Human hydrometry: comparison of multifrequency bioelectrical impedance with 2H2O and bromine dilution

The traditionalmethod of assessing total body water (TBW), extracellular water (ECW),and intracellular water (ICW) has been the use of isotopes, on thebasis of the dilution principle. Although the development ofbioelectrical impedance techniques has eliminated many of themeasurement constraints associated with the dilution methods, thedegree of interchangeability between the two methods remains uncertain.We used multifrequency bioelectrical impedance spectroscopy (BIS),²H₂Odilution, and bromine dilution to assess TBW, ECW, and ICW in 469 healthy subjects (248 males, 221 females) aged 3-29 yr. We foundthat the TBW, ECW, and ICW estimates for the BIS and dilution methodswere significantly correlated(r² = 0.80-0.96, P < 0.0001, SE ofthe estimate = 2.3-2.7 liters). On the basis of population, theconstants used in the BIS analysis could be adjusted so that the meandifferences with the dilution methods would become zero. The SD valuesfor the mean differences between the dilution and BIS methods, however,remained significant for both males and females: TBW (±2.1-2.8liters), ECW (±1.4-1.6 liters), and ICW (2.0-3.1 liters).To improve the accuracy of the BIS measurement for an individual withinthe age range we have examined, further refinement of the constantsused in the BIS analysis is needed.

     

Effect of subclinical hypothyroidism on body fluid compartments.

OBJECTIVE: The present study was aimed to assess the effects of subclinical hypothyroidism on body composition (BC). SUBJECTS: Thirty-one women (age: 37 +/- 9.9 years) with a wide range of body mass index (BMI) were studied. Subclinical hypothyroidism was defined by a basal TSH > or = 4 mU/L and/or TRH stimulated peak > or = 30 mU/L. MEASUREMENTS: For each subject, weight, height, BMI, multifrequency bioelectrical impedance spectroscopy (BIS) and D2O and NaBr dilution tests were performed to assessed total body water (TBW) and extracellular water (ECW). Thyroid function (basal and TRH stimulated TSH, free T3, and free T4) were determined from fasting blood samples for all subjects. Total body dual energy X-ray absorptiometry (DXA) were used to measure fat mass (FM) and lean mass (Lean). RESULTS: The results of BIS were compared with the TBW and ECW estimated by the dilution techniques on the same individuals. The correlation was R2 = 0.65 for impedance at 5 kHz and ECW by NaBr and R2 = 0.72 for impedance at 100 kHz and TBW by D2O. Intracellular water (ICW) was calculated as differences between TBW and ECW measured by dilution methods. Percent of ECW and ICW were related to BMI (ANOVA, p < 0.001). No difference in TBW, body water distribution and body composition related to thyroid function was demonstrated. CONCLUSIONS: In our patients affected with subclinical hypothyroidism, with or without obesity, only obesity appeared related to TBW, ECW and ICW; the subclinical hypothyroidism, on the contrary, had no effect on compartments of body fluids. Bioimpedance is a valid tool to assess body fluid distribution in subclinical hypothyroidism.     

Predicting body cell mass with bioimpedance by using theoretical methods: a technological review

De Lorenzo, A., A. Andreoli, J. Matthie, and P. Withers.Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. J. Appl.Physiol. 82(5): 1542-1558, 1997.The body cellmass (BCM), defined as intracellular water (ICW), was estimated in 73 healthy men and women by total body potassium (TBK) and by bioimpedancespectroscopy (BIS). In 14 other subjects, extracellular water (ECW) andtotal body water (TBW) were measured by bromide dilution and deuteriumoxide dilution, respectively. For all subjects, impedance spectral datawere fit to the Cole model, and ECW and ICW volumes were predicted byusing model electrical resistance terms R_E andR_I in an equation derived from Hanai mixture theory,respectively. The BIS ECW prediction bromide dilution wasr = 0.91, standard error of theestimate (SEE) 0.90 liter. The BIS TBW prediction of deuterium spacewas r = 0.95, SEE 1.33 liters. The BISICW prediction of the dilution-determined ICW wasr = 0.87, SEE 1.69 liters. The BIS ICWprediction of the TBK-determined ICW for the 73 subjects wasr = 0.85, SEE = 2.22 liters. Theseresults add further support to the validity of the Hanai theory, theequation used, and the conclusion that ECW and ICW volume can bepredicted by an approach based solely on fundamental principles.

     

Measurement of nutritional status in simulated microgravity by bioelectrical impedance spectroscopy.

The potential of bioelectrical impedance spectroscopy (BIS) for assessing nutritional status in spaceflight was tested in two head-down-tilt bed-rest studies. BIS-predicted extracellular water (ECW), intracellular water (ICW), and total body water (TBW) measured using knee-elbow electrode placement were compared with deuterium and bromide dilution (DIL) volumes in healthy, 19- to 45-yr-old subjects. BIS was accurate during 44 h of head-down tilt with mean differences (BIS - DIL) of 0-0.1 kg for ECW, 0.3-0.5 for ICW, and 0.4-0.6 kg for TBW (n = 28). At 44 h, BIS followed the within-individual change in body water compartments with a relative prediction error (standard error of the estimate/baseline volume) of 2.0-3.6% of water space. In the second study, BIS did not detect an acute decrease (-1.41 +/- 0.91 kg) in ICW secondary to 48 h of a protein-free, 800 kcal/day diet (n = 18). BIS's insensitivity to ICW losses may be because they were predominantly (65%) localized to the trunk and/or because there was a general failure of BIS to measure ICW independently of ECW and TBW. BIS may have potential for measuring nutritional status during spaceflight, but its limitations in precision and insensitivity to acute ICW changes warrant further validation studies.     

Evaluation of bioimpedance spectroscopy for measurements of body water distribution in healthy women before, during, and after pregnancy.

Bioimpedance spectroscopy (BIS) is a technique of interest in the study of human pregnancy because it can assess extracellular (ECW), intracellular (ICW), and total body water (TBW) as ECW plus ICW. The technique requires appropriate resistivity coefficients and has not been sufficiently evaluated during the reproductive cycle. Therefore, in a methodological study, we estimated ECW, ICW, and TBW, by means of BIS, and compared the results with the corresponding estimates obtained by using reference methods. Furthermore, results obtained by means of population-specific resistivity coefficients were compared with results obtained by means of general resistivity coefficients. These comparisons were made before pregnancy, in gestational weeks 14 and 32, as well as 2 wk postpartum in 21 healthy women. The reference methods were isotope and bromide dilution. Average ICW, ECW, and TBW, estimated by means of BIS, were in agreement with reference data before pregnancy, in gestational week 14, and postpartum. The corresponding comparison in gestational week 32 showed good agreement for ICW, whereas estimates by means of BIS were significantly (P < 0.001) lower than the corresponding reference values for ECW and TBW. Thus the BIS technique, which was based on a model developed for the nonpregnant body, estimated increases in ICW accurately, whereas increases in ECW and TBW tended to be underestimated. Estimates obtained by using population-specific and general resistivity coefficients were very similar. In conclusion, the results indicated that BIS is potentially useful for studies during pregnancy but that further work is needed before it can be generally applied in such studies.     

Estimation of body composition from bioelectrical impedance of body segments

This study provides values of anthropometric measurements and specific impedance, for a sample of 104 adults. The hypothesis that the body composition can be estimated more accurately from measurements of lengths and impedance values of the body segments than from the whole body was tested. The impedance of upper and lower extremities (arm and leg) and trunk were used to compute estimates of body composition parameters (FFM, FM, %F, TBW, ECW). The results were compared with those estimated by the impedance of the whole body. These comparisons demonstrated that significative differences resulted from body composition obtained by segmental impedance and by the whole body.     

Dual-energy X-ray absorptiometry lean soft tissue hydration: independent contributions of intra- and extracellular water

Dual-energy X-ray absorptiometry (DEXA) provides a measure of lean soft tissue (LST). LST hydration, often assumed to be constant, is relevant to several aspects of DEXA body composition estimates. The aims of this study were to develop a theoretical model of LST total body water (TBW) content and to examine hydration effects with empirically derived model coefficients and then to experimentally test the model's prediction that, in healthy adults, LST hydration is not constant but varies as a function of extra- and intracellular water distribution (E/I). The initial phase involved TBW/LST model development and application with empirically derived model coefficients. Model predictions were then tested in a cross-sectional study of 215 healthy adults. LST was measured by DEXA, extracellular water (ECW) by NaBr dilution, intracellular water (ICW) by whole body (40)K counting, and TBW by (2)H(2)O dilution. TBW estimates, calculated as ECW + ICW, were highly correlated with (r = 0.97, SEE = 2.1 kg, P < 0.001) and showed no significant bias compared with TBW measured by (2)H(2)O. Model-predicted TBW/LST was almost identical to experimentally derived values (means +/- SD) in the total group (0.767 vs. 0.764 +/- 0.028). LST hydration was significantly correlated with E/I (total group, r = 0.30, SEE = 0.027, P < 0.001). Although E/I increased with age (men, r = 0.48; women, r = 0.37; both P < 0.001), the association between TBW/LST and age was nonsignificant. Hydration of the DEXA-derived LST compartment is thus not constant but varies predictably with ECW and ICW distribution. This observation has implications for the accuracy of body fat measurements by DEXA and the use of TBW as a means of checking DEXA system calibration.     

Impedance electrodes positioned on proximal portions of limbs quantify fluid compartments in dogs

Body resistance and reactance to the conduction of an alternating electrical current were measured using electrodes attached to distal and proximal portions of limbs in anesthetized dogs. Body impedance was calculated from these measurements obtained at 30-min time intervals during a control period and after intravenous administration of 0.9% saline. Extracellular (ECW) and total body water (TBW) were determined by bromide and heavy water dilution techniques, respectively. Baseline impedance obtained from proximal electrodes was related to ECW (r = 0.95, P less than 0.001) and TBW (r = 0.80, P less than 0.02). After saline infusion, proximal electrodes detected a significant fall in impedance (P less than 0.001), whereas distal electrodes did not (P = 0.06). Furthermore, ECW and TBW could be estimated from the drop of proximal impedance after this bolus infusion (r = 0.82, P less than 0.02, and r = 0.86, P less than 0.01, respectively), but not from distal impedance measurements. Proximally placed impedance electrodes are superior to traditionally used distal electrodes for assessment of body fluid changes in the dog.     

Serial Measurements of Body Composition in Obese Subjects During a Very-Low-Energy Diet (VLED) Comparing Bioelectrical Impedance with Hydrodensitometry

Bioelectrical impedance analysis (BIA) is a convenient, inexpensive, and noninvasive technique for measuring body composition. BIA has been strongly correlated with total body water (TBW) and also has been validated against hydrodensitometry (HD). The accuracy and clinical utility of BIA and HD during periods of substantial weight loss remain controversial. We measured body composition in moderately and severely obese patients serially using both methods during a very-low-energy diet (VLED). Mean initial weight in these patients was 116 (± 30) kg (range, 74–196 kg). Mean weight loss was 24 (± 13) kg with a decrease in fat mass (FM) by HD of 20 kg (p<0.001) and a decrease in fat-free mass (FFM) of 3.6 kg (p<0.05). Loss of FFM is best predicted by the rate (kg/wk) of weight loss (r² = 0.86, p<0.0001). FFM, as predicted from BIA equations, was highly correlated with FFM as estimated by HD during all testing sessions (r=0.92-0.98). Although highly correlated, BIA overestimated FFM relative to HD and this difference appeared to be more pronounced for taller patients with greater truncal obesity. Although the discrepancy was no greater during weight-loss treatment, the level of disagreement was considerable. Therefore, the two methods cannot be used interchangeably to monitor relative changes in body composition in patients with obesity during treatment with VLED. The discrepancy between BIA and HD may be caused by body mass distribution considerations and by perturbations in TBW which affect the hydration quotient for FFM (BIA) and/or which affect the density constants for FFM and FM (HD).     

ESTIMATION OF TOTAL BODY WATER IN HARBOR SEALS: HOW USEFUL IS BIOELECTRICAL IMPEDANCE ANALYSIS?

We evaluated bioelectrical impedance analysis (BIA) as a means of rapidly and inexpensively estimating total body water (TBW) of harbor seals ( Phoca vitulina ). Deuterium oxide dilution was used to estimate TBW in 17 adult females and 16 of their pups between birth and late lactation. Isotope dilution was also used to determine TBW in 12 adult males early and 10 of these males late in the breeding season. At the same time, resistance ( Rs ) and reactance ( Xc ) measurements were taken using a tetrapolar, impedance plethysmograph (Model 101 A, RJL Systems). Seals were sedated with diazepam prior to taking BIA measurements. Within-day duplicate Rs measurements on pups and adults, taken 2-240 min apart, differed by an average of 3.0%± 1.4% ( n = 42, CV = 102%). Movement of the seal during BIA measurements caused variability in both Rs and Xc values. BIA measurements were generally poor predictors of TBW. Rs was significantly correlated with TBW in pups only ( Rs = 0.93, P = 0.001, n = 11). Bioelectrical conductor volume (length2/ Rs ) was significantly correlated with TBW only in adult females ( Rs = 0.63, P = 0.02, n = 14). We conclude that BIA is not a reliable method of estimating TBW in wild harbor seals.     

Equation for estimating total body water by bioelectrical impedance measurements in Japanese subjects]

This article reports a study in which the equation for total body water (TBW) estimated from deuterium (2H2O)-dilution method and bioelectrical impedance measurement (BIM) is described. Subjects were 60 healthy males aged 30 +/- 18.3 yr (18-74) and 31 healthy females aged 37 +/- 17.5 yr (19-70). Total body water determined by the analysis of the dilution of orally ingested deuterium oxide (1g2H2O, 99.75 atom % excess/kg body weight) in urine. Bioelectrical impedance was measured for each subjects in a supine position using an electrical impedance analyzer (500 microA, 50kHz, T-1988K, Toyo Physical Inc.) with a four electrodes (Y-250, Nihon Kohden). The mean values of total body water and the impedance in males and females subjects were 34.1 +/- 4.27 l and 25.7 +/- 2.42 l, 567 +/- 28.5 omega and 562 +/- 32.5 omega, respectively. Height squared divided by resistance (Ht2/R) correlated well with TBW as measured by 2H2 O, r = 0.530 (p less than 0.001) in males and r = 0.782 (p less than 0.001) in females. The best-fitting regression equation to predict TBW comprised Ht2/R(X1) and body weight (X2) (R = 0.915, SEE = 1.70 l in males and R = 0.834, SEE = 1.28 l in females). Equations were provided with BIM instrument for the prediction of TBW: for males TBW, l = 0.1983X1 + 0.4004X2 - 0.7938 and for females TBW, l = 0.3536X1 + 0.1269X2 + 3.3417. These results suggest that bioelectrical impedance measurement is a useful measure of total body water in Japanese subjects.     

Evaluation of the deuterium dilution method to estimate body composition in the barnacle goose: accuracy and minimum equilibration time

We examined body composition in barnacle geese (Branta leucopsis) by proximate carcass analysis and by deuterium isotope dilution. We studied the effect of isotope equilibration time on the accuracy of total body water (TBW) estimates and evaluated models to predict fat-free mass (FFM) and fat mass (FM) from different measurements varying in their level of invasiveness. Deuterium enrichment determined at 45, 90, and 180 min after isotope injection did not differ significantly. At all sampling intervals, isotope dilution spaces (TBW(d)) consistently overestimated body water determined by carcass analysis (TBW(c)). However, variance in the deviation from actual TBW was higher at the 45-min sampling interval, whereas variability was the same at 90 and 180 min, indicating that 90 min is sufficient time to allow for adequate equilibration. At 90 min equilibration time, deuterium isotope dilution overestimated TBW(c) by 7.1% +/= 2.6% (P < 0.001, paired t-test, n=20). This overestimate was consistent over the range of TBW studied, and TBW(c) could thus be predicted from TBW(d) (r2=0.976, P<0.001). Variation in TBW(c) and TBW(d) explained, respectively, 99% and 98% of the variation in FFM. FM could be predicted with a relative error of ca. 10% from TBW estimates in combination with body mass (BM). In contrast, BM and external body measurements allowed only poor prediction. Abdominal fat fresh mass was highly correlated to total FM and, if the carcass is available, allows simple means of fat prediction without dissecting the entire specimen.     

Total body water and ECFV measured using bioelectrical impedance analysis and indicator dilution in horses.

The purposes of this study were 1) to determine the compartmentation of body water in horses by using indicator dilution techniques and 2) to simultaneously measure bioelectrical impedance to current flow at impulse current frequencies of 5 and 200 kHz to formulate predictive equations that could be used to estimate total body water (TBW), extracellular fluid volume (ECFV), and intracellular fluid volume (ICFV). Eight horses and ponies weighing from 214 to 636 kg had catheters placed into the left and right jugular veins. Deuterium oxide, sodium thiocyanate, and Evans blue were infused for the measurement of TBW, ECFV, and plasma volume (PV), respectively. Bioelectrical impedance was measured by using a tetrapolar electrode configuration, with electrode pairs secured above the knee and hock. Measured TBW, ECFV, and PV were 0.677 +/- 0.022, 0.253 +/- 0.006, and 0.040 +/- 0.002 l/kg body mass, respectively. Strong linear correlations were determined among measured variables that allowed for the prediction of TBW, ECFV, ICFV, and PV from measures of horse length or height and impedance. It is concluded that bioelectrical impedance analysis (BIA) can be used to improve the predictive accuracy of noninvasive estimates of ECFV and PV in euhydrated horses at rest.     

A prediction equation for total body water from bioelectrical impedance in Japanese children

Total body water (TBW) measured by isotope dilution techniques can be used to assess body composition safely and accurately in children. Unfortunately, this method is not readily available for most research projects, particularly when working with large groups of people, because the equipment is complicated and highly specialized. Bioelectrical impedance (BI) method is a simple, quick, and inexpensive method for the assessment of total body water (TBW). In Japanese child population, however, a lack of prediction equations is a problem to determine TBW. The purpose of this study was to determine the prediction equation for TBW determination in Japanese children using the isotope dilution technique as the reference method. Seventy Japanese children (39 boys, 31 girls) with ages ranging between 3 and 6 years participated in this study. They were randomly divided into the validation group (26 boys, 20 girls) and cross-validation group (13 boys, 11 girls). In a forward stepwise regression analysis, 96% of the variability in TBW measured by deuterium oxide (D(2)O) dilution could be predicted by the following equation: TBW(kg)=0.149 x Resistance Index (Stature(2)/resistance, cm(2)/Omega)+0.244 x Weight(kg)+0.460 x Age(y)+0.501 x Sex (boy=1, girl=0)+1.628, with a root mean square error (RMSE) of 0.440 kg in the validation group. This equation predicted TBW in the cross-validation group with R(2)=0.946 and a pure error (PE)=0.400 kg TBW. Hence, this equation should be applicable for predicting TBW in Japanese children aged 3-6 y.     

Contribution of genetic and environmental factors to variation in body compartments--a twin study in adults

This study aimed at analyzing the contribution of genetic and environmental factors on phenotypic variation of various traits of body composition. Subjects were 30 same-sexed pairs of twins including 20 monozygous (MZ) and 10 dizygous (DZ) pairs, aged 19-62 years. Zygosity was determined by DNA typing and morphological diagnosis. Body composition parameters (fat mass FM, lean body mass LBM, body cell mass BCM, extracellular mass ECM, total body water TBW, extracellular water ECW, and intracellular water ICW) were estimated by tetrapolar bioelectrical impedance analysis. Potential environmental factors influencing body composition (number of children, sporting activity and smoking behaviour) were determined by questionnaires. Heritabilities for traits of body composition were calculated by use of the twin method. Intraclass correlation is > 0.80 for the variation of LBM, BCM, ECM, TBW, ECW, and ICW in both MZ and DZ twins. Estimated heritability (h2) for FM, LBM, BCM, ECW, TBW, ECW, and ICW is 65%, 77%, 79%, 83%, 76%, 68%, and 82%, respectively. The h2 values for FM and LBM are consistent with those reported in other twin studies. For BCM, ECM, ECW and ICW, no comparative h2 estimates exist. Within-pair differences in body compartments do not change with increasing age in MZ and DZ twin pairs (p > 0.05). Stepwise multiple regression analyses indicate that zygosity, age, sex, number of children, sporting level and smoking behaviour do not significantly predict within-pair differences for weight, BMI, FM, LBM, TBW, ECW and ICW (each, p > 0.05). In contrast, sex and the number of children explain together 27% of observed within-pair differences for BCM. Zygosity is the only significant predictor of within-pair differences for ECM and height, explaining 20% (p = 0.008) and 36% of variance, respectively (p < 0.0001). Results indicate that genetic factors exert stronger influences on body composition than the considered environmental traits.     

Are Ethnic and Gender Specific Equations Needed to Derive Fat Free Mass from Bioelectrical Impedance in Children of South Asian,Black African-Caribbean and White European Origin? Results of the Assessment of Body Composition in Children Study

Background

Bioelectrical impedance analysis (BIA) is a potentially valuable method for assessing lean mass and body fat levels in children from different ethnic groups. We examined the need for ethnic- and gender-specific equations for estimating fat free mass (FFM) from BIA in children from different ethnic groups and examined their effects on the assessment of ethnic differences in body fat.

Methods

Cross-sectional study of children aged 8–10 years in London Primary schools including 325 South Asians, 250 black African-Caribbeans and 289 white Europeans with measurements of height, weight and arm-leg impedance (Z; Bodystat 1500). Total body water was estimated from deuterium dilution and converted to FFM. Multilevel models were used to derive three types of equation {A: FFM = linear combination(height+weight+Z); B: FFM = linear combination(height²/Z); C: FFM = linear combination(height²/Z+weight)}.

Results

Ethnicity and gender were important predictors of FFM and improved model fit in all equations. The models of best fit were ethnicity and gender specific versions of equation A, followed by equation C; these provided accurate assessments of ethnic differences in FFM and FM. In contrast, the use of generic equations led to underestimation of both the negative South Asian-white European FFM difference and the positive black African-Caribbean-white European FFM difference (by 0.53 kg and by 0.73 kg respectively for equation A). The use of generic equations underestimated the positive South Asian-white European difference in fat mass (FM) and overestimated the positive black African-Caribbean-white European difference in FM (by 4.7% and 10.1% respectively for equation A). Consistent results were observed when the equations were applied to a large external data set.

Conclusions

Ethnic- and gender-specific equations for predicting FFM from BIA provide better estimates of ethnic differences in FFM and FM in children, while generic equations can misrepresent these ethnic differences.     

USE OF BIOELECTRICAL IMPEDANCE ANALYSIS TO ASSESS BODY COMPOSITION OF SEALS

Abstract: Bioelectrical impedance analysis (BIA) measures resistance and reactance of a current as it passes through an organism. The validity of using BIA as a tool to measure body water content, and hence body composition and condition, was tested on harp and ringed seals. The resistance and reactance readings from BIA were compared to estimates of total body water (TBW) determined via tritiated water dilution. The relationship between resistance and TBW (% of body mass) was linear after logarithmic transformation and the two variables were highly correlated. We describe the electrode configuration and placements which provide reliable results in these seals. Our findings indicate that BIA has considerable potential as an inexpensive, rapid, and reliable technique for estimating body composition of phocid seals.     

Increased extracellular water compartment, relative to intracellular water compartment, after weight reduction.

The hydration of fat free mass (FFM) and extracellular (ECW) and intracellular water (ICW) compartments were studied in 30 obese premenopausal women before and after a 3-mo weight-reduction program and again after a 9-mo weight-maintenance program. Body fat was determined by a four-compartment model. Total body water and ECW were determined by deuterium dilution and bromide dilution, respectively. After the weight-reduction period, mean weight loss was 12.8 kg, and body fat was reduced on average by 10.9 kg. During weight maintenance, changes in body mass and body fat were not significant. Before weight reduction, mean ECW/ICW ratio was relatively high (0.78 +/- 0.10). During the the study, total body water and ICW did not change significantly. ECW did not change significantly after weight reduction, but 12 mo after the start ECW was significantly increased by 1 liter. The ECW/ICW ratio increased to 0.87 +/- 0.12 (month 12). The hydration of the FFM increased from 74 +/- 1 to 77 +/- 2% during the weight reduction and remained elevated during weight maintenance. In conclusion, the ECW/ICW ratio and the hydration of the FFM, did not normalize during weight reduction and weight maintenance.     

Extracellular Water and Blood Pressure in Adults with Growth Hormone (GH) Deficiency: A Genotype-Phenotype Association Study

Objectives

Growth hormone deficiency (GHD) in adults is associated with decreased extracellular water volume (ECW). In response to GH replacement therapy (GHRT), ECW increases and blood pressure (BP) reduces or remains unchanged. Our primary aim was to study the association between polymorphisms in genes related to renal tubular function with ECW and BP before and 1 year after GHRT. The ECW measures using bioimpedance analysis (BIA) and bioimpedance spectroscopy (BIS) were validated against a reference method, the sodium bromide dilution method (Br⁻).

Design and Methods

Using a candidate gene approach, fifteen single-nucleotide polymorphisms (SNPs) in nine genes with known impact on renal tubular function (AGT, SCNN1A, SCNN1G, SLC12A1, SLC12A3, KCNJ1, STK39, WNK1 and CASR) were genotyped and analyzed for associations with ECW and BP at baseline and with their changes after 1 year of GHRT in 311 adult GHD patients. ECW was measured with the Br⁻, BIA, and BIS.

Results

Both BIA and BIS measurements demonstrated similar ECW results as the reference method. At baseline, after adjustment for sex and BMI, SNP rs2291340 in the SLC12A1 gene was associated with ECW volume in GHD patients (p = 0.039). None of the SNPs influenced the ECW response to GHRT. One SNP in the SLC12A3 gene (rs11643718; p = 0.024) and three SNPs in the SCNN1G gene [rs5723 (p = 0.02), rs5729 (p = 0.016) and rs13331086 (p = 0.035)] were associated with the inter-individual differences in BP levels at baseline. A polymorphism in the calcium-sensing receptor (CASR) gene (rs1965357) was associated with changes in systolic BP after GHRT (p = 0.036). None of these associations remained statistically significant when corrected for multiple testing.

Conclusion

The BIA and BIS are as accurate as Br⁻ to measure ECW in GHD adults before and during GHRT. Our study provides the first evidence that individual polymorphisms may have clinically relevant effects on ECW and BP in GHD adults.     

Intra-Abdominal Pressure Correlates with Extracellular Water Content

Background

Secondary increase in intra-abdominal pressure (IAP) may result from extra-abdominal pathology, such as massive fluid resuscitation, capillary leak or sepsis. All these conditions increase the extravascular water content. The aim of this study was to analyze the relationship between IAP and body water volume.

Material and Methods

Adult patients treated for sepsis or septic shock with acute kidney injury (AKI) and patients undergoing elective pharyngolaryngeal or orthopedic surgery were enrolled. IAP was measured in the urinary bladder. Total body water (TBW), extracellular water content (ECW) and volume excess (VE) were measured by whole body bioimpedance. Among critically ill patients, all parameters were analyzed over three consecutive days, and parameters were evaluated perioperatively in surgical patients.

Results

One hundred twenty patients were studied. Taken together, the correlations between IAP and VE, TBW, and ECW were measured at 408 time points. In all participants, IAP strongly correlated with ECW and VE. In critically ill patients, IAP correlated with ECW and VE. In surgical patients, IAP correlated with ECW and TBW. IAP strongly correlated with ECW and VE in the mixed population. IAP also correlated with VE in critically ill patients. ROC curve analysis showed that ECW and VE might be discriminative parameters of risk for increased IAP.

Conclusion

IAP strongly correlates with ECW.