A predictive model for muscle mass loss in obesity: Validation of phase angle and fat-free mass as independent predictors.

Background. Obesity is one of the most acute health care problems. Numerous methods of combating excess body weight have been developed, but the existing strategies do not lead to permanent and proportional weight loss, some of them have a number of contraindications and side effects, so new methods of body weight correction are constantly being sought. A short-term low-carbohydrate and low-fat diet with additional use of amino acids is promising. The purpose of the study was to evaluate the efficacy of a 21-day low-carbohydrate and low-fat diet with the additional use of an amino acid complex for weight loss. Materials and methods. Thirty-seven women with a diagnosis of obesity were involved. They were randomly divided into two groups — experimental (19 women) and control (18 women), with the same age, body weight and results of bioimpedance analysis. The patients of the control group were put on a hypocaloric Mediterranean diet, and the patients of the experimental group — on a low-carbohydrate, low-fat diet with the additional use of an amino acid complex. Duration of observation was 21 days. Before and after completion of observation, all patients underwent anthropometric measurements. Results. After 21 days, the experimental group had a greater decrease in body weight compared to the control group (6.7 ± 0.4 % vs. 3.8 ± 0.7 %, p < 0.05), in body volumes (chest volume: 4.3 ± 0.4 % vs. 1.9 ± 0.4 %, waist volume: 5.2 ± 0.2 % vs. 2.2 ± 0.4 %, hip volume: 5.1 ± 0.3 % vs. 2.3 ± 0.5 %, all p < 0.05). In this group, there was also a greater decrease in adipose tissue (13.6 ± 0.8 % vs. 7.0 ± 2.0 %, p < 0.05), and in the degree of visceral obesity (2.0 ± 0.2 units vs. 0.9 ± 0.3 units, p < 0.05); the amount of muscle tissue, on the contrary, increased (–2.3 ± 0.6 % vs. 2.6 ± 0.7 %, p < 0.05). Conclusions. There was a significantly greater decrease in body weight, in main body volumes, a greater reduction in adipose tissue and the degree of visceral obesity in patients who were on a low-carbohydrate and low-fat diet with additional use of amino acids compared to patients who ate according to the conventional method.

Children with cerebral palsy have a number of risk factors for the development of sarcopenic obesity: low motor activity, limited joint mobility, eating disorders, deficiency of actual nutrition, dysphagia, taking medications. The aim of the study was to analyze the frequency and structure of sarcopenic obesity depending on the type of physical development, gender, form and class of motor activity in children with cerebral palsy Materials and methods. Anthropometric indicators (body weight, height, body mass index), body component composition were studied in 132 children with spastic forms of cerebral palsy aged 4–17 years with the level of motor disorders GMFCS I–V. Sarcopenic obesity was detected with an increase in the MFR — muscle-to-fat ratio index, calculated as the ratio of the content of musculoskeletal mass to fat mass. Results. According to the level of physical development, underweight prevailed in 50% of children, and overweight and obesity were observed in 11% of patients. Sarcopenic obesity was detected in 15.9% of children with cerebral palsy, its frequency did not significantly differ in children depending on gender, class of motor activity and form. Sarcopenic obesity was more often found in overweight and obese children than in children with normal physical development and protein-energy deficiency ( p <0,001). Conclusions: The conducted study shows the need to use bioimpedance analysis and calculation of the MFR indicator in assessing the nutritional status of children with cerebral palsy for the timely diagnosis of sarcopenia and sarcopenic obesity and the appointment of correction.

Children with severe traumatic brain injury are at high risk of developing nutritional disorders, the frequency of which, according to the literature, reaches 50%. The aim of the study is to analyze the structure and frequency of nutritional disorders in children after severe traumatic brain injury for subsequent dietary correction. Materials and methods. The study examined anthropometric parameters and body composition using bioimpedance analysis in 33 children with severe traumatic brain injury in the acute period (Me — 24 days (Q1-Q3: 16.5–35.5) from the moment of injury). In 10 children, these indicators were assessed dynamically after an average of 121 days (Q1-Q3: 63.2 — 142.2). Results. A high frequency of protein-energy malnutrition was revealed (in 42.4% of patients), as well as significant disturbances in body component composition: 83% of children were diagnosed with skeletal muscle mass deficiency and sarcopenia. During dynamic observation, sarcopenia persisted or worsened in 90% of patients, and 15% were at risk of sarcopenic obesity. Phase angle indicators decreased by the second visit, indicating a decrease in physical activity and deterioration of nutritional status. Statistically significant correlations of the phase angle with mineral mass and active cell mass indicators confirm the importance of a comprehensive assessment of body composition. Conclusion. The introduction of bioimpedance analysis into a comprehensive assessment of the nutritional status of children with severe traumatic brain injury allows us to differentiate the type of nutritional disorders, monitor them for further nutritional correction in order to optimize the rehabilitation process in children after severe traumatic brain injury.

The role of visceral fat mass in preserved ratio impaired spirometry (PRISm): The Nagahama study.

Phase angle and nutrition in the acute phase are associated with the subsequent recovery of activities of daily living ability after stroke.

Background: It is crucial to precisely measure resting energy expenditure (REE) to provide nutritional support, especially for obese individuals. Although indirect calorimetry (IC) is the gold standard, its limited accessibility necessitates the evaluation of alternative methods such as bioelectrical impedance analysis (BIA).Objective: To compare the accuracy of REE measurements obtained using BIA and IC in obese adults.Methods: This prospective cross-sectional observational study was conducted in the intensive care unit (ICU) of S. L. Raheja Hospital, Mumbai. Fifty adults aged 18-65 years with a body mass index (BMI) ≥25 kg/m² were evaluated. REE was measured using BIA (InBody, Seoul, Korea) and IC (COSMED Q-NRG, Rome, Italy) under standardized fasting and resting conditions. A paired t-test was used to compare mean REE values, and additional agreement and equivalence analyses were performed.Results: The mean REE measured by IC was 1601.56 ± 376.72 kcal/day, while BIA yielded 1554.20 ± 355.70 kcal/day. The two approaches did not differ significantly (p = 0.05196). However, non-significance alone does not imply equivalence; therefore, further analyses were conducted. Bland-Altman analysis demonstrated a small mean bias between the two methods, with values within the 95% limits of agreement and no evidence of proportional bias. Lin's concordance correlation coefficient (CCC) indicated strong concordance, and the mean absolute percentage error remained within an acceptable clinical margin of ±10% relative to IC. A two one-sided test (TOST) procedure confirmed statistical equivalence between BIA and IC within the predefined ±10% equivalence margin. These findings collectively suggest that BIA provides a clinically comparable estimate of REE to IC, supporting its potential use when IC is unavailable.Conclusion: BIA demonstrated clinically acceptable agreement with IC for estimating REE in obese Indian adults. Using a predefined equivalence margin of ±10% (≈±160 kcal/day) of IC values, both the mean bias and Bland-Altman limits of agreement fell within this range, supporting statistical and clinical comparability between the two methods. Given its accessibility, portability, and cost-effectiveness, BIA may serve as a practical alternative to IC in clinical and research settings, although further validation across larger and more diverse populations is warranted.

Abstract Background and Aims The GNRI (Geriatric Nutritional Risk Index1) is an index used in geriatrics to predict the risk of complications and mortality associated with malnutrition. It considers serum albumin levels and the ratio of current weight or BMI to the ideal theoretical weight/BMI. The aim of this study was to evaluate this index in a population of metabolically stable chronic hemodialysis patients aged >60 years and associate it with other nutritional markers. Method The studied patient cohort was divided in two groups based on their Geriatric Nutritional Risk Index (GNRI) scores: Gr 1 with GNRI score <97 and Gr 2 with GNRI ≥97. We registered the anthropometric, clinical and biological data of the study population. Results One hundred seventy-seven patients (102M-75F) undergoing chronic hemodialysis were included Table 1). There were no differences in age, muscle mass estimated by bioimpedance analysis, potassium levels, phosphorus levels, and nPCR between the groups. However, there were significant differences between the two groups concerning the primary disease. Gr 1 presented with a higher prevalence of diabetes and cardiovascular comorbidities. Additionally, Gr 1 presented with lower handgrip strength (Mean ± standard deviation in kg, 19.79 ± 9.37 vs 26.83 ± 11.63, P = 0.05), lower fat mass index estimated by bioimpedance analysis (Mean ± standard deviation in kg/m2, 7.31 ± 4.55 vs 15.24 ± 6.47, P < 0.001), and higher CRP levels (Mean ± standard deviation in mg/l, 22.27 ± 23.49 vs 8.13 ± 10.14, P < 0.001). Conclusion In conclusion, the GNRI, an easily calculated tool for nutritional assessment, is associated with important nutritional status parameters in chronic hemodialysis patients.

Abstract Background and Aims Fluid overload (FO) is a key factor in cardiovascular risk and mortality in peritoneal dialysis (PD). While bioimpedance is commonly used for volume assessment, its limited availability highlights the need for alternative methods. This study proposes the development of a biomarker-based predictive model, utilizing NT-proBNP and serum albumin, to improve fluid status assessment in PD patients. Method This retrospective study analyzed adequacy and bioimpedance data from PD patients assessed between July 2023 and December 2024 at a Portuguese PD center. Adequacy testing, bioimpedance analysis, and biomarker quantification were performed on the same day. Outliers were removed using the interquartile range (IQR) method, and NT-proBNP was log-transformed [LN(NT-proBNP)] to improve model performance. All variables were correlated with %OH, and those with significant associations (P < 0.05) were selected for logistic regression analysis (NT-proBNP and serum albumin). The final model included LN(NT-proBNP) and serum albumin, predicting OH as a binary outcome. Model discrimination was assessed using the area under the ROC curve (AUC), while calibration was evaluated with the Hosmer-Lemeshow test. Results A total of 88 measurements from 46 peritoneal dialysis patients were analyzed, with bioimpedance confirming OH ≥5% in 71.6% of cases. In adequacy assessments, mean age was 61.00 ± 10.34 years, PD duration 24.08 ± 24.24 months, 30.7% were female, and 63.6% were on automated PD. Mean NT-proBNP was 8042.10 ± 20073.37 pg/mL, and serum albumin 3.61 ± 0.36 g/dL. FO (%OH ≥ 5%) was present in 71.6% (n = 63). Edema was detected in 23.9% of the general population, and 33.9% of FO cases, showing low sensitivity (33.0%) and NPV (37.9%). LN(NT-proBNP) was significantly associated with OH (OR = 9.905, 95% CI: 2.768–35.442, P < 0.001), and serum albumin showed an inverse correlation (OR = −5.217, 95% CI: 0.000–0.215, P = 0.005). The logistic regression model was statistically significant (χ² = 49.624, P < 0.001) and explained 69.7% of OH variability (Nagelkerke's R² = 0.697). The model demonstrated excellent discrimination (AUC = 0.931, 95% CI: 0.869–0.992, P < 0.001). The final logistic regression model predicting OH was: Conclusion This study developed a biomarker-based predictive model for overhydration in peritoneal dialysis patients, demonstrating strong predictive performance. This tool may serve as a valuable complement to clinical evaluation, particularly in cases of diagnostic uncertainty or when bioimpedance is unavailable. Further validation in larger cohorts is needed to confirm its role in routine PD management.

Abstract Background and Aims With the growing obesity epidemic, there is an increasing number of patients with excess body weight in the group of hemodialysis patients. At the same time, research indicates the occurrence of protein-energy wasting (PEW) in this group of patients. The aim of the study was to evaluate the prevalence of overweight and obesity and diagnosis of PEW in a cohort of stable HD patients. Method Nutritional status was examined by ISRNM criteria, GLIM criteria, s-albumin, nPNA and anthropometry. Body composition was assessed by bioimpedence analysis (BCM). Inflammatory markers (hsCRP, IL-6) and routine laboratory parameters were measured in serum. Results 165 HD patients with a mean age of 52.3 years were included to the study. In the studied population 37.5% of HD patients presented overweight and 12.5% obesity. 50% of the HD population had a high BMI - above 25 and at the same time presented signs of PEW according ISRNM criteria. The GLIM assessment correlated with the ISRNM criteria. PEW was diagnosed in 23.4% of patients independently to BMI. Also, patients with PEW presented lower nPNA, s-albumin and lean tissue index (LTI) compared to well-nourished (P < 0.05). In multiple regression analysis, the age, low LTI and hsCRP proved to be a predictor of the PEW. Conclusion A high BMI does not exclude malnutrition; in the group of hemodialysis patients, a particular problem is the loss of muscle mass (sarcopenia), chronic inflammation and incorrect protein intake.

Abstract Background and Aims Resistance to erythropoietin-stimulating agents (ESA) is a common challenge in treating anemia among hemodialysis patients. This study examines the relationship between body composition parameters and erythropoietin resistance index (ERI) to identify potential predictors of ESA responsiveness. Methods This cross-sectional study included 90 chronic hemodialysis patients (60% male; mean age: 60.45 ± 11.58 years) receiving ESA therapy at the Clinic for Nephrology and Clinical Immunology, Clinical Center of Vojvodina. Patients had been on ESA therapy for at least three months, with transferrin saturation >25% and ferritin >800 ng/mL to ensure adequate iron stores. Body composition was assessed using bioimpedance analysis (BCM Monitor, Fresenius), measuring BMI, lean tissue index (LTI), fat tissue index (FTI), relative fat mass (rel FAT), and adipose tissue mass (ATM). ERI was calculated as weekly ESA dose (IU/kg)/hemoglobin (g/dL) and categorized into percentiles for subgroup comparisons. Results The median ERI was 4.98 (IQR: 3.13–7.68 UI/kg/week/(g/dL)). Significant negative correlations were found between ERI and BMI (r = −0.25, P = 0.02), FTI (r = −0.27, P = 0.01), rel FAT (r = −0.24, P = 0.03), and ATM (r = −0.28, P = 0.01). Transferrin saturation (TSAT) showed a positive correlation with ERI (r = 0.25, P = 0.01). Notably, hemoglobin (HGB) and hematocrit (HCT) levels demonstrated the strongest inverse correlations with ERI (HGB: r = −0.57, P < 0.001; HCT: r = −0.55, P < 0.001), highlighting their predictive value. Patients in the lower ERI percentile (<75th) had significantly higher BMI (27.59 ± 5.18 vs. 24.36 ± 3.79; P = 0.01), FTI (12.79 ± 5.70 vs. 7.94 ± 4.28; P < 0.001), and rel FAT (32.60 ± 13.16% vs. 23.73 ± 11.19%; P = 0.01) compared to those in the higher percentile. Among the cohort, 63.3% were treated with short-acting ESA, and 36.7% received darbepoetin alfa. Patients on darbepoetin alfa exhibited a trend toward lower ERI values, although this difference was not statistically significant (P = 0.19). No significant associations were observed between ERI and inflammatory markers, including CRP (P = 0.79) or albumin (P = 0.20). Conclusion Higher adiposity, as indicated by BMI, FTI, and rel FAT, is associated with reduced erythropoietin resistance. While no significant differences were observed between ESA types, these findings highlight the potential role of body composition in guiding personalized anemia management strategies for hemodialysis patients.

Abstract Background and Aims Sarcopenia, defined as the loss of muscle mass and strength, is closely associated with aging and chronic diseases. The diagnostic criteria, as updated by the European Working Group on Sarcopenia in Older People (EWGSOP2), emphasize identifying reduced muscle mass accompanied by impaired function. Various diagnostic techniques, including magnetic resonance imaging (MRI) and bioelectrical impedance analysis (BIA), are widely employed. The aim of this study is to describe the nutritional, sarcopenic, and frailty profiles of patients undergoing chronic hemodialysis (HD) at San Pedro Hospital, Logroño. descriptive cross-sectional study, employing validated surveys to assess malnutrition (MIS), sarcopenia (SARC-F), functional capacity (Lawton and Brody), frailty (FRAIL), and long-term mortality based on patient comorbidity (Charlson Comorbidity Index). Method This descriptive cross-sectional study evaluated the nutritional, sarcopenic, and frailty profiles of patients on chronic HD at San Pedro Hospital, Logroño. Validated surveys, including the Malnutrition Inflammation Score (MIS), the SARC-F for sarcopenia, the Lawton and Brody scale for functional capacity, the FRAIL scale for frailty, and the Charlson Comorbidity Index, were employed to assess the population. Sarcopenia was further evaluated using handgrip strength as an indicator of muscle strength and the phase angle (PA) measured through single-frequency bioimpedance analysis (50 Hz). The inclusion criteria encompassed patients undergoing HD for over three months and those without acute inflammatory conditions. The study population was categorized based on the presence of sarcopenia, as determined by a positive SARC-F screening. Clinical, analytical, and impedance data were compared between the sarcopenic and non-sarcopenic groups. Results The study included 39 patients, of which 33% were women and 66% were men, with a mean age of 65 years. The mean scores for the SARC-F, FRAIL, MIS, and Charlson Comorbidity Index were 2.4, 2.05, 8.6, and 4.28, respectively. Regarding nutritional status, as assessed by the MIS, 24% of the patients were categorized as having normal nutritional status (MIS <6), 55% as mildly malnourished (MIS = 7–12), and 21% as moderately to severely malnourished (MIS = 13–18). Sarcopenia, defined as a SARC-F score ≥4, was present in 53.8% of patients, while 46.2% were categorized as non-sarcopenic (SARC-F <4). Based on the FRAIL scale, 15.4% of patients were classified as non-frail (FRAIL = 0), 43.6% as pre-frail (FRAIL = 1–2), and 41% as frail (FRAIL >3). Functional dependence, assessed via the Lawton and Brody scale, indicated that 15.5% of patients were fully dependent for instrumental activities of daily living, 61.5% exhibited moderate dependence, and 23.1% were independent. The Charlson Comorbidity Index revealed that none of the patients exhibited an absence of comorbidities (0–1 point), 13% had low comorbidities (2 points), and 87% demonstrated high comorbidities (>3 points). Body composition analysis revealed significant differences between sexes, with women exhibiting lower skeletal muscle mass and lean mass percentage (27% vs. 34%) but a higher phase angle (5.6 vs. 4) compared to men. A statistically significant correlation was observed between sarcopenia severity and frailty, as measured by the FRAIL scale (P = 0.021), as well as with malnutrition (P = 0.073). However, no significant correlation was identified between sarcopenia severity and handgrip strength (P = 0.318) or body mass index (BMI). Conclusion This study highlights the high prevalence of frailty, sarcopenia, and malnutrition in patients undergoing HD. Severe sarcopenia was notably common within this population. While no significant demographic, biochemical, nutritional, anthropometric, or body composition parameters were found to distinguish sarcopenia in HD patients, the clinical implications of these findings suggest the need for routine assessment of functional capacity and muscle strength in this population.

ABSTRACT The bioimpedance technique is a noninvasive imaging technique capable of assessing the internal electrical properties of biological tissues through boundary voltage and current measurements. In this work, an Internet of Things (IoT) driven automated system is proposed for smart agriculture, integrating electrical Impedance tomography (EIT) with thermal imaging and bio-impedance analysis to evaluate the maturity of fruits and vegetables. The system comprises multiple stages, beginning with thermal imaging for initial scanning, followed by parametric data conversion to extract relevant features. The next stage involves experimental bio-impedance analysis combined with algorithm-based prediction to assess ripeness accurately. IoT-enabled connectivity via Wi-Fi/Bluetooth facilitates seamless data transmission, while real-time monitoring through PC or mobile devices ensures user accessibility. A MATLAB-based Graphical User interface (GUI) controls the entire process, including image reconstruction, data analysis, ensuring a fast, cost-effective, and user-friendly operation. Simulation and phantom-based validation confirm the system’s ability to map impedance variations, which correlate with key maturity indicators such as sugar content and firmness. The analysis shows high accuracy in predicting fruit maturity: papaya (96.2%), melon (94.8%), watermelon (98.1%), apples (95.5%), with minimal time-to-peak errors (±0.5–1.0 days). This research created a low-cost, nondestructive system for assessing crop maturity, to improve quality and reduce waste.

Background/Objectives: Dysphagia is a common condition among older adults, associated with significant health risks. This prospective, open-label observational cohort study aimed to determine the prevalence of dysphagia and its impact on nutritional status and clinical outcomes in elderly residents of six long-term care facilities. Methods: Patients aged ≥ 65 years were screened using the 3 oz Water Swallow Test (WST); those with dysphagia were followed for 6 months. Nutritional status was evaluated with the Mini Nutritional Assessment short-form (MNA-SF), the Global Leadership Initiative on Malnutrition (GLIM), and the SARC-F questionnaire. Anthropometric and body composition measurements were also obtained. Results: Among 656 patients screened, 188 (28.6%) had dysphagia (median age 90 years; 89.9% females). Mild dysphagia was present in 34.0%, while 66.0% had moderate-to-severe dysphagia. At baseline, patients with moderate-to-severe dysphagia had significantly lower BMI (18.4 vs. 20.6 kg/m2, p = 0.014), smaller calf circumference (24.0 vs. 28.0 cm, p = 0.005), and higher SARC-F score (8 vs. 7, p = 0.028). Bioimpedance analysis showed lower fat mass (6.7 vs. 12.9 kg, p < 0.001) and fat mass% (14.7 vs. 25.4%, p < 0.001), and higher FFM% (85.3 vs. 74.6%, p < 0.001). At 6 months, BMI, calf circumference, handgrip strength, fat mass, and fat mass% resulted significantly lower in patients with moderate-to-severe dysphagia. A total of 23 participants (12.2%) died during follow-up, with a higher mortality rate in the moderate-to-severe group (HR 2.58, 95% CI 1.20–7.59, p = 0.044); aspiration pneumonia was the leading cause (21.7%). Conclusions: Dysphagia significantly affects nutritional status and survival in elderly residents of long-term care facilities. Early personalized nutritional intervention is pivotal to improve outcomes.

BackgroundBasic anthropometric (BA) indicators of adiposity, such as body mass index, may not fully capture disease risk. Whether more advanced anthropometric measurements derived from bioimpedance analysis (BIA) or magnetic resonance imaging (MRI) enhance our understanding of the relationship between adiposity and health-related outcomes is debated.MethodsWe used data from 40,338 participants from the UK Biobank imaging sub-study with anthropometric measurements derived from BIA and abdominal MRI, in addition to BA indicators, to evaluate their discriminatory performance. We studied the relationship between these adiposity indicators and all-cause mortality, risks of cardiovascular diseases (CVDs), obesity-related cancer, overall cancer, and type 2 diabetes (T2D) using Cox models adjusted for established risk factors. For each health-related outcome, relevant anthropometric indicators were selected using a stepwise approach, and the discriminatory power of each model was evaluated with cross-validated C-indexes.ResultsMRI-derived organ morphometry indicators moderately improved risk discrimination for T2D (cross-validated C-index increased from 0.83 [95% CI: 0.81, 0.84] to 0.85 [0.83, 0.86]; adjusted p = 4.05E − 6) and obesity-related cancers (from 0.59 [0.57, 0.62] to 0.61 [0.59, 0.64]), albeit with borderline significance (adjusted p = 0.053). Although improved discrimination was also observed for overall cancer and all-cause mortality compared to BA alone, differences were not statistically significant (all adjusted p > 0.200). Conversely, the inclusion of BIA indicators generally did not lead to improved discriminatory power.ConclusionsMRI-derived organ morphometry indicators may provide information beyond BA indicators for the assessment of adiposity and its association with risk of some health-related outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04356-9.

Metabolic bariatric surgery (MBS) is an effective treatment for weight loss, but a significant proportion of patients undergoing MBS experience weight regain or muscle loss. Exercise is recommended for patients undergoing MBS, but inconsistent outcomes have been reported on the effect of exercise on weight loss. This study investigated the association between increased physical activity and the changes in weight and body composition of Korean subjects with obesity after MBS. This study prospectively analyzed 78 subjects who underwent MBS from April 2019 to April 2022. The levels of physical activity were assessed using self-report questionnaires before and one year after MBS. Physical activity-related energy expenditure (MET-min/week) was calculated by multiplying the frequency, intensity, and duration of activities. Subjects were classified into two groups based on changes in physical activity levels before and after surgery: the MET-non-increased group and the MET-increased group. Body composition was analyzed by bioimpedance analysis. The mean age of the subjects was 41.7 ± 10.2 years, 31 (39.7%) were male, and baseline weight and body mass index (BMI) were 104.6 ± 19.4 kg and 37.7 ± 5.5 kg/m2, respectively. The MET-increased group had a significantly greater reduction in weight, BMI, and fat mass (FM) after MBS compared to the MET-non-increased group (weight, -32.2 ± 13.0 kg vs. -25.6 ± 9.3 kg, P = 0.015; BMI, -11.7 ± 4.5 kg/m2 vs. -9.1 ± 3.0 kg/m2, P = 0.005; FM, -27.0 ± 11.2 kg vs. -19.4 ± 7.5 kg, P = 0.002). However, no significant difference was observed in the change in muscle mass between the two groups. A greater increase in of physical activity and exercise level was associated with a greater reduction in weight (ß = -0.263, P = 0.003) and fat mass (ß = -0.292, P = 0.003) after MBS when age, sex, BMI, HbA1c, and baseline metabolic parameters were adjusted. Increased physical activity after MBS was associated with a greater reduction in weight and body fat. Emphasizing increasing physical activity is a key component for maximizing the benefits of MBS.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19383-y.

Relevance. Nutritional status disorders are common in patients with cerebral palsy (CP) and are caused by multiple factors related to the disease and its complications. They aggravate the underlying disease, reduce the quality of life, and decrease rehabilitation effectiveness. Objective. To study the body composition characteristics of children with CP using bioimpedance analysis. Materials and methods. Body composition parameters were studied to assess the nutritional status of 100 children with CP. Results. The study revealed significant differences in body composition in children with CP associated with nutritional deficiencies. Latent changes in body composition were detected in children without physical developmental delays. Follow-up after 12 months confirmed a progressive decrease in the active cell mass, lean body mass, and skeletal muscle mass in patients with CP. Conclusions. Children with cerebral palsy have been shown to have significant changes in body composition, including decreased muscle and fat mass, which progress over time even with normal anthropometric parameters.

Introduction. Bioimpedance is a promising method for assessing hydration status in hemodialysis patients. However, the optimal algorithm for "dry" weight correction and its effectiveness – particularly with respect to hard outcomes – remains to be clarified.Patients and methods. In a single-center, open-label randomized trial involving 98 patients, we evaluated both the short-term (weight dynamics, peridialysis blood pressure, and intradialysis complications) and long-term outcomes (five-year survival from study initiation) of dry weight correction guided by clinical and instrumental data compared with correction based solely on clinical indicators. Weight correction was performed according to a newly developed algorithm incorporatinh multi-frequency bioimpedance spectroscopy and vector bioimpedance analysis for six months, followed by a five-year observation period.Results. 51 patients were assigned to study group (SG), and 47 to the control group (CG). Baseline clinical and laboratory parameters did no differ between the groups. In the SG, target weight increased in 13 patients by 1.3±0.9 kg, decreased in 26 patients (-1.1±0.4 kg), and remained unchanged in 12. In the CG, during the three-month follow-up period, target weight increased in 19 patients (1.3±0.9 kg), decreased in 26 (-1.2±0.8 kg), and remained unchanged in 2. The SG demonstrated a significant reduction in the number of complications per month (32 vs. 52, p=0.033), primary due to a reduction in intradialysis hypertension (15 vs. 34, p=0.009). A greater intradialytic blood pressure decrease was achieved in the SG; an effect size of 5.3 mmHg compared to CG (p=0.04). Moreover, 65% of SG patients did not require a second adjustment of target weight. Five-year survival rate was significantly higher in the in SG (χ2=4.096; p=0.043). Active dehydration was not associated with reduced survival compared with maintaining or increasing target weight (χ2=2.454, p=0.117).Conclusions. A comprehensive algorithm for "dry" weight correction – incorporating a calculated hyperhydration coefficient, bioimpedance spectroscopy with vector analysis, and clinical signs of impaired hydration – can reduce the complications rates and the hypertension severity, improve hemodynamic stability during dialysis, and enhance patient survival.

ObjectiveCertain leading medical organisations are considering alternatives to the Body Mass Index (BMI) as a predictor of the risk for non-communicable chronic disease (NCD) or death. Our objective was to evaluate the associations between various measures of body fat and the risk of incident NCDs or mortality, independent of inflammation.DesignPopulation-based prospective cohort study (the UK Biobank cohort).SettingThe UK.ParticipantsAdults (aged between 40 and 69 years) were accrued between March 2006 and October 2010 and followed until December 2022. There were 500 107 participants: the median age was 58 years (IQR 50–63) at baseline, 45.6% were male and 94.7% were white.ExposuresBMI, waist-to-hip ratio (WHR), body fat percentage measured by bioimpedance analysis (BIA; fatBIA), C-reactive protein (CRP) and various other measures of body fat obtained by dual-energy X-ray absorptiometry (DXA; including visceral adipose tissue (VAT)) and magnetic resonance imaging (MRI).OutcomesAll-cause death, cardiovascular disease (heart failure, hypertension, myocardial infarction, pulmonary embolism and stroke), cancers (breast, colorectal, endometrial, oesophageal, kidney, ovarian, pancreatic and prostate), diabetes, asthma, gallbladder disease, chronic back pain and osteoarthritis.ResultsThe 5th and 95th percentiles for measures of body fat were BMI 20.5 (considered ‘healthy’) and 37.0 kg/m2 (considered ‘unhealthy’), WHR 0.71 and 0.94 and BIA 24.8% and 47.6% in females, and BMI 22.0 (considered ‘healthy’) and 35.4 kg/m2 (considered ‘unhealthy’), WHR 0.83 and 1.05 and BIA 15.5% and 34.7% in males. BMI was strongly correlated to fatBIA (0.85 in females and 0.80 in males) but less so with WHR (0.46 in females and 0.59 in males). All measures of body fat were positively associated with the incidence of NCDs, but only WHR remained positively associated with death after full adjustment (HR 95th percentile vs 5th percentile (95% CI): BMI 0.80 (0.76 to 0.84), WHR 1.21 (1.16 to 1.28) and BIA 0.80 (0.76 to 0.84) in females; BMI 0.89 (0.85 to 0.93), WHR 1.19 (1.14 to 1.24) and BIA 0.89 (0.85 to 0.92) in males). Simpler models that adjusted for age, sex, CRP, WHR and either BMI or fatBIA gave similar results. Associations between body fat and the incidence of NCDs after accounting for the competing risk of death were also similar.ConclusionsBMI was strongly correlated with fatBIA, but WHR and visceral adipose tissue percentage were less so. All measures of body fat were associated with the incidence of NCDs, but only WHR was independently associated with mortality. These findings support the hypothesis that body fat may be protective against death and that the excess risk associated with higher WHR may be mediated by something other than body fat.

We previously demonstrated that combining a sodium-glucose cotransporter 2 (SGLT2) inhibitor with diuretics significantly reduces interstitial fluid volume without excessive depletion of circulating plasma volume or activation of the renin-angiotensin-aldosterone system (RAAS). However, the differential effects of SGLT2 inhibitor monotherapy versus combination therapy with diuretics on fluid dynamics in patients with pre-existing fluid retention remain unclear. This study included patients with fluid retention, defined by an extracellular water to total body water (ECW/TBW) ratio > 0.400, as measured by bioimpedance analysis. We evaluated 6-month changes in body fluid status and serum copeptin levels, a surrogate marker for vasopressin, between two groups: patients receiving SGLT2 inhibitor dapagliflozin monotherapy (SGLT2i group, n = 13; estimated glomerular filtration rate [eGFR] 25.0 ± 8.5 mL/min/1.73 m2) and those receiving dapagliflozin in combination with loop or thiazide diuretics (SGLT2i + diuretic group, n = 18; eGFR 29.8 ± 15.2 mL/min/1.73 m2). Changes in systolic blood pressure and estimated plasma volume did not significantly differ between groups. However, reductions in ECW/TBW, TBW, and interstitial fluid were significantly greater in the combination group than in the monotherapy group. Moreover, the increase in serum copeptin was significantly suppressed in the SGLT2i + diuretic group. No significant intergroup differences were observed in renin and aldosterone changes. These findings suggest that co-administration of SGLT2 inhibitor with diuretics can more effectively reduce interstitial fluid retention without inducing excessive plasma volume reduction or RAAS activation.