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Quist JR, Rud CL, Brantlov S, Ward LC, Dahl Baunwall SM, Hvas CL. Bioelectrical impedance analysis as a clinical marker of health status in adult patients with benign gastrointestinal disease: A systematic review. Clin Nutr ESPEN 2024; 59:387-397. [PMID: 38220401 DOI: 10.1016/j.clnesp.2023.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Body composition reflects nutritional status, disease status and progression, and treatment responses. Mounting evidence supports the use of bioelectrical impedance analysis (BIA) as a non-invasive tool to assess body composition. Patients with benign gastrointestinal (GI) disease experience disease-related alterations in their body composition, and bioimpedance outcomes in patients with benign GI diseases have not previously been summarized. We aimed to evaluate BIA as a clinical body composition marker for benign GI diseases and describe its association with physical health status. METHODS We systematically searched PubMed, Scopus, Web of Science, Embase, and CINAHL from inception to October 2023 (PROSPERO registration: CRD42021265866). Of 971 screened studies, 26 studies were included in the final analysis, comprising a total of 2398 adult patients with benign GI disease. The main outcome was raw impedance data. RESULTS The most frequently reported BIA outcome was phase angle (PhA) (reported in 18 of 26 studies), followed by fat-free-mass (FFM) (reported in 13 of 26 studies). The consensus view of the included studies illustrates that BIA can be a useful tool for evaluating body composition in patients with benign GI diseases, and low PhA and FFM were associated with increased nutritional risk, abnormal physical characteristics, and increased mortality risk. CONCLUSION To fully utilize BIA as a clinical marker of health in patients with benign GI disease, standardized protocols specific to this population are needed and prospective studies testing cut-offs and ranges, accuracy, and other raw BIA parameters for classifying disease status.
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Affiliation(s)
| | - Charlotte Lock Rud
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Steven Brantlov
- Department of Procurement & Clinical Engineering, Central Denmark Region, Denmark
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Schwaiger E, Simon A, Wabel P, Schairer B, Berner C, Signorini L, Ernstbrunner M, Evstatiev R, Schwabl P, Hinterholzer G, Frommlet F, Vychytil A, Müller CJ, Hecking M. Bioimpedance spectroscopy for fluid status assessment in patients with decompensated liver cirrhosis: Implications for peritoneal dialysis. Sci Rep 2020; 10:2869. [PMID: 32071351 PMCID: PMC7028989 DOI: 10.1038/s41598-020-59817-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 01/31/2020] [Indexed: 01/08/2023] Open
Abstract
Bioimpedance spectroscopy (BIS) is routinely used in peritoneal dialysis patients and might aid fluid status assessment in patients with liver cirrhosis, but the effect of ascites volume removal on BIS-readings is unknown. Here we determined changes in BIS-derived parameters and clinical signs of fluid overload from before to after abdominal paracentesis. Per our pre-specified sample size calculation, we studied 31 cirrhotic patients, analyzing demographics, labs and clinical parameters along with BIS results. Mean volume of the abdominal paracentesis was 7.8 ± 2.6 L. From pre-to post-paracentesis, extracellular volume (ECV) decreased (20.2 ± 5.2 L to 19.0 ± 4.8 L), total body volume decreased (39.8 ± 9.8 L to 37.8 ± 8.5 L) and adipose tissue mass decreased (38.4 ± 16.0 kg to 29.9 ± 12.9 kg; all p < 0.002). Correlation of BIS-derived parameters from pre to post-paracentesis ranged from R² = 0.26 for body cell mass to R² = 0.99 for ECV. Edema did not correlate with BIS-derived fluid overload (FO ≥ 15% ECV), which occurred in 16 patients (51.6%). In conclusion, BIS-derived information on fluid status did not coincide with clinical judgement. The changes in adipose tissue mass support the BIS-model assumption that fluid in the peritoneal cavity is not detectable, suggesting that ascites (or peritoneal dialysis fluid) mass should be subtracted from adipose tissue if BIS is used in patients with a full peritoneal cavity.
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Affiliation(s)
- Elisabeth Schwaiger
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine II, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Amrei Simon
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Peter Wabel
- Fresenius Medical Care, Research and Development, Bad Homburg, Germany
| | - Benjamin Schairer
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Carolin Berner
- 1st Medical Department, Division for Nephrology, Sozialmedizinisches Zentrum Süd, Vienna, Austria
| | - Lorenzo Signorini
- Dipartimento di Nefrologia e Dialis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matthäus Ernstbrunner
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Rayko Evstatiev
- Department of Internal Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Philipp Schwabl
- Department of Internal Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Georg Hinterholzer
- 1st Medical Department, Division for Nephrology, Sozialmedizinisches Zentrum Süd, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Christian J Müller
- Department of Internal Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
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Pahl A, Wehrle A, Kneis S, Gollhofer A, Bertz H. Whole body vibration training during allogeneic hematopoietic cell transplantation-the effects on patients' physical capacity. Ann Hematol 2020; 99:635-648. [PMID: 31970448 PMCID: PMC7060160 DOI: 10.1007/s00277-020-03921-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) experience a considerable decline in physical and psycho-social capacity. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system and enhance cardiorespiratory fitness and muscle strength in frail individuals, we hypothesized that WBV would maintain various physical and psychological capacities in patients during alloHCT. Seventy-one patients were randomly allocated to either an intervention group (IG) doing WBV or an active control group (CG) doing mobilization exercises five times per week. We determined peak oxygen consumption (VO2peak) and maximum power, maximum strength, functional performance, body composition, quality of life (QoL), and fatigue. Tests were carried out before conditioning therapy, at hospital discharge and at day ± 180 (follow-up). As 18 patients did not participate in post-intervention assessment and follow-up data from 9 patients was not collectible, per-protocol (PP) analysis of 44 patients is presented. During hospitalization, WBV maintained maximum strength, height, and power output during jumping, as well as reported QoL, physical functioning, and fatigue level compared with mobilization. At follow-up, relative VO2peak (p = 0.035) and maximum power (p = 0.011), time and power performing chair-rising test (p = 0.022; p = 0.009), and reported physical functioning (p = 0.035) significantly increased in the IG, while fatigue decreased (p = 0.005). CG’s body cell mass and phase angle had significantly decreased at follow-up (p = 0.002; p = 0.004). Thus, WBV might maintain maximum strength, functional performance, QoL, and fatigue during alloHCT, while cardiorespiratory fitness might benefit from accelerated recovery afterwards.
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Affiliation(s)
- Antonia Pahl
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Anja Wehrle
- Institute for Exercise and Occupational Medicine, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Sarah Kneis
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center-University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Charatsi A, Dusser P, Freund R, Maruani G, Rossin H, Boulier A, Le Bourgeois M, Chedevergne F, de Blic J, Letourneur A, Casimir G, Jais J, Sermet-Gaudelus I. Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance. J Cyst Fibros 2016; 15:825-833. [DOI: 10.1016/j.jcf.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 01/10/2023]
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Reid TJ, Jin Z, Shen W, Reyes-Vidal CM, Fernandez JC, Bruce JN, Kostadinov J, Post KD, Freda PU. IGF-1 levels across the spectrum of normal to elevated in acromegaly: relationship to insulin sensitivity, markers of cardiovascular risk and body composition. Pituitary 2015; 18:808-19. [PMID: 25907335 PMCID: PMC4619193 DOI: 10.1007/s11102-015-0657-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Activity of acromegaly is gauged by levels of GH and IGF-1 and epidemiological studies demonstrate that their normalization reduces acromegaly's excess mortality rate. However, few data are available linking IGF-1 levels to features of the disease that may relate to cardiovascular (CV) risk. Therefore, we tested the hypothesis that serum IGF-1 levels relative to the upper normal limit relate to insulin sensitivity, serum CV risk markers and body composition in acromegaly. METHODS In this prospective, cross-sectional study conducted at a pituitary tumor referral center we studied 138 adult acromegaly patients, newly diagnosed and previously treated surgically, with fasting and post-oral glucose levels of endocrine and CV risk markers and body composition assessed by DXA. RESULTS Active acromegaly is associated with lower insulin sensitivity, body fat and CRP levels than acromegaly in remission. %ULN IGF-1 strongly predicts insulin sensitivity, better than GH and this persists after adjustment for body fat and lean tissue mass. %ULN IGF-1 also relates inversely to CRP levels and fat mass, positively to lean tissue and skeletal muscle estimated (SM(E)) by DXA, but not to blood pressure, lipids, BMI or waist circumference. Gender interacts with the IGF-1-lean tissue mass relationship. CONCLUSIONS Active acromegaly presents a unique combination of features associated with CV risk, reduced insulin sensitivity yet lower body fat and lower levels of some serum CV risk markers, a pattern that is reversed in remission. %ULN IGF-1 levels strongly predict these features. Given the known increased CV risk of active acromegaly, these findings suggest that of these factors insulin resistance is most strongly related to disease activity and potentially to the increased CV risk of active acromegaly.
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Affiliation(s)
- Tirissa J Reid
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, 9-905, New York, NY, 10032, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Wei Shen
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, 9-905, New York, NY, 10032, USA
| | - Carlos M Reyes-Vidal
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, 9-905, New York, NY, 10032, USA
| | - Jean Carlos Fernandez
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, 9-905, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Jane Kostadinov
- Department of Neurosurgery, Mt. Sinai School of Medicine, New York, NY, USA
| | - Kalmon D Post
- Department of Neurosurgery, Mt. Sinai School of Medicine, New York, NY, USA
- Department of Medicine, Mt. Sinai School of Medicine, New York, NY, USA
| | - Pamela U Freda
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, 9-905, New York, NY, 10032, USA.
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Alicandro G, Battezzati A, Bianchi ML, Loi S, Speziali C, Bisogno A, Colombo C. Estimating body composition from skinfold thicknesses and bioelectrical impedance analysis in cystic fibrosis patients. J Cyst Fibros 2015; 14:784-91. [DOI: 10.1016/j.jcf.2015.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 01/10/2023]
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Kallwitz ER. Sarcopenia and liver transplant: The relevance of too little muscle mass. World J Gastroenterol 2015; 21:10982-10993. [PMID: 26494955 PMCID: PMC4607898 DOI: 10.3748/wjg.v21.i39.10982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/09/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Loss of muscle mass and function is a common occurrence in both patients with decompensated cirrhosis and those undergoing liver transplantation. Sarcopenia is associated with morbidity and mortality before and after liver transplantation. The ability of skeletal muscle mass to recover after transplant is questionable, and long term adverse events associated with persistent sarcopenia have not been well studied. Limited data is available examining mechanisms by which decreased muscle mass might develop. It is not clear which interventions might reduce the prevalence of sarcopenia and associated health burdens. However, measures to either decrease portal hypertension or improve nutrition appear to have benefit. Research on sarcopenia in the liver transplant setting is hampered by differing methodology to quantify muscle mass and varied thresholds determining the presence of sarcopenia. One area highlighted in this review is the heterogeneity used when defining sarcopenia. The health consequences, clinical course and potential pathophysiologic mechanisms of sarcopenia in the setting of cirrhosis and liver transplantation are further discussed.
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Hayashi F, Matsumoto Y, Momoki C, Yuikawa M, Okada G, Hamakawa E, Kawamura E, Hagihara A, Toyama M, Fujii H, Kobayashi S, Iwai S, Morikawa H, Enomoto M, Tamori A, Kawada N, Habu D. Physical inactivity and insufficient dietary intake are associated with the frequency of sarcopenia in patients with compensated viral liver cirrhosis. Hepatol Res 2013; 43:1264-1275. [PMID: 23489325 DOI: 10.1111/hepr.12085] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 12/12/2022]
Abstract
AIM The association between sarcopenia and nutritional status is thought to be an important problem in patients with cirrhosis. In this study, we investigated whether nutritional factors were related to sarcopenia in patients with liver cirrhosis. METHODS The subjects were 50 patients with cirrhosis aged 41 years or older. In this study, the subjects were interviewed about their dietary habits, and their daily physical activity was surveyed using a pedometer. The skeletal muscle mass index (SMI) was calculated using the appendicular skeletal muscle mass (ASM) measured by bioelectric impedance analysis. The handgrip strength was measured using a hand dynamometer. Sarcopenia was defined by SMI and handgrip strength. The patients with cirrhosis were categorized as normal group or sarcopenia group, and the two groups were compared. Univariate and multivariate logistic regression modeling were used to identify the relevance for sarcopenia in patients with cirrhosis. RESULTS Height (odds ratio (OR), 5.336; 95% confidence interval [CI], 1.063-26.784; P = 0.042), energy intake per ideal bodyweight (IBW) (OR, 5.882; 95% CI, 1.063-32.554; P = 0.042) and number of steps (OR, 4.767; 95% CI, 1.066-21.321; P = 0.041) were independent relevant factors for sarcopenia. Moreover, a significantly greater number of the patients in the sarcopenia group had low values for both parameters' energy intake per IBW and number of steps. CONCLUSION Our results suggest that walking 5000 or more steps per day and maintaining a total energy intake of 30 kcal/IBW may serve as a reference for lifestyle guidelines for compensated cirrhotic patients.
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Affiliation(s)
- Fumikazu Hayashi
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
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9
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Johnson TM, Overgard EB, Cohen AE, DiBaise JK. Nutrition Assessment and Management in Advanced Liver Disease. Nutr Clin Pract 2013; 28:15-29. [DOI: 10.1177/0884533612469027] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | | | - John K. DiBaise
- Division of Gastroenterology, Mayo Clinic in Arizona, Phoenix, Arizona
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Mally K, Dittmar M. Comparison of three segmental multifrequency bioelectrical impedance techniques in healthy adults. Ann Hum Biol 2012; 39:468-78. [DOI: 10.3109/03014460.2012.711858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ling CHY, de Craen AJM, Slagboom PE, Gunn DA, Stokkel MPM, Westendorp RGJ, Maier AB. Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population. Clin Nutr 2011; 30:610-5. [PMID: 21555168 DOI: 10.1016/j.clnu.2011.04.001] [Citation(s) in RCA: 427] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/28/2011] [Accepted: 04/05/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Body composition measurement is a valuable tool for assessing nutritional status and physical fitness in a variety of clinical settings. Although bioimpedance analysis (BIA) can easily assess body composition, its accuracy remains unclear. We examined the accuracy of direct segmental multi-frequency BIA technique (DSM-BIA) in assessing different body composition parameters, using dual energy X-ray absorptiometry (DEXA) as a reference standard. METHODS A total of 484 middle-aged participants from the Leiden Longevity Study were recruited. Agreements between DSM-BIA and DEXA for total and segmental body composition quantification were assessed using intraclass correlation coefficients and Bland-Altman plots. RESULTS Excellent agreements were observed between both techniques in whole body lean mass (ICC female = 0.95, ICC men = 0.96), fat mass (ICC female = 0.97, ICC male = 0.93) and percentage body fat (ICC female = 0.93, ICC male = 0.88) measurements. Similarly, Bland-Altman plots revealed narrow limits of agreements with small biases noted for the whole body lean mass quantification but relatively wider limits for fat mass and percentage body fat quantifications. In segmental lean muscle mass quantification, excellent agreements between methods were demonstrated for the upper limbs (ICC female≥0.91, ICC men≥0.87) and lower limbs (ICC female≥0.83, ICC male≥0.85), with good agreements shown for the trunk measurements (ICC female = 0.73, ICC male = 0.70). CONCLUSIONS DSM-BIA is a valid tool for the assessments of total body and segmental body composition in the general middle-aged population, particularly for the quantification of body lean mass.
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Affiliation(s)
- Carolina H Y Ling
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Sakata M, Kawaguchi T, Taniguchi E, Nakayama A, Ishizaki S, Sonaka I, Nakamura T, Itou M, Oriishi T, Abe M, Yanagimoto C, Koga H, Sata M. Oxidized albumin is associated with water retention and severity of disease in patients with chronic liver diseases. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eclnm.2010.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Freda PU, Shen W, Reyes-Vidal CM, Geer EB, Arias-Mendoza F, Gallagher D, Heymsfield SB. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab 2009; 94:2880-6. [PMID: 19491226 PMCID: PMC2730874 DOI: 10.1210/jc.2009-0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/21/2009] [Indexed: 12/25/2022]
Abstract
CONTEXT GH and IGF-I are nitrogen retaining and anabolic, but the impact of long-term exposure to supraphysiological GH and IGF-I, either from endogenous overproduction in acromegaly or exogenous sources, on skeletal muscle (SM) mass is not clear. OBJECTIVES The objectives of the study were to assess SM mass by whole-body magnetic resonance imaging (MRI) in acromegaly and test the hypothesis that dual-energy x-ray absorptiometry (DXA) lean tissue mass-derived estimates of SM accurately estimate true SM mass. DESIGN, SETTING, AND PATIENTS The design was a cross-sectional study in 27 acromegaly patients compared with predicted models developed in 315 nonacromegaly subjects and to matched controls. OUTCOME MEASURES Mass of SM from whole-body MRI and lean tissue from DXA were measured. RESULTS SM mass did not differ from predicted or control values in active acromegaly: 31.75 +/- 8.6 kg (acromegaly) vs. 33.06 +/- 8.9 kg (predicted); SM was 95.6 +/- 12.8% of predicted (range 66.7-122%) (P = 0.088). Lean tissue mass (DXA) was higher in acromegaly than controls: 65.91 +/- 15.2 vs. 58.73 +/- 13.5 kg (P < 0.0001). The difference between lean tissue mass (DXA) and SM in acromegaly patients was higher than that in controls (P < 0.0001) consistent with an enlarged non-SM lean compartment in acromegaly. SM mass predicted by DXA correlated highly with SM mass by MRI (r = 0.97, P < 0.0001). SM (MRI) to SM (DXA predicted) ratio was 1.018 (range 0.896-1.159), indicating high agreement of these measures of SM. CONCLUSIONS SM mass in active acromegaly patients did not differ from predicted values. SM mass estimated from DXA agreed highly with SM by MRI, supporting the validity of the DXA model in assessing SM in acromegaly and other disorders of GH/IGF-I secretion.
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Affiliation(s)
- Pamela U Freda
- Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
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Abstract
Acromegaly is a condition characterized by growth hormone (GH) and insulin-like growth factor-1 (IGF-1) hypersecretion, and is associated with boney overgrowth, and soft tissue abnormalities due to anabolic, lipolytic, and sodium retaining actions of GH. GH and IGF-1 excess is associated with alterations in body composition, including an increase in body water and lean body mass, and a reduction in body fat. Achievement of biochemical control of the disease results in a reduction in body water and fat-free mass, and an increase in body fat. BMD is generally increased in acromegaly, though the anabolic effect of GH excess on bone is reduced, if not negated, by the presence of hypogonadism, particularly with regard to the trabecular compartment. Further studies are necessary to determine the effect of long-term biochemical control on bone density in subjects with acromegaly.
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Affiliation(s)
- Laurence Katznelson
- Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305-5826, USA.
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15
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Woodhouse LJ, Mukherjee A, Shalet SM, Ezzat S. The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev 2006; 27:287-317. [PMID: 16543384 DOI: 10.1210/er.2004-0022] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The availability of recombinant human GH and somatostatin analogs has resulted in widespread treatment for adults with GH deficiency (GHD) and those with GH excess (acromegaly). Despite being at opposite ends of the spectrum in terms of their GH/IGF-I axis, both of these populations experience overlapping somatic impairments. Adults with untreated GHD have low circulating levels of IGF-I that manifest as altered body composition with increased fat and reduced lean body and skeletal muscle mass. At the other end of the spectrum, adults with GH excess, who have elevated levels of IGF-I, also have altered body composition. Impairments that result from disorders of either GHD or GH excess are both associated with increased functional limitations, such as reduced ability to walk quickly for prolonged periods, and poorer health-related quality of life (HR-QoL). Adults with untreated GHD and GH excess both commonly complain of excessive fatigue that seems to be associated more with impaired aerobic than muscular performance. Several studies have documented that administration of GH or somatostatin analogs to adults with GHD or GH excess, respectively, ameliorates abnormal biochemical profile and the associated somatic impairments. However, whether these improvements translate into improved physical function in adults with GHD or GH excess remains largely unknown, and their impact on HR-QoL controversial. Review of placebo-controlled trials to date suggests that GH and somatostatin analogs have greater effects on gas exchange and aerobic performance than as anabolic agents on skeletal muscle mass and function. Future investigations should include dose-response studies to establish the optimal combination of pharmacological agents plus exercise required to improve not only biochemical markers but also physical function and HR-QoL in adults with GHD or GH excess.
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Affiliation(s)
- Linda J Woodhouse
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, M W J Schols A, Pichard C. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 2005; 23:1430-53. [PMID: 15556267 DOI: 10.1016/j.clnu.2004.09.012] [Citation(s) in RCA: 1422] [Impact Index Per Article: 71.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 09/07/2004] [Indexed: 02/06/2023]
Abstract
BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.
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Affiliation(s)
- Ursula G Kyle
- Clinical Nutrition Unit, Geneva University Hospital, 1211 Geneva 14, Switzerland
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Marra M, De Filippo E, Signorini A, Silvestri E, Pasanisi F, Contaldo F, Scalfi L. Phase angle is a predictor of basal metabolic rate in female patients with anorexia nervosa. Physiol Meas 2005; 26:S145-52. [PMID: 15798227 DOI: 10.1088/0967-3334/26/2/014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the relationship between basal metabolic rate (BMR) and bioelectrical impedance analysis (BIA) in undernourished female patients with anorexia nervosa. Participants were 86 female patients with anorexia nervosa (age 20.8+/-4.7 years; weight 39.3+/-5.2 kg; body mass index 15.4+/-1.6 kg m-2). BMR was measured by indirect calorimetry and single-frequency BIA was determined at 50 kHz on the whole body. The BIA variables considered were resistance, reactance, phase angle and the bioimpedance index (height2/resistance). Fat-free mass was calculated from subcutaneous skin fold thickness. In the study group BMR was 3782+/-661 kJ d-1 while bioimpedance index varied between 27.6 and 49.9 cm2 Omega-1 and phase angle between 2.54 degrees and 6.49 degrees. BMR was significantly correlated with weight, height, body mass index and fat-free mass, and, among BIA variables, with reactance and phase angle. Multiple regression analysis indicated that phase angle was a predictor of BMR not only when solely BIA variables were considered, but also in combination with either weight and age or fat-free mass. In conclusion, phase angle emerged as a strong predictor of BMR in female patients with anorexia nervosa. Nevertheless, further studies are necessary to confirm this finding in other forms of protein energy malnutrition and justify the inclusion of BIA variables in the equations used to predict BMR in the clinical setting.
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Affiliation(s)
- Maurizio Marra
- Department of Clinical and Experimental Medicine, Federico II University, Napoli, Italy.
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Pietrobelli A, Rubiano F, St-Onge MP, Heymsfield SB. New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr 2005; 58:1479-84. [PMID: 15138459 DOI: 10.1038/sj.ejcn.1601993] [Citation(s) in RCA: 272] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Bioimpedance analysis (BIA) is a potential field and clinical method for evaluating skeletal muscle mass (SM) and %fat. A new BIA system has 8-(two on each hand and foot) rather than 4-contact electrodes allowing for rapid 'whole-body' and regional body composition evaluation. DESIGN This study evaluated the 50 kHz BC-418 8-contact electrode and TBF-310 4-contact electrode foot-foot BIA systems (Tanita Corp., Tokyo, Japan). SUBJECTS There were 40 subject evaluations in males (n=20) and females (n=20) ranging in age from 6 to 64 y. BIA was evaluated in each subject and compared to reference lean soft-tissue (LST) and %fat estimates in the appendages and remainder (trunk+head) provided by dual-energy X-ray absorptiometry (DXA). Appendicular LST (ALST) estimates from both BIA and DXA were used to derive total body SM mass. RESULTS The highest correlation between total body LST by DXA and impedance index (Ht(2)/Z) by BC-418 was for the foot-hand segments (r=0.986; left side only) compared to the arm (r=0.970-0.979) and leg segments (r=0.942-0.957)(all P<0.001). The within- and between-day coefficient of variation for %fat and ALST evaluated in five subjects was <1% and approximately 1-3.7%, respectively. The correlations between 8-electrode predicted and DXA appendicular (arms, legs, total) and trunk+head LST were strong and highly significant (all r> or =0.95, P<0.001) and group means did not differ across methods. Skeletal muscle mass calculated (Kim equation) from total ALST by DXA (X+/-s.d.)(23.7+/-9.7 kg) was not significantly different and highly correlated with BC-418 estimates (25.2+/-9.6 kg; r=0.96, P<0.001). There was a good correlation between total body %fat by 8-electrode BIA vs DXA (r=0.87, P<0.001) that exceeded the corresponding association with 4-electrode BIA (r=0.82, P<0.001). Group mean segmental %fat estimates from BC-418 did not differ significantly from corresponding DXA estimates. No between-method bias was detected in the whole body, ALST, and skeletal muscle analyses. CONCLUSIONS The new 8-electrode BIA system offers an important new opportunity of evaluating SM in research and clinical settings. The additional electrodes of the new BIA system also improve the association with DXA %fat estimates over those provided by the conventional foot-foot BIA.
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Affiliation(s)
- A Pietrobelli
- Pediatric Unit, Verona University Medical School, Verona, Italy.
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