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The validity of bioelectrical impedance analysis to estimate total body water in patients with cirrhosis of the liver
C R
LAW 1s $1 17 fO.5
Fan 02.l t1.3 59.8 t1.6
Fcs 37.0 f13 40.1 il.6
L 2.1 to.8 2.3 to.6
TCR MS rr 145 t5
FIDP 3.1 to.5 4.7 to.6
OWF -64.3 to.4 -62.4 ?O.Y
P.118 The vewty of --anrlyrkti -~lbodyW~in~ti-dlhOlhfU
M.C.Wikena,J.I4’.O. van&n&g, J.H.P. WsonradG.R.Swwt Dapf. of /n&ma/ Medicine //, Univwsity Ho8pital @k&t, RoWdam, Netheriands
inanyofthebiochemicalassays, ~thehighervslueofDGATPinC,legdsustoconckxlethatrefeeding, in this study, does not restore completely muscle energe6i in contracting muscle.
Therewemnosi~M~WcJfferences
The
Thisstudyas9es@thevaliiofbiiknpedanceanaty@sOto predicttotalbodywater~inpatientswithci~ottheIhrsr.TBWwas estimated by Deuterium oxide difution (020) and compared to TBW predicted by B!A in 27 patients with cirrhosis of the Iii with and without ascites or oedema (group A), in a subgroup of 18 cirrhotii without dinical signs of fluid overload (group B) and in 27 healthy controk. In the cinfv~6i group A, BIA significantly underpredicted !&O-TBW by 3.12L and the regression line was diient from the line of identii. In the cin’hotic group B and in the controls mean TBW was predicted correctly. correlation coefficients were high in all 3 groups, r (SEE) wee 0.89 (3.754,0.96 (2.23L) and 0.98 (1.33 L) in the cirrhotic group A, cirrhotic group B and in thecontrols respectively. We conclude that BIA is not a valid method to estimate TBW in patii with cirrhosis of the liver with ascites or oedema. In cirrhotii without clinical signs of fluid overload BlA can be used to predii TBW, although accuracy is slightly lower than in heaithy controls.
P.116 Changee in extraceltularwater @tomiMedietrkwti~n apace) at4 eerum aibumln Concentrationsduring stew&on i3ndeePaisintherabbil X.Guimo,M.I.Garcfa-Domingo, G. Franch andA. Sitges-Stwa Aypatiment of Surgery, Hospital Unive&ari de/ Mar, Barcelona, Spain f%racellular water (ECW) is a major determinant of serum albumin concentratkms. To clarify the relationship between these two metabolic variibles, rabbits were starved (S, n = 18) by reducing their usual chow intake by 90% or wrdement laparotomy and ligature of the tip of the appendix resulting in an int&domii abscess (IA, n * 17). Body weigM loss, serum albumin, cumulative water balance and ECW were detemined before and after one week of S or LA. ECW was calculated using the sodium bromide dilution technique& serum bromidemeasurad byespectrophotometry. There was a15%bodyweigMlossinSand9%inlA(p=0.003).ECWrelatedtobody w incmaaad in both groups by 10% (p = 0.04 compared to basal values) but in (A there was an absolute sligM decrease of ECW (751 vs 714 ml, p = 0.1) whereas ECW did not change in IA (763 vs 772 ml, n.s.). Serum albumin ccnc&rations decreased in IA (37 vs 28 a/l, p = O.OC01)but remained stable in S (36 vs 37 g/l). Cumulative water balance was lower in S than in IA (187 vs 321 mV7 days, p = 0.03) and cofrelated with ECW expansion in S (r = 0.73) but not in IA. Serum albumin changes correlatedwith ECW expansion in IA (r = 0.67) but not in S since in this group albumin was not altered. Thus, a similar degree of relative ECW expansion was observed after one week S or IA. This markedly contributed to hypoalbuminemia in IA. The mechanisms feading to ECW expansion are d&rent and S and IA, the latter involving a tendency towards water retention.
P.119 Determinationof muscle maw, by the use of a model based on duel-energyX-ray absorptbmtfy H.J. Fuller, A. Laskey’and M. Nia MRC Dunn Clinical Nutrition Centre and ‘Addenbrooke’s Hospital, Cambridge, UK Assessment of body composition by dual-energy X-ray absorptiometry (DEXA) was validated against hydrodensitometry in 16 male (ranges: age, 18-55; weigM 59.4-90.1 kg; heigM. 1.64-1.88m; and BMI, 20-28 kglm2) and 12 female (ranges: age, 21-59; weigM, 48.3-67.8 kg; height, 1.56-l .76 m; and BMI, 17-25 k@$) healthy subjects. Limb muscle mass was calculated from DEXA estimates of total limb mass, fat and bone ash using equations based on a new model (Equation 1 for males and 2 for females). This model incorporated assumptions regarding the reiatiie propartions of fat and fat-free soft tissue in muscle, in adipose tissue, in ekii (skin mass was calculated from mean skin thickness and limb surface area, estimated from body weight and height), and in skeleton (from bone ash). Whole body muscle mass was estimated from limb muscle mass (assuming that 75% of whole body muscle was located within the limbs). Equation 1: Limb muscle mass (all masses in kg) = 1.0291 limb mass 0.905 skin mass - 2.800 ash mass - 1.286 fat mass Equation 2: Limb muscle mass (ail masses in kg) = 1.0371 limb mass 0.913 skin mass - 2.824 ash mass - 1.297 fat mass For fat-free mass, the bias and 95% limits of agreement (k2SD) between DEXA and hydrodensitometry were 0.48 + 2.98 kg. Estimates of muscle mass were found to be higher in males than females, irmspectiie of whether thevalueswerecompared inabsolutetermsoraspercentageofbodyweight or fat-free mass (Table).
P.117 SegmerW evaluationof bodycompositiin and bioimpedance parambtersin anorexia netvosa L S&i, L. Blanchi: C. Sapio, G. Di Base, A. Coltorti, F. Contaldo and M. Salvatore’ C/in. Nuts., 2nd Medical .Sch&, ‘Fondaz. G. Pas&e, Nap/es Changas in body composition are a typical feature of chronic energy deficiency. In the present study, they were evaluated by using bio-impedence anaiysii @!.A) and dual photon absorptiometry (DPA) in 30 young wrnnen: 10 severely underweigM anomctics (A-group: Mean + SE, age 24.8 + 3.3 yls, wt 37.8 + 2.6 kg, BMI 15.0 + 0.8 kg/mq, and 20 control young women (C-group: 23.5 + 0.8 yrs, 52.4 +- 1.5 kg, 21 .O f 0.6 k4/m2). The B!A paremeters - resistance (R), reactance (Xc) and phase angle (4) - were obtained (using an Akem BIA 101) separately for aRns, legs and trunk; for the same bcdy segments fat free mass (FFM) and fat mass (FM) were calculated by a DPA Lunar lnstrwnent. The BfA parameters were altered in the A-group, particularly with respect to the I$ of tha 3 bodysegments, whichwereallsignificantly decreased (p < 0.01) in comp&on to the C-subjects. However, tha differences in R and Xc were lass pronounced for trunk and verymarked for 8nns. Both FFM and FM of the A-patisnts were significantly decmased (p < 0.01) in the 3 body segments; the FFM of the arms represented only 8.1 + 0.5% of total FFM in theAgroupincompar&onwithameanvalueof9.9f.1.8%intheC-group@ < 0.01). FFM was signif. reiated to R for each of the body segments in the C-group and to the Xc of arms and legs in the A-group. In conclusion, sign&ant changes in both BIA parameters and body composition were observed in the body segments (Amos,legs and trunk) of anorectic patients. These changes seem to be more evident for arms than for legs and trunk.
It isconcludedthatW(Ameasu~arevalidforpredictinghydrodensiDEXAelsohasthe tometric estimates of body compositii. F-9 advantage of providing 8s98ssmBn15 of the mass anddiiributii of muscle tissue, whii may be of value in ce&in clinical conditions, particularly wasting diseases. 61
LAW 1s $1 17 fO.5
Fan 02.l t1.3 59.8 t1.6
Fcs 37.0 f13 40.1 il.6
L 2.1 to.8 2.3 to.6
TCR MS rr 145 t5
FIDP 3.1 to.5 4.7 to.6
OWF -64.3 to.4 -62.4 ?O.Y
P.118 The vewty of --anrlyrkti -~lbodyW~in~ti-dlhOlhfU
M.C.Wikena,J.I4’.O. van&n&g, J.H.P. WsonradG.R.Swwt Dapf. of /n&ma/ Medicine //, Univwsity Ho8pital @k&t, RoWdam, Netheriands
inanyofthebiochemicalassays, ~thehighervslueofDGATPinC,legdsustoconckxlethatrefeeding, in this study, does not restore completely muscle energe6i in contracting muscle.
Therewemnosi~M~WcJfferences
The
Thisstudyas9es@thevaliiofbiiknpedanceanaty@sOto predicttotalbodywater~inpatientswithci~ottheIhrsr.TBWwas estimated by Deuterium oxide difution (020) and compared to TBW predicted by B!A in 27 patients with cirrhosis of the Iii with and without ascites or oedema (group A), in a subgroup of 18 cirrhotii without dinical signs of fluid overload (group B) and in 27 healthy controk. In the cinfv~6i group A, BIA significantly underpredicted !&O-TBW by 3.12L and the regression line was diient from the line of identii. In the cin’hotic group B and in the controls mean TBW was predicted correctly. correlation coefficients were high in all 3 groups, r (SEE) wee 0.89 (3.754,0.96 (2.23L) and 0.98 (1.33 L) in the cirrhotic group A, cirrhotic group B and in thecontrols respectively. We conclude that BIA is not a valid method to estimate TBW in patii with cirrhosis of the liver with ascites or oedema. In cirrhotii without clinical signs of fluid overload BlA can be used to predii TBW, although accuracy is slightly lower than in heaithy controls.
P.116 Changee in extraceltularwater @tomiMedietrkwti~n apace) at4 eerum aibumln Concentrationsduring stew&on i3ndeePaisintherabbil X.Guimo,M.I.Garcfa-Domingo, G. Franch andA. Sitges-Stwa Aypatiment of Surgery, Hospital Unive&ari de/ Mar, Barcelona, Spain f%racellular water (ECW) is a major determinant of serum albumin concentratkms. To clarify the relationship between these two metabolic variibles, rabbits were starved (S, n = 18) by reducing their usual chow intake by 90% or wrdement laparotomy and ligature of the tip of the appendix resulting in an int&domii abscess (IA, n * 17). Body weigM loss, serum albumin, cumulative water balance and ECW were detemined before and after one week of S or LA. ECW was calculated using the sodium bromide dilution technique& serum bromidemeasurad byespectrophotometry. There was a15%bodyweigMlossinSand9%inlA(p=0.003).ECWrelatedtobody w incmaaad in both groups by 10% (p = 0.04 compared to basal values) but in (A there was an absolute sligM decrease of ECW (751 vs 714 ml, p = 0.1) whereas ECW did not change in IA (763 vs 772 ml, n.s.). Serum albumin ccnc&rations decreased in IA (37 vs 28 a/l, p = O.OC01)but remained stable in S (36 vs 37 g/l). Cumulative water balance was lower in S than in IA (187 vs 321 mV7 days, p = 0.03) and cofrelated with ECW expansion in S (r = 0.73) but not in IA. Serum albumin changes correlatedwith ECW expansion in IA (r = 0.67) but not in S since in this group albumin was not altered. Thus, a similar degree of relative ECW expansion was observed after one week S or IA. This markedly contributed to hypoalbuminemia in IA. The mechanisms feading to ECW expansion are d&rent and S and IA, the latter involving a tendency towards water retention.
P.119 Determinationof muscle maw, by the use of a model based on duel-energyX-ray absorptbmtfy H.J. Fuller, A. Laskey’and M. Nia MRC Dunn Clinical Nutrition Centre and ‘Addenbrooke’s Hospital, Cambridge, UK Assessment of body composition by dual-energy X-ray absorptiometry (DEXA) was validated against hydrodensitometry in 16 male (ranges: age, 18-55; weigM 59.4-90.1 kg; heigM. 1.64-1.88m; and BMI, 20-28 kglm2) and 12 female (ranges: age, 21-59; weigM, 48.3-67.8 kg; height, 1.56-l .76 m; and BMI, 17-25 k@$) healthy subjects. Limb muscle mass was calculated from DEXA estimates of total limb mass, fat and bone ash using equations based on a new model (Equation 1 for males and 2 for females). This model incorporated assumptions regarding the reiatiie propartions of fat and fat-free soft tissue in muscle, in adipose tissue, in ekii (skin mass was calculated from mean skin thickness and limb surface area, estimated from body weight and height), and in skeleton (from bone ash). Whole body muscle mass was estimated from limb muscle mass (assuming that 75% of whole body muscle was located within the limbs). Equation 1: Limb muscle mass (all masses in kg) = 1.0291 limb mass 0.905 skin mass - 2.800 ash mass - 1.286 fat mass Equation 2: Limb muscle mass (ail masses in kg) = 1.0371 limb mass 0.913 skin mass - 2.824 ash mass - 1.297 fat mass For fat-free mass, the bias and 95% limits of agreement (k2SD) between DEXA and hydrodensitometry were 0.48 + 2.98 kg. Estimates of muscle mass were found to be higher in males than females, irmspectiie of whether thevalueswerecompared inabsolutetermsoraspercentageofbodyweight or fat-free mass (Table).
P.117 SegmerW evaluationof bodycompositiin and bioimpedance parambtersin anorexia netvosa L S&i, L. Blanchi: C. Sapio, G. Di Base, A. Coltorti, F. Contaldo and M. Salvatore’ C/in. Nuts., 2nd Medical .Sch&, ‘Fondaz. G. Pas&e, Nap/es Changas in body composition are a typical feature of chronic energy deficiency. In the present study, they were evaluated by using bio-impedence anaiysii @!.A) and dual photon absorptiometry (DPA) in 30 young wrnnen: 10 severely underweigM anomctics (A-group: Mean + SE, age 24.8 + 3.3 yls, wt 37.8 + 2.6 kg, BMI 15.0 + 0.8 kg/mq, and 20 control young women (C-group: 23.5 + 0.8 yrs, 52.4 +- 1.5 kg, 21 .O f 0.6 k4/m2). The B!A paremeters - resistance (R), reactance (Xc) and phase angle (4) - were obtained (using an Akem BIA 101) separately for aRns, legs and trunk; for the same bcdy segments fat free mass (FFM) and fat mass (FM) were calculated by a DPA Lunar lnstrwnent. The BfA parameters were altered in the A-group, particularly with respect to the I$ of tha 3 bodysegments, whichwereallsignificantly decreased (p < 0.01) in comp&on to the C-subjects. However, tha differences in R and Xc were lass pronounced for trunk and verymarked for 8nns. Both FFM and FM of the A-patisnts were significantly decmased (p < 0.01) in the 3 body segments; the FFM of the arms represented only 8.1 + 0.5% of total FFM in theAgroupincompar&onwithameanvalueof9.9f.1.8%intheC-group@ < 0.01). FFM was signif. reiated to R for each of the body segments in the C-group and to the Xc of arms and legs in the A-group. In conclusion, sign&ant changes in both BIA parameters and body composition were observed in the body segments (Amos,legs and trunk) of anorectic patients. These changes seem to be more evident for arms than for legs and trunk.
It isconcludedthatW(Ameasu~arevalidforpredictinghydrodensiDEXAelsohasthe tometric estimates of body compositii. F-9 advantage of providing 8s98ssmBn15 of the mass anddiiributii of muscle tissue, whii may be of value in ce&in clinical conditions, particularly wasting diseases. 61