Body Water Ratio Research Articles

Relationship between extracellular water to total body water ratio and severe diabetic retinopathy in type 2 diabetes.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes, and identifying the risk factors for severe DR is important. We aimed to investigate the relationship between severe DR and the extracellular water to total body water ratio (ET ratio). Retrospective cross-sectional study. Department of Endocrinology, Metabolism, and Diabetes at Kyushu University Hospital. A total of 205 adults with type 2 diabetes (T2D) were included. The patients were divided into two groups: non-proliferative DR (non-PDR; n = 161, 126 with no DR and 35 with simple DR) and proliferative DR (PDR; n = 44, 18 with pre-proliferative DR and 26 with PDR). The ET ratio was measured using bioelectrical impedance analysis. The ET ratio was significantly higher in the PDR group than in the non-PDR group (0.390 vs. 0.398; P < .0001). Multivariate logistic regression analysis showed that the ET ratio was significantly associated with PDR, independent of known risk factors for DR progression. In the subgroup analysis by age, multivariate logistic regression analysis revealed a significant association between the ET ratio and PDR, independent of known risk factors for DR progression in patients younger than 60 years. However, in patients 60 years and older, only the urinary albumin to creatinine ratio (UACR) showed a significant association with PDR in a model using the UACR and the ET ratio. In patients with T2D younger than 60 years, the ET ratio may be a useful indicator for identifying severe DR.

Extracellular water to total body water ratio may mediate the association between phase angle and mortality in patients with cancer cachexia: A single-center, retrospective study

Extracellular water to total body water ratio may mediate the association between phase angle and mortality in patients with cancer cachexia: A single-center, retrospective study

The importance of high total body water/fat free mass ratio and serial changes in body composition for predicting hospital mortality in patients with severe pneumonia: a prospective cohort study

PurposeThis study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient.MethodsWe conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality.ResultsMultivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission.ConclusionsThe mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter.

Association of Body Water Balance, Nutritional Risk, and Sarcopenia with Outcome in Patients with Acute Ischemic Stroke: A Single-Center Prospective Study.

In the present study, we examined the inter-relationships between body water balance, nutritional risk, sarcopenia, and outcome after acute ischemic stroke (AIS) in patients who were living independently. We defined abnormal body water balance as overhydration, with an extracellular fluid/total body water ratio > 0.390. A geriatric nutritional risk index (GNRI) < 98 was considered low GNRI. Sarcopenia was defined according to the 2019 Asian Working Group for sarcopenia criteria. Poor outcome was defined as a modified Rankin scale (mRS) score ≥ 3 at discharge. Among 111 eligible patients (40 females, median age: 77 years), 43 had a poor prognosis, 31 exhibited overhydration, 25 had low GNRI, and 44 experienced sarcopenia. Patients with poor outcomes had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores, which were significantly more common with overhydration, low GNRI, and sarcopenia (p < 0.001 for all). Concomitant overhydration, low GNRI, and sarcopenia were associated with poorer outcomes. In multivariate analysis, overhydration [odds ratio (OR) 5.504, 95% confidence interval (CI) 1.717-17.648; p = 0.004], age (OR 1.062, 95%CI 1.010-1.117; p = 0.020), and NIHSS score (OR 1.790, 95%CI 1.307-2.451; p < 0.001) were independent prognostic factors for poor outcome. The results indicated that the combination of overhydration, low GNRI, and sarcopenia predict poor outcomes following AIS. Overhydration was particularly associated with poor outcomes.

Factors associated with an improvement in extracellular water-to-total body water ratio in older adults with hip fractures: A decision tree analysis

Background & AimsThe extracellular water-to-total body water ratio (ECW/TBW) increases with age and after fractures. A high ECW/TBW may hinder improvements in physical function and skeletal muscle mass. However, the effects of ECW/TBW improvement have not been properly investigated. The aim of this study was to investigate the factors associated with ECW/TBW improvement in older adults with hip fractures. MethodsThis retrospective cohort study included 203 patients with hip fractures who were admitted to a convalescent rehabilitation ward. ECW/TBW and skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. The patients were classified into two groups: those with an improvement in ECW/TBW (n = 123) and those without an improvement (n = 80). Decision tree analysis was performed to examine the factors associated with ECW/TBW improvement. As a secondary objective, a multiple regression analysis was performed to identify the factors associated with SMI gain. ResultsDecision tree analysis identified rehabilitation volume and protein intake as the first and second factors most significantly associated with an improvement in ECW/TBW, respectively. Multiple regression analysis showed that improved ECW/TBW (β: 0.400, p < 0.001) was significantly associated with SMI gain. ConclusionsRehabilitation volume and protein intake are clinically important for improving ECW/TBW in older adults with hip fractures.

The relationship between mothers' body composition and anthropometric characteristics of baby and breast milk nutrient content: A cross-sectional study.

The composition and amount of breast milk is affected by factors such as the duration and frequency of breastfeeding, the time between two breastfeeding sessions, the effectiveness of breastfeeding, breastfeeding technique, genetic characteristics of the mother and diet. Breast milk macronutrients are provided by milk synthesized in lactocytes, mother's diet and maternal stores. This study was conducted to investigate the relationship between the body composition of mothers and the anthropometric characteristics of the baby and the nutritional content of breast milk. The descriptive study was conducted between March and November 2023 in a hospital in a low socioeconomic neighbourhood in Turkey. The study sample consisted of 96 mothers and ibabies. Anthropometric measurements of mothers and babies and the nutrient content of breast milk were evaluated on the first postpartum day, Days 5 and 15. Breast milk macronutrient content was analyzed by Miris milk analyzer and body composition of mothers was analyzed by TANITA BC 730. From the weight and body composition of the mothers in the study group; a positive correlation was found between body fat, muscle and water ratio, and breast milk carnonhydrate and protein (p < 0.05). There was no correlation between the gestational age of the baby and the content of breast milk (p > 0.05). A positive correlation was found between the weight and height of the babies and the macronutrients of breast milk (p < 0.05). As the weight of mothers increases, breast milk protein and carbohydrate levels increase. As breast milk macronutrients increase, babies' weight and height increase.

The extracellular-to-total body water ratio reflects improvement in the activities of daily living in patients who experienced acute stroke

ObjectivesTo determine the relationship between bioelectrical impedance analysis (BIA) parameters, including the extracellular water-to-total body water ratio (ECW/TBW), and the activities of daily living (ADL) improvement, in patients who experienced acute stroke. Materials and methodsThis retrospective cohort study included 307 patients (mean age, 72 years; 39 % female) who experienced acute stroke and were admitted to the stroke unit of the Nippon Medical School Hospital (Bunkyo-ku, Tokyo, Japan) between April 2021 and March 2022. The Functional Independence Measure (FIM) was assessed at initial rehabilitation and discharge, and FIM effectiveness was calculated as ADL improvement in the participating acute care hospitals. BIA markers included the skeletal muscle mass index (SMI), phase angle (PhA), and ECW/TBW. Multiple linear regression models were used to estimate the relationship between the FIM effectiveness and each BIA marker. ResultsThe mean (±SD) FIM effectiveness was 0.45 ± 0.36. The proportions of low SMI (male, <7.0 kg/m2; female, <5.7 kg/m2) and low PhA (male <5.36 degrees, female <3.85 degrees), were 48.9 % and 43.3 %, respectively. In addition, the proportions of of low (<0.36), normal (0.36-0.40), and high (>0.4) ECW/TBW ratios were 1.3 %, 78.5 %, and 20.2 %, respectively. After adjustments for demographic and clinical variables, low PhA, low ECW/TBW, and high ECW/TBW were all significantly associated with FIM effectiveness (P < 0.05), with β coefficients of -0.126, -0.089, and -0.117, respectively. ConclusionsLow and High ECW/TBW and low PhA levels were negatively correlated with improvements in ADL. The ECW/TBW ratio may be an additional indicator of rehabilitation trainability in patients who experience acute stroke.

Varicose vein treatment reduces edema not only in the treated legs but also in the entire body.

We explored the connection between varicose vein and edema, by investigating extracellular water ratio (E/T) using bioelectrical impedance analysis. In a prospective cohort study 120 patients underwent varicose vein surgery with extracellular fluid to total body water ratio (E/T) and E/T postop divided by E/Tpreop (E/T ratio) measured using a body composition analyzer. Edema was defined as E/T ≥0.390. Seventy-nine patients received unilateral treatment, while 41 underwent bilateral. p < .05 is statistically significant. Preoperatively, patients exhibited edema (E/T) in the treated leg (0.394 ± 0.009), untreated leg (0.392 ± 0.009), trunk (0.390 ± 0.007), and whole body (0.391 ± 0.007). Postoperatively, E/T decreased across body (p < .05). The lowest E/T ratio was observed in the treated leg (0.991 ± 0.012), followed by the untreated leg (0.994 ± 0.012), the trunk (0.995 ± 0.009), and the whole body (0.994 ± 0.009). E/T ratio of bilateral group were lower than unilateral group (p < .05). Varicose vein contributes to generalized edema, and treatment alleviates edema in the treated leg and the entire body.

Body Water Compartment and Sympathovagal Balance: Association with Visuomotor Retention in Young Adults

Cognitive functions are important for visuomotor learning and are associated with physiological factors such as body fluid compartment and cardiovascular reactivity. Previous studies found that body fluid compartment is associated with brain blood flow, which is regulated via sympathovagal balance. However, more evidence is needed to determine whether body fluid compartment and cardiovascular reactivity are associated with visuomotor learning. The purpose of this study was to explore the relationship of body fluid compartment and cardiovascular reactivity to visuomotor learning. We hypothesized that these physiological factors are associated with overall learning retention using upper extremity (including feedforward, volitional, and feedback conditions). Methods: Thirty young adults (12 males, 24.6 ± 3.9 years, right hand dominant) participated in this study. Participants tracked a sinusoidal wave with left arm at pre-test, learning, and post-test sessions on the first visit and at retention test session on the second visit seven days later. Participants performed one set of nine trials during each test and five sets of three trials during learning. Resistance and wave velocity were different in each trial. Learning error was calculated by the averaged absolute distance between the tracking line and the target line. Heart rate (HR), systolic blood pressure (SBP), and low to high frequency power ratio of heart rate variability (LF/HF) were continuously recorded during baseline before pre-test and during tests and learning. We analyzed participants’ extracellular to intracellular body water ratio (ECW/ICW) using an InBody body composition analyzer and tested their cognitive function with Picture Sequence Memory (PSMT), Pattern Comparison Processing Speed, Dimensional Change Card Sort, Flanker Inhibitory Control and Attention, and List Sorting Working Memory Tests from NIH Cognitive Toolbox. Data were statistically analyzed using linear regression analysis and quartile analysis. Results: ECW/ICW was associated with young adults’ ability to retain visuomotor learning after one week (R2 = 0.138, p = 0.043), whereas HR, SBP, and LF/HF at each session were not significantly associated with visuomotor retention. No differences were found in pre-test error among quartiles of five cognitive tests. Significant differences in retention error among quartiles were only found in PSMT, with participants scoring in the highest quartile of PSMT having lower SBP during the first visit and lower retention error compared to the lowest quartile. This finding suggests that young adults with better episodic memory were less stressed during learning and had better visuomotor retention. Conclusion: These findings support that ECW/ICW is associated with not only cognitive function but also visuomotor retention. In addition, cardiovascular reactivity during visuomotor learning may provide information for retention behavior. Relationship of body water compartment and sympathovagal balance to feedforward and feedback conditions in learning will be further discussed. Research Support: This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development: R01HD084645, R01HD082109. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Delayed post-dialysis recovery times are associated with relative changes in intracellular and extracellular fluid ratios between different body compartments.

Hemodialysis patient groups have advocated reducing dialysis fatigue and symptoms. We investigated whether compartmental fluid shifts were associated with peri-dialytic fatigue and symptoms. Sessional dialysis records of patients reporting both a short and delayed recovery (<1 h and ≥1 h) with corresponding bioimpedance measurements were reviewed. One hundred and twenty-four patients reported both short and delayed recovery times, mean age 66.0 ± 14.8 years, 66.1% male. Differences between sessions included higher distress thermometer [4 (1-6) vs. 3 (0-5)], fatigue [4 (0-9) vs. 2 (0-7)], total symptom scores [20.5 (12.3-34.5) vs. 16 (7-28)], change in extracellular water to total body water ratios between body compartments [right leg/left arm 2.36 (1.23-4.19) vs. 1.28 (0.12-2.01), all p < 0.01] with delayed recovery, and more hemodialysis than hemodiafiltration sessions (χ2 4.6, p = 0.02). Sessions with prolonged recovery times were associated with more peri-dialytic symptoms, psychological distress, and hemodialysis mode, and greater changes in compartmental fluid shifts.

Correlation between body composition and disease severity in patients with chronic obstructive pulmonary disease.

Body composition changes are important extrapulmonary manifestations in chronic obstructive pulmonary disease (COPD) patients. This study aimed to investigate the characteristics of body composition in patients with COPD, and its correlation with disease severity. A total of 105 COPD patients admitted to Zhongshan Hospital affiliated to Dalian University, from May 1, 2021 to January 31, 2023, were included as the COPD group, and 105 subjects without COPD were enrolled as the control group during the same period. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) comprehensive assessment indicators, COPD patients were divided into groups: the degree of pulmonary function airflow limitation was grouped according to FEV1%pred; clinical symptoms were grouped according to mMRC scores and CAT scores; the risk of acute exacerbation was divided into low risk and high risk groups. Body composition was measured by bioelectrical impedance analysis (BIA). (1) Concerning body composition, the body mass index (BMI), fat-free mass index (FFMI), and angle of phase (PhA) of COPD patients were lower than those of the control group. Extracellular water-to-total body water ratio (ECW/TBW) and extra-to-intracellular water ratio (ECW/ICW) were higher than those of the control group, and the difference was statistically significant (p < 0.05). (2) There were differences in body composition among COPD patients with different severity of disease: FFMI and PhA in the mild/moderate airflow limitation group were higher than those in the severe/very severe airflow limitation group. According to mMRC scores classification, the FFMI and PhA of the less symptomatic group were higher than those of the more symptomatic group, and ECW/TBW and ECW/ICW were lower than those of the more symptomatic group. According to CAT scores classification, FFMI and PhA in the mild/moderate disease group were higher than those in the severe/very severe disease group. The FFMI of the low-risk group was higher than that of the high-risk group, and ECW/TBW was lower than that of the high risk group. (3) Correlation analysis between body composition and disease severity indicators showed that FFMI and PhA were negatively correlated with mMRC scores and CAT scores, and positively correlated with FEV1%pred. ECW/TBW ratio and ECW/ICW ratio were positively correlated with mMRC scores and CAT scores, and negatively correlated with FEV1%pred, and the difference was statistically significant (p < 0.05). There are significant differences in body composition between COPD patients and the control group, and there are significant differences in body composition between COPD patients with different severity of disease, with correlations between body composition and severity of disease.

Use of Bioelectrical Impedance Analysis to Explore the Effectiveness of Stellate Ganglion Block in Patients with Post-Stroke Complex Regional Pain Syndrome: A Retrospective Pilot Study.

Post-stroke complex regional pain syndrome (CRPS) poses challenges in pain assessment for survivors. Stellate ganglion block (SGB) is a treatment, but evaluating its effectiveness is difficult for patients with communication limitations. Edema, a prominent symptom, can serve as an evaluation marker. Bioelectrical impedance analysis (BIA), assessing body composition and fluid status, is used independently of patient cooperation. This retrospective, observational pilot study aims to explore BIA's utility as an assessment tool post-SGB, revealing the effects and time courses of a single SGB on the bodily composition of post-stroke CRPS patients. Seven patients received ultrasound-guided SGB with a 5 mL solution containing 4 mL of 0.25% bupivacaine hydrochloride and 40 mg of triamcinolone into the prevertebral muscle space. BIA compared measures between affected and unaffected arms. The affected arm had higher segmental body water (SBW) and extracellular water ratios before SGB (p = 0.028 and p = 0.018, respectively). The SBW of the affected side, the SBW ratio, and the 1 and 5 kHz SFBIA ratios improved over time (p = 0.025, 0.008, 0.001, and 0.005, respectively). Rapid improvement occurred around 3 days post-injection, with maximum effects within approximately 1 week, persisting up to 3 weeks. SGB successfully reduced edema in post-stroke CRPS patients, with BIA serving as a useful tool for follow-up, facilitating the development of efficient treatment plans.

Determination of the relationship between body composition and nutritional habits and chronotype in healthy Turkish adults.

This cross-sectional study aims to determine the relationship between chronotype characteristics, dietary habits, and body composition in 110 adults, of which 75.5% are female, residing in Mersin, Türkiye. Data collection included a descriptive information form, the Morningness-Eveningness Scale for assessing chronotype, a detailed 24-hour dietary record for evaluating dietary intake, and Bioelectrical Impedance Analysis for accurate anthropometric measurements of body composition. The evening types had higher BMI, body weight, waist circumference, hip circumference, total fat mass, and lower body water ratio than the morning types. Positive correlations were found between sleep duration and body mass index, total fat mass, and fat percentage. The evening types tended to skip breakfast more frequently and had higher energy intake during dinners and snacks. Additionally, the evening types consumed more lipids, carbohydrates, sodium, and saturated and polyunsaturated fatty acids. These findings suggest that chronotype influences anthropometric measurements, nutritional habits, and meal energy distribution. These findings highlight the importance of considering chronotype characteristics to understand how body composition and dietary patterns interact, underscoring the need for customized interventions to promote healthier lifestyles.

Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study.

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

Influence of aging on extracellular water-to-total body water ratio in community-dwelling females

Background & AimsThe European Working Group of Sarcopenia in Older People 2 has emphasized the significance of evaluating not only muscle mass but also muscle quality as a diagnostic criterion for sarcopenia. The extracellular water-to-total body water ratio (ECW/TBW), measured using bioelectrical impedance analysis (BIA), has recently received attention as an indicator of muscle quality. However, the influence of aging on the ECW/TBW remains unclear. If ECW/TBW increases with age, it is important to know whether the timing of the decrease in SMI and the increase in ECW/TBW are the same or different. This study aimed to investigate the influence of aging on ECW/TBW in community-dwelling females. MethodsThis cross-sectional study included 237 community-dwelling females aged 20–89 years who could perform activities of daily living independently. ECW/TBW and SMI were measured using BIA. Multiple linear regression analyses of ECW/TBW and SMI were conducted. Age, body mass index, number of medications, pain, and medical history were considered independent variables in the multiple linear regression. The participants were divided into three (20–39, 40–64, and 65–89 years) or four (20–39, 40–64, 65–74, and 75-89 years) groups based on age. Analysis of covariance adjusted for the number of medications, pain, and medical history was conducted to determine the differences in ECW/TBW and SMI among the three or four groups. ResultsIn the multiple linear regression analysis, age was significantly and independently associated with ECW/TBW and SMI. When the participants were divided into three groups based on age, an increase in ECW/TBW and a decrease in SMI in the 65–89-year group were confirmed compared with the 20–39 and 40–64-year groups. When the participants were divided into four groups based on age, an increase in ECW/TBW in the 75–89-year group was confirmed compared with the 65–74-year group. However, there were no significant differences in SMI among the four groups. ConclusionsThis study revealed that ECW/TBW increases with aging in community-dwelling females. Moreover, the negative influences of aging were confirmed earlier in ECW/TBW than in SMI. Assessing muscle mass alone may not be adequate to capture the influences of aging on muscle composition, and evaluating ECW/TBW may be crucial for diagnosing sarcopenia.

Effect of body fat mass loss on prognosis of radical resection for pancreatic ductal adenocarcinoma based on bioelectrical impedance analysis

BackgroundFew reports have performed a prognostic analysis based on bioelectrical impedance analysis in patients with radical resection of pancreatic ductal adenocarcinoma (PDAC), and its usefulness in prognostic analysis remains unclear. This study aimed to evaluate body composition changes in patients undergoing radical resection for PDAC and analyze its impact on prognosis.MethodsThe medical records of radical resection for patients with PDAC were retrospectively reviewed, and the parameters of body composition, including body weight, skeletal muscle mass, body fat mass (BFM), and extracellular water-total body water ratio, from preoperatively to 12 months postoperatively, for each surgical procedure were measured based on direct segmental multifrequency bioelectrical impedance analysis with an InBody 770 (InBody Inc., Tokyo, Japan) device. The clinicopathological and prognostic factors were analyzed.ResultsAmong 79 patients who underwent radical resection for PDAC, 36 (46%), 7 (8%), and 36 (46%) underwent pancreatoduodenectomy, total pancreatectomy, and distal pancreatectomy, respectively. The multivariate overall survival analysis demonstrated that BFM loss percentage at 1 month postoperatively ≧14% (p = 0.021), lymph node metastasis (p = 0.014), and non-adjuvant chemotherapy (p < 0.001) were independent poor prognostic factors. Multivariate analysis revealed that preoperative BFM < 12 kg and preoperative albumin < 3.5 g/dL were independently associated with BFM loss percentage at 1 month postoperatively ≧14% (p = 0.021 and p = 0.047, respectively).ConclusionsLoss of BFM in the early postoperative period may have a poor prognosis in radical resection of PDAC.

Effects of aerobic morning intervention on body composition changes in young women of morning and neither chronotypes

This study aimed to compare the effect of a morning physical intervention on the body composition of young women (n = 8, mean age ± SD = 23.1 ± 1.0 years, mean height ± SD = 168.9 ± 5.8 cm, mean weight ± SD = 66.2 ± 6.8 kg) of the morning chronotype (M-types) vs. young women (n = 25, mean age ± SD = 21.4 ± 1.5 years, mean height ± SD = 167.1 ± 5.4 cm, mean weight ± SD = 65.6 ± 7.8 kg) of the neither chronotypes (N-types). We used bioimpedance analysis to detect changes in the following indicators: weight, body mass index, fat mass (FM%), fat free mass (FFM), muscle mass (MM), total body water (TBW), extracellular and total body water ratio (ECW/TBW), extracellular and body cell mass ratio (ECM/BCM), and phase angle (PA). Intervention effects in groups were compared and evaluated by Cohen’s d within the statistical procedure of paired samples t-test, which did not show any significant differences in all indicators, except PA, between the pre-test and post-test (p&gt;0.05). Statistical improvement was denoted and examined in the PA of the N-types. The most significant difference was found in the ECM/BCM indicator, which was stimulated more effectively in M-types after the morning intervention compared with the N-types. M-type participants improved in ECM/BCM (d = 0.62) and PA (d = 0.70) with a medium effect, but scored worse in FM% (d = 0.47) with a small effect, FFM (d = .43), MM (d = 0.42), and TBW (d = 0.40), whereas no effect was found in ECW/TBW (d = 0.15). N-type participants improved in PA (d = .60) with a medium effect, FFM (d = 0.29), MM (d = 0.28), and ECW/TBW (d = 0.28) with a small effect; no effect was observed in ECM/BCM (d = 0.01), FM% (d = 0.03), and TBW (d = 0.04). The results showed that the ECM/BCM and PA parameters were more sensitive than the other parameters. Our findings indicate the importance of further exploration and examination of the problem of time effect examination on particular chronotypes.

Fluid homeostatic action of dapagliflozin in patients with chronic kidney disease: the DAPA-BODY Trial.

Sodium glucose cotransporter 2 (SGLT2) inhibitors have both glucose-lowering and diuretic effects. We recently reported that the SGLT2 inhibitor dapagliflozin exerts short-term fluid homeostatic action in patients with chronic kidney disease (CKD). However, the long-term effects of SGLT2 inhibitors on body fluid status in patients with CKD remain unclear. This was a prospective, non-randomized, open-label study that included a dapagliflozin treatment group (n = 73) and a control group (n = 24) who were followed for 6 months. Body fluid volume was measured using a bioimpedance analysis device. The extracellular water-to-total body water ratio (ECW/TBW), a predictor of renal outcomes, was used as a parameter for body fluid status (fluid retention, 0.400 ≤ ECW/TBW). Six-month treatment with dapagliflozin significantly decreased ECW/TBW compared with the control group (-0.65% ± 2.03% vs. 0.97% ± 2.49%, p = 0.0018). Furthermore, dapagliflozin decreased the ECW/TBW in patients with baseline fluid retention, but not in patients without baseline fluid retention (-1.47% ± 1.93% vs. -0.01% ± 1.88%, p = 0.0017). Vasopressin surrogate marker copeptin levels were similar between the control and dapagliflozin groups at 6 months (32.3 ± 33.4 vs. 30.6 ± 30.1 pmol/L, p = 0.8227). However, dapagliflozin significantly increased the change in copeptin levels at 1 week (39.0% ± 41.6%, p = 0.0010), suggesting a compensatory increase in vasopressin secretion to prevent hypovolemia. Renin and aldosterone levels were similar between the control and dapagliflozin groups at 6 months, while epinephrine and norepinephrine (markers of sympathetic nervous system activity) were significantly lower in the dapagliflozin group than in the control group. In conclusion, the SGLT2 inhibitor dapagliflozin ameliorated fluid retention and maintained euvolemic fluid status in patients with CKD, suggesting that SGLT2 inhibitors exert sustained fluid homeostatic actions in patients with various fluid backgrounds. Clinical trial registration: https://www.umin.ac.jp/ctr/, identifier [UMIN000048568].

Association between ICW/TBW ratio and cancer prognosis: Subanalysis of a population-based retrospective multicenter study

Disease burden is known to alter cellular integrity and water balance. Therefore, the intracellular water/total body water (ICW/TBW) ratio is used as an adjunctive indicator to predict disease severity and prognosis. The ICW/TBW ratio of patients with cancer, who typically present with low muscle mass, poor nutritional status, and high inflammatory response, reportedly differs from that of the healthy population. Herein, we aimed to evaluate the effect of the ICW/TBW ratio on the prognosis of different subgroups of patients with cancer. This multicenter cohort study included 2787 patients with malignancies between June 2014 and December 2018. The association between covariates and overall survival (OS) was assessed using restricted cubic spline models. The multivariate Cox regression model included variables demonstrating a statistical significance in the univariate Cox regression analysis (P<0.05) without multicollinearity. The generated nomogram used the C-index and calibration curves to validate the predictive accuracy of the scoring system. The optimal cut-off value for the ICW/TBW ratio was 0.61. The ICW/TBW ratio was an independent prognostic factor (hazard ratio [HR]: 0.621; 95% confidence interval [CI]: 0.537-0.719, P<0.001). Moreover, the ICW/TBW ratio had a greater impact on the prognosis of patients receiving chemoradiotherapy than on those receiving chemotherapy alone (chemoradiotherapy: HR=0.495, P=0.005 vs. chemotherapy: HR=0.646, P<0.001). Multivariate Cox regression analysis showed that sex, age, tumor stage, body mass index, neutrophil-to-lymphocyte ratio (NLR), and ICW/TBW ratio were associated with OS. Subsequently, a nomogram was developed incorporating these variables and yielded a C-index of 0.743. The ICW/TBW ratio was associated with muscle mass, nutritional status, and inflammation. A low ICW/TBW ratio is an independent risk factor for poor prognosis in patients with cancer, especially when they are female, have advanced cancer stage, have sarcopenia, and are receiving radiotherapy.

Extracellular water /total body water ratio as a predictor of functionality in patients with advanced chronic kidney disease

Extracellular water /total body water ratio as a predictor of functionality in patients with advanced chronic kidney disease