictors of lung congestion, only New York Heart Association (NYHA) class, ECW, estimated glomerular filtration rate (eGFR), and LVEF levels maintained an independent association with the number of B-lines. During the follow-up, 33 patients died. In multivariable Cox analysis, a B-line number of at least 15 remained significantly associated with all-cause mortality, independently of age, sex, diabetes, LVEF, estimated glomerular filtration rate, C-reactive protein, N-terminal pro-brain natriuretic peptide, or ECW values (adjusted HR = 3.84, 95% CI: 1.12-13.09). Conclusions: We show for the first time in HF patients that pulmonary congestion, as assessed by LUS, is associated with the severity of NYHA class, LVEF, eGFR, and ECW, and it identifies those at increased risk of death. [ABSTRACT FROM AUTHOR]

Introduction: Hemodialysis patient groups have advocated reducing dialysis fatigue and symptoms. We investigated whether compartmental fluid shifts were associated with peri‐dialytic fatigue and symptoms. Methods: Sessional dialysis records of patients reporting both a short and delayed recovery (<1 h and ≥1 h) with corresponding bioimpedance measurements were reviewed. Results: One hundred and twenty‐four patients reported both short and delayed recovery times, mean age 66.0 ± 14.8 years, 66.1% male. Differences between sessions included higher distress thermometer [4 (1–6) vs. 3 (0–5)], fatigue [4 (0–9) vs. 2 (0–7)], total symptom scores [20.5 (12.3–34.5) vs. 16 (7–28)], change in extracellular water to total body water ratios between body compartments [right leg/left arm 2.36 (1.23–4.19) vs. 1.28 (0.12–2.01), all p < 0.01] with delayed recovery, and more hemodialysis than hemodiafiltration sessions (χ2 4.6, p = 0.02). Conclusion: Sessions with prolonged recovery times were associated with more peri‐dialytic symptoms, psychological distress, and hemodialysis mode, and greater changes in compartmental fluid shifts. [ABSTRACT FROM AUTHOR]

Abstract Background Our aim was to develop and evaluate a method for the measurement of muscle mass during the 12‐channel electrocardiogram (ECG), to determine the incidence of sarcopenia in patients with overhydration and to correct it for congestion. Methods A 12‐channel ECG that simultaneously provided multifrequency segmental impedance data was used to measure total body water (TBW), extracellular water (ECW), ECW/TBW ratio and appendicular muscle mass (AppMM), validated by whole‐body dual‐energy X‐ray absorptiometry. The mean ECW/TBW ratio was 0.24 ± 0.018 (SD) and 0.25 ± 0.016 for young (age range 20–25 years) healthy males (n = 77) and females (n = 88), respectively. The deviation of the ECW/TBW ratio from this mean was used to correct AppMM for excess ECW (‘dry AppMM’) in 869 healthy controls and in 765 patients with chronic heart failure (CHF) New York Heart Association classes II–IV. The association of AppMM and dry AppMM with grip strength was also examined in 443 controls and patients. Results With increasing N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), a continuous decline of AppMM indices is observed, which is more pronounced for dry AppMM indices (for males with NT‐proBNP 1000 pg/mL: AppMM index mean = 7.6 ± 0.98, AppMM index dry mean = 6.2 ± 1.11 [n = 137, P 1000 pg/mL: AppMM index mean = 5.9 ± 0.96, AppMM index dry mean = 4.8 ± 0.94 [n = 109, P

We previously reported that sodium–glucose cotransporter 2 (SGLT2) inhibitors exert sustained fluid homeostatic actions through compensatory increases in osmotic diuresis-induced vasopressin secretion and fluid intake. However, SGLT2 inhibitors alone do not produce durable amelioration of fluid retention. In this study, we examined the comparative effects of the SGLT2 inhibitor dapagliflozin (SGLT2i group, n = 53) and the combined use of dapagliflozin and conventional diuretics, including loop diuretics and/or thiazides (SGLT2i + diuretic group, n = 23), on serum copeptin, a stable, sensitive, and simple surrogate marker of vasopressin release and body fluid status. After six months of treatment, the change in copeptin was significantly lower in the SGLT2i + diuretic group than in the SGLT2i group (−1.4 ± 31.5% vs. 31.5 ± 56.3%, p = 0.0153). The change in the estimated plasma volume calculated using the Strauss formula was not significantly different between the two groups. Contrastingly, changes in interstitial fluid, extracellular water, intracellular water, and total body water were significantly lower in the SGLT2i + diuretic group than in the SGLT2i group. Changes in renin, aldosterone, and absolute epinephrine levels were not significantly different between the two groups. In conclusion, the combined use of the SGLT2 inhibitor dapagliflozin and conventional diuretics inhibited the increase in copeptin levels and remarkably ameliorated fluid retention without excessively reducing plasma volume and activating the renin–angiotensin–aldosterone and sympathetic nervous systems. [ABSTRACT FROM AUTHOR]

Abstract Background Total body water (TBW) fraction, which accounts for 60% of body weight, is an important indicator of body composition, and the extracellular water to TBW ratio (ECW/TBW) is reportedly useful in predicting clinical outcomes of patients with organ disorders. We aimed to clarify the clinical impact of preoperative ECW/TBW status on survival outcomes in cancer patients. Methods We used a database of 320 colorectal cancer (CRC) patients who underwent potentially curative resections. Preoperative ECW/TBW was measured using a bioelectrical impedance analysis (BIA), and its correlation with patient survival outcomes, clinicopathological factors, laboratory data, and comorbidities were analyzed. Results A high preoperative ECW/TBW was significantly associated with poorer relapse‐free survival (RFS; p = 0.001) and overall survival (OS; p = 0.003). A high ECW/TBW ratio was significantly associated with older age (p

BackgroundHigh sodium intake and fluid overhydration are common factors of and strongly associated with adverse outcomes in chronic kidney disease (CKD) patients. Yet, their effects on cardiac dysfunction remain unclear.AimsThe study aimed to explore the impact of salt and volume overload on cardiac alterations in non-dialysis CKD.MethodsIn all, 409 patients with CKD stages 1–4 (G1–G4) were enrolled. Daily salt intake (DSI) was estimated by 24-h urinary sodium excretion. Volume status was evaluated by the ratio of extracellular water (ECW) to total body water (TBW) measured by body composition monitor. Recruited patients were categorized into four groups according to DSI (6 g/day) and median ECW/TBW (0.439). Echocardiographic and body composition parameters and clinical indicators were compared. Associations between echocardiographic findings and basic characteristics were performed by Spearman’s correlations. Univariate and multivariate binary logistic regression analysis were used to determine the associations between DSI and ECW/TBW in the study groups and the incidence of left ventricular hypertrophy (LVH) and elevated left ventricular filling pressure (ELVFP). In addition, the subgroup effects of DSI and ECW/TBW on cardiac abnormalities were estimated using Cox regression.ResultsOf the enrolled patients with CKD, the median urinary protein was 0.94 (0.28–3.14) g/d and estimated glomerular filtration rate (eGFR) was 92.05 (IQR: 64.52–110.99) mL/min/1.73 m2. The distributions of CKD stages G1–G4 in the four groups was significantly different (p = 0.020). Furthermore, compared to group 1 (low DSI and low ECW/TBW), group 4 (high DSI and high ECW/TBW) showed a 2.396-fold (95%CI: 1.171–4.902; p = 0.017) excess risk of LVH and/or ELVFP incidence after adjusting for important CKD and cardiovascular disease risk factors. Moreover, combined with eGFR, DSI and ECW/TBW could identify patients with higher cardiac dysfunction risk estimates with an AUC of 0.704 (sensitivity: 75.2%, specificity: 61.0%). The specificity increased to 85.7% in those with nephrotic proteinuria (AUC = 0.713). The magnitude of these associations was consistent across subgroups analyses.ConclusionThe combination of high DSI (>6 g/d) and high ECW/TBW (>0.439) independently predicted a greater risk of LVH or ELVFP incidence in non-dialysis CKD patients. Moreover, the inclusion of eGFR and proteinuria improved the risk stratification ability of DSI and ECW/TBW in cardiac impairments in CKD.

Objective: To compare bioelectrical impedance analysis (BIA)-derived parameters in healthy volunteers and critically ill patients and to assess its prognostic value in an ICU patient cohort. Design: Retrospective, observational data analysis. Setting: Single centre, tertiary-level ICU (Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg Hospital). Patients: 101 patients and 101 healthy subjects, participants of International Fluid Academy Days. Measurements and main results: Compared to healthy volunteers, both male and female ICU patients had significantly higher values for total body water (TBW), extracellular water (ECW), extracellular fluid (ECF), plasma, and interstitial fluid volumes. The phase angle was significantly lower and the malnutrition index was significantly higher in ICU patients, regardless of gender. Non-survivors in the ICU had significantly higher extracellular water content (ECW, 50.7 ± 5.1 vs. 48.9 ± 4.3%, p = 0.047) and accordingly significantly lower intracellular water (ICW, 49.2 ± 5.1 vs. 51.1 ± 4.3%, p = 0.047). The malnutrition index was also significantly higher in non-survivors compared to survivors (0.94 ± 0.17 vs. 0.87 ± 0.16, p = 0.048), as was the capillary leak index (ECW/ICW). Conclusions: Compared to healthy volunteers, this study observed a higher malnutrition index and TBW in ICU patients with an accumulation of fluids in the extracellular compartment. ICU non-survivors showed similar results, indicating that ICU patients and a fortiori non-survivors are generally overhydrated, with increased TBW and ECW, and more undernourished, as indicated by a higher malnutrition index. [ABSTRACT FROM AUTHOR]

Background: Total body water (TBW) fraction, which accounts for 60% of body weight, is an important indicator of body composition, and the extracellular water to TBW ratio (ECW/TBW) is reportedly useful in predicting clinical outcomes of patients with organ disorders. We aimed to clarify the clinical impact of preoperative ECW/TBW status on survival outcomes in cancer patients. Methods: We used a database of 320 colorectal cancer (CRC) patients who underwent potentially curative resections. Preoperative ECW/TBW was measured using a bioelectrical impedance analysis (BIA), and its correlation with patient survival outcomes, clinicopathological factors, laboratory data, and comorbidities were analyzed. Results: A high preoperative ECW/TBW was significantly associated with poorer relapse‐free survival (RFS; p = 0.001) and overall survival (OS; p = 0.003). A high ECW/TBW ratio was significantly associated with older age (p < 0.001), low BMI (p = 0.009), and right‐sided tumors (p = 0.03). In a multivariate analysis, a high ECW/TBW significantly predicted a higher RFS mortality (HR: 2.07, 95% CI: 1.10–3.88, p = 0.024) and OS mortality (HR: 3.23, 95% CI: 1.25–8.36, p = 0.016). Furthermore, a high ECW/TBW was significantly associated with lower hemoglobin (p < 0.001) and albumin levels (p < 0.001), but not comorbidities. Conclusions: A high preoperative ECW/TBW was a predictive factor for recurrence and poorer overall survival independent of the tumor, node, and metastasis (TNM) stage. Our data suggest that preoperative evaluation of ECW/TBW using BIA might serve as a novel tool for developing CRC treatment strategies. [ABSTRACT FROM AUTHOR]

The need for a practical method for routine determination of body fat has progressed from body mass index (BMI) to bioelectrical impedance analysis (BIA) and smartphone two-dimensional imaging. We determined agreement in fat mass (FM) estimated with 50 kHz BIA and smartphone single lateral standing digital image (SLSDI) compared to dual X-ray absorptiometry (DXA) in 188 healthy adults (69 females and 119 males). BIA underestimated (p < 0.0001) FM, whereas SLSDI FM estimates were not different from DXA values. Based on limited observations that BIA overestimated fat-free mass (FFM) in obese adults, we tested the hypothesis that expansion of the extracellular water (ECW), expressed as ECW to intracellular water (ECW/ICW), results in underestimation of BIA-dependent FM. Using a general criterion of BMI > 25 kg/m2, 54 male rugby players, compared to 40 male non-rugby players, had greater (p < 0.001) BMI and FFM but less (p < 0.001) FM and ECW/ICW. BIA underestimated (p < 0.001) FM in the non-rugby men, but SLSDI and DXA FM estimates were not different in both groups. This finding is consistent with the expansion of ECW in individuals with excess body fat due to increased adipose tissue mass and its water content. Unlike SLSDI, 50 kHz BIA predictions of FM are affected by an increased ECW/ICW associated with greater adipose tissue. These findings demonstrate the validity, practicality, and convenience of smartphone SLSDI to estimate FM, seemingly not influenced by variable hydration states, for healthcare providers in clinical and field settings. [ABSTRACT FROM AUTHOR]

Fat-free mass (FFM) is a heterogeneous compartment comprising body cell mass (BCM), intracellular water (ICW), extracellular solids, and extracellular water (ECW). The BCM/FFM and ECW/ICW ratios vary among individuals and decrease with age. This study aimed to determine whether BCM/FFM and ECW/ICW ratios are predictors of maximal oxygen uptake (V̇̇O2peak) independently of age, sex, and objectively measured physical activity (PA). A total of 115 Japanese males and females, aged 55.3 ± 8.0 years (mean ± standard deviation), were included in the study. Anthropometry, explosive leg muscle power, and V̇̇O2peak were measured, and BCM, FFM, ICW, and ECW were estimated. Step count and PA were objectively measured using a triaxial accelerometer. Blood flow volume was assessed using ultrasonography. BCM and ICW were negatively correlated with age, whereas FFM and ECW were not significantly correlated with age. FFM, ICW/ECW, BCM/FFM, step counts, moderate and vigorous PA, and leg muscle power were positively correlated with V̇̇O2peak, even after adjusting for age and sex (p <.05). Multiple regression analysis indicated that either BCM/FFM or ECW/ICW, leg power, and objectively measured PA were associated with V̇̇O2peak independent of age, sex, and FFM. Blood flow volume was significantly correlated with ECW (p <.05), but not with BCM. The BCM/FFM and ECW/ICW ratios were significant predictors of V̇̇O2peak, independent of age, sex, FFM, leg power, and objectively measured PA. [ABSTRACT FROM AUTHOR]

Aim:Coronavirus disease-2019 (COVID-19) pneumonia is characterized by a clinical picture showing similar features in severe patients. Some studies evaluate the pathophysiology, prognosis, and treatment of COVID-19 pneumonia. Different laboratory tests have been used to assess the severity and prognosis of rigorously ill COVID-19 patients in addition to clinical and radiological findings. There is no precise indicator for predicting prognosis. We aimed to analyze disease severity by using extracellular water (ECW) measurements.Methods:Extracellular water values and cardiac parameters as cardiac output (CO), and stroke volume (SV) measurements of patients were performed using a non-invasive, easy-to-use, validated device non-invasive cardiac system (NICaS) within the first 2 h after admission. Hemodynamic parameters and ECW values were measured by connecting the NICaS device to make 12 measurements for 2 h at 5 min intervals during admission to service and intensive care patients.Results:Comparing the ward and intensive care groups, there was not any statistically significant difference found between demographic data and ECW, SV, and CO measurements.Conclusion:Although we could not find a statistically significant difference between our measurements, we believe that the NICaS device can play a significant role in the fluid treatment of COVID-19 patients.

Xin Wang,1,2 Qianqian Liang,1,2 Zheng Li,1– 4 Fengsen Li1– 4 1Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China; 2Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Urumqi, Xinjiang, People’s Republic of China; 3Xinjiang Key Laboratory of Respiratory Disease Research, Urumqi, Xinjiang, People’s Republic of China; 4Xinjiang Clinical Medical Research Center of Respiratory Obstructive Diseases, Urumqi, Xinjiang, People’s Republic of ChinaCorrespondence: Zheng Li; Fengsen Li, Tel +86-13999297797 ; +86-13999980996, Email peterli1129@hotmail.com; fengsen602@163.comAbstract: The proportion of obese or overweight patients in COPD patients is increasing. Although BMI, WC and other easy to measure indicators have been proven to be related to the risk of COPD, they cannot accurately reflect the distribution and changes of body composition, ignoring the body composition (such as fat distribution, muscle content, water content, etc.), the relationship between it and disease risk may be missed. By analyzing the correlation between different body composition indexes and COPD patients, we can provide new research ideas for the prognosis judgment or intervention of COPD disease.Keywords: obesity, COPD, body composition, BMI, waist circumference, waist-to-hip ratio, body fat rate, visceral fat, FFMI, extracellular water, intracellular water, phase angle

Background and Objectives: Extracellular water is increased in patients with edema, such as those with chronic heart failure, and it is difficult to assess skeletal muscle mass with the skeletal muscle mass index when extracellular water is high. We investigated the relationship between phase angle and physical function, nutritional indices, and sarcopenia in patients with cardiovascular diseases, including chronic heart failure. Methods and Study Design: In 590 patients with cardiovascular diseases (372 men), handgrip strength, gait speed, and anterior midthigh muscle thickness by ultrasound were measured, and the skeletal muscle mass index, phase angle, and the extracellular water: total body water ratio were measured with a bioelectrical impedance analyzer, and presence of sarcopenia was evaluated. Results: Phase angle, but not the skeletal muscle mass index, was correlated with serum albumin (r = 0.377, p < 0.001) and hemoglobin values in women. Multivariate regression analysis showed that at the extracellular water: total body water ratio below 0.4, both phase angle and skeletal muscle mass index were independent determinants of handgrip strength and log mid-thigh muscle thickness in men, after adjustment for age and presence of chronic heart failure. In contrast, for the ratio of 0.4 or greater, after adjustment for age and presence of chronic heart failure, phase angle was a stronger independent determinant of handgrip strength and log mid-thigh muscle thickness than the skeletal muscle mass index in men. Conclusions: Phase angle is a good marker of muscle wasting and malnutrition in patients with cardiovascular disease, including chronic heart failure. [ABSTRACT FROM AUTHOR]

Patients undergoing dialysis through a permanent catheter often experience infection or malfunction. However, few studies have clarified the predictors of permanent catheter patency survival in patients undergoing hemodialysis. We assessed the relationship between the parameters of body composition monitoring (BCM), determined before the initiation of dialysis, and the patency survival of the permanent catheters inserted in 179 patients who commenced hemodialysis between 14 January 2020 and 31 August 2021. The relationships between permanent catheter patency at 6 weeks and BCM parameters, laboratory tests, age, sex, comorbidities, and medications at baseline were studied using Kaplan–Meier survival curves. Permanent catheter patency was observed to be superior at high extracellular-to-intracellular (ECW/ICW) ratio (p < 0.005). After adjustment for covariates, the ECW/ICW ratio remained an independent factor associated with permanent catheter patency survival. When patients with non-patent catheters were subdivided into infection and malfunction groups, and the associations of BCM parameters were evaluated in those groups, the ECW/ICW ratio was not significantly associated with permanent catheter patency survival in the infection group (p = 0.327); instead, a significant association was found for the lean tissue index (p < 0.001). In the malfunction group, the ECW/ICW ratio remained significantly associated with permanent catheter patency survival (p < 0.001). [ABSTRACT FROM AUTHOR]

We aimed to compare fluid status as determined by multifrequency bioimpedance spectroscopy (MF-BIS, Xitron 4200, USA) with that determined by the isotope dilution method among a contemporary Chinese cohort. Healthy Chinese subjects (HS, n = 30) were recruited in Zhengzhou. Hemodialysis (HD, n = 49) and peritoneal dialysis (PD, n = 48) patients were screened at the First Affiliated Hospital of Zhengzhou University. Total body water (TBW) and extracellular water (ECW) were measured by deuterium (TBWD) and bromide (ECWBr) dilution, respectively, and by MF-BIS using the Moissl equation (ME). The results of MF-BIS were compared to the reference method by Pearson analysis and Bland–Altman analysis in the three groups. The accuracy of overhydration as determined by MF-BIS was analyzed by receiver operating characteristic (ROC) curves. The TBWD and TBWME values were 34.67 ± 7.31 and 35.41 ± 5.76 L, 37.30 ± 8.58 and 37.02 ± 8.10 L, and 38.61 ± 10.02 and 38.44 ± 7.59 L in the HS, HD and PD groups, respectively. The ECWBr and ECWME values were 14.88 ± 3.33 and 15.53 ± 2.39 L, 16.24 ± 5.08 and 16.90 ± 3.93 L, and 19.08 ± 6.41 and 18.23 ± 3.61 L in the HS, HD and PD groups, respectively. The mean bias between TBWD and TBWME was −0.74 L, 0.28 L, and 0.17 L in the HS, HD and PD groups, respectively. The mean bias between ECWBr and ECWME was −0.65 L, −0.66 L, and 0.85 L in the HS, HD and PD groups, respectively. Compared to the ECWBr/TBWD ratio, the area under the ROC curve (AUC) of the ECWME/TBWME ratio for the diagnosis of overhydration was 0.76 and 0.68 in the HD and PD groups, respectively. In summary, MF-BIS with ME could be used in Chinese HD and PD patients.

A thorough knowledge of body composition assessment techniques is the cornerstone for initiating a customized nutritional program. The second step is to consider the potential of their application in different physiological and pathological conditions and their effectiveness in the management of a monitoring pathway during dietary interventions. To date, bioimpedance analysis is the most effective and reliable method for assessing body composition due to its advantages in terms of speed of execution, non-invasiveness and low cost. Therefore, this review article aims to analyze the main concepts and application areas of bioimpedance measurement techniques, in particular vector frequency-based analysis (BIVA) systems, in order to assess their validity in both physiological and pathological conditions. [ABSTRACT FROM AUTHOR]

Bioelectrical impedance analysis (BIA) has proven to be particularly useful due to its inexpensive and rapid assessment of total body water and body density. However, recent fluid intake may confound BIA results since equilibration of fluid between intra- and extracellular spaces may take several hours and furthermore, ingested fluids may not be fully absorbed. Therefore, we aimed to evaluate the impact of different fluid compositions on the BIA. A total of eighteen healthy individuals (10 females, mean ± SD age of 23.1 ± 1.8 years) performed a baseline measurement of body composition before they consumed isotonic 0.9% sodium-chloride (ISO), 5% glucose (GLU) or Ringer (RIN) solutions. During the visit of the control arm (CON), no fluid was consumed. Further impedance analyses were conducted every 10 min after the fluid consumption for 120 min. We found statistically significant interactions between the effects of solution ingestion and time for intra- (ICW, p < 0.01) and extracellular water (ECW, p < 0.0001), skeletal muscle mass (SMM, p < 0.001) and body fat mass (FM, p < 0.01), respectively. Simple main effects analysis showed that time had a statistically significant effect on changes in ICW (p < 0.01), ECW (p < 0.01), SMM (p < 0.01) and FM (p < 0.01), while fluid intake did not have a significant effect. Our results highlight the importance of a standardized pre-measurement nutrition, with particular attention to hydration status when using a BIA for the evaluation of body composition. [ABSTRACT FROM AUTHOR]

Abstract Background Body water measured by bioelectrical impedance analysis (BIA) predicts the outcomes of many diseases. This study aimed to evaluate the relationship between body water and the prognosis of cancer patients with sarcopenia. Methods This study employed 287 cancer patients with sarcopenia underwent BIA from a prospective multicenter study of patients with cancer in China from 2013 to 2020. The primary outcome of interest was all-cause mortality presented as the longest time to follow-up available. Eight indicators of body water [total body water, extracellular water, intracellular water, free fat mass, active cell mass, extracellular water/intracellular water, extracellular water/total body water (ECW/TBW), and intracellular water/total body water] were included in the research. Neutrophil–lymphocyte ratio (NLR) = neutrophil (× 109)/lymphocyte (× 109). The discriminatory ability and prediction accuracy of each factor were assessed using the C-index. The hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. Results The median age was 65 years old, and 138 (48%) patients were men. During a mean follow-up of 46 months, 140 deaths were recorded, resulting in a rate of 204.6 events per 1000 patient-years. ECW/TBW showed the best predictive accuracy (C-index = 0.619) compared to the other indicators [p = 0.004, adjusted HR (95% CI) 1.70 (1.18,2.44)]. In the middle tertile (0.385–0.405), ECW/TBW had a strong independent negative association with patient survival [adjusted HR (95% CI) 2.88 (1.39–5.97), p = 0.004]. Patients who had a high ECW/TBW (ECW/TBW ≥ 0.395) combined with a high NLR had 3.84-fold risk of mortality (p

Objective: This report aimed to examine changes in constituents of body composition that correlate to cardiovascular morbidity and mortality in patients with acromegaly using bioelectrical impedance analysis (BIA). Materials and Methods: This prospective study included 62 patients who were followed up after their acromegaly diagnosis and 40 healthy volunteers. All patients' body compositions were evaluated using a body composition analyzer (TANITA MC-780-Black) with the BIA method. The laboratory and anthropometric measurements and body composition parameters were compared between the patients with acromegaly and the controls. Moreover, these parameters were examined according to the disease activity. Results: This study showed that patients with acromegaly have higher plasma glucose levels than the control group (p=0.001). The homeostasis model assessment-insulin resistance index of patients with acromegaly was significantly higher than that of the controls (p=0.02). The compartments of intracellular water (ICW) and extracellular water (ECW) in the patients with acromegaly were larger than that in the controls (respectively; p=0.02 and p=0.001). The lean mass of the patients with acromegaly in the trunk and extremities was significantly higher than the controls (respectively; p=0.002 and p=0.001). The compartment of muscle was significantly larger than that in the controls (p=0.001). The basal metabolism in patients with acromegaly was significantly higher than that in the controls (p=0.002). Conclusion: Determining the body composition using the BIA method can provide important information about the cardiovascular risks in patients with acromegaly. With the BIA method, cardiovascular risk can be estimated and reduced with effective strategies. [ABSTRACT FROM AUTHOR]

Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

Aim: Coronavirus disease-2019 (COVID-19) pneumonia is characterized by a clinical picture showing similar features in severe patients. Some studies evaluate the pathophysiology, prognosis, and treatment of COVID-19 pneumonia. Different laboratory tests have been used to assess the severity and prognosis of rigorously ill COVID-19 patients in addition to clinical and radiological findings. There is no precise indicator for predicting prognosis. We aimed to analyze disease severity by using extracellular water (ECW) measurements. Methods: Extracellular water values and cardiac parameters as cardiac output (CO), and stroke volume (SV) measurements of patients were performed using a non-invasive, easy-to-use, validated device non-invasive cardiac system (NICaS) within the first 2 h after admission. Hemodynamic parameters and ECW values were measured by connecting the NICaS device to make 12 measurements for 2 h at 5 min intervals during admission to service and intensive care patients. Results: Comparing the ward and intensive care groups, there was not any statistically significant difference found between demographic data and ECW, SV, and CO measurements. Conclusion: Although we could not find a statistically significant difference between our measurements, we believe that the NICaS device can play a significant role in the fluid treatment of COVID-19 patients. [ABSTRACT FROM AUTHOR]

We aimed to compare fluid status as determined by multifrequency bioimpedance spectroscopy (MF-BIS, Xitron 4200, USA) with that determined by the isotope dilution method among a contemporary Chinese cohort. Healthy Chinese subjects (HS, n = 30) were recruited in Zhengzhou. Hemodialysis (HD, n = 49) and peritoneal dialysis (PD, n = 48) patients were screened at the First Affiliated Hospital of Zhengzhou University. Total body water (TBW) and extracellular water (ECW) were measured by deuterium (TBWD) and bromide (ECWBr) dilution, respectively, and by MF-BIS using the Moissl equation (ME). The results of MF-BIS were compared to the reference method by Pearson analysis and Bland–Altman analysis in the three groups. The accuracy of overhydration as determined by MF-BIS was analyzed by receiver operating characteristic (ROC) curves. The TBWD and TBWME values were 34.67 ± 7.31 and 35.41 ± 5.76 L, 37.30 ± 8.58 and 37.02 ± 8.10 L, and 38.61 ± 10.02 and 38.44 ± 7.59 L in the HS, HD and PD groups, respectively. The ECWBr and ECWME values were 14.88 ± 3.33 and 15.53 ± 2.39 L, 16.24 ± 5.08 and 16.90 ± 3.93 L, and 19.08 ± 6.41 and 18.23 ± 3.61 L in the HS, HD and PD groups, respectively. The mean bias between TBWD and TBWME was −0.74 L, 0.28 L, and 0.17 L in the HS, HD and PD groups, respectively. The mean bias between ECWBr and ECWME was −0.65 L, −0.66 L, and 0.85 L in the HS, HD and PD groups, respectively. Compared to the ECWBr/TBWD ratio, the area under the ROC curve (AUC) of the ECWME/TBWME ratio for the diagnosis of overhydration was 0.76 and 0.68 in the HD and PD groups, respectively. In summary, MF-BIS with ME could be used in Chinese HD and PD patients. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9–89.3) vs. 73.7% (73.2–82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59–0.75) vs. 0.54 (0.48–0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459–6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664–3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906–10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375–2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care. [ABSTRACT FROM AUTHOR]

Abstract Background Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms. Methods We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW). Results We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times. We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times. Conclusion We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.

This study was designed to identify the fluid spaces that are most changed during ultrafiltration (UF) according to intradialytic blood pressure (BP) difference. BP data were collected five times (before hemodialysis [HD] and 1–4 h of HD). Intradialytic BP difference was calculated as the highest minus lowest of these BP measurements. Intradialytic systolic BP (SBP) difference over 20 mm Hg and diastolic BP (DBP) difference over 10 mm Hg were defined as wide intradialytic SBP difference (SYS-W) and DBP difference (DIA-W), respectively. We measured the various fluid spaces before HD and 1–4 h of HD, and 30 min after HD using a portable, whole-body bioimpedance spectroscopy (BIS). In this study, 85 prevalent patients aged over 18 years with a fixed dry weight (65.38 ± 12.45 years, 54.18% men, 52.50% patients with diabetes), undergoing HD had participated. 1) Mean relative reduction of extracellular water (ECW) was significantly higher in SYS-W than in narrow intradialytic SBP difference (SYS-N) patients from 1 h to 30 min after HD. 2) Mean relative reduction of intracellular water (ICW) was significantly lower in DIA-W than in narrow intradialytic DBP difference (DIA-N) patients from 1 h to 30 min after HD. 3) ECW of patients with SYS-W was significantly lower than that of patients with SYS-N. Patients with SYS-W have the characteristics of fluid shifts in which reduction of ECW was steeper than patients with SYS-N whereas fluid shifts of ICW were lower in patients with DIA-W than patients with DIA-N.

Background: Body water measured by bioelectrical impedance analysis (BIA) predicts the outcomes of many diseases. This study aimed to evaluate the relationship between body water and the prognosis of cancer patients with sarcopenia. Methods: This study employed 287 cancer patients with sarcopenia underwent BIA from a prospective multicenter study of patients with cancer in China from 2013 to 2020. The primary outcome of interest was all-cause mortality presented as the longest time to follow-up available. Eight indicators of body water [total body water, extracellular water, intracellular water, free fat mass, active cell mass, extracellular water/intracellular water, extracellular water/total body water (ECW/TBW), and intracellular water/total body water] were included in the research. Neutrophil–lymphocyte ratio (NLR) = neutrophil (× 109)/lymphocyte (× 109). The discriminatory ability and prediction accuracy of each factor were assessed using the C-index. The hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. Results: The median age was 65 years old, and 138 (48%) patients were men. During a mean follow-up of 46 months, 140 deaths were recorded, resulting in a rate of 204.6 events per 1000 patient-years. ECW/TBW showed the best predictive accuracy (C-index = 0.619) compared to the other indicators [p = 0.004, adjusted HR (95% CI) 1.70 (1.18,2.44)]. In the middle tertile (0.385–0.405), ECW/TBW had a strong independent negative association with patient survival [adjusted HR (95% CI) 2.88 (1.39–5.97), p = 0.004]. Patients who had a high ECW/TBW (ECW/TBW ≥ 0.395) combined with a high NLR had 3.84-fold risk of mortality (p < 0.001, 95% CI 1.99,7.38). Conclusions: ECW/TBW was better than other indicators in predicting survival of cancer patients with sarcopenia. High ECW/TBW combined with high NLR would further increase the risk of mortality. Trial registration: The Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) (Chinese Clinical Trial Registry: ChiCTR1800020329, URL of registration: http://www.chictr.org.cn/showprojen.aspx?proj=31813). [ABSTRACT FROM AUTHOR]

Observational hemodialysis (HD) studies report an association between hyponatremia and increased mortality. As volume overload is also associated with mortality, we wished to determine whether hyponatremia is linked to increased extracellular water (ECW). We measured ECW, total body water (TBW) and body composition predialysis with multifrequency bioimpedance, arm strength with pinch gauge and hand grip strength (PS, HGS), standard biochemistry profiles, comorbidity and clinical frailty scores (CFS). We reviewed 324 patients, 195 (60.2%) male, mean age 62.3 ± 15.6 years. Thirty‐eight (11.7%) patients were hyponatremic (sodium ≤135 mmol/L), ECW/height2 was not different, but ECW/TBW (0.409 ± 0.016 vs. 0.402 ± 0.016, p < 0.01), C reactive protein (CRP) (9(4–6) vs. 5(2–12) g/L, p < 0.05), CFS (5(4–6) vs. 4(3–6), p < 0.05) were higher in hyponatremic patients, whereas appendicular lean mass index (8.6 ± 1.7 vs. 9.4 ± 1.8 kg/m2, p < 0.01), serum albumin (36.3 ± 5.5 vs. 38.8 ± 5.0 g/L, p < 0.01) and PS (3.7(2.7–4.7) vs. 4.7 (3.2–6.5) kg, p < 0.05)) were lower. Both serum sodium, and serum sodium after adjustment for glucose were associated with serum creatinine (β 4.26, (95% confidence limits [CL] 1.9–6.7), β 3.98 (CL 1.6–6.4), both p = 0.001, respectively) and negatively with CRP (β −0.76, [CL] ‐1.5 to −0.5), β −0.72 (CL −1.44 to −0.12), p = 0.036, p = 0.046, respectively) in a multivariable model. Hyponatremic HD patients did not simply have an increased ECW, as the increased ECW/TBW and ECW/ICW ratios were more likely secondary to loss of muscle mass and strength, associated with increased CRP and reduced albumin, suggesting that hyponatremia is associated with inflammation, loss of muscle mass and increasing frailty. [ABSTRACT FROM AUTHOR]

Bioelectrical impedance analysis (BIA) has proven to be particularly useful due to its inexpensive and rapid assessment of total body water and body density. However, recent fluid intake may confound BIA results since equilibration of fluid between intra- and extracellular spaces may take several hours and furthermore, ingested fluids may not be fully absorbed. Therefore, we aimed to evaluate the impact of different fluid compositions on the BIA. A total of eighteen healthy individuals (10 females, mean ± SD age of 23.1 ± 1.8 years) performed a baseline measurement of body composition before they consumed isotonic 0.9% sodium-chloride (ISO), 5% glucose (GLU) or Ringer (RIN) solutions. During the visit of the control arm (CON), no fluid was consumed. Further impedance analyses were conducted every 10 min after the fluid consumption for 120 min. We found statistically significant interactions between the effects of solution ingestion and time for intra- (ICW, p < 0.01) and extracellular water (ECW, p < 0.0001), skeletal muscle mass (SMM, p < 0.001) and body fat mass (FM, p < 0.01), respectively. Simple main effects analysis showed that time had a statistically significant effect on changes in ICW (p < 0.01), ECW (p < 0.01), SMM (p < 0.01) and FM (p < 0.01), while fluid intake did not have a significant effect. Our results highlight the importance of a standardized pre-measurement nutrition, with particular attention to hydration status when using a BIA for the evaluation of body composition.

This study was designed to identify the fluid spaces that are most changed during ultrafiltration (UF) according to intradialytic blood pressure (BP) difference. BP data were collected five times (before hemodialysis [HD] and 1–4 h of HD). Intradialytic BP difference was calculated as the highest minus lowest of these BP measurements. Intradialytic systolic BP (SBP) difference over 20 mm Hg and diastolic BP (DBP) difference over 10 mm Hg were defined as wide intradialytic SBP difference (SYS-W) and DBP difference (DIA-W), respectively. We measured the various fluid spaces before HD and 1–4 h of HD, and 30 min after HD using a portable, whole-body bioimpedance spectroscopy (BIS). In this study, 85 prevalent patients aged over 18 years with a fixed dry weight (65.38 ± 12.45 years, 54.18% men, 52.50% patients with diabetes), undergoing HD had participated. 1) Mean relative reduction of extracellular water (ECW) was significantly higher in SYS-W than in narrow intradialytic SBP difference (SYS-N) patients from 1 h to 30 min after HD. 2) Mean relative reduction of intracellular water (ICW) was significantly lower in DIA-W than in narrow intradialytic DBP difference (DIA-N) patients from 1 h to 30 min after HD. 3) ECW of patients with SYS-W was significantly lower than that of patients with SYS-N. Patients with SYS-W have the characteristics of fluid shifts in which reduction of ECW was steeper than patients with SYS-N whereas fluid shifts of ICW were lower in patients with DIA-W than patients with DIA-N. [ABSTRACT FROM AUTHOR]

The current study aimed: (i) to external validate total body water (TBW) and extracellular water (ECW) derived from athlete and non-athlete predictive equations using radioisotope dilution techniques as a reference criterion in male and female athletes; (ii) in a larger sample, to determine the agreement between specific and generalized equations when estimating body fluids in male and female athletes practicing different sports. A total of 1371 athletes (men: n = 921, age 23.9 ± 1.4 y; women: n = 450, age 27.3 ± 6.8 y) participated in this study. All athletes underwent bioelectrical impedance analyses, while TBW and ECW were assessed with dilution techniques in a subgroup of 185 participants (men: n = 132, age 21.7 ± 5.1 y; women: n = 53, age 20.3 ± 4.5 y). Two specific and eight generalized predictive equations were tested. Compared to the criterion methods, no mean bias was observed using the athlete-specific equations for TBW and ECW (-0.32 to 0.05, p > 0.05) and the coefficient of determination ranged from R² = 0.83 to 0.94. The majority of the generalized predictive equations underestimated TBW and ECW (p < 0.05); R² ranged from 0.66 to 0.89. In the larger sample, all the generalized equations showed lower TBW and ECW values (ranging from -6.58 to -0.19, p < 0.05) than specific predictive equations; except for TBW in female power/velocity (one equation) athletes and team sport (two equations). The use of generalized BIA-based equations leads to an underestimation of TBW, and ECW compared to athlete-specific predictive equations. Additionally, the larger sample indicates that generalized equations overall provided lower TBW and ECW compared to the athlete-specific equations. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the association between sarcopenia and extracellular water-to-total body water ratio (ECW/TBW), one of the results of bioimpedance that can be easily measured in communities, following the recent revision of the Asian Working Group for Sarcopenia. Methods: This study data were extracted from the baseline data of Namgaram-2. Among the surveyed subjects, 885 persons aged 60 years or older were selected as study subjects. All surveys were conducted on a one-on-one interview basis; blood tests, physical function evaluations (hand grip strength, short physical performance battery; SPPB), and dual-energy X-ray absorptiometry (DEXA) and bioimpedance were also conducted. The Asian Working Group's revised definition of sarcopenia was applied. ECW/TBW was one of the results of bioimpedance this study. Results: A high ECW/TBW was 1.63 times higher in the low grip strength group than in the robust group (P = 0.017) and was 2.13 times higher in the low SPPB group compared to the robust group (P < 0.001). ECW/TBW higher than 0.391 was 2.17 times more likely to occur in sarcopenic patients compared to the robust group (P < 0.001). In addition, ECW/TBW lower than 0.391 was 3.65 times more likely to occur in severely sarcopenic patients compared to the robust group (P = 0.002). Conclusion: The ECW/TBW may be one of the valid research tools to evaluate the strength and physical performance of the elderly. In addition, it is expected to be one of the effective indicators for tracking physical function under newly revised sarcopenia criteria. [ABSTRACT FROM AUTHOR]

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 < 0.05 was considered statistically significant. 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. [ABSTRACT FROM AUTHOR]

We aimed to validate bioelectrical impedance spectroscopy (BIS), compared with tracer dilution measurements, for assessing total body water (TBW), intracellular water (ICW), and extracellular water (ECW) in athletes differing in hydration status. A total of 201 athletes participated. Reference TBW and ECW were determined by deuterium and bromide dilution methods, respectively; ICW was calculated as TBW‐ECW. Water compartments were estimated by BIS. Urine specific gravity (USG) classified athletes into well‐hydrated (WH) (USG < 1.023), euhydrated (EH) (USG:1.024–1.026), and dehydrated (DH) (USG>1.027). No significant differences were found between BIS and the reference methods for WH, EH, and DH athletes for TBW, ICW nor ECW (p>0.05). Concordance of TBW and its compartments by method was significant (p < 0.001) with coefficients of determination ranging by hydration classification [EH:52–96%;DH:56–98%;WH:71–96%]. Bland‐Altman analyses showed no trend for TBW and its compartments with the exception of ICW in the WH athletes. The 95% confidence BIS intervals for the WH group ranged from −3.08 to 2.68 kg for TBW, −4.28 to 4.14 kg for ICW, and −3.29 to 3.02 kg for ECW. For the EH athletes, the 95% confidence intervals ranged from −2.78 to 2.24 kg for TBW, −4.10 to 3.94 kg for ICW, and −3.44 to 3.06 kg for ECW. In DH group, TBW ranged between −1.99 and 2.01 kg, ICW between −3.78 and 6.34 kg, and ECW between −6.22 and 3.74 kg. These findings show that BIS is useful at a group level in assessing water compartments in athletes differing in hydration status. However, the usefulness of BIS is limited at an individual level, especially in dehydrated athletes. [ABSTRACT FROM AUTHOR]

Objective To observe the changes of body fluid distribution in patients with primary liver cancer (PLC) and to provide the basis for nutritional evaluation of PLC patients. Methods Eighty patients with PLC were divided into group A, group B and group C according to the Child-Pugh classification of liver function. Twenty-four healthy people were included as normal control group (group N). The total body water (TBW), extracellular water (ECW), intracellular water (ICW), edema index (ECW/TBW) and body cell mass (BCM) were measured by bioelectrical impedance method. Results In PLC patients, ICW and BCM insufficiency accounted for 37.5% (30/80), ECW abnormality accounted for 42.5% (34/80), and edema (ECW/TBW＞0.39) accounted for 85% (68/80). The proportion of edema patients was significantly higher in group B and group C than that in group A (P＜0.05). All patients in group C showed edema. The proportion of patients with abnormal ICW and BCM increased with the deterioration of liver function (P＜0.05). The content of intracellular water adjusted by ideal weight was significantly lower in group C than that of the control group (P＜0.05). There was no significant difference in ECW/BW and ECW/TBW between the case groups (P＞0.05), but which were higher in the case groups than that of the normal control group (P＜0.05). There were no significant differences in ICW, ECW, ECW/SW and BCM between the case groups and the normal control group (P＞0.05). Conclusion The number of functional cells is gradually consumed in patients with primary liver cancer, and the abnormal distribution of intracellular and extracellular water in body is common, leading to the increase of edema index. It is suggested that rational nutrition therapy should be carried out as soon as possible. [ABSTRACT FROM AUTHOR]

Objectives: Arterial stiffness, measured by pulse wave velocity (PWV), is reported to be increased in hemodialysis (HD) patients and increases cardiovascular mortality. Previous studies have reported an association between extracellular water (ECW) and PWV. We wished to review whether PWV increases over time and whether this is associated with ECW. Methods: We reviewed repeat aortic PWV measurements using an oscillograph method along with corresponding ECW measured by multifrequency bioimpedance in HD patients a minimum of 5 years apart. Results: Twenty-four patients (16 [66.7%] male and 11 [45.8%] diabetic, mean age 61.7 ± 15.2 years) had PWV and ECW initially measured after 46 (26–124) months of HD and then after 112 (97–202) months. Overall, there was no change in PWV or ECW (9.4 ± 2.2 vs. 8.1 ± 2.5 cm/s; 14.7 ± 2.5 vs. 15.2 ± 2.9 L, respectively), whereas the ECW/total body water ratio increased (0.399 ± 0.015 vs. 0.408 ± 0.021, p < 0.05). We found no association between changes in PWV and ECW (r = −0.05, p = 0.84), whereas there was an association with the change in peri-dialytic systolic blood pressure (SBP) (r = 0.59, p = 0.007). Conclusion: In our small observational study, there was no overall change in PWV, after 5 years of HD, with PWV increasing in 50% and falling in 50%. Changes in PWV were not associated with changes in ECW but were associated with changes in peri-dialytic SBP. Our study demonstrates that PWV does not increase in all HD patients with time, and interventional studies are required to determine whether targeted blood pressure control reduces PWV in HD patients. [ABSTRACT FROM AUTHOR]

Background: This case–control retrospective study focused on the extracellular water ratio (%ECW) of lymphedemic limbs measured by bioelectrical impedance analysis (BIA) as a possible indicator of the development and severity of unilateral and bilateral leg lymphedema. Methods and Results: BIA was used to evaluate changes in %ECW due to lymphedema in female patients with unilateral secondary leg lymphedema and in healthy controls. Receiver operating characteristic (ROC) analysis was employed to assess the diagnostic ability of %ECW to distinguish leg lymphedema patients from controls. Thirty-eight female patients were eligible for inclusion along with an equal number of healthy control volunteers. The %ECW of the affected leg correlated with leg body water volume (R2 = 0.28) and the water volume difference between affected and unaffected legs (R2 = 0.58). The ROC analysis showed that %ECW had a high diagnostic ability as a screening tool for the development of leg lymphedema (area under the ROC curve = 0.96). A cutoff %ECW value of 40.0% could predict the presence of leg lymphedema with a sensitivity of 81.6% and specificity of 97.4%. Conclusions: %ECW value may be a simple and useful indicator of the development and severity of leg lymphedema. As a screening test, %ECW measurement can predict the presence of unilateral or bilateral leg lymphedema in a single measurement without the need for arm, contralateral leg, or previous measurements as controls. [ABSTRACT FROM AUTHOR]

Exercise may prevent changes in body composition and provide an effective means of improving the side effects of treatment without causing lymphedema. Purpose: Test the effectiveness of a 12-week water aerobics program on body composition and lymphedema risk in breast cancer survivors. Methods: Body composition analysis was completed at weeks 0, 6, and 12 weeks. Results: Ten females completed all testing. Baseline subject characteristics were as follows: age (59.40 ± 8.22 years), weight (169.91 ± 41.70 lbs), body fat percent (%BF) (40.15 ± 9.84%), body fat mass (BFM) (71.27 ± 31.50 lbs), lean body mass (LBM) (98.66 ± 13.24 lbs), skeletal muscle mass (SMM) (53.17 ± 8.09 lbs), intracellular water (ICW) (44.24 ± 6.18 lbs), and extracellular water (ECW) (28.91 ± 3.62 lbs). One-way ANOVA showed no statistically significant differences over time as determined for weight (F(2.27) = 0.002, P = 0.96), %BF (F(2.27) = 0.004, P = 0.97), BFM (F(2.27) = 0.001, P = 0.97), LBM (F(2.27) = 0.013, P = 0.95), SMM (F(2.27) = 0.027, P = 0.91), ICW (F(2.27) = 0.021, P = 0.93), and ECW (F(2.27) = 0.01, P = 0.94) across the 12 weeks. Conclusions: A water aerobics program for 12 weeks was not enough to observe changes in body composition nor did it increase the risk for lymphedema and may be a safe exercise method for breast cancer survivors. [ABSTRACT FROM AUTHOR]

Intradialytic hypotension is the most common complication of hemodialysis (HD) treatments. Excessive ultrafiltration results in reduced cardiac preload. We aimed to determine whether a fall in systolic blood pressure during HD was greater in patients starting HD with (a) less overhydration measured by extracellular water (ECW) and (b) lower cardiac preload by cardiac magnetic resonance imaging (MRI). Pre‐HD measurements of ECW and total body water (TBW) were performed using multifrequency bioimpedance (MFBIA). Cardiac chamber sizes and functions were determined by MRI. Twenty‐six patients, 18 males (69.2%), 11 (42.3%) with diabetes, mean age 63.9 ± 15.9 years were studied. Systolic blood pressure (SBP) fell in 15 (57.7%) patients, and either did not change or increased in 9. There was no difference in demographics between groups. Patients with a fall in SBP had lower pre‐HD ECW/TBW (0.400 ± 0.018 vs 0.418 ± 0.021), indexed right ventricular end‐diastolic volume (81.2 ± 37.6 vs 100.8 ± 33.7 mL/m2), and indexed left atrial size (13.7 ± 3.9 vs 18.3 ± 5.0 mL/m2), all P <.05, respectively. There were univariate correlations between the change in SBP and pre‐HD ECW/TBW for the trunk (r =.50, P =.009) and indexed left atrial volume (r =.54, P =.005). A fall in blood pressure occurred more commonly in patients starting HD with lower overhydration as measured by bioimpedance, and those with smaller cardiac chamber sizes. Patients with the lowest ECW/TBW and smallest cardiac chamber sizes had the greatest falls in SBP. This study reinforces the importance of determining physiological target weights and avoiding inappropriately low target weights for HD patients. [ABSTRACT FROM AUTHOR]

Background: The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never‐medicated EH and normotensive controls (n = 130 in all groups). Methods: The hypertensive groups were matched for age (53 years), sex (84 male/46 female) and body mass index (BMI) (30 kg m−2); normotensive controls had similar sex distribution (age 48 years, BMI 27 kg m−2). Haemodynamics were recorded using whole‐body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm. Results: Radial and aortic systolic and diastolic blood pressure was similar in PA and never‐medicated EH, and higher than in medicated EH and normotensive controls (P ≤ 0.001 for all comparisons). Extracellular water balance was ~ 4% higher in PA than in all other groups (P < 0.05 for all), whilst cardiac output was ~ 8% higher in PA than in medicated EH (P = 0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never‐medicated EH than in medicated EH and normotensive controls (P ≤ 0.033 for all comparisons). Conclusions: Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future. [ABSTRACT FROM AUTHOR]

Combination therapy with peritoneal dialysis and hemodialysis (PD+HD) is widely used in Japan for PD patients with decreased residual renal function. However, fluid status in PD+HD patients has not been well studied. In this cross‐sectional study, we compared fluid status in 41 PD+HD patients with that in 103 HD and 92 PD patients using the bioimpedance spectroscopy. Extracellular water normalized to patient height (NECW, kg/m) was the highest in pre‐HD (8.3 ± 1.6) followed by PD (7.9 ± 2.7), PD+HD (7.5 ± 2.5), and post‐HD patients (6.9 ± 1.5) (P < 0.01). By multiple linear regression analysis, PD+HD was associated with a significantly lower NECW than pre‐HD (β = −0.8, P = 0.03) and similar to PD (β = −0.5, P = 0.24) and post‐HD (β = 0.6, P = 0.08) after adjustment for age, sex, diabetic nephropathy, ischemic heart disease, dialysis period, and daily urine volume. There was no correlation between NECW and daily urine volume in all dialysis groups. Average daily fluid removal (a sum of urine volume and ultrafiltration volume by dialysis) was positively correlated with NECW in PD+HD and pre‐HD, but not in PD and post‐HD patients. Our results suggest that fluid status in PD+HD patients with decreased residual renal function is acceptable as compared with that in HD and PD patients. [ABSTRACT FROM AUTHOR]