Clinical impact of disease-related malnutrition and fluid overload assessment via bioimpedance vector analysis in hospitalized patients.

Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.

Twenty years ago, ESPEN published its "Guidelines for nutritional screening 2002", with the note that these guidelines were based on the evidence available until 2002, and that they needed to be updated and adapted to current state of knowledge in the future. Twenty years have passed, and tremendous progress has been made in the field of malnutrition risk screening. Many screening tools have been developed and validated for different patient groups and different health care settings. Some countries even have introduced mandatory screening for malnutrition at admission to hospital. Yet, changes in society and healthcare require a reflection on current practice and policies regarding malnutrition risk screening. In this opinion paper, we share our perspectives on malnutrition risk screening in the twenty-twenties, addressing the changing and varying profile of the malnourished individual, the goals of screening and screening tools (i.e., preventive or reactive), the construct of malnutrition risk (i.e., screening for risk factors or screening for existing malnutrition), and screening alongside a patient's journey.

Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for social resources and even a high mortality.In Catalonia, CPCHN account for 3.5-5 % of the Catalan population (250,000 to 375,000 patients), and we have data pointing to a high prevalence of malnutrition in CPCHN admitted in hospitals for an acute episode (36 % malnourished, 47 % risk of malnutrition). Nevertheless, the prevalence of DRM in CPCHN in the community has been not sufficiently studied. In addition, health and social risk factors for malnutrition are unknown in these population.Taking all these into account, it is necessary to establish an integrated and a collaborative health and social strategy for the screening and management of nutritional care, mainly from a community-based as well as a patient-centered approach.The strategy to tackle against malnutrition in CPCHN is led by the Department of Health of Catalonia (PPAC, PIAISS), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) and the Family and Community Nursing Association (AIFICC), with the support of the University of Vic. This strategy is based on a Decalogue of actions to fight against malnutrition previously identified by a consensus among experts from scientific societies, social services and public health, incorporating the vision of patients and caregivers. Aims:1. Highlight the DRM problem in CPCHN launching a prevalence study of DRM in the CPCHN selecting a representative sample of Catalonian society.2. Establish an integrated and a collaborative intervention plan (nutritional and social) linked to the detection of malnutrition and/or social dysfunction.Results and impact:1. The prevalence study of DRM in the CPCHN is a prospective observational and multicenter randomized study that has been performed in a region of Catalonia, representative of the Catalan society (80 % urban, 20 % rural). The sample size calculated was 384 patients, a total of 404 patients have been participated. A very high prevalence of malnutrition and risk of malnutrition has been found (46.5 % risk, 5.9 % malnutrition) Living alone, polypharmacy and dysphagia were the most important social and health determinants that influence DRM and will allow us to focus strategies to improve patient care.2. The integrated and collaborative intervention plan to tackle against DRM in CPCHN is based on a protocol that includes the clinical, nutritional and social risk screenings. With this aim, Primary Care teams (doctors and nurses) and Social Service professionals (Primary Care and community resources) are coordinated with the Nutritional Support Unit in the reference hospital in a collaborative manner. The first step has been to incorporate mandatory nutritional and social risk factors screenings in patients identified as CPCHN. A positive nutritional or social screening have been linked to comprehensive nutritional and social assessment plans that will allow diagnosing and encoding malnutrition and identifying patients at risk of social dysfunction. Diagnosis of DRM or social dysfunction is linked to an integrated intervention plan (nutritional and social), that includes case-conferences in the case of patients with complex needs.Highlights: Prior to the development of the strategy for dealing with DRM in CPCHN, a low implementation of nutritional screening was detected. This fact was probably due to a low awareness of DRM, but also for lack of a feasible and efficient plan of approach, that must include not only the health aspects but also the social determinants that accompany the disease.Contingencies: The implementation of this strategy is time-consuming, and requires an integrated health and social work.Tutorials have been attached to the shared medical history of Catalonia to guide professionals in the application of the screenings.Timeline: The prevalence study of DRM in the community has been finished at January 2016.The mandatory screening and the validation of the nutritional and social intervention plan will be implemented during 2016.Conclusion: The results of the prevalence study of DRM in CPCHN could be extrapolated to the rest of Catalonia, allowing us to manage effectively the health and social policies. It will also allow us to analyze the impact of different health care quality indicators linked to the strategy to approach to DRM. Nutritional and social community intervention can be cost-efficient, as demonstrated in the hospital setting, and probably will allow reducing unnecessary admissions, readmissions, complications, need for social resources and will help improve the quality of life in CPCHN. The impact of this strategy is based in detecting and treating in an integrated and collaborative manner DRM in CPCHN.

The practical application of the bioimpedance analysis of human body composition (BIA) technology began four decades ago. The first two-dimensional representation of the dependence of one bioimpedance parameter on another was proposed in 1994 in the work of Piccoli et al. This representation is referred to as bioimpedance vector analysis (BIVA). The position of the point in BIVA coordinates has an unambiguous relationship with values of the phase angle (PA), as BIVA coordinates can be used for calculating PA. In this case, the two-dimensional BIVA graph can be supplemented with values of the phase angle ranges, thus forming a pseudo-three-dimensional representation. Continuing with the BIVA logic, you can use other pairs of BIA parameters to build two-dimensional representations (and in some cases, pseudo-three-dimensional), including body composition parameters. This technology can be referred to as the two-dimensional bioimpedance analysis of the human body composition (2D BIA or BIVA HBC - bioimpedance vector analysis of human body composition). The informativeness of BIVA reports and BIVA HBC reports, in the case when the values deposited along the axes are clinically related, will increase. Nevertheless, the practice of using various BIA techniques indicates that from 6 to 10 parameters are used to obtain a complete picture of the processes of changing body composition. In terms of BIVA HBC, it is 3–5 visual representations, and with the partial use of BIVA HBC+ technology (with the introduction of the third parameter), in the monitoring window, you can limit yourself to tracking 2–4 forms of visual representation of body composition parameters.

POS-654 ASSESSMENT OF OVERHYDRATION IN CHILDREN ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS BY BIOIMPEDANCE VECTOR ANALYSIS – A LONGITUDINAL OBSERVATIONAL STUDY

Bioimpedance Can Solve Problems of Fluid Overload

Dehydration is common and frequently under-diagnosed in chronic malnourished children, leading to life-threatening conditions. In this pilot study we applied bioimpedance vector analysis (BIVA) to determine hydration status in 52 neurologically impaired (NI) paediatric patients (14.08 ± 5.32). Clinical and biochemical data were used to define malnutrition and dehydration. Body composition analysis and hydration were also assessed by BIVA and we considered 143 normal-weight healthy subjects (15.0 ± 1.7), as controls for hydration status assessment. BIVA revealed a pathological hydration status in NI children, showing higher resistance (p < 0.001) and reactance values (p = 0.001) compared to controls. No differences in reactance and resistance were detected between well-nourished and under-nourished subjects. Four patients out of 52 showed mild signs of dehydration; no severe dehydration was detected. Laboratory data, suggestive for dehydration, were similar in well-nourished and under-nourished NI subjects. In conclusion, in our sample of NI paediatrics, dehydration according to clinical signs and laboratory data was under-diagnosed. BIVA showed specific bioelectrical characteristics that could be compatible with impaired hydration status. Further studies are necessary to confirm that BIVA may an applicable tool for defining dehydration status and guiding rehydration in NI children.

The aim of the study was to verify whether the bioimpedance vector analysis (BIVA) could be a valid methodology to assess the fluid overload, whether there was a correlation between brain natriuretic peptide (BNP) and the fluid overload detected by BIVA, and whether this technique could be a valid guide in the management of the therapy in patients with acute decompensated heart failure (ADHF). A total of 51 patients arriving to the emergency department of the University Hospital Sant'Andrea (Rome, Italy) from December 2008 to April 2009 were enrolled. Hydration state, BNP, and caval index were evaluated at admission in the emergency department, at 24 and 72 hours, and at discharge. Vascular pedicle width was evaluated at admission and at discharge. BIVA values were correlated with BNP levels. A follow-up by phone at 3 months was performed. ADHF patients showed higher values of hydration state compared with controls. In ADHF patients, the difference between t 0 and t 72 BIVA mean values (P<.001) and between t 0 and discharge BIVA mean value (P<.0001) was statistically significant. Vascular pedicle width in ADHF patients showed a statistically significant difference (P<.0004) in compared with vascular pedicle width in controls.

Effects of lipodystrophy and physical exercise on bioimpedance parameters in people living with HIV: A cross-sectional study

Purpose: Bioimpedance data through bioimpedance vector analysis (BIVA) is used to evaluate cellular function and body fluid content. This study aimed to (i) identify whether BIVA patters differ according to the competitive period and (ii) provide specific references for assessing bioelectric properties at the start of the season in male elite soccer players. Methods: The study included 131 male soccer players (age: 25.1 ± 4.7 yr, height: 183.4 ± 6.1 cm, weight: 79.3 ± 6.6) registered in the first Italian soccer division (Serie A). Bioimpedance analysis was performed just before the start of the competitive season and BIVA was applied. In order to verify the need for period-specific references, bioelectrical values measured at the start of the season were compared to the reference values for the male elite soccer player population. Results: The results of the two-sample Hotelling T2 tests showed that in the bivariate interpretation of the raw bioimpedance parameters (resistance (R) and reactance (Xc)) the bioelectric properties significantly (T2 = 15.3, F = 7.6, p ≤ 0.001, Mahalanobis D = 0.45) differ between the two phases of the competition analyzed. In particular, the mean impedance vector is more displaced to the left into the R-Xc graph at the beginning of the season than in the first half of the championship. Conclusions: For an accurate evaluation of body composition and cellular health, the tolerance ellipses displayed by BIVA approach into the R-Xc graph must be period-specific. This study provides new specific tolerance ellipses (R/H: 246 ± 32.1, Xc/H: 34.3 ± 5.1, r: 0.7) for performing BIVA at the beginning of the competitive season in male elite soccer players.

Aim: The purpose of the study was to reveal the rates of malnutrition risk among inpatients, to determine those who were not malnourished but became iatrogenically-malnourished, and to identify whether malnutrition was prevented or alleviated among how many patients following enteral/parenteral nutrition. Materials and Method: We carried out the study with 349 patients hospitalized in internal and surgical medicine wards between March 01-31, 2017 (1 month) at the Medical Faculty Hospital of Kırıkkale University. The data of this descriptive research was gathered using the NRS-2002 test administered at initial admission and in the first and second weeks (for malnutrition screening) and a demographic information form inquiring about patients’ demographic characteristics, chronic illnesses, medication, and malignancy status. Findings: The findings revealed the mean age of the patients was 60.1±15.5 years and that 54.4% were males. While 75.1% were hospitalized in internal medicine wards, 24.9% received inpatient treatment in surgical medicine wards. About one-fourth of the patients (24.4%) had malnutrition at first admission: 28.6% in internal medicine wards and 11.5% in surgical medicine wards (p = 0.001). Besides, %34.9 of the geriatric group and %16.7 of the non-geriatric group had malnutrition risk, and the difference between the groups was significant (p&lt;0.001). Moreover, there was a significant difference between the male and female patients by malnutrition risk (32.1% vs. 15.1%; p&lt;0.001). The patients in internal medicine and pulmonology wards had significantly increased rates of malnutrition risk in the first week (p = 0.001 and p&lt;0.001, respectively). Yet, the second-week evaluations among the patients in these wards and the first-week and second-week evaluations among those in other wards yielded no significant increase in their malnutrition risk. Conclusion: Overall, the NRS-2002 test revealed considerably high rates of malnutrition risk among the participating inpatients. The risk was found to be significantly higher in the males, geriatric patients, patients with malignancy, and patients in internal medicine wards when compared to the females, non-geriatric patients, patients without malignancy, and patients in pulmonology wards, respectively. Besides, the rates of malnutrition risk significantly increased among the patients in internal medicine and pulmonology wards at the end of the first week. Considering the excess rates of malnutrition risk in the present findings, prioritizing malnutrition risk assessment among all patients admitted may be a simple but effective solution to prevent malnutrition from hindering relevant therapies.

Bioimpedance standards are well established for the normal healthy population and in clinical settings, but they are not available for many sports categories. The aim of this study was to develop reference values for male and female athletes using classic bioimpedance vector analysis (BIVA). In this study, 1556 athletes engaged in different sports were evaluated during their off-season period. A tetrapolar bioelectrical impedance analyzer was used to determine measurements of resistance (R) and reactance (Xc). The classic BIVA procedure, which corrects bioelectrical values for body height, was applied, and fat-free mass, fat mass, and total body water were estimated. In order to verify the need for specific references, classic bioelectrical values were compared to the reference values for the general male and female populations. Additionally, athletes were divided into three groups: endurance, velocity/power, and team sports. In comparison with the general healthy male and female populations, the mean vectors of the athletes showed a shift to the left on the R–Xc graph. Considering the same set of modalities, BIVA confidence graphs showed that male and female endurance athletes presented lower body fluids, fat mass, and fat-free mass than other sets of modalities. This study provides BIVA reference values for an athletic population that can be used as a standard for assessing body composition in male and female athletes.

Background Body composition (BC) and its changes over time may influence performance in soccer players. BC assessment techniques are mainly based on quantitative evaluation, originating from model-based indirect estimates of FatFree Mass and Fat Mass. DXA, particularly the advanced iDXA technology, is considered to be precise enough for this kind of assessment. On the other hand, Bio Impedance Vector Analysis (BIVA) allows the direct assessment of athletes’ body composition from impedance vector (Z vector), irrespective of body weight, prediction models or hydration assumptions and may classify qualitative changes in soft tissues hydration. The objective of this study was to investigate, compare, and integrate seasonal variations of soft tissues (assessed with DXA and BIVA) in elite soccer players, playing in the Italian top level championship (national major league). Methods

Nutritional status in hemodialysis patients and bioimpedance vector analysis

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del Soccorso” General hospital, San Benedetto del Tronto, Italy) aimed, firstly, to measure energy expenditure via indirect calorimetry (IC) (Q-NRG+® Metabolic Monitor, Cosmed, Rome, Italy), derived respiratory quotient (R/Q1) and, malnutrition risk via Mini Nutritional Assessment (MNA) test and body composition through bioimpedance vector analysis (BIVA-Akern, Pontassieve, Italy); secondly, to assess their effect on energy needs, body composition and physical rehabilitation steps in critically ill adults after ICU discharge. The provision of nutrients (PIS test) was also recorded. Oral nutritional supplementation was used to reach the optimal nutritional intake. All patients followed a standardized rehabilitation program. Results: A total of 43 patients were enrolled from January 2024 until February 2025 at the beginning of their post-ICU period. The mean age was 65.7 ± 1.0 years, the mean BMI was 20.73 ± 0.8 kg/m2 at the recovery ward, and 60.4% (n = 26) were male. The mean admission period was 19.5 ± 1.7 days. The resting energy expenditure (mREE) was 1591 ± 71.2 at the admission and 1.856 ± 62.7 kcal/kg/d at the discharge (p < 0.05). The median phase angle value was 4.33 ± 0.15 at the admission and 5.05 ± 0.17° at the discharge (p < 0.05); R/Q1 at the admission was 0.7 ± 0.1 and 1.086± 0.11 at the discharge (p < 0.05). Improved energy expenditure significantly correlated with R/Q1 and phase angle (r = 0.81 and r = 0.72, respectively). Interestingly, there was no significant correlation between improved metabolism and improved PIS test scores (r = 0.18). Improved metabolism and nutritional status showed a tendency to correlate with shorter post-ICU courses and earlier physical recovery, without reaching statistical significance. Conclusions: Measurement of energy expenditure and caloric intake, along with the assessment of body composition is feasible and provides an objective tool to guide and possibly enhance the functional recovery in patients during the post-ICU period.