Lower Body Cell Mass Research Articles

Prevalence of low-body cell mass evaluated by bioelectrical impedance vector analysis related to aging.

The objective of this study was to determine the prevalence of low-body cell mass by sex and age in a community-dwelling population. In this retrospective study, 981 community-dwelling adults aged ≥35 years (648 women and 333 men) from Mexico City were recruited in a subway station between February and April 2012. Demographic data, anthropometry, and body composition were assessed, and self-reported comorbidities were recorded in the consulting room. Impedance values were obtained using mono-frequency equipment at 50 kHz. For the diagnosis of low-body cell mass by bioelectrical impedance vectorial analysis: resistance (R, Ohm) and reactance (Xc, Ohm) values were adjusted for height to obtain impedance vector (R/H and Xc/H) and then plotted in the R/Xc to perform the bioelectrical impedance vectorial analysis RXc Z-score analysis. The total prevalence of low body cell mass by bioelectrical impedance vectorial analysis was 29.4% (n=288) with a 95%CI 26.5-32.3%; was higher in men (39%) compared with women (24.4%) (p<0.0001). The group aged>75 years had the highest prevalence (men: 85.3%, p<0.001; women: 63.3%, p<0.001). The bioelectrical impedance vectorial analysis RXc Z-score analysis showed lower cell mass in men aged>75 years (R Z-score -0.30, Xc Z-score -2.13), and women aged 65-74 years also presented with overhydration (Z-score -2.6, Z-score -1.27). The prevalence of low body cell mass, evaluated by bioelectrical impedance vectorial analysis, increased with age. RXc Z-score analysis could be a useful tool to evaluate nutritional status and changes in hydration in community-dwelling populations.

Nutritional Status, Body Composition, and Inflammation Profile in Older Patients with Advanced Chronic Kidney Disease Stage 4-5: A Case-Control Study.

Nutritional status is a predictor of adverse outcomes and mortality in patients with advanced chronic kidney disease (ACKD). This study aimed to explore and evaluate risk factors related to nutritional status, body composition, and inflammatory profile in patients with ACKD compared with age- and sex-matched controls in a Mediterranean cohort of the Spanish population. Out of 200 volunteers recruited, 150 participants (64%) were included, and a case-control study was conducted on 75 ACKD patients (stages 4–5), matched individually with controls at a ratio of 1:1 for both age and sex. At enrolment, demographic, clinical, anthropometric, and laboratory parameters were measured. Bioimpedance analysis (BIA) was used to assess both body composition and hydration status. ACKD patients had lower body cell mass (BCM%), muscle mass (MM%) phase angle (PA), s-albumin, and higher C-reactive protein (s-CRP) than controls (at least, p < 0.05). PA correlated positively with BCM% (cases: r = 0.84; controls: r = 0.53, p < 0.001), MM% (cases: r = 0.65; controls: r = 0.31, p < 0.001), and inversely with s-CRP (cases: r = −0.30, p < 0.001; controls: r = −0.31, p = 0.40). By univariate and multivariate conditional regression analysis, total body water (OR: 1.186), extracellular mass (OR: 1.346), s-CRP (OR: 2.050), MM% (OR: 0.847), PA (OR: 0.058), and s-albumin (OR: 0.475) were significantly associated among cases to controls. Nutritional parameters and BIA-derived measures appear as prognostic entities in patients with stage 4–5 ACKD compared to matched controls in this Mediterranean cohort.

The use of bioelectrical impedance vector analysis for a nutritional evaluation of older adults in the community.

The body composition of an older adult person is characterized by an increase in body fat, as well as by a reduction in both muscle mass and total body water. The bioelectrical impedance vector analysis (BIVA) overcomes the limits imposed by bioelectrical impedance, since it only requires the resistance (R) and reactance (Xc) values, standardized by the individual's height, which makes the method more individualized and accurate. The aim of this study was to evaluate the body composition using the BIVA of the community-living older adults, with regard to sex and body mass index (BMI) classification, and compare the results with the reference population. Cross-sectional study with the community-living older adults of both sexes. Bioimpedance was carried out and the R and Xc data analyzed, based on height, and plotted on RXc graphs. One hundred and forty-four older adults (n=33 men; n=111 women; mean age of 80.2±9.2years) participated in the study. Low weight (<23kg/m2) was the most prevalent in BMI classification. The older adult women presented a higher average BMI, body fat percentage and R/Height values, while the older adult men presented a higher average for fat-free mass and the phase angle (p<0.05). The older adult, regardless of their BMI, located in the right quadrant, indicated cachexia; those with low weight were dehydrated, and those with overweight (BMI≥28kg/m2) presented hyperhydration. The majority of the older adults with normal weight or overweight has impedance vectors indicating loss of muscle mass and water imbalance (dehydration or hyperhydration).

Comparative Performance of Body Composition Parameters in Prediction of Death in Hospitalized Patients on Maintenance Hemodialysis: A Cohort Study

We compared the prognostic value of nutritional or volumetric parameters measured by body composition in hospitalized patients on maintenance hemodialysis. We conducted a cohort study to assess the association of different parameters of body composition with all-cause mortality in inpatients admitted to our nephrology department from January 2014 to December 2016. Of the 704 study patients, 160 (22.7%) died during a median follow-up of 33 months. In multivariate adjusted Cox models, higher ratio of extracellular water to body cell mass (ECW/BCM) (adjusted HR per 1-SD, 1.49; 95% CI, 1.19 to 1.85), lower lean tissue index (LTI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.57 to 0.86) and lower body cell mass index (BCMI) (adjusted HR per 1-SD, 0.70; 95% CI, 0.58 to 0.85) were associated with a significantly greater risk of death. When these parameters were added to the fully adjusted model, BCMI performed best in improving the predictability for all-cause mortality (integrated discrimination improvement = 0.02, P = 0.04; net reclassification index = 0.11, P = 0.04). Among body composition indexes, ECW/BCM was the most relevant fluid volume indices to mortality and BCMI and LTI were the most relevant nutritional status indices to mortality in maintenance hemodialysis patients.

Dental agenesis and evaluation of body composition through bioelectrical impedance analysis. Observational study on a sample of paediatric subjects.

The aim of the present study was to evaluate the anthropometric parameters and the body composition through bioelectrical impedance analysis on paediatric subjects with dental agenesis. The study was conducted on 144 subjects (58.3% females and 41.7% males), aged 7-14 years (average age 10.22±2.53 years). Each patient underwent a dental check-up at the Paediatric Dentistry Unit, University of Rome Tor Vergata (Italy) and a nutritional evaluation, aimed at analysing the anthropometric characteristics and evaluating the indices of body composition through bioelectrical impedance analysis (BIA) at the Human Nutrition Unit, University of Rome Tor Vergata. The sample was divided into three groups: a group with single agenesis (Group 1), a group with multiple agenesis (Group 2) and a control group (Group A). Using the predictive equations, the following values were evaluated: resistance (R), reactance (Xc), phase angle (PHA), body cell mass index (BCMI), body cell mass (BCM), total body water (TBW), intracellular water (ICW), extracellular water (ECW), fat mass (FM), fat free mass (FFM). The Excel environment and the SAS System, version 9.3, were used for statistical analysis, providing a descriptive and parametric analysis of the sample. The values of the anthropometric parameters were expressed as mean ± standard deviation. For the statistical analysis of anthropometric parameters and body composition, analysis of variance (1-way ANOVA) was used, which allowed us to find differences and the Student's t-test to compare Groups 1, 2, and A. There is a significant difference in the resistance R value between the case group with single agenesis (Group 1) and the control group (Group A) (R, 710.28±72.46 vs 667.4±104.16, p=0.028), and the phase angle PHA between the case group with multiple agenesis (Group 2) and the control group (Group A) (PHA, 5.18±0.48 vs 5.85±1.05, p=0.028). The BCM% value shows a significant difference between both Group 1 and Group A (BCM%, 50.53 ± 3.29 vs 52.68 ± 4.74, p=0.016) and between Group 2 and Group A (BCM%, 49.25± 2.86 vs 52.68 ± 4.74, p=0.035). The TBW, ICW, ECW, FM, FFM values showed no significant differences between the various groups analysed. Body composition in subjects with dental agenesis presents a higher R, a consequently lower PHA and a lower BCM% compared to the control group. For the first time, the results highlighted the possible relationship between dental agenesis and body composition, measured through BIA.

Nutritional prognostic factors for survival in amyotrophic lateral sclerosis patients undergone percutaneous endoscopic gastrostomy placement

Objective: There are conflicting data on nutritional factors influencing survival in amyotrophic lateral sclerosis (ALS) patients after percutaneous endoscopic gastrostomy (PEG) placement. We performed an observational cross-sectional study evaluating body mass index (BMI) categories and cholesterol levels as prognostic factors for survival after PEG. Moreover, we assessed body composition in a subgroup of patients to better explain the influence of BMI on survival. Methods: Neurological and nutritional parameters were evaluated at the time of PEG implantation in 47 consecutive patients. Moreover, body composition was evaluated in a subgroup of 22 patients by bioelectrical impedance analysis. Survival was calculated as the time from the PEG placement to death. Results: Underweight patients had a significantly increased risk of death as compared to normal-weight patients using Cox regression analysis [HR = 3.37 (1.29–8.81); p = 0.04]. Similarly, older age at the onset of symptoms significantly increased the risk of death [HR = 1.07 (1.02–1.12); p = 0.001]. Neither overweight/obesity nor hypercholesterolemia affected survival. All ALS patients showed an altered body composition compared to the general population. In addition, a BMI <18.5 kg/m2 identified patients with a significant reduction of body cell mass (BCM) and phase angle (PhA) compared to patients with normal BMI taken as the reference value. Conclusions: In the later stages of the disease, only a BMI < 18.5 kg/m2 and older age at symptom onset had a prognostic value on survival. Dyslipidemia did not affect survival. The low BCM and PhA characterizing underweight patients support the role of BMI as a predictor of survival.

Major barriers responsible for malnutrition in hemodialysis patients: challenges to optimal nutrition.

Background:Nutritional barriers may contribute to malnutrition in hemodialysis (HD) patients. Higher rates of morbidity and mortality rates have been reported in malnourished HD patients. These patients are faced with different challenges affecting their nutritional status.Objectives:The aim of this cross-sectional study was to identify most important barriers responsible for malnutrition in HD patients.Patients and Methods:We randomly selected 255 of 800 stable HD patients from three HD centers with an age range of 18-85 years, who had been on hemodialysis for at least three months without any acute illness. Each patient was interviewed to evaluate malnutrition [subjective global assessment (SGA), malnutrition inflammation score (MIS)], and potential medical, behavioral and socioeconomic barriers. Body composition of patients was checked through bioelectrical impedance analysis (BIA). Routine clinical markers of malnutrition such as serum albumin and total protein were measured using standard automated techniques. Binary logistic regression model was used to find the association between nutritional markers and potential barriers.Results:Patients with higher SGA had lower knowledge about general nutrition [odds ratio (OR), 1.3], potassium (OR, 1.89), difficulty chewing (OR, 1.16), and shopping (OR, 1.16). Those with greater MIS scores had poor appetite (OR, 1.3), depression (OR, 1.21), and difficulty with cooking (OR, 1.15). Lower BCM (body cell mass) was associated with poor appetite (OR, 0.92) and needed help for cooking (OR, 0.88). Patients with higher BFMI (body fat mass index) had insufficient general nutrition (OR, 1.15), and protein (OR, 1.27) knowledge, and needed help for shopping (OR, 1.14). Moreover, patients with higher SGA scores were those with older age and longer duration of HD.Conclusions:Three medical barriers (poor appetite, depression and difficulty chewing), one behavioral barrier (poor total nutrition, protein, and potassium knowledge), and one socioeconomic barrier (needing help for shopping and cooking) were independently associated with nutritional markers.

The effect of long-term gymnastic exercises on body composition changes in women after mastectomy

This study describes the effects of regular 4-year-long rehabilitation exercises based on a 45 min exercise session 3 times/w, on changes in body composition of 23 postmenopausal women (experimental group - E) following mastectomy. Anthropometric measurements and body composition (BIA method) were compared between the E women and a control (C) group of non-exercising women (N = 20) who underwent the same surgical procedure. Following four years of regular exercise, significant increase in body cell mass (BCM) (kg, %) and intracellular water (ICW) (1) was observed ( P< 0.05), whereas the content of extracellular water (ECW) (%) and extracellular mass (ECM) (kg) decreased ( P< 0.05). Body mass, body mass index (BMI) and fat mass (FM) (kg, %), did not change significantly. Central fat deposition measured by waist-to-hip ratio (WHR) and the waist circumference increased ( P< 0.05), whereas hip circumference did not change. Compared to the C group the E group had a lower BCM, BMI, FM (kg, %), ECW (l, %) and ECM (kg) ( P< 0.05), and a higher total body water (TBW) (%), fat-free mass (FFM) (%) and BCM (%) content ( P< 0.05). Hence, regular exercise may have a positive effect on the abovementioned factors which are considered among breast cancer risk factors after mastectomy.

Pre- and perioperative factors affecting infection after living donor liver transplantation

ObjectiveInfectious complications, including sepsis, that often occur after liver transplantation (LT) comprise the most frequent causes of in-hospital death. This study investigated the predictors of post-transplantation infectious complications to establish a strategy with which to improve short-term outcomes after LT. MethodsWe used univariate and multivariate analyses to assess pre- and perioperative risk factors for post-transplantation infectious complications in 100 consecutive patients who underwent living donor LT from February 2008 through February 2010 at our institute. ResultsMultivariate analysis showed that low preoperative body cell mass and the absence of preoperative supplementation with branched-chain amino acids were of prognostic significance for post-transplantation sepsis. In addition, Child–Pugh classification C and massive operative blood loss were independent risk factors for post-transplantation bacteremia, and preoperative low body cell mass was an independent risk factor for in-hospital death from infection. ConclusionPretransplantation nutritional intervention and decreases in operative blood loss would help prevent post-transplantation infectious complications from developing during living donor LT. Branched-chain amino acid supplementation before LT affects the occurrence of infectious complications.

Bioimpedance and Bioimpedance Vector Analysis in patients with Anorexia Nervosa

The utility of bioelectrical impedance analysis (BIA) in patients with anorexia nervosa (AN) is imperfectly defined. Furthermore, any advantage accrued by BIA with vector analysis (BIVA) is unknown. We conducted a retrospective analysis of 57 women with AN admitted to our service who underwent BIA and BIVA. Twenty-seven women were observed during short-term (3 weeks) and 13 women during longer-term (3 months) weight gain. Bioelectrical impedance analysis produced implausible results in 47% of the patients. BIVA demonstrated low body cell mass and highly variable extracellular water (ECW) volume, ranging from volume contraction to volume expansion on admission and during treatment. BIVA suggested that short-term weight gain predominantly consisted of ECW volume, whereas longer-term weight gain resulted in increased hydrated body cell mass. Conventional BIA has little utility in these patients. However, BIVA could be a suitable alternative in the medical management reflecting ECW volume changes and later genuine tissue mass increases.

Association between oral health and body cell mass in hospitalised elderly

To examine whether oral health in hospitalised elderly was associated with body cell mass (BCM) measured with Bioimpedance spectroscopy. Body cell mass is the tissue producing the metabolic work necessary for all body functions. BCM is mainly muscle tissue. Low BCM is associated with diseases, ageing and poor nutritional status. Reduced oral health is also associated with these parameters; thus, BCM and oral health may be related. Body cell mass was measured using Bioimpedance spectroscopy in 138 acutely hospitalised elderly ≥70 years. The number of own teeth, posterior occluding tooth pairs and decayed teeth were registered. Oral hygiene was registered with Mucosal-Plaque Score, an index based on assessment of plaque accumulation and mucosal/gingival inflammation. Mini Nutritional Assessment-Short Form, body mass index and handgrip strength were used as nutritional indicators. Comorbidity was assessed with Cumulative Index Rating Scale. Mean age was 83.2 ± 5.9 years, ranging from 70 to 101 years. Dentition status was significantly and positively associated with BCM. Reduced oral hygiene was significantly associated with low BCM. These findings remained significant after adjusting for confounders. These results show that compromised oral health was significantly associated with reduced BCM in hospitalised elderly.

Longitudinal Study of Total Body Potassium in Healthy Men

Objectives: Total body potassium (TBK) is an index of fat-free mass and an accurate measure of body cell mass (BCM). To date, however, no longitudinal studies have evaluated body composition using TBK in aging healthy adults. The purpose of this study was to assess TBK and BCM in healthy men over a 21-year period, and to evaluate changes with age.Design: A 21-year longitudinal, prospective, observational study evaluating TBK and BCM and their relationship to changes with aging and body mass index (BMI).Subjects: Body composition of 133 healthy Italian men, 20 to 66 years of age, was measured by whole-body counting of 40K. TBK was calculated by using this formula: 40K × 8.474. BCM was calculated from TBK by using this formula: BCM (kg) = 0.00833 × TBK (mmol).Results: The prevalence of overweight and obesity increased significantly from baseline to end of study (p < 0.01), with no change in TBK observed over the 21-year period. BCM summaries were tested to determine if any was a good predictor of BMI after age 30. Participants with a low maximum BCM (<27 kg) at an early age tended to exhibit decreased BMI as they aged, whereas those with a high maximum BCM (>27 kg) at an early age tended to show increased BMI as they aged.Conclusion: Despite an overall increase in the incidence of overweight and obesity over the 21-year period, a high maximum BCM at an early age was a predictor of an increase in BMI as men got older.

Bioelectrical impedance vector analysis detects low body cell mass and dehydration in patients with Alzheimer's disease.

This paper evaluates the nutritional status in patients with mild-moderate and severe Alzheimer's disease (AD) by bioelectrical impedance vector analysis (BIVA). Cross-sectional study. Alzheimer Center, SS. Trinita Hospital, Cagliari, and "Monsignor Angioni" Nursing Home, Quartu Sant'Elena (Cagliari, Italy). 83 free-living patients with mild-moderate Alzheimer's disease (29 men, 54 women), 9 institutionalized women in the severe stage; 468 age-matched controls (202 men, 266 women). Mini Nutritional Assessment (MNA), anthropometric (height, weight, BMI), bioelectrical (R, Xc) and biochemical variables (serum albumin) were assessed. Bioelectrical characteristics were significantly different in the patients with mild-moderate AD with respect to controls, indicating low body cell mass (men, T2= 12.8; women, T2=34.9; p < 0.01). Women with severe AD showed low body cell mass and dehydration with respect to patients with mild-moderate AD (T2=17.1; p < 0.01). The phase angle, R/H and Z/H were significantly correlated (p < 0.05) with MNA (phase: r = 0.31; R/H: r =-0.37; Z/H: r =-0.37) and albumin (phase: r=0.47; R/H: r=-0.36; Z/H: r=-0.36). Alzheimer's disease is characterized by a tendency to malnutrition, present even in the mild-moderate stages, and a tendency to dehydration that appears in the severe stage. The BIVA technique is a promising tool for the screening and monitoring of nutrition and hydration status in Alzheimer's disease.

Male hypogonadism associated with advanced cancer: a systematic review

Male hypogonadism is commonly diagnosed on the basis of subphysiological concentrations of androgen hormones, and is associated with many symptoms present in advanced cancer. Androgen deficiency might be an important cause of muscle wasting in both cancer cachexia and sarcopenia. We did a systematic review of the clinical association of male hypogonadism in advanced cancer. We searched PubMed, Medline, and Embase for publications on the relation between male hypogonadism and functional status, nutritional status, body composition, symptoms, and quality of life in patients with advanced cancer. Of 381 publications identified, six original articles were included. We found no definitive association between nutritional, functional, or quality-of-life characteristics and male hypogonadism. Possible associations between male hypogonadism and weight loss, low albumin, low-body cell mass index, low-peripheral fat and muscle mass, higher inflammation, higher pain, higher opioid consumption, worse scores for anxiety, depression, and emotional and functional well-being need to be confirmed by better designed studies. There is no clear epidemiological data to indicate whether male hypogonadism is independently associated with clinical and biological sequelae of cancer cachexia, such as higher inflammation, fatigue, and body wasting. Standardised kits sensitive to low concentrations of free-testosterone or bioavailable testosterone are needed to diagnose androgen deficiency in women. A clearer epidemiology of androgen deficiencies in advanced cancer will help determine which patients should receive testosterone-replacement therapy for alleviating cancer cachexia symptoms and improving quality of life.

Nutritional status in the healthy longeval population from Sardinia (Italy).

The aim of this study was to evaluate sex- and age-related variations of the nutritional status in the aged population of central Sardinia, a geographical area with a high frequency of long-lived people, particularly men. The sample consisted of 200 subjects over 70 years of age (men: N= 100, age= 81.0 +/- 7.0 years; women: N= 100, age= 81.5 +/- 7.3 years). Orroli (central Sardinia, Italy). Mini nutritional assessment (MNA) and bioelectrical impedance vector analysis (BIVA) were used to evaluate nutritional status and body composition. The indicators revealed a generally good nutritional status. The MNA results (men: 24.6 +/- 2.2; women: 23.4 +/- 2.5) showed that 64.1% of the subjects had a normal nutritional status and only a small proportion (1.2%) could be classified as malnourished. BIVA showed that most subjects (74.2%) were normal, while the prevalence of low body cell mass was 10.7% and that of dehydration 11.2%. According to the MNA, the nutritional status was significantly better in the men. Almost three-quarters of the men (73.1%) were well nourished vs. half of the women (50.6%). A worsening of the nutritional status with age was observed. The proportion of malnourished individuals, as assessed by MNA, increased from 0% to 9.1% from 70-79 to > 90 years. With respect to their contemporaries from other regions, the elderly of Orroli presented a better nutritional status, a similar worsening with age and generally higher sexual dimorphism.

Evaluation of Nutrition Assessment Tools Compared With Body Cell Mass for the Assessment of Malnutrition in Chronic Kidney Disease

We compared the subjective global assessment (SGA) and a range of SGA-based assessment tools with body cell mass (BCM) in patients with stage IV and V predialysis chronic kidney disease (CKD). This was a cross-sectional, observational study. The study took place at a public tertiary hospital predialysis outpatient clinic. A total of 56 consecutive consenting patients with CKD (61% were male; age [mean +/- standard deviation] 70.2 +/- 11.6 years; glomerular filtration rate 22.2 +/- 6.8 mL/min). Nutrition status was the main outcome measure. In this population, the prevalence of malnutrition was 19.6% (n = 11, SGA B; no C ratings). Malnutrition was associated with lower BCM (mean BCM, 26.3 vs. 33.4 kg, P = .007, measured by total body potassium), body weight (64.8 vs. 76.1 kg, P = .042), body mass index (23.7 vs. 27.6 kg/m(2), P = .015), and greater weight loss over the previous 6 months (-6.2 vs. -0.1 kg, P = .004). BCM had a weak relationship with 7-point SGA (P = .267), malnutrition inflammation score (r = -0.27 P = .063), and patient-generated SGA (r = -0.27 P = .060). There was no association for either measure of nutrition status (SGA or BCM) with albumin, glomerular filtration rate, or C-reactive protein. SGA in its original form most accurately delineated malnutrition by depleted BCM and is the most appropriate tool for cross-sectional assessment of nutrition status in patients with predialysis CKD.

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy.

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis

To examine the impact of HIV coinfection, socioeconomic status (SES) and severity of tuberculosis (TB) on the body composition and anthropometric status of adults with pulmonary TB. Cross-sectional study. Five TB clinics in Dar es Salaam, Tanzania. A total of 2231 adult men and women diagnosed with pulmonary TB, prior to the initiation of anti-TB therapy. We compared the distribution of anthropometric characteristics including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin-fold (TSF), and arm muscle circumference (AMC) by HIV status, SES characteristics, and indicators of TB severity (bacillary density in sputum and Karnofsky performance score). Similar comparisons were carried out with body composition variables from bioelectrical impedance analysis and albumin concentrations, in a subsample of 731 subjects. In multivariate analysis, HIV infection was significantly associated with lower MUAC and AMC in both men and women, but not with BMI or TSF. Compared to HIV-uninfected women, those who were HIV infected had lower body cell mass (BCM) (adjusted difference = -0.85 kg, P = 0.04), intracellular water (-0.68 l, P = 0.04), and phase angle (-0.52, P = 0.02). Albumin concentrations were significantly lower in both men and women infected with HIV. Among HIV-infected men, CD4 cell counts <200/mm(3) were related to lower intracellular water, BCM, fat-free mass and phase angle. Independent of HIV infection, BMI and MUAC were positively related to SES indicators and the Karnofsky performance score; and inversely related to bacillary density. HIV infection is associated with indicators of low lean body mass in adults with TB; socioeconomic factors and TB severity are important correlates of wasting, independent of HIV. The National Institute of Allergy and Infectious Diseases (UO1 AI 45441-01).

Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents.

To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all-cause mortality in a sample of older nursing home residents. Prospective study with a median follow-up period of 3.5 years. Istituto di Riposo per Anziani, Padua, Italy. A total of 344 participants (79.1% women) aged 65 and older at baseline. Anthropometric, nutritional, and metabolic parameters were measured at baseline. BCM was measured using tetrapolar bioelectric impedance analysis. Up to 4 years of follow-up data for vital status were available. Survival analysis was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. During the follow-up period, there were 179 deaths. After adjustment for age and sex, subjects with low BMI and low BCM (lowest sex-specific tertiles) had significantly higher mortality than those with higher BMI or BCM levels. In a fully adjusted regression model, there was no association between BMI levels and risk of mortality, with subjects in the top tertile having the same likelihood of mortality as subjects in the lowest tertile (relative risk (RR)=0.94, 95% confidence interval (CI)=0.61-1.43). Conversely, there was a strong and significant inverse association between BCM levels and mortality (RR for tertile III=0.55, 95% CI=0.35-0.87; P<.01). Furthermore, participants who had high BCM had comparable survival rates in all BMI tertiles. In this sample of older nursing home residents, BCM was a strong and independent risk factor for mortality. BCM assessment might provide more useful prognostic information for clinicians than BMI.

OVERHYDRATION IN CHRONIC HEMODIALYSIS PATIENTS IS ASSOCIATED WITH HYPOALBUMINEMIA

Hypoalbuminemia is an important risk factor for increased morbidity and mortality in dialysis patients. Hypoalbuminemia is usually attributed to malnutrition and/or a state of chronic inflammation. However, a low serum albumin could also be due to hemodilution during states of chronic volume expansion. We evaluated both intracellular (ICW) and extracellular (ECW) water content by bioelectrical impedance, and related results to serum albumin concentrations in 142 hemodialysis (HD) patients (mean age: 62±14 years 41% female 37% black 43% diabetic). Values in each group are expressed as the annual mean±SEM (*P < 0.001).TablePatients with decreased serum albumin values had lower body weight, BMI, BUN, serum creatinine, dietary protein intake and ICW content than patients with normal values. ICW content in hypoalbuminemic patients was decreased as expected with a lower body cell mass. Nevertheless, ECW was noted to be significantly increased in the hypoalbuminemic patients. These results indicate that hypoalbuminemia is a clinical marker of extracellular volume expansion in HD patients.