Changes In Body Water Research Articles

Sodium-Glucose Cotransporter 2 Inhibitor Combined with Conventional Diuretics Ameliorate Body Fluid Retention without Excessive Plasma Volume Reduction.

We previously reported that sodium-glucose cotransporter 2 (SGLT2) inhibitors exert sustained fluid homeostatic actions through compensatory increases in osmotic diuresis-induced vasopressin secretion and fluid intake. However, SGLT2 inhibitors alone do not produce durable amelioration of fluid retention. In this study, we examined the comparative effects of the SGLT2 inhibitor dapagliflozin (SGLT2i group, n = 53) and the combined use of dapagliflozin and conventional diuretics, including loop diuretics and/or thiazides (SGLT2i + diuretic group, n = 23), on serum copeptin, a stable, sensitive, and simple surrogate marker of vasopressin release and body fluid status. After six months of treatment, the change in copeptin was significantly lower in the SGLT2i + diuretic group than in the SGLT2i group (-1.4 ± 31.5% vs. 31.5 ± 56.3%, p = 0.0153). The change in the estimated plasma volume calculated using the Strauss formula was not significantly different between the two groups. Contrastingly, changes in interstitial fluid, extracellular water, intracellular water, and total body water were significantly lower in the SGLT2i + diuretic group than in the SGLT2i group. Changes in renin, aldosterone, and absolute epinephrine levels were not significantly different between the two groups. In conclusion, the combined use of the SGLT2 inhibitor dapagliflozin and conventional diuretics inhibited the increase in copeptin levels and remarkably ameliorated fluid retention without excessively reducing plasma volume and activating the renin-angiotensin-aldosterone and sympathetic nervous systems.

Hypernatremia in Hyperglycemia: Clinical Features and Relationship to Fractional Changes in Body Water and Monovalent Cations during Its Development.

In hyperglycemia, the serum sodium concentration ([Na]S) receives influences from (a) the fluid exit from the intracellular compartment and thirst, which cause [Na]S decreases; (b) osmotic diuresis with sums of the urinary sodium plus potassium concentration lower than the baseline euglycemic [Na]S, which results in a [Na]S increase; and (c), in some cases, gains or losses of fluid, sodium, and potassium through the gastrointestinal tract, the respiratory tract, and the skin. Hyperglycemic patients with hypernatremia have large deficits of body water and usually hypovolemia and develop severe clinical manifestations and significant mortality. To assist with the correction of both the severe dehydration and the hypovolemia, we developed formulas computing the fractional losses of the body water and monovalent cations in hyperglycemia. The formulas estimate varying losses between patients with the same serum glucose concentration ([Glu]S) and [Na]S but with different sums of monovalent cation concentrations in the lost fluids. Among subjects with the same [Glu]S and [Na]S, those with higher monovalent cation concentrations in the fluids lost have higher fractional losses of body water. The sum of the monovalent cation concentrations in the lost fluids should be considered when computing the volume and composition of the fluid replacement for hyperglycemic syndromes.

The Effectiveness of Low-Carb Diet vs Low-Fat Diet on Body Composition in People with Obesity: A Literature Review

Background: Obesity is still become a serious problem today. Obesity is caused by excessive adipose tissue. One of many factors that contribute to a person's obesity is food intake. Excess carbohydrate and fat intake will be stored in the form of triglycerides in adipose tissue. In the meantime, Low-Carb Diet (LCD) and Low-Fat Diet (LFD) are one of the most popular treatments on obesity. However there are many pros and cons related to each diet based on several studies. Objectives: The indicated study aims to determine the effectiveness of LCD and LFD on body composition in people with obesity. Methods: The study was conducted through journal and literature review, based on five journal publications, filtered by related keywords. In accordance to inclusion and exclusion criteria within the last ten years in Pubmed/Medline database, Science Direct, and Wiley Online Library with the keywords "Low-Carb Diet", "Low-Fat Diet", "Body Mass Index", "Lipid Levels", "Adipose Tissue", "Obese", and "Body Water". Discussion: Total body mass and fat mass decreased significantly after being given LCD intervention compared to LFD. The group that was given two dietary interventions also losing weight, but there was no changes in body water. In addition, negative effects were found from the LCD and LFD interventions such as constipation, fatigue, polyuria, nausea, vomiting, changes in appetite, and headaches. Kidney failure, ketosis, and premature coronary artery also occurred in the group that was given with LCD intervention. Conclusions: LCD and LFD interventions can affect body composition of people with obesity.

Fluids and body composition during anesthesia in children and adolescents: A pilot study

The purpose of this study is to evaluate the intracellular and extracellular volume before and after anesthesia in order to ascertain their variations and determine the potential utility of this information in optimizing intraoperative fluid administration practices. A bioimpedance spectroscopy device (body composition monitor, BCM) was used to measure total body fluid volume, extracellular volume, and intracellular volume. BCM measurements were performed before and after general anesthesia in unselected healthy children and adolescents visiting the Pediatric Institute of Southern Switzerland for low-risk surgical procedures hydrated with an isotonic solution. In 100 children and adolescents aged 7.0 (4.8–11) years (median and interquartile range), the average total body water increased perioperatively with a delta value of 182 (0–383) mL/m2 from pre- to postoperatively, as well as the extracellular water content, which had a similar increase with a delta value of 169 (19–307) mL/m2. The changes in total body water and extracellular water content significantly correlated with the amount of fluids administered. The intracellular water content did not significantly change. Conclusion: Intraoperative administration of isotonic solutions results in a significant fluid accumulation in low-risk schoolchildren during general anesthesia. The results suggest that children without major health problems undergoing short procedures do not need any perioperative intravenous fluid therapy, because they are allowed to take clear fluids up to 1 h prior anesthesia. In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy.What is Known:• Most children who undergo common surgical interventions or investigations requiring anesthesia are nowadays hydrated at a rate of 1700 mL/m2/day with an isotonic solution.• The use bioimpedance spectroscopy for the assessment of fluid status in healthy children has already been successfully validated.• The bioimpedance spectroscopy is already currently widely used in various nephrological settings to calculate fluid overload and determine patient’s optimal fluid status.What is New:• Routine intraoperative fluid administration results in a significant fluid accumulation during general anesthesia in low-risk surgical procedures.• This observation might be relevant for children and adolescents with conditions predisposing to fluid retention.• In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy.

Effect of 1-Week Weight Loss While Maintaining Total Body Water on Jump Performance.

Jumping performance is influenced by body composition and excess fat mass impairs performance. Maintaining optimal fat mass and fat-free mass (FFM) is crucial for enhancing jump height. However, there is limited evidence on short-term weight loss programs that reduce fat mass without water restriction and their effects on muscle function and jumping performance. This study aimed to clarify the effects of a 1-week weight loss program on jumping height and muscle function of volleyball players. The weight loss group engaged in two 40 min slow-paced jogging sessions in addition to their daily training routine. Energy intake was restricted without limitations on water intake. Total body water and body composition using the deuterium dilution method, muscle strength, and jump height before and after 1 week were evaluated for those in the weight loss and control groups. Body mass was significantly reduced in the weight loss group (-2.7 ± 1.3%, p < 0.05) with a significant reduction in fat mass (-17.7 ± 10.7%, p < 0.05). Meanwhile, there were no significant changes in total body water or FFM. Muscle strength and power tests indicated no significant differences between the groups; no notable differences were observed in handgrip strength or knee extension torque. The height of a single vertical and continuous jump remained consistent pre- and postintervention in the control group. In the weight loss group, although the height of a single vertical jump exhibited a slight decline postintervention, the height of a continuous jump displayed no significant changes. The short-term weight loss program significantly reduced fat mass without compromising muscle function, which is crucial for sports performance. These findings may benefit other athletes who require fat mass reduction while maintaining muscle function and help create new programs during specific training phases.

Semi-physiological Enriched Population Pharmacokinetic Modelling to Predict the Effects of Pregnancy on the Pharmacokinetics of Cytotoxic Drugs.

As a result of changes in physiology during pregnancy, the pharmacokinetics (PK) of drugs can be altered. It is unclear whether under- or overexposure occurs in pregnant cancer patients and thus also whether adjustments in dosing regimens are required. Given the severity of the malignant disease and the potentially high impact on both the mother and child, there is a high unmet medical need for adequate and tolerable treatment of this patient population. We aimed to develop and evaluate a semi-physiological enriched model that incorporates physiological changes during pregnancy into available population PK models developed from non-pregnant patient data. Gestational changes in plasma protein levels, renal function, hepatic function, plasma volume, extracellular water and total body water were implemented in existing empirical PK models for docetaxel, paclitaxel, epirubicin and doxorubicin. These models were used to predict PK profiles for pregnant patients, which were compared with observed data obtained from pregnant patients. The observed PK profiles were well described by the model. For docetaxel, paclitaxel and doxorubicin, an overprediction of the lower concentrations was observed, most likely as a result of a lack of data on the gestational changes in metabolizing enzymes. For paclitaxel, epirubicin and doxorubicin, the semi-physiological enriched model performed better in predicting PK in pregnant patients compared with a model that was not adjusted for pregnancy-induced changes. By incorporating gestational changes into existing population pharmacokinetic models, it is possible to adequately predict plasma concentrations of drugs in pregnant patients which may inform dose adjustments in this population.

DIETARY SODIUM RESTRICTION REDUCES NOCTURNAL BLOOD PRESSURE IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION

Objective: Patients with treatment resistant hypertension (TRH) are characterised by lack of blood pressure (BP) control despite antihypertensive treatment. They are at particular risk of cardiovascular disease and more likely to experience BP increase as a response to sodium loading than other individuals. In this study, we aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH. Moreover, we aimed to analyse the effect of this on nocturnal and 24h BP, and how BP changes were correlated to changes in plasma levels of BNP, nitric oxide and body water content. Design and method: The study was conducted as an interventional cross-over study including patients with TRH from 20-70 years. Patients were screened with 24h ambulatory BP monitoring initiated after observed intake of usual antihypertensive medication. They were included if 24h systolic BP&gt;130/80 mmHg. Study participation included two periods of 14 days; a standard period with usual diet and an interventional period with instructed dietary sodium restriction and handed-out sodium-free bread. At the end of each period, patients were examined with 24h BP monitoring, 24h urine collection (sodium excretion), blood samples (nitric oxide, BNP), and bioimpedance measurement (body water content). Results: Participation was completed by 15 patients with mean age 59 years and mean 24h BP 144/82 mmHg. Mean baseline urinary sodium excretion was 192(86) mmol/24h (11.2 grams of salt). As seen in Table 1, sodium excretion was reduced to 91 mmol/24h equalling 5.3 grams of salt. BP levels were reduced significantly. Plasma levels of nitric oxide increased significantly, and this was correlated to the change in 24h BP. Total body water content and plasma levels of BNP was reduced significantly. The changes in BP were not correlated to changes in sodium excretion, body water or BNP. Conclusions: Self-performed dietary sodium restriction could be implemented resulting in a significant reduction in BP levels. BP change was not related to changes in body water or sodium excretion. Increased levels of nitric oxide may be evidence of improved endothelial function and may be one of the involved mechanisms in BP decrease following sodium restriction

In vivo assessment of antidiabetic activity and safety of polyherbal teas from selected Cameroonian medicinal plants: Persea americana, Ageratum conyzoides and Mangifera indica

Background: Diabetes mellitus (DM) is a metabolic disorder of the endocrine system which results in persistently high blood glucose levels. Available control measures do not completely cure the disease and most patients in the tropics cannot afford diabetes drugs regularly. Amongst other plants, Mangifera indica (MI), Persea americana (PA), and Ageratum conyzoides (AC) are used individually as traditional medicine by most people for the management of diabetes. This work was set to produce polyherbal teas (water infusion) from these plants and evaluate in vivo antidiabetic activity and safety of the teas. Methods: Three (3) monoherbal teas (MI, PA, AC) and 4 polyherbal of which 3 composed of two plants each (MI+PA, MI+AC, PA+AC) and one including all the plants (MI+PA+AC) were formulated. The antidiabetic activity was assessed by evaluating the hypoglycaemic activity of the teas by carrying out the oral glucose tolerance test (OGTT) in male Wistar albino rats and the subacute antidiabetic assay in streptozotocin-induced diabetic rats. Safety was evaluated using the in vivo acute toxicity test in mouse model. Results: The OGTT revealed a significant drop in post-prandial glucose peak in rats treated with 20mg/kg monoherbal tea from Mangifera indica leaf (MI), as compared to the negative control (distilled water). The polyherbal tea of all three plants (AC+MI+PA) at a dose of 20mg/kg was able to return the glucose levels to normal 30mins after the glucose peak. The tea AC+MI+PA also exhibited a higher antidiabetic activity as it produced a 60% glycemia recovery rate compared to the reference drug glibenclamide and monoherbal tea MI with 40% and 20% recovery rate respectively. Polyherbal tea and MI exhibited hepato-protective and nephron-protective activities. The in vivo acute toxicity test showed that the teas were not toxic as there was no record of mortality and adverse effects in physical appearance, behavior, change in body weight, water, and food intake. Conclusion: Out of the seven teas produced, two showed promising antidiabetic potential, with both acute hypoglycemic effects and significant subacute efficacy. Further investigations are envisaged to pursue the development of improved alternative therapies from these, to address the enduring challenge of diabetes, particularly in resource-limited settings. Keywords: Diabetes mellitus; antidiabetic; activity; polyherbal tea.

Fluid balance during physical work in the heat is not modified by the menstrual cycle when fluids are freely available.

We tested the hypothesis that women may be more at risk of becoming dehydrated during physical work in the heat in the early follicular phase (EF), compared with the late follicular (LF) and mid-luteal (ML) phases of the menstrual cycle when allowed free access to drink. Twelve healthy, eumenorrheic, unacclimated women (26 ± 5 yr) completed three trials (EF, LF, and ML phases) involving 4 h of exposure to 33.8 ± 0.8 °C, 54 ± 1% relative humidity. Each hour, participants walked on a treadmill for 30 min at a rate of metabolic heat production of 338 ± 9 W. Participants drank a cool, flavor-preferred non-caloric sport drink ad libitum. Nude body weight was measured pre- and post-exposure, and percent changes in body weight loss were interpreted as an index of changes in total body water. Total fluid intake and urine output were measured and sweat rate was estimated from changes in body mass corrected for fluid intake and urine output. Fluid intake was not different between phases (EF: 1,609 ± 919 mL; LF: 1,902 ± 799 mL; ML: 1,913 ± 671; P = 0.202). Total urine output (P = 0.543) nor sweat rate (P = 0.907) differed between phases. Percent changes in body mass were not different between phases (EF: -0.5 ± 0.9%; LF: -0.3 ± 0.9%; ML: -0.3 ± 0.7%; P = 0.417). This study demonstrates that the normal hormonal fluctuations that occur throughout the menstrual cycle do not alter fluid balance during physical work in the heat.NEW & NOTEWORTHY The effect of the menstrual cycle on fluid balance during physical work in the heat when fluids are freely available is unknown. This study demonstrates that fluid balance is not modified in women across three distinct phases of the menstrual cycle during physical work in the heat These results indicate that when women have free access to cool fluid during physical work in the heat, they respond similarly across all three phases to maintain fluid homeostasis across the menstrual cycle.

Predicting outcomes of continuous renal replacement therapy using body composition monitoring: a deep-learning approach

Fluid balance is a critical prognostic factor for patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). This study evaluated whether repeated fluid balance monitoring could improve prognosis in this clinical population. This was a multicenter retrospective study that included 784 patients (mean age, 67.8 years; males, 66.4%) with severe AKI requiring CRRT during 2017–2019 who were treated in eight tertiary hospitals in Korea. Sequential changes in total body water were compared between patients who died (event group) and those who survived (control group) using mixed-effects linear regression analyses. The performance of various machine learning methods, including recurrent neural networks, was compared to that of existing prognostic clinical scores. After adjusting for confounding factors, a marginal benefit of fluid balance was identified for the control group compared to that for the event group (p = 0.074). The deep-learning model using a recurrent neural network with an autoencoder and including fluid balance monitoring provided the best differentiation between the groups (area under the curve, 0.793) compared to 0.604 and 0.606 for SOFA and APACHE II scores, respectively. Our prognostic, deep-learning model underlines the importance of fluid balance monitoring for prognosis assessment among patients receiving CRRT.

Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy.

Background and Objectives: Cancer treatments can adversely influence body weight status, body composition, phase angle (PhA), and resting metabolic rate (RMR), which could possibly affect disease course. Τhe aim was to assess differences in body composition, PhA, RMR, and related parameters in non-small-cell lung cancer (NSCLC) patients after treatment. Methods: The sample consisted of 82 NSCLC (stage IV) male patients (chemotherapy (C) 15.7%; immunotherapy (I) 13.3%; C + I 25.3%; (C) + radiotherapy (R) 22.9 %; and other 15.5%). Body weight and body composition, PhA, RMR, oxygen consumption (VO2), ventilation rate, and diet were assessed at baseline and at 3 months after initiation of therapy. Results: Reductions in PhA, RMR, VO2, ventilation rate, and intracellular water were observed at follow up. Weight loss was evident for 45% of patients who also had a reduction in lean body mass. In the group under C, lean mass was reduced at follow up (55.3 ± 11.53 vs. 52.4 ± 12.6, p = 0.04) without significant weight changes. In subjects with a low adherence to the Mediterranean diet (MedDietScore &lt; 30), RMR (1940 ± 485 vs. 1730 ± 338 Kcal, p = 0.001), VO2 (277.1 ± 70.2 vs. 247 ± 49.1 mL/min, p = 0.001), and ventilation rate (10.1 ± 2.28 vs. 9. ± 2 2.2 L/min, p = 0.03) were significantly reduced. The changes in body weight were positively related to % of change in fat mass (rho = 0.322, p = 0.003) and absolute lean mass change (rho = 0.534, p &lt; 0.001) and negatively associated with % of change in total body water (rho = -0.314, p = 0.004) (Spearman correlation coefficients). Conclusions: In conclusion, cancer therapy related to reductions in PhA and RMR, while lean mass reduction may be related to the type of treatment. Our results emphasize the importance of a more holistic nutritional and body composition assessment beyond body weight, to better address patients' needs in clinical practice.

Body Fluid Estimation Via Segmental Multi-Frequency Bioelectrical Impedance Analysis Following Acute Resistance Exercise

Segmental multi-frequency bioelectrical impedance analysis (S-MFBIA) estimates body composition and fluids by passing electrical currents through the body and can separate the body into distinct segments. The minimum required abstention from exercise before S-MFBIA is unclear. PURPOSE: The purpose of this study was to monitor changes in total body water (TBW), intracellular water (ICW), and extracellular water (ECW) estimated via S-MFBIA following acute, localized bouts of resistance exercise (RE). METHODS: Thirty-two female (n = 18; age: 22.7 ± 1.4 y; height: 167.5 ± 7.5 cm; body mass: 66.6 ± 14.5 kg; body fat: 30.3 ± 6.2%) and male (n = 14; age: 24.2 ± 2.9; height: 178.7 ± 5.3; body mass: 85.7 ± 7.8 kg; body fat: 19.6 ± 6.9%) resistance-trained volunteers completed three randomly assigned conditions in a crossover design. Each RE protocol (REUPPER or RELOWER) consisted of three exercises and began with two warm-up sets of 12-15 repetitions per exercise. This was followed by a RE circuit of 5 sets of 10 repetitions per exercise with a one-minute rest interval between circuits. In the resting (REST) condition, participants did not complete any physical activity. S-MFBIA was performed at five timepoints: pre-exercise, immediate post-exercise, 15-, 30-, and 60-minutes post-exercise. Data were analyzed using linear mixed-effects models with a random intercept for participant. In all models, REST was the reference condition, and pre-exercise was the reference time point. RESULTS: Although body mass did not differ between conditions, condition by time interactions were observed for TBW, ICW, and ECW (p < 0.001 each), with the higher values observed at post-exercise time points in REUPPER as compared to the REST condition. Mean differences between REUPPER and REST for TBW, ICW, and ECW ranged from 0.6-1.0 kg, 0.4-0.6 kg, and 0.2-0.4 kg, respectively. Conversely, RELOWER did not alter fluid estimates. CONCLUSIONS: An acute increase in TBW, ICW, and ECW is detected by S-MFBIA after a single bout of upper body, but not lower body, RE. This could be due to the smaller initial diameter and greater relative change in diameter of the arms as compared to legs. Due to the potential of artificial body fluid changes, users should avoid exercise - particularly upper body exercise - prior to S-MFBIA assessments.

Standard toxicity study of clinical-grade allogeneic human bone marrow-derived clonal mesenchymal stromal cells

IntroductionMesenchymal stromal cells (MSCs) have opened a new window to treat inflammatory and non-inflammatory diseases. Nonetheless, their clinical applications require rigorous control and monitoring procedures to ensure full compliance with the principles of good manufacturing practice (GMP). Various evaluations should be passed in conjunction with the development of these newly emerging therapeutic products from bench-to-bedside. These evaluations include in vitro characterization, preclinical studies, and clinical trials to ensure product safety and efficacy. Therefore, a robust and well-designed preclinical study is critical to confirm product safety. This study aims to determine the probable toxicity effects of local and systemic injections of cryopreserved human bone marrow-derived clonal MSCs (BM-cMSCs) during subacute and subchronic periods of time.MethodsBM-cMSCs were characterized according to the International Society for Cell and Gene Therapy (ISCT) criteria for MSCs. Both safety and toxicity of the BM-cMSCs population produced under GMP-compatible conditions were assessed in both sexes of Sprague Dawley (SD) rats via systemic intravenous (IV) administration and local injection in intervertebral disc (IVD). Behavioral changes, clinical signs of toxicity, and changes in body weight, water and food consumption were the important variables for product toxicity testing over 14 consecutive days during the subacute period and 90 consecutive days during the subchronic period. At the end of the assessment periods, the rats were killed for histopathology analysis of the target tissues. The BM-cMSCs potential for tumorigenicity was checked in nude mice.ResultsSingle IV and IVD injections of BM-cMSCs did not cause significant signs of clinical toxicity, or changes in laboratory and histopathology data during the subacute (14 day) and subchronic (90 day) periods. Ex vivo-expanded and cryopreserved BM-cMSCs did not induce tumor formation in nude mice.ConclusionThe results suggest that local and systemic administrations of xenogeneic BM-cMSCs in both sexes of SD rats do not cause toxicity during the subacute and subchronic periods of time. Also, BM-cMSCs were non-tumorigenic in nude mice.

The Effects of Fluid Hydration Status on Ultrasound Muscle Measurement in Hemodialysis Patients

This study aimed to explore the effects of fluid hydration status on ultrasound muscle measurement in hemodialysis (HD) patients. Ultrasound muscle examination of the right rectus femoris and bioelectrical impedance analysis measurement of the right lower limb were performed in HD patients at the periods of predialysis and postdialysis. The correlations between the changes in the corresponding ultrasound and bioelectrical impedance analysis variables were analyzed. A total of 50 patients on maintenance HD were included, with mean age of 52.6±13.5years. Patients were 40% female (n=20), and average dialysis duration was 2.62±2.42years. Compared to predialysis, the measurements of cross-sectional area, muscle thickness, echo intensity (EI), and their percentage changes all decreased significantly after the HD procedure (P<.05). The change in EI and its percentage change were significantly correlated with changes in total body water, intracellular water, and extracellular water (P<.05). The HD session may have significant effects on ultrasound muscle measurement. Both the indicators of muscle quantity (cross-sectional area and muscle thickness) and quality (EI) significantly decreased after HD, which may contribute to the change in fluid hydration status and the change in fluid composition.

Fluid Balance is Unlikely Modified by the Menstrual Cycle when Ad Libitum Drinking is Permitted During Physical Work in the Heat

PurposeFederal and local entities provide recommendations aiming to limit dehydration during occupational heat stress. These recommendations are largely founded on the premise that during physical work in the heat humans under drink, which increases the likelihood of dehydration. Nearly all these studies have been conducted in men. The female menstrual cycle is characterized by fluctuations in estrogen and progesterone, such that elevations in these ovarian sex hormones may modify fluid regulation by both reducing urine output and promoting fluid intake. However, it is unknown if body fluid balance (i.e., both fluid intake and output) during occupationally relevant heat stress scenarios is altered across the menstrual cycle. Therefore, we tested the hypothesis that during physical work in the heat women will be more dehydrated during the early follicular (EF) phase (when ovarian sex hormones are low), compared to the late follicular (LF) and mid‐luteal (ML) phases of the menstrual cycle (when ovarian sex hormones are elevated).MethodsEight healthy, eumenorrheic, unacclimated women (26 ± 5 y) completed three trials consisting of 4 h (half a workday) exposure to 33.8 ± 0.8°C, 54 ± 1% relative humidity (WBGT = 28.3 ± 0.2°C, the average heat stress encountered in outdoor occupations) during the EF, LF, ML phases of their menstrual cycle. All visits were completed using a block‐randomized, crossover design. Each hour participants walked on a treadmill for 30 min at an intensity evoking a rate of metabolic heat production (Hprod) of ~430 W (the average Hprod for outdoor workers in the U.S.), while the work‐rest ratio is consistent with the NIOSH heat stress recommendations. Participants drank a cool (12 ± 1°C) flavor preferred non‐caloric sport drink (Gatorade Zero) ad libitum. Nude body weight was measured pre‐ and post‐ exposure, and percent changes in body weight loss (%BWL) were interpreted as an index of changes in total body water. Total fluid intake and urine output were also measured and sweat loss was estimated from changes in body weight corrected for fluid intake and urine loss. Rectal temperature is reported as a change from pre‐ to post‐ exposure. Data are presented as mean ± SD.ResultsChanges in rectal temperature did not differ between menstrual cycle phases (EF: 0.3 ± 0.2°C, LF: 0.5 ± 0.5°C, ML: 0.3 ± 0.3°C, p = 0.544). Sweat loss (EF: 2628 ± 1504 mL, LF: 2804 ± 1204 mL, ML: 2817 ± 1267 mL, p = 0.762) and urine output (EF: 864 ± 494 mL, LF: 955 ± 540 mL, ML: 925 ± 480 mL, p = 0.725) also did not differ between phases. Likewise, there were no differences in fluid intake between phases (EF: 1764 ± 1039 mL, LF: 1849 ± 694 mL, ML: 1892 ± 883 mL, p = 0.785). Thus, %BWL did not differ between phases (EF: ‐0.3 ± 0.7%, LF: ‐0.1 ± 0.7%, ML: ‐0.3 ± 0.8, p = 0.530) and %BWL did not statistically differ from zero (p ≥ 0.247).ConclusionWhen cool, flavor preferred fluids are freely accessible, fluid balance in women likely does not differ across three distinct phases of the menstrual cycle and thus, is unlikely to result in a net loss of body water during occupationally relevant heat stress scenarios.

Kids With Altitude: Acute Mountain Sickness and Changes in Body Mass and Total Body Water in Children Travelling to 3800 m.

We explored the incidence of acute mountain sickness (AMS) and extravascular lung water (ELW) in children in relation to changes in body composition and peripheral blood oxygenation (SpO2) during 1 week of acclimatization to 3800 m. In a prospective cohort study, 10 children (7 female, ages 7-14 y) and 10 sex-matched adults (ages 23-44 y) traveled via automobile from sea level to 3000 m for 2 nights, followed by 4 nights at 3800 m. Each morning, body mass and body water (bioelectrical impedance), SpO2 (pulse oximetry), AMS (Lake Louise Questionnaire), and ELW (transthoracic echocardiography) were measured. No differences were found between children and adults in SpO2 or ELW. At 3800 m 7 of 10 children were AMS+ vs 4 of 10 adults. Among those AMS+ at 3800 m, the severity was greater in children compared to adults (5±1 vs 3 ± 0; P=0.005). Loss of body mass occurred more quickly in children (day 5 vs day 7) and to a greater extent (-7±3% vs -2±2%; P<0.001); these changes were mediated via a larger relative loss in total body water in children than in adults (-6±5% vs -2±2%; P=0.027). Children demonstrated a higher incidence of AMS than adults, with greater severity among those AMS+. The loss of body water and body mass at high altitude was also greater in children, albeit unrelated to AMS severity. In addition to awareness of AMS, strategies to maintain body weight and hydration in children traveling to high altitudes should be considered.

Fluid balance assessment in pediatric hemodialysis patients by using whole-body bioimpedance spectroscopy (WB-BIS).

Fluid overload is a major factor in morbidity and mortality in dialysis patients. Whole-body bioimpedance spectroscopy (WB-BIS) is a noninvasive method for assessing fluid status. We hypothesized that fluid status measurement of changes in total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF) by WB-BIS would correlate with the weight (Wt) changes before and after hemodialysis (HD) and the amount of ultrafiltration (UF) in pediatric HD patients. We also examined the relationship between the ECF percent of total body water (ECF%) and ECF/ICF ratio with the pre-HD systolic blood pressure percentile (SBP%ile). WB-BIS measurements were made both before and after HD on three separate occasions in each patient. Pre- and post-HD Wt, BP, and UF volumes were collected on the day of BIS measurement. At total of 96 measurements were obtained from 16 HD patients. There were 6 females (mean age: 13.2 ± 4.5 yrs). UF correlated with changes in weight, TBW and ECF (p < 0.001) but not with ICF changes (p = 0.345). Pre-HD SBP%ile correlated with ECF%. Our findings suggest that WB-BIS can be used to monitor the fluid status in pediatric HD patients. The fluid that is removed from the patient during the HD treatment primarily comes from the ECF and not the ICF. Mobilization of fluid from the ICF appears to be delayed. Patients with significantly higher pre-HD ECF% and ECF/ICF ratio had higher pre-HD systolic BP. A higher resolution version of the Graphical abstract is available as Supplementary information.

Changes in Intra-to-Extra-Cellular Water Ratio and Bioelectrical Parameters from Day-Before to Day-Of Competition in Bodybuilders: A Pilot Study.

The present study analyzed the effects from day-before to day-of bodybuilding competition on intracellular water (ICW), extracellular water (ECW), total body water (TBW), and bioimpedance analysis (BIA) parameters (resistance, R; reactance, Xc; and derived scores) in bodybuilding athletes. We assessed anthropometry and BIA (foot-to-hand; tetrapolar; 50 kHz) in 11 male bodybuilders (29 ± 4 year-old; 81 ± 8 kg; 172 ± 7 cm; 27 ± 2 kg/m2) both on the pre-competition day and on the contest day. Results revealed significant increases in ICW (31.6 ± 2.9 to 33.1 ± 2.8 L), with concomitant decreases in ECW (19.8 ± 1.8 to 17.2 ± 1.4 L) and TBW (51.4 ± 4.6 to 50.3 ± 4.2 L) from the day-before competition to contest day, which resulted in relatively large increases in the ICW/ECW ratio (1.60 ± 0.03 to 1.92 ± 0.01 L). Moreover, significant increases in R (391 ± 34 to 413 ± 33 ohm), Xc (64 ± 7 to 70 ± 6 ohm), and phase angle (9.3 ± 0.6 to 9.6 ± 0.7 degree) were observed between time periods. The phase angle scores reported on show-day of 9.6 and 11.2 appear to be the highest group mean and individual values observed in the literature to date. In conclusion, the strategies carried out on the final day of peak-week bodybuilding preparation lead to changes in BIA parameters and body water, with fluids shifting from the extra- to the intracellular compartment.

Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6\u201359\u2009months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study

BackgroundSevere acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world’s acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions.MethodsThe longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < − 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment.The study’s primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted.DiscussionThere is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children.Trial registrationThe study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013) Date of registration 24/09/2020.

Body composition analysis in patients with acute heart failure: the Scale Heart Failure trial.

AimsIn this study, we aimed to investigate whether body composition analysis (BCA) derived from bioelectrical impedance vector analysis (BIVA) could be used to monitor the hydration status of patients with acute heart failure (AHF) during intensified diuretic therapy.Methods and resultsThis observational, single‐centre study involved a novel, validated eight‐electrode segmental body composition analyser to perform BCA derived from BIVA with an alternating current of 100 μA at frequencies of 5, 7.5, 50, and 75 kHz. The BCA‐derived and BIVA‐derived parameters were estimated and compared with daily body weight measurements in hospitalized patients with AHF. A total of 867 BCA and BIVA assessments were conducted in 142 patients (56.3% men; age 76.8 ± 10.7 years). Daily changes in total body water (TBW) and extracellular water (ECW) were significantly associated with changes in body weight in 62.2% and 89.1% of all measurements, respectively (range, ±1 kg). Repeated measures correlation coefficients between weight loss and TBW loss resulted with rho 0.43, P < 0.01, confidence interval (CI) [0.36, 0.50] and rho 0.71, P > 0.01, CI [0.67, 0.75] for ECW loss. Between the first and last assessments, the mean weight loss was −2.5 kg, compared with the −2.6 L mean TBW loss and −1.7 L mean ECW loss. BIVA revealed an increase in mean Resistance R and mean Reactance Xc across all frequencies, with the subsequent reduction in body fluid (including corresponding body weight) between the first and last assessments.ConclusionsBody composition analysis derived from BIVA with a focus on ECW is a promising approach to detect changes in hydration status in patients undergoing intensified diuretic therapy. Defining personalized BIVA reference values using bioelectrical impedance devices is a promising approach to monitor hydration status.