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O.77 Estimation of body cell mass in liver cirrhosis:comparison of multifrequency bioelectric impedance analysis and total body potassium counting
Session 12 - ASSESSMENT AND SU RVEYS
between the two techniques were also found when assessing changes in FM (r = 0.66, P < 0.02) and FFM (r = 0.59, P < 0.05) over a 2 month period. In the Bland and Altman analysis, reasonable agreement between both methods was observed, with a 0.82 -+ 0.49 kg overestimation of the loss in FM, and underestimation of the loss in FFM, by skinfold anthropometry. Conclusion: Our results show that skinfold anthropometry is useful for measuring changes in body composition in a patient population with advanced lung cancer. However, a relative overestimation of loss in FM and underestimation of loss in FFM must be taken into account.
0.77 Estimation of body cell mass in liver cirrhosis: comparison of multifrequency bioelectric impedance analysis and total body potassium counting Pirlich, S. Ertel, T. Spachos, T. SchEitz, A.-E. Roske, M.-L. WeiB, H. Lochs and M. Plauth Medizinische Klinik, Klinikum Chadt# der Humboldt-Universit&t und Klinikum Buch, Berlin, Germany. M.
Loss of body cell mass (BCM) is of prognostic relevance in chronically ill patients. In patients with liver cirrhosis, the validity of body composition analysis using bioelectrical impedance analysis (BIA) has been questioned due to erroneous estimates of intraperitoneal fluid. Since the trunc represents only about 10% of total body impedance we evaluated, whether multifrequency BIA (MF-BIA) can be used as a reliable method for determination of BCM in patients with liver cirrhosis. Methods: in 28 patients with liver cirrhosis (56 +_ 9 years; 7 female, 21 male; BMh 24.8 _+ 4.8 kg/m 2, Child-Pugh score: A n = 7, B n = 11, C n = 10) with (n = 15) or without (n = 13) ascites BCM was assessed by MF-BIA using 1, 5, 50 and 100 kHz (BIA 2000-M, Data Input, Frankfurt, Germany). As a reference, BCM was determined by total body [4°K] counting (BCMTBK). Muscle mass as a subcompartment of BCM was assessed by 24-hour urinary creatinine excretion (MMcREA) and from anthropometry (MMANTHRO). In patients with ascites, MF-BIA was repeated immediately after large volume paracentesis (5.5 -+ 2.8 L). Values are mean _+sd. Results: BGMBI A was significantly correlated with BGMTB K in patients without ascites (r = 0.95, P < 0.001), but also in patients with ascites (r = 0.72, P < 0.002). Mean values of BCMBI A were not different from BCMTB K in patients without ascites (27.4 _ 9 vs 26.6 -+ 9 kg) or with ascites (21.3 _+4 vs 21.9 _+3.5 kg). MMANTHRO (r = 0.80, P < 0.004) and MMcREA (r = 0.83, P < 0.002) showed a significant and good correlation to BCMTB K in patients without ascites, whereas in patients with ascites MMANTHRO (r = 0.37) and MMcREA (r = 0.36) were not correlated with BCM-mK (both n.s.). Conclusions: MF-BIA can be used to determine BCM in non-ascitic patients with liver cirrhosis with an excellent correlation to values obtained by total body [4°K] counting. Even in patients with substantial ascites MF-BIA yields reliable BCM values. Thus, we suggest that MFBIA has the potential for a cheap, non-invasive and valid bed-side method for the measurement of the metabolically and prognostically relevant compartment BCM also in patients with liver cirrhosis.
0.79 Bone mineral density and bone markers in patients with malabsorption K. H a d e r s l e v * , P. B. Jeppesen*, R B. Mortensen*, H. A. S~rensent
and M. Staun* *Department of Gastroenterology CA 2121, Rigshospitalet, Denmark. ?The Osteoporosis Research Centre, Copenhagen Municipal Hospital Aims: Metabolic bone disease is a well known complication in patients with extensive bowel resections. The aim of the present study was to assess the prevalence and mechanism of reduced bone mineral density (BMD) in patients with bowel resections and malabsorption with a faecal energy loss greater than 2.0 MJ/d. Diagnoses were inflammatory bowel disease (n = 35) and other (n = 9). Methods: BMD (Z-scores) at the hip and the lumbar spine was measured by dual energy X-ray absorptiometry. Bone formation was assessed by Sosteocalcium, and bone resorption was evaluated by urinary deoxypyridinoline and pyridinoline. In addition calcium regulating hormones vitamin D and PTH were measured. Faeces collected for 2 days were analysed for the excretion of fat. Results: Time elapsed since last bowel resection did not differ between groups (mean =10 years). Markers of bone resorption were low, while the formation marker was within normal range in alt groups. Mean values for PTH were within normal limits in all groups. The majority of patients with a steatorrhoea > 25 g/d received supplementation with calcium and vitamin D. Table showing mean +_SD, *value below normal range, P < 0.05.
Faecal fat (g/d)
0.78 Changes in body composition in advanced lung cancer measured by skinfold anthropometry compared with deuterium oxide dilution
X<25 (n= 12) 25 < X < 50 (n = 14) X>50 (n= 18)
H. J. A g t e r e s c h * , P. C. Dagnelie*t, T. Rietveld* J. W O. van den
Berg* and J. H. P. Wilson* *Department of Internal Medicine II, Erasmus University Rotterdam and ?Department of Epidemiology, Maastricht University, The Netherlands.
25-OH vitamin D (normal 15-40 ng/ml)
BMD Z-scores (spine/hip)
9.1_+6.0" 12.6 _+6.2 17.1+_12.4
*-0.94_+1.04/-0.87_+1.18" -0.19 _+1.63 / -0.87 _+1.33" -0.34-+1.25/-0.55_+1.00"
Conclusions: BMD was significantly reduced, but deviations in BMD showed no correlation to parameters of malabsorption. Biochemical markers indicated low bone turnover. The 25-OH vitamin D level was low in all groups and significantly reduced in patients with moderate steatorrhoea. This study supports that vitamin D supplementation of patients with intestinal resections is important.
Introduction: Measurement of body composition is important to assess nutritional depletion in patients with cancer cachexia. Although widely used, the validity of skinfold anthropometery to measure changes in body composition in cancer patients is not clear. In this study, we estimated the accuracy of skinfold measurements to assess changes in fat mass (FM) and fat-free mass (FFM) in cancer patients, using the deuterium oxide dilution technique as a standard. Methods: In 12 patients (9 men, 3 women) with stage IIIB/IV non-small cell bronchus carcinoma, aged 63 _+ 13.5 years (mean _+ sd), weight, skinfold thickness and total body water were measured at baseline and after 2 months. FM and FFM were calculated from: 1) the sum of four skinfolds as described by Durnin and Womersley (1974); and 2) determination of total body water by the deuterium oxide dilution technique. The two methods were compared using Pearson's correlation coefficient and by graphic presentation according to Bland and AItman (1986). Results: After 2 months, a mean weight loss of 2.7 _+ 2.6 kg (P < 0.005, paired Student t-test) was observed. Body composition measurement by the two methods were highly correlated on t = 0 (for FM: r = 0.85; for FFM: r = 0.92, both P < 0.001) and t = 2 months (r = 0.88 and r = 0.96, resp., P < 0.001). Significant positive correlations
0.80 Lack of adaptation to severe malnutrition in the elderly X. H ~ b u t e r n e , F. Longo, S. Schneider, R. AI Jaouni and P. Rampal
Gastroenterology and Nutrition, Archet Hospital, 06202 Nice Cedex 3, France. During severe malnutrition the Resting Energy Expenditure (REE) is known to decrease, but when adapted to Fat Free Mass (FFM) it is similar to that in moderately malnourished patients. The aim of this study was to evaluate the REE and body composition of severely malnourished elderly patients. Methods: 27 malnourished (BM] < 20 kg/m2), but ambulatory eIdedy patients (>65 years), refered to our unit for refeeding were evaluated. All received cyclic enteral nutrition for at least 21 days and suffered from chronic malnutrition; none had infection or cancer. Ten patients were considered to be severely malnourished (G1 : 4F/6M, 81.5 +- 3.2 years, BMI < 16:14.2 _+1.4 kg/m2), and 17 were considered to be moderately malnour23
between the two techniques were also found when assessing changes in FM (r = 0.66, P < 0.02) and FFM (r = 0.59, P < 0.05) over a 2 month period. In the Bland and Altman analysis, reasonable agreement between both methods was observed, with a 0.82 -+ 0.49 kg overestimation of the loss in FM, and underestimation of the loss in FFM, by skinfold anthropometry. Conclusion: Our results show that skinfold anthropometry is useful for measuring changes in body composition in a patient population with advanced lung cancer. However, a relative overestimation of loss in FM and underestimation of loss in FFM must be taken into account.
0.77 Estimation of body cell mass in liver cirrhosis: comparison of multifrequency bioelectric impedance analysis and total body potassium counting Pirlich, S. Ertel, T. Spachos, T. SchEitz, A.-E. Roske, M.-L. WeiB, H. Lochs and M. Plauth Medizinische Klinik, Klinikum Chadt# der Humboldt-Universit&t und Klinikum Buch, Berlin, Germany. M.
Loss of body cell mass (BCM) is of prognostic relevance in chronically ill patients. In patients with liver cirrhosis, the validity of body composition analysis using bioelectrical impedance analysis (BIA) has been questioned due to erroneous estimates of intraperitoneal fluid. Since the trunc represents only about 10% of total body impedance we evaluated, whether multifrequency BIA (MF-BIA) can be used as a reliable method for determination of BCM in patients with liver cirrhosis. Methods: in 28 patients with liver cirrhosis (56 +_ 9 years; 7 female, 21 male; BMh 24.8 _+ 4.8 kg/m 2, Child-Pugh score: A n = 7, B n = 11, C n = 10) with (n = 15) or without (n = 13) ascites BCM was assessed by MF-BIA using 1, 5, 50 and 100 kHz (BIA 2000-M, Data Input, Frankfurt, Germany). As a reference, BCM was determined by total body [4°K] counting (BCMTBK). Muscle mass as a subcompartment of BCM was assessed by 24-hour urinary creatinine excretion (MMcREA) and from anthropometry (MMANTHRO). In patients with ascites, MF-BIA was repeated immediately after large volume paracentesis (5.5 -+ 2.8 L). Values are mean _+sd. Results: BGMBI A was significantly correlated with BGMTB K in patients without ascites (r = 0.95, P < 0.001), but also in patients with ascites (r = 0.72, P < 0.002). Mean values of BCMBI A were not different from BCMTB K in patients without ascites (27.4 _ 9 vs 26.6 -+ 9 kg) or with ascites (21.3 _+4 vs 21.9 _+3.5 kg). MMANTHRO (r = 0.80, P < 0.004) and MMcREA (r = 0.83, P < 0.002) showed a significant and good correlation to BCMTB K in patients without ascites, whereas in patients with ascites MMANTHRO (r = 0.37) and MMcREA (r = 0.36) were not correlated with BCM-mK (both n.s.). Conclusions: MF-BIA can be used to determine BCM in non-ascitic patients with liver cirrhosis with an excellent correlation to values obtained by total body [4°K] counting. Even in patients with substantial ascites MF-BIA yields reliable BCM values. Thus, we suggest that MFBIA has the potential for a cheap, non-invasive and valid bed-side method for the measurement of the metabolically and prognostically relevant compartment BCM also in patients with liver cirrhosis.
0.79 Bone mineral density and bone markers in patients with malabsorption K. H a d e r s l e v * , P. B. Jeppesen*, R B. Mortensen*, H. A. S~rensent
and M. Staun* *Department of Gastroenterology CA 2121, Rigshospitalet, Denmark. ?The Osteoporosis Research Centre, Copenhagen Municipal Hospital Aims: Metabolic bone disease is a well known complication in patients with extensive bowel resections. The aim of the present study was to assess the prevalence and mechanism of reduced bone mineral density (BMD) in patients with bowel resections and malabsorption with a faecal energy loss greater than 2.0 MJ/d. Diagnoses were inflammatory bowel disease (n = 35) and other (n = 9). Methods: BMD (Z-scores) at the hip and the lumbar spine was measured by dual energy X-ray absorptiometry. Bone formation was assessed by Sosteocalcium, and bone resorption was evaluated by urinary deoxypyridinoline and pyridinoline. In addition calcium regulating hormones vitamin D and PTH were measured. Faeces collected for 2 days were analysed for the excretion of fat. Results: Time elapsed since last bowel resection did not differ between groups (mean =10 years). Markers of bone resorption were low, while the formation marker was within normal range in alt groups. Mean values for PTH were within normal limits in all groups. The majority of patients with a steatorrhoea > 25 g/d received supplementation with calcium and vitamin D. Table showing mean +_SD, *value below normal range, P < 0.05.
Faecal fat (g/d)
0.78 Changes in body composition in advanced lung cancer measured by skinfold anthropometry compared with deuterium oxide dilution
X<25 (n= 12) 25 < X < 50 (n = 14) X>50 (n= 18)
H. J. A g t e r e s c h * , P. C. Dagnelie*t, T. Rietveld* J. W O. van den
Berg* and J. H. P. Wilson* *Department of Internal Medicine II, Erasmus University Rotterdam and ?Department of Epidemiology, Maastricht University, The Netherlands.
25-OH vitamin D (normal 15-40 ng/ml)
BMD Z-scores (spine/hip)
9.1_+6.0" 12.6 _+6.2 17.1+_12.4
*-0.94_+1.04/-0.87_+1.18" -0.19 _+1.63 / -0.87 _+1.33" -0.34-+1.25/-0.55_+1.00"
Conclusions: BMD was significantly reduced, but deviations in BMD showed no correlation to parameters of malabsorption. Biochemical markers indicated low bone turnover. The 25-OH vitamin D level was low in all groups and significantly reduced in patients with moderate steatorrhoea. This study supports that vitamin D supplementation of patients with intestinal resections is important.
Introduction: Measurement of body composition is important to assess nutritional depletion in patients with cancer cachexia. Although widely used, the validity of skinfold anthropometery to measure changes in body composition in cancer patients is not clear. In this study, we estimated the accuracy of skinfold measurements to assess changes in fat mass (FM) and fat-free mass (FFM) in cancer patients, using the deuterium oxide dilution technique as a standard. Methods: In 12 patients (9 men, 3 women) with stage IIIB/IV non-small cell bronchus carcinoma, aged 63 _+ 13.5 years (mean _+ sd), weight, skinfold thickness and total body water were measured at baseline and after 2 months. FM and FFM were calculated from: 1) the sum of four skinfolds as described by Durnin and Womersley (1974); and 2) determination of total body water by the deuterium oxide dilution technique. The two methods were compared using Pearson's correlation coefficient and by graphic presentation according to Bland and AItman (1986). Results: After 2 months, a mean weight loss of 2.7 _+ 2.6 kg (P < 0.005, paired Student t-test) was observed. Body composition measurement by the two methods were highly correlated on t = 0 (for FM: r = 0.85; for FFM: r = 0.92, both P < 0.001) and t = 2 months (r = 0.88 and r = 0.96, resp., P < 0.001). Significant positive correlations
0.80 Lack of adaptation to severe malnutrition in the elderly X. H ~ b u t e r n e , F. Longo, S. Schneider, R. AI Jaouni and P. Rampal
Gastroenterology and Nutrition, Archet Hospital, 06202 Nice Cedex 3, France. During severe malnutrition the Resting Energy Expenditure (REE) is known to decrease, but when adapted to Fat Free Mass (FFM) it is similar to that in moderately malnourished patients. The aim of this study was to evaluate the REE and body composition of severely malnourished elderly patients. Methods: 27 malnourished (BM] < 20 kg/m2), but ambulatory eIdedy patients (>65 years), refered to our unit for refeeding were evaluated. All received cyclic enteral nutrition for at least 21 days and suffered from chronic malnutrition; none had infection or cancer. Ten patients were considered to be severely malnourished (G1 : 4F/6M, 81.5 +- 3.2 years, BMI < 16:14.2 _+1.4 kg/m2), and 17 were considered to be moderately malnour23