Showing papers on "Body water published in 2019"

The Role of Water Homeostasis in Muscle Function and Frailty: A Review

Abstract: Water, the main component of the body, is distributed in the extracellular and intracellular compartments. Water exchange between these compartments is mainly governed by osmotic pressure. Extracellular water osmolarity must remain within very narrow limits to be compatible with life. Older adults lose the thirst sensation and the ability to concentrate urine, and this favours increased extracellular osmolarity (hyperosmotic stress). This situation, in turn, leads to cell dehydration, which has severe consequences for the intracellular protein structure and function and, ultimately, results in cell damage. Moreover, the fact that water determines cell volume may act as a metabolic signal, with cell swelling acting as an anabolic signal and cell shrinkage acting as a catabolic signal. Ageing also leads to a progressive loss in muscle mass and strength. Muscle strength is the main determinant of functional capacity, and, in elderly people, depends more on muscle quality than on muscle quantity (or muscle mass). Intracellular water content in lean mass has been related to muscle strength, functional capacity, and frailty risk, and has been proposed as an indicator of muscle quality and cell hydration. This review aims to assess the role of hyperosmotic stress and cell dehydration on muscle function and frailty.

Effects of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan.

Abstract: AIM Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic properties. We recently reported that an SGLT2 inhibitor ameliorated extracellular fluid expansion with a transient increase in urinary Na+ excretion. However, the effects of SGLT2 inhibitors on fluid distribution in comparison to conventional diuretics remain unclear. METHODS Forty chronic kidney disease patients with fluid retention (average estimated glomerular filtration rate 29.2 ± 3.2 mL/min per 1.73 m2 ) were divided into the SGLT2 inhibitor dapagliflozin (DAPA), loop diuretic furosemide (FR) and vasopressin V2 receptor antagonist tolvaptan (TLV). The body fluid volume was measured on days 0 and 7 using a bioimpedance analysis device. RESULTS In all three groups, body weight was significantly and similarly decreased, and urine volume numerically increased for 7 days. Bioimpedance analysis showed that the changes in intracellular water were similar, but that there were significant changes in the extracellular water (ECW) (DAPA -8.4 ± 1.7, FR -12.5 ± 1.3, TLV -7.4 ± 1.5%, P = 0.048). As a result, the change in the ratio of ECW to total body water in the DAPA group was significantly smaller than that in the FR group, but numerically larger than that in the TLV group (DAPA -1.5 ± 0.5, FR -3.6 ± 0.5, TLV -0.5 ± 0.4%, P < 0.001). CONCLUSION Sodium-glucose cotransporter 2 inhibitor DAPA predominantly decreased the ECW with a mild increase in urine volume, but the change in the ECW/total body water was smaller than that in patients treated with FR, and larger than that in patients treated with TLV, suggesting that the effects of SGLT2 inhibitors on fluid distribution may differ from those of conventional diuretics.

Reliability and validity of various laboratory methods of body composition assessment in young adults.

Abstract: Accurate measures of body composition (BC) are essential for performance and health. In addition to accuracy, BC measures should be practical and be minimally invasive to maximize their utility. The purpose of the present study was to compare the day-to-day variability and validity of four common laboratory-based body composition assessments to a criterion four-compartment model. Dual x-ray absorptiometry (DXA), air displacement plethysmography (BP), multi-frequency bioelectrical impedance (MF-BIA) and underwater weighing (UWW) were performed twice in a sample of 32 young men and women. Participants were assessed in a fasted, euhydrated state 2-7 days apart. All methods were compared to a criterion four-compartment model using BP-derived body volume, DXA-derived bone mineral content and MF-BIA-derived total body water (4CBP ). Additional four-compartment models using UWW- and DXA-derived body volume were also examined (4CUWW ) and (4CDXA ). Validity results were conducted with paired t-tests and Bland-Altman analysis. Reliability was determined using intraclass correlations (ICC), coefficients of variation (CV) and standard error of the measurement (SEM). Validity analysis revealed that all methods overestimated per cent body fat and fat mass, and underestimated fat-free mass when compared with 4CBP , but only DXA and BP were significantly different (P 0·9, CVs < 12%). Results of the present study indicate that typical laboratory-based methods of body composition are valid and reliable. However, we caution that results should not be translated between methods and assessments should be performed with the same instrument when the goal is to monitor changes in body composition over time.

25 Hydroxyvitamin D Levels are Negatively and Independently Associated with Fat Mass in a Cohort of Healthy Overweight and Obese Subjects.

Abstract: BACKGROUND Obesity is associated with lower serum vitamin D (25(OH)D) levels through several mechanisms. The aim of the study was to examine the possibility of a negative association between fat mass and 25(OH)D levels in a cohort of otherwise healthy overweight and obese subjects, independently of age, sex, blood pressure levels and anthropometric and metabolic parameters. MATERIALS AND METHODS 147 overweight and obese subjects (106 women and 41 men), aged between 18 and 69 years, were enrolled into the study. All of them did not show any clinically evident metabolic or chronic diseases (i.e. hypertension, diabetes mellitus, renal failure, etc.) and did not use any kind of drug. Serum fasting levels of 25(OH)D, insulin, glucose, uric acid and lipids (triglycerides, total, HDL and LDL cholesterol) were measured. The season in which the blood samples were collected was autumn. Insulin resistance was assessed by using the Homeostasis Model Assessment (HOMA-IR). Body composition parameters (Fat Mass [FM], Fat Free Mass [FFM], body cell mass [BCM], Total Body Water [TBW]) were measured by electrical Bioimpedance Analysis (BIA). Lastly, demographic, anthropometric and clinical parameters (age, Body Mass Index [BMI], Waist Circumference [WC], Systolic (SBP) and Diastolic (DBP) blood pressure) were also assessed. RESULTS 25(OH)D levels were significantly and negatively correlated with BMI (P <0.001), WC (P <0.01), DBP (P <0.05), insulin (P <0.001), HOMA-IR (P <0.01), triglycerides (P <0.01), and fat mass (P <0.001). A multivariate regression analysis was performed by considering 25(OH)D levels as the dependent variable and sex, waist circumference, fat mass, DBP, triglycerides, and insulin (or HOMAIR) as the independent ones, and 25(OH)D levels maintained a significant and independent relationship only with fat mass (negative) (P <0.01). CONCLUSION This study clearly shows that 25(OH)D circulating levels are progressively lower with the increase of fat mass, independently of sex, body fat distribution, blood pressure and insulin and metabolic parameters. These data strongly show that adipose tissue accumulation per se is absolutely the main factor responsible factor for lower 25(OH)D levels in obese subjects, possibly through sequestration of fat soluble 25(OH)D in fat mass.

Total Body Water and Intracellular Water Relationships with Muscle Strength, Frailty and Functional Performance in an Elderly Population.

Abstract: As a person ages, total body water (TBW), intracellular water (ICW), muscle mass and muscle strength tend to decline. The decline in ICW may reflect losses in the number of muscle cells but may also be responsible for less hydrated muscle cells. To assess whether TBW and ICW are associated with muscle strength, functional performance and frailty in an aged population, independently of muscle mass. An observational cross-sectional study of community-dwelling individuals aged 75 years and older. TBW, ICW, fat mass, lean mass and muscle mass were assessed by bioelectrical impedance analysis, frailty status was measured according to Fried criteria, handgrip strength was measured using the hand-held JAMAR dynamometer, and functional performance was measured according to the Barthel index and gait speed. A total of 324 subjects were recruited (mean age 80.1 years, 47.5% women). TBW and ICW were closely correlated with muscle mass in both sexes. ICW was also associated with Barthel score, gait speed and frailty in both sexes and with handgrip in men. Considerable variability in ICW was observed for the same muscle mass. Multivariate analysis showed a positive effect of ICW on handgrip, functional performance and gait speed and a protective effect of ICW on frailty, independently of age, sex, body mass index and number of comorbidities. In elderly individuals with similar muscle mass, those with higher ICW had a better functional performance and a lower frailty risk, suggesting a protective effect of cell hydration, independently of muscle mass.

Inter-correlations Among Clinical, Metabolic, and Biochemical Parameters and Their Predictive Value in Healthy and Overtrained Male Athletes: The EROS-CORRELATIONS Study

Abstract: Objectives: The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study identified multiple hormonal and metabolic conditioning processes in athletes, and underlying mechanisms and biomarkers of overtraining syndrome (OTS). The present study’s objective was to reveal independent predictors and linear correlations among the parameters evaluated in the EROS study to predict clinical, metabolic, and biochemical behaviors in healthy and OTS-affected male athletes. Methods: We used multivariate linear regression and linear correlation to analyze possible combinations of the 37 parameters evaluated in the EROS study that revealed significant differences between healthy and OTS-affected athletes. Results: The testosterone-to-estradiol (T:E) ratio predicted the measured-to-predicted basal metabolic rate (BMR) ratio; the T:E ratio and total testosterone level were inversely predicted by fat mass and estradiol was not predicted by any of the non-modifiable parameters. Early and late growth hormone, cortisol, and prolactin responses to an insulin tolerance test (ITT) were strongly correlated. Hormonal responses to the ITT were positively correlated with fat oxidation, predicted-to-measured BMR ratio, muscle mass, and vigor, and inversely correlated with fat mass and fatigue. Salivary cortisol 30 minutes after awakening and the T:E ratio were inversely correlated with fatigue. Tension was inversely correlated with libido and directly correlated with body fat. The predicted-to-measured BMR ratio was correlated with muscle mass and body water, while fat oxidation was directly correlated with muscle mass and inversely correlated with fat mass. Muscle mass was directly correlated with body water, and extracellular water was directly correlated with body fat and inversely correlated with body water and muscle mass. Conclusions: Hypothalamic-pituitary responses to stimulation were diffuse and indistinguishable between the different axes. A late hormonal response to stimulation, increased cortisol after awakening, and the T:E ratio were correlated with vigor and fatigue. The T:E ratio was also correlated with body metabolism and composition, testosterone was predicted by fat mass, and estradiol predicted anger. Hydration status was inversely correlated with edema, and inter-correlations were found among fat oxidation, hydration, and body fat.

Influence of Water Intake and Balance on Body Composition in Healthy Young Adults from Spain.

Abstract: The increasing prevalence of overweight and obesity has become an epidemic public health problem worldwide. In the last years, several investigations have suggested that water intake and retention could have important implications for both weight management and body composition. However, there is a lack of information about this issue globally, and mainly specifically in Spain. Thus, the aim of this study was to analyze the association between hydration status and body composition in a sample of healthy Spanish adults. The study involved 358 subjects, aged 18–39 years. The recently validated “hydration status questionnaire” was used to assess their water intake, elimination, and balance. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK). Body composition variables were acquired by bioelectrical impedance analysis. Differences in anthropometric and body composition variables were assessed through the ANOVA test and considered significant at p < 0.05. Fluid intake was correlated with body water content. Inverse associations between water consumption, normalized by weight, with body weight, body fat mass, and waist circumference were found. Moreover, according to water balance, significant differences in body water content in females were observed. In conclusion, higher fluid intake seems to be related with a healthier body composition. Therefore, the improvement of water intake and water balance could be useful for overweight and obesity prevention, although further studies are needed to confirm the present findings.

Relationship between body composition and the level of aerobic and anaerobic capacity in highly trained male rowers.

Abstract: Background Body composition may affect the potential for success in sports. For this reason, our study aimed to determine the impact of body composition on the level of aerobic and anaerobic capacity in competitive rowers. Methods The study involved 48 males aged 20±2 years. Body composition was analysed using electrical bioimpedance. Maximum aerobic capacity (VO2max) and average anaerobic power (AP) were determined using an incremental cycling test until exhaustion and a standard Wingate Anaerobic Test (WAT), respectively. Results The optimal ranges of body components with respect to the level of anaerobic and aerobic capacity at preparatory period for highly trained rowers aged 17-23 years, with body mass 67.5-104.7 kg, were 86-88% for fat free mass (FFM), 63-65% for total body water (TBW) and 11-13% for fat mass (FM). Regression analyses showed that BM and FFM significantly contributed to the prediction of VO2max and AP. The increase in FFM and BM by 1 kg resulted in the change of VO2max by +0.161 l.min-1 and -0.057 l.min-1, and AP by +5.51 W and +4.74 W, respectively. Conclusions Body composition is closely related to the level of aerobic and anaerobic capacity in rowers, and we suggest that its regulation can serve as an effective tool to improve physical performance. The regression models we developed seem to be promising for estimating the changes in physical capacity based on body composition modifications, however, their accuracy should be verified in an experimental study.

Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis.

Abstract: Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months. Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.

Body weight, body composition and survival after 1 year: follow-up of a nutritional intervention trial in allo-HSCT recipients

Abstract: The role of body weight change in survival among recipients of hematopoietic stem-cell transplantation is controversial. We assessed the effect of optimizing energy and protein intake on 1-year survival, body weight and body composition, and the effect of body weight and body composition on 1-year survival in 117 patients (57 intervention, 60 control) in a randomized controlled trial. Cox regression was used to study effects of the intervention, weight and body composition on death, relapse, and nonrelapse mortality (NRM). We found no significant effect of intervention versus control on death hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.54−2.04, p = 0.88), relapse (HR 1.15, 95% CI 0.48−2.27, p = 0.75), and NRM (HR 0.95, 95% CI 0.39−2.28, p = 0.90). Body weight, fat-free mass index, body fat mass index and total body water changed over time (p < 0.001), similarly in both groups (0.17 ≤ p ≤ 0.98). In multivariable analyses adjusted for group, gender and age, HRs and 95% CIs per one kilo increase in weight were 1.03 (1.01−1.06) and 1.04 (1.01−1.08) for death and NRM after 1 year (p ≤ 0.02), respectively, and 1.08 (1.01−1.15) for relapse after 3 months (p = 0.02). In conclusion, weight gain is possibly due to fluid retention and is an indicator of a complication in HSCT, rather than a marker of improved nutritional status.

Serum Sodium Concentration and Tonicity in Hyperglycemic Crises: Major Influences and Treatment Implications

Abstract: Maintenance of the volume of all cells, particularly those of the central nervous system, is critical for their function and survival.1, 2, 3, 4, 5, 6 Tonicity (ie, effective osmolarity) of a solution refers to its property to cause osmotic fluid shifts into or out of cells suspended in it. Direct determination of serum tonicity is not readily available for clinical applications.6 Serum sodium concentration ([Na]S) is the main parameter used as a surrogate value for serum tonicity.5, 6, 7 The only direct information provided by [Na]S is whether serum tonicity is normal (the volume of cells exposed to a serum with normal [Na]S is not affected), low (the volume of cells exposed to a serum with low [Na]S increases by osmotic intracellular transfer of water), or high (the volume of cells exposed to a serum with high [Na]S decreases by osmotic transfer of water out of the cells).6, 7 In a pivotal study, Edelman and coinvestigators identified total body sodium, total body potassium, and total body water as the universal determinants of [Na]S in patients with various states potentially associated with extracellular volume disturbances.8 Abnormalities in [Na]S usually result from changes in the external balance of one of its 3 determinants or a combination thereof. The relations between [Na]S and total body sodium, total body potassium, and total body water have been expressed by various formulas. The original Edelman formula expresses sodium concentration in plasma water.8 The Nguyen and Kurtz formula expresses sodium concentration in plasma, which is essentially equal to [Na]S.9 Nguyen and Kurtz developed their formula by multiplying the components of the Edelman formula by a correction coefficient equal to 0.93, which represents the normal plasma water fraction. The Rose formula, which represents a simplified version of the Edelman formula, expresses [Na]S as the fraction (total body sodium plus total body potassium) over total body water.10 Formulas calculating the tonicity of replacement solutions for correction of dysnatremias applied in clinical practice11, 12, 13, 14 are based on the Rose formula, which will also be the basis of the calculations in this review. The principle that underlies the distribution of body water in the 2 major body‐fluid compartments states that the intracellular/extracellular volume ratio is equal to the intracellular/extracellular solute ratio.15 This relationship is a direct consequence of Peter's osmotic principle, which states that in the steady state, solute concentration (osmolality) is equal in the intracellular and extracellular fluids.16 Total body sodium and potassium represent the major solutes in body fluids: sodium is essentially restricted in the extracellular compartment and potassium in the intracellular compartment. Consequently, total body sodium is a measure of effective extracellular solutes, whereas total body potassium represents the effective intracellular solutes. Hyperglycemic crises create complex disturbances in body water and its distribution between the intracellular and extracellular compartments, in addition to tonicity problems not reflected directly in [Na]S. This review analyzes the pathogenesis and treatment of hyperglycemic hypertonicity.

Human Body Composition and Muscle Mass

Abstract: Knowledge on body composition is important both in health and in disease, especially when considering chronic (i.e., growing, ageing, pregnancy) and interventional (nutrition, exercise, physical training) biological processes, as well as in predicting, preventing and managing such modern chronic diseases as sarcopenia, obesity, type 2 diabetes or metabolic syndrome. Therefore, in this chapter we present human body composition by taking advantage of widely accepted models, from the simplest 2-compartment model, which allows fat and fat-free body mass to be distinguished, up to a more complex, 6-compartment model, capable of distinguishing body fat, total body water, bone minerals, proteins, soft-tissue minerals, and glycogen. Moreover, in this chapter we provide equations that can be applied in laboratory and clinical practice to predict the main components of body composition, such as body water, skeletal muscles (SMs), body fat, and bone minerals. Special attention is given to the methods of evaluation of SM mass and its importance in health and disease.

Effect of 12-Week Swimming Training on Body Composition in Young Women.

Abstract: Background: Systematic physical activity can permanently prevent disadvantageous developments in the human body. This is very important especially for women, for whom the maintenance of a lean body in good shape is sometimes a primary consideration. However, in most cases, this activity is taken randomly and does not produce the desired effects such as reducing body fat. The purpose of the study was to evaluate changes in female body composition induced by 12 weeks of swimming training compared to sedentary controls. Methods: Training sessions occurred three times per week (60 min/session). Height, body mass, and waist/hip circumference and waist/hips ratio (WHR) were measured. Body cell mass (BCM), total body water (TBW), extracellular (ECW) and intracellular water (ICW), fat mass (FM), lean mass (FFM), and muscle mass (MM) were measured using bioelectrical impedance (pre/post). Results: Training elicited decreases in hip circumference and increase in WHR. No changes were recorded in BCM, TBW, ECW, ICW, FM, FFM, and MM. Controls experienced decreases in values of BCM, ICW, and MM and increases in ECW. Conclusion: The applied swimming training did not significantly affect the body composition parameters. Inactivity also triggered a tendency toward unhealthy movement of water from the intracellular to extracellular space.

Association between Hydration Status and Body Composition in Healthy Adolescents from Spain

Abstract: At present, obesity and overweight are major public health concerns. Their classical determinants do not sufficiently explain the current situation and it is urgent to investigate other possible causes. In recent years, it has been suggested that water intake could have important implications for weight management. Thus, the aim of this study was to examine the effect of hydration status on body weight and composition in healthy adolescents from Spain. The study involved 372 subjects, aged 12–18 years. Water intake was assessed through the validated “hydration status questionnaire adolescent young”. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK) and body composition was estimated by bioelectrical impedance analysis. Water intake normalized by body weight was positively correlated with body water content (boys (B): r = 0.316, p = 0.000; girls (G): r = 0.245, p = 0.000) and inversely with body mass index (BMI) (B: r = −0.515, p = 0.000; G: r = −0.385, p =0.000) and fat body mass (B: r = −0.306, p = 0.000; G: r = −0.250, p = 0.001). Moreover, according to BMI, overweight/obese individuals consumed less water than normal weight ones. In conclusion, higher water balance and intake seems to be related with a healthier body composition.

Role of Lung Ultrasound in Adjusting Ultrafiltration Volume in Hemodialysis Patients.

Abstract: Chronic fluid over-hydration is common in dialysis patients. It is associated with mortality and cardiovascular events. Optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. The purpose of this study was to evaluate the usefulness of ultrasound in quantifying body water. In 35 hemodialysis patients, we performed ultrasound of the chest, pre-tibial skin tissue thickness (TT), heart and inferior vena cava (IVC) before and after dialysis. We compared B-line scores of lungs, IVC diameters and cardiac functions in pre-dialysis and post-dialysis groups. We then estimated the correlations between ultrasound parameters and ultrafiltration volumes. Ultrafiltration parameters were adjusted prospectively for subsequent dialysis. As a result, both extravascular and intravascular water decreased during ultrafiltration. The median numbers of B-line scores (10 [0-42] vs. 4 [0-30]; p 6 in the previous dialysis. All patients tolerated the protocol well without any symptoms. Ultrafiltration volume was most associated with lung water, reflected by variation in B-line score. It was not associated with cardiac function, IVC diameter, IVC collapse rate or TT. Lung ultrasound is a useful imaging tool for dialysis patients.

Relationships Between Peritoneal Protein Clearance and Parameters of Fluid Status Agree with Clinical Observations in Other Diseases that Venous Congestion Increases Microvascular Protein Escape

Abstract: BACKGROUND: Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal microvessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements. METHODS: A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram. RESULTS: Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, p = 0.007) and right atrial area (β 0.01, p = 0.03) were significant independent predictors of peritoneal protein clearance. CONCLUSION: Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality.

Impact of serum albumin levels on the body fluid response to tolvaptan in chronic kidney disease patients

Abstract: Tolvaptan exerts an aquaretic effect by blocking vasopressin V2 receptor. Although tolvaptan ameliorates body fluid retention even in patients with chronic kidney disease (CKD), predictors of body fluid reduction induced by tolvaptan remain unclear. We, therefore, examined the clinical parameters associated with the effect of tolvaptan on fluid volume in CKD patients. Twelve CKD patients (stage 3–5) with fluid retention were treated with tolvaptan in addition to conventional diuretic treatment. Patients were divided into low and high responders by the median change in total body water (TBW) for 1 week measured by a bioimpedance analysis (BIA) device, and clinical parameters were compared between the groups. The body weight significantly decreased by 2.0 ± 2.3 kg (p = 0.005), but the estimated glomerular filtration rate (eGFR) was not significantly changed (16.9 ± 11.9 vs. 17.4 ± 12.4 mL/min/1.73 m2, p = 0.139) after 1 week. The BIA showed that the intracellular water (ICW) decreased by 6.0% ± 4.7% (p < 0.001), the extracellular water (ECW) decreased by 6.7% ± 5.4% (p = 0.001), and the TBW decreased by 6.3% ± 4.9% (median value − 6.02%, p < 0.001). The serum albumin level in the high responders was significantly lower than in the low responders (2.3 ± 0.5 vs. 3.3 ± 0.8 g/dL, p = 0.013). Significant partial correlations adjusted for the eGFR were observed between the baseline serum albumin level and changes in the ICW (r = 0.440, p = 0.048), ECW (r = 0.593, p = 0.009) and TBW (r = 0.520, p = 0.020). Serum albumin levels predict the body fluid response to tolvaptan in CKD patients. Tolvaptan may be a promising therapeutic option for ameliorating body fluid retention, especially in patients with hypoalbuminemia.

Factors Affecting and Adjustments for Sex Differences in Current Perception Threshold With Transcutaneous Electrical Stimulation in Healthy Subjects

Abstract: OBJECTIVE Current perception threshold (CPT) measurement is a noninvasive, easy, and semi-objective method for determining sensory function using transcutaneous electrical stimulation. Previous studies have shown that CPT is determined by physical characteristics, such as sex, age, physical sites, and presence of neuropathy. Although the CPT reported in males is clearly higher than that in females, the reason for this difference remains unclear. This study investigates the cause of sex-based differences in CPT and suggests an adjustment method, which may suppress the sex difference in CPT. MATERIALS AND METHODS Electrical stimulation was applied with PainVision® via five sizes of circular surface electrodes. Seventy healthy participants were examined thrice under each electrode. The relationship among body water percentage, body fat percentage, and CPT was then analyzed. RESULTS CPT values are higher in males than that in females, with statistically significant sex differences with each electrode pairs (EL 1: p < 0.001; EL 2: p = 0.006; EL 3: p < 0.001; EL 4: p < 0.001; EL 5: p < 0.001). By adjusting for body fat percentage or body water percentage, the log-transformation values (CPT values) no longer exhibit sex differences with any electrode pairs (body fat: p = 0.09; body water: p = 0.08). CONCLUSION We conclude that sensitivity for perceiving electrical stimulation can be influenced by the subjects' characteristics, such as body fat or body water percentages.

Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease.

Abstract: OBJECTIVE The recognition of fluid retention is critical in treating heart failure (HF). Bioelectrical impedance analysis (BIA) is a well-known noninvasive method; however, data on its role in managing patients with congenital heart disease (CHD) are limited. Here, we aimed to clarify the correlation between BIA and HF severity as well as the prognostic value of BIA in adult patients with CHD. DESIGN This prospective single-center study included 170 patients with CHD admitted between 2013 and 2015. We evaluated BIA parameters (intra- and extracellular water, protein, and mineral levels, edema index [EI, extracellular water-to-total body water ratio]), laboratory values, and HF-related admission prevalence. RESULTS Patients with New York Heart Association (NYHA) functional classes III-IV had a higher EI than those with NYHA classes I-II (mean ± SD, 0.398 ± 0.011 vs 0.384 ± 0.017, P 0.386, the median value in the present study, was significantly associated with a future increased risk of HF-related admission (HR = 4.15, 95% CI = 1.70－11.58, P < .001). A body weight reduction during hospitalization was also related to EI reduction. CONCLUSIONS EI determined using BIA could be a useful marker for HF severity that could predict future HF-related admissions in adult patients with CHD.

Association of Body Fluid Expansion With Optical Coherence Tomography Measurements in Diabetic Retinopathy and Diabetic Macular Edema.

Abstract: Purpose To evaluate associations of body fluid status with optical coherence tomography measurements in patients with diabetic retinopathy (DR). Methods This prospective, cross-sectional study enrolled a total of 104 eyes from 104 patients with diabetes mellitus for fundus evaluations of DR and optical coherence tomography examinations. DR severity was graded via fundus photography. Systemic body fluid status was recorded via a body composition monitor with output values of total body water, extracellular water (ECW), intracellular water, and overhydration (OH). Relative overhydration (ROH) was defined as OH/ECW. Volume overload was defined as ROH ≥7%. Correlations of central subfield thickness (CST) with body fluid status were analyzed by partial correlation with adjustment for age, sex, and body mass index (BMI). Logistic regression analysis was used to evaluate factors associated with diabetic macular edema (DME). Results Higher levels of ECW, OH, and ROH were correlated with thick CST in patients with DR (P = 0.006, 0.021, and 0.008, respectively), but not in those without any DR (all P > 0.05), after adjusting for age, sex, and BMI. Patients with DME (n = 31) had higher OH than DR patients without DME (n = 28) or those without any DR (n = 45) (P = 0.002 and P < 0.001, respectively). Multiple regression model showed that volume overload was the independent factor for the presence of DME (odds ratio, 9.532; 95% confidence interval, 2.898-31.348; P < 0.001). Conclusions While both ECW and OH reflect CST in patients with DR, overhydration had particularly strong associations with DME. This study provides a novel insight into our current understanding regarding the pathogenesis for DME.

Lean women on metformin and oral contraceptives for polycystic ovary syndrome demonstrate a dehydrated osteosarcopenic phenotype: a pilot study.

Abstract: Scarce data exist on the body composition of lean women with polycystic ovary syndrome (PCOS) on treatment with metformin and oral contraceptives (OCs). Thirty-four lean (body mass index 18.5–24.9 kg/m2) women (17 with PCOS on metformin and OCs treatment for six months and 17 controls) aged 18–40 years were assessed for body composition parameters (fat, muscle, glycogen, protein masses, bone masses, and body water compartments) and phase angles. PCOS patients demonstrated lower muscle, glycogen and protein masses (U = 60, p = 0.003), along with a lower bone mineral content and mass (U = 78, p = 0.021; U = 74, p = 0.014) than their healthy counterparts, while total and abdominal fat masses were similar between the two groups. PCOS patients also exhibited increased extracellular body water (U = 10, p < 0.001) and decreased intracellular water, compatible with low-grade inflammation and cellular dehydration. Key differences in body composition between women with PCOS and controls demonstrated an osteosarcopenic body composition phenotype in PCOS patients. A confirmation of these findings in larger studies may render osteosarcopenia management a targeted adjunct therapy in women with PCOS.

Do Pre-Hemodialysis Estimates of Extracellular Volume Excess Using Bioimpedance and N-Terminal Brain Natriuretic Peptide Correlate With Cardiac Chamber Size Measured by Magnetic Resonance Imaging?

Abstract: Bioimpedance can be used to measure extracellular water (ECW) and total body water in hemodialysis (HD) patients and estimate ECW excess. However, ECW excess potentially includes both an increase in the plasma volume and also the extravascular volume. Overestimating the amount of fluid to be removed during HD risks intra-dialytic hypotension. We wished to determine the association between estimates of ECW excess comparing several different equations using bioimpedance, brain N-terminal pro-brain natriuretic peptide (NT-proBNP) with cardiac chamber volumes and function as determined by cardiac magnetic resonance imaging pre-HD measurements of ECW and total body water were made using multifrequency bioimpedance and cardiac chamber sizes and function were determined by magnetic resonance imaging. Thirty patients, 20 males (66.7%), mean age 64.4 ± 15.3 years were studied. ECW and ECW/height were positively associated with indexed right ventricular end-systolic (RVESVi) and end-diastolic volume (RVEDVi) (RVESi r = 0.46, r = 0.43; RVEDi r = 0.50, r = 0.44, all P < 0.05), but not with left sided cardiac volumes. Whereas NT-proBNP was associated with indexed left atrial and ventricular size (r = 0.47, r = 0.58, P < 0.05), but not right sided cardiac volumes. Pre-HD NT-proBNP was associated with left sided cardiac chamber sizes, but not with right sided chamber sizes, whereas ECW/height was associated with right sided cardiac chamber sizes. As right-sided cardiac chamber size is more responsive to and reflective of changes in intravascular volume than the left atrium and ventricle, then bioimpedance measured ECW is potentially more reliable in estimating plasma volume expansion.

Training and Body Composition during Preparation for a 48-Hour Ultra-Marathon Race: A Case Study of a Master Athlete

Abstract: Although the acute effects of ultra-endurance exercise on body composition have been well studied, limited information exists about the chronic adaptations of body composition to ultra-endurance training. The aim of the present study was to examine the day-by-day variation of training and body composition of a master athlete during the preparation for a 48-hour ultra-marathon race. For all training sessions (n = 73) before the race, the running distance, duration, and pace were recorded, and body mass, body fat (BF), body water (%), visceral fat, fat-free mass (FFM), four circumferences (i.e., waist, upper arm, thigh and calf), and eight skinfolds (i.e., chest, mid-axilla, triceps, subscapular, abdomen, iliac crest, thigh and calf) were measured accordingly in a 53-year-old experienced ultra-endurance athlete (body mass 80.1 kg, body height 177 cm, body mass index 25.6 kg·m-2). The main findings of the present study were that (a) the training plan of the ultra-endurance master athlete followed a periodization pattern with regard to exercise intensity and training volume, which increased over time, (b) the body mass, BF, and FFM decreased largely during the first 30 training sessions, and (c) the circumferences and skinfolds reflected the respective decrease in BF. The findings of this case study provided useful information about the variation of training and body composition during the preparation for an ultra-marathon race in a male master ultra-marathoner. The preparation for an ultra-endurance race seems to induce pronounced changes in body mass and body composition.

Bioelectrical impedance analysis does not detect an increase in total body water following isotonic fluid consumption.

Abstract: Purpose: To determine if single-frequency foot-to-foot bioelectrical impedance analysis (BIA) can detect acute changes in total body water (TBW) following consumption of isotonic saline. All partic...

Hypertonic saline for fluid resuscitation after cardiac surgery (HERACLES): study protocol for a preliminary randomised controlled clinical trial

Abstract: Intraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy. It has been shown that a positive fluid balance has a major impact on postoperative outcome. Today, the advantages and disadvantages of buffered crystalloid solutes are a topic of controversy, with no consensus being reached so far. The use of hypertonic saline (HS) has shown promising results with respect to lower total fluid balance and postoperative weight gain in critically ill patients in preliminary studies. However, collection of more data on HS in critically ill patients seems warranted. This preliminary study aims to investigate whether fluid resuscitation using HS in patients following cardiac surgery results in less total fluid volume being administered. In a prospective double-blind randomised controlled clinical trial, we aim to recruit 96 patients undergoing elective cardiac surgery for ischaemic and/or valvular heart disease. After postoperative admission to the intensive care unit (ICU), patients will be randomly assigned to receive 5 ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl) infused within 60 min. Blood and urine samples will be collected preoperatively and postoperatively up to day 6 to assess changes in renal, cardiac, inflammatory, acid-base, and electrolyte parameters. Additionally, we will perform renal ultrasonography studies to assess renal blood flow before, during, and after infusion, and we will measure total body water using preoperative and postoperative body composition analysis (bioimpedance). Patients will be followed up for 90 days. The key objective of this study is to assess the cumulative amount of fluid administered in the intervention (HS) group versus control (NS) group during the ICU stay. In this preliminary, prospective, randomised controlled clinical trial we will test the hypothesis that use of HS results in less total fluids infused and less postoperative weight gain when compared to the standard of intensive care in cardiac surgery patients. ClinicalTrials.gov, NCT03280745 . Registered on 12 September 2017.

Perioperative fluid dynamics evaluated by bioelectrical impedance analysis predict infectious surgical complications after esophagectomy.

Abstract: Transthoracic esophagectomy, among the most invasive surgeries, is highly associated with postoperative infectious complications which adversely affect postoperative management including fluid dynamics. The aim of the study is to evaluate the utility of perioperative bioelectrical impedance analysis (BIA) measurements for the patients after transthoracic esophagectomy. Multi-frequency BIA measurements were conducted in 24 patients undergoing transthoracic esophagectomy preoperatively, at 1 h after surgery, and twice daily for the following 7 days. The amounts of extracellular water (ECW), internal cellular water (ICW), total body water (TBW), and fat-free mass (FFM) were calculated. Changing trends in variables were analyzed, and the patients were subdivided according to the presence of infectious surgical adverse events to identify differences in fluid dynamics. ECW was the major body fluid compartment showing an increase after surgery, and peaked on postoperative day (POD) 2. Twelve patients experienced infectious complications. The peaks of changes in ECW and ECW/TBW appeared earlier and their values at the highest peak were significantly lower in the group without infectious complications on POD 2. The ICW/FFM value showed a mild decrease as compared to POD1 and then gradually recovered. It was significantly lower even before surgery and showed the most significant stratification on POD2. ECW/TBW of 48% and ICW/FFM of 37% on POD2 were predictive cut-off values for infectious adverse events with high area-under receiver operating characteristic (ROC) curves: 0.80 or higher. BIA measurements are useful for monitoring fluid retention and may predict infectious complications in the early phase after transthoracic esophagectomy. Registry name: UMIN-CTR, ID: UMIN000030734, Registered on January 9, 2018, retrospectively registered.

Changes in Body Composition, Energy Metabolism, and Appetite-Regulating Hormones in Korean Professional Female Ballet Dancers Before and After Ballet Performance.

Abstract: This study investigated changes in body composition, energy balance, and appetite-regulating hormones in professional female ballet dancers before and after 3 days of ballet performances. The subjects were 43 professional female ballet dancers in Korea. The mean age of the subjects was 25.9 ± 2.8 years, and they had over 13 years of ballet training on average. For body composition, the body mass index (BMI), percent body fat (%BF), lean body mass (LBM), and total body water (TBW) were evaluated. By way of blood analysis the serum levels of ghrelin, leptin, and insulin were examined. The calculations of energy intake (EI) and expenditure (EE) were based on journals that were self-recorded by the subjects for 14 days. For statistical analysis, the dependent sample t-test was applied (p < 0.05). The results showed no significant change in %BF, but the BMI, LBM, and TBW increased significantly in the post-performance measurement. Energy balance results demonstrated a significant increase in EI and decrease in EE. Both the ghrelin and leptin levels increased significantly. Although reported energy intake increased after performances, it remained below estimated energy requirements. Ballet dancers should be aware of the need to maintain energy balance in order to optimize their health and performance.