Abstract:

Deboer, H.; Blok, G.J.; Voerman, B.; Devries, P.; Poppsnijders, C.; Vanderveen, E.

The optimal growth hormone replacement dose in adults, derived from bioimpedance analysis
Journal of Clinical Endocrinology and Metabolism
80
7
JUL
1995
2069-2076
H Deboer
Free Univ Amsterdam Hosp
Dept Endocrinol
POB 7057
1007 MB Amsterdam, Netherlands
0021-972X
BIOELECTRICAL IMPEDANCE ANALYSIS; TOTAL-BODY WATER; FAT-FREE MASS; DEFICIENT ADULTS; GH DEFICIENCY; FLUID; BONE; ANTHROPOMETRY; METABOLISM; SEGMENTS
The prevalence of clinical signs and symptoms related to fluid retention is high in most studies evaluating the efficacy of GH treat ment in GH-deficient (GHD) adults. This may be a consequence of supraphysiological GH replacement. To examine whether fluid retention is a dose- related phenomenon, we evaluated the impact of various GH substitution doses on body fluid status in 46 GHD men participating in a l-yr, double blind, and placebo-controlled study. The patients were randomized to receive either placebo (n = 13) or GH ina dose of 1(n = 11), 2 (n = 10), or 3 (n = 12) IU/m(2) day, respectively. Treatment was tarted at one third of the predetermined dose and was subsequently increased by another third every month until the maintenance dose was reached. Tissue hydration was assessed by means of electrical impedance measurements. Normal values were obtained from 128 age- and sex-matched controls. In the untreated GHD state, whole body resistance was abnormally high (observed, 642 +/- 82 Omega; predicted, 550 +/- 31 Omega; P < 0.001). This was mainly caused by an increase in specific resistance of the lean body as a consequence of a reduction in extracellular mater (ECW). The first month of GK treatment was associated with a sharp decline in electrical resistance that was attributed to an increase in ECW.Whole body resistance reached its nadir after 3 months of treatment (517 +/- 72 Omega, i.e. 19.6 +/- 6.5% lower than before treatment; P < 0.001) and did not change significantly thereafter. The GH-induced changes in body resistance were dose dependent. A significant decrease was observed with a dose as low as 0.33 IU/m(2) . day (P < 0.005). However, whole body resistance remained higher than normal in patients receiving less than 0.67 IU/m(2) . day (P = 0.05). Abnormally low resistance values, indicative of overhydration, were observed in patients receiving doses equal to or higher than 2 IU/m(2) . day (P < 0.005). Regression analysis of the pooled data shelved that GH replacement in a dose of 1.10 IU/m(2) . day (95% confidence interval, 0.85-1.45 IU/ m(2) . day) resulted in a normalization of whole body resistance. In conclusion, GH replacement therapy in adults rapidly corrects the preexisting deficit in ECW. This rehydration process is dose dependent and may result in a substantial weight gain. To prevent side-effects related to excessive fluid retention, it is advised to start GH replacement ata dose of 0.5-1 IU/m(2) day with subsequent monthly increments in steps of O.5-1 IU until a maintenance dose of approximately 1.10 IU/m(2) . day is reached. This dose is 40-60% lower than that used in most previous studies.

Degodoy, I.; Donahoe, M.; Calhoun, W.J.; Mancino, J.; Rogers, R.M.
Elevated TNF-alpha production by peripheral blood monocytes of weight-losing COPD patients
Journal American Journal of Respiratory and Critical Care Medicine
153
2
FEB
1996
633-637
RM Rogers
Univ Pittsburgh
Sch Med
440 Scaife Hall
Pittsburgh, PA 15261 USA
1073-449X
TUMOR-NECROSIS-FACTOR; OBSTRUCTIVE PULMONARY-DISEASE; BIOELECTRICAL-IMPEDANCE ANALYSIS; CHRONIC HEART-FAILURE; CYSTIC-FIBROSIS; ANOREXIA; PLASMA; MASS
The inflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1 beta), have been associated with accelerated metabolism and protein turnover following exogenous administration in normal humans. We hypothesized that these inflammatory cytokines might contribute to the weight-losing process in patients with chronic obstructive pulmonary disease (COPD). COPD patients were identified prospectively as ''weight losers'' (WL; n = 10) if they reported 5% weight loss during the preceding year or as ''weight stable'' (WS; n = 10) if their body weight fluctuated less than or equal to 5%. Age-matched healthy volunteers were selected as the control group (C; n = 13). Monocytes were isolated from a peripheral blood sample, cultured, and exposed to lipopolysaccharide (LPS). The concentration of TNF-alpha and IL-1 beta in the monocyte supernatant was measured using a four layer enhanced ELISA. No significant difference in LPS-stimulated IL-1 beta production was found in the three study populations. However, LPS-stimulated TNF-alpha production (mean [range] ng/ml) by monocytes was significantly higher in the WL COPD patients (20.2 [6.3 to 44.8]), compared with WS patients (6.9 [1.5 to 16.6]), and C subjects (5.7 [0 to 61.8]). This difference was not maintained at 6 mo follow-up in the absence of ongoing weight loss. Definition of a causal relationship between TNF-alpha production and weight loss will require further understanding of the relationship between energy metabolism and TNF-alpha production in these patients.

Delbecqueboussard, L.; Gottrand, F.; Ategbo, S.; Nelken, B.; Mazingue, F.; Vic, P.; Farriaux, J.P.; Turck, D.
Nutritional status of children with acute lymphoblastic leukemia: A longitudinal study
Journal American Journal of Clinical Nutrition
65
1
JAN
1997
95-100
F Gottrand
Ctr Hosp Reg & Univ Lille
Hop Huriez
Serv Pediat
Pl Verdun
F-59037 Lille, France
0002-9165
children; nutritional status; energy expenditure; leukemia; body composition; dietary recall SKINFOLD MEASUREMENTS; CHILDHOOD; OBESITY; MALNUTRITION; CANCER
To evaluate the nutritional consequences of acute lymphoblastic leukemia and its treatment, 15 children with leukemia were studied. Anthropometric data, fat-free mass by impedance, energy intake, and resting energy expenditure (REE) were determined at diagnosis and on days 22, 36, and 71 of the treatment. Interleukin (IL)-1 beta, IL-6, interferon-gamma, and tumor necrosis factor were also measured. Fifteen healthy control subjects were matched for age and sex. Body weight and height and body composition were comparable at all times of the study, although three children were underweight at diagnosis (weight-for-height < 85% of French standards). Although two different methods were used for dietary recall in the two groups, energy intake expressed as a percentage of normal recommended values for age and sex was lower in patients than in control subjects (104 +/- 19%) on day 1 (47 +/- 32.1%) and day 22 (58 +/- 24%), but was comparable on day 36 (85 +/- 71%) and day 71 (85 +/- 48%). This low energy intake involved both carbohydrates and fats. Energy and carbohydrate intakes improved significantly during the study in patients. The nonprotein respiratory quotient (RQ) in patients was significantly lower than in control subjects (0.84 +/- 0.04) on day 1 (0.79 +/- 0.02) but was comparable on day 71. The REE of the patients on day 1 (5057.8 +/- 1588.4 kJ/24 h) and day 71 (4844.7 +/- 116.1 kJ/24 h) and of the control subjects (4313.8 +/- 823.5 kJ/24 h) was not significantly different. Cytokines remained undetectable on days 1, 36, and 71. The results showed that at the time of diagnosis and during this period of chemotherapy there was no evidence of raised REE. The poor intakes during the first month of chemotherapy were recent as shown by the parents' questionnaire responses and the absence of consequences in body composition. The transient decrease in RQ seemed to be an adaptative mechanism to the poor carbohydrate intake. No indication of undernutrition in the patients as a group was evident during the first 71 d of treatment although further long-term nutritional assessment is needed.

Delorenzo, A.; Candeloro, N.; Andreoli, A.; Deurenberg, P.
Determination of intracellular water by multifrequency bioelectrical impedance
Journal Annals of Nutrition and Metabolism
39
3
MAY-JUN
1995
177-184
A Delorenzo
Univ Roma Tor Vergata
Dept Human Physiol
Via O Raimondo 1
I-00173 Rome, Italy
0250-6807
body composition; total body water; extracellular water; intracellular water; body potassium; multifrequency impedance; adult males TOTAL-BODY WATER; ELECTRICAL-IMPEDANCE; CROSS-VALIDATION; CHROMATOGRAPHY; PREDICTION; BROMIDE; FAT
Body composition was measured in 57 healthy males by K-40 measurements and by multifrequency bioelectrical impedance. Intracellular resistance (Ricf) was calculated from the impedance values using the Cole-Cole model. From total body potassium, intracellular water (ICW) was calculated. In addition, in 14 subjects, total body water (TBW) and extracellular water (ECW) was measured using deuterium oxide dilution and bromide dilution, respectively. Prediction formulas from the literature from impedance at different frequencies were used to predict TBW and ECW, and ICW was calculated as the difference of predicted TBW and ECW. Predicted and measured values of TBW, ECW and ICW did not always show the same values as measured. Generally the ICW from potassium was well. correlated with calculated ICW from impedance values, correlation coefficients varying from 0.68 to 0.79, depending on the used prediction formula. From the impedance index H-2/Ricf, body weight and age, ICW from potassium was predicted with stepwise multiple regression. The prediction formula was ICW = 0.37065 . H-2/Ricf - 0.132 . age + 0.105 . weight + 12.2. The prediction error was 1.9 kg and the explained variance 0.69. The residuals of this prediction formula were dependent on the level of ICW as measured by potassium. The same phenomenon was observed wizen ICW was calculated as the difference of predicted TBW and ECW. The results show that multifrequency impedance is able to predict ICW, however, the prediction is influenced by body water distribution.

Delorenzo, A.; Deurenberg, P.; Andreoli, A.; Sasso, G.F.; Palestini, M.; Docimo, R.
Multifrequency impedance in the assessment of body water losses during dialysis - Reply Journal Renal Physiology and Biochemistry
18
5
SEP-OCT
1995
269-270
A Delorenzo
Univ Roma Tor Vergata
Dept Human Physiol
Via Orazio Raimondo 1
I-00173 Rome, Italy
1011-6524

Delorenzo, A.; Sasso, G.F.; Andreoli, A.; Sorge, R.; Candeloro, N.; Cairella, M.
Improved prediction formula for total body water assessment in obese women
Journal International Journal of Obesity
19
8
AUG
1995
535-538
A Delorenzo
Univ Roma Tor Vergata
Dipartimento Med Sperimentale
Cattedra Fisiol Umana
Via O Raimondo 1
I-00173 Rome, Italy
0307-0565
body composition; obesity; total body water; bioelectric impedance BIOELECTRICAL IMPEDANCE ANALYSIS; EXTRACELLULAR FLUID
OBJECTIVE: To validate an improved formula for the calculation of total body water (TBW) from impedance values in obese women. SUBJECTS: A sample of 37 overweight females BMI ranging from 29.5 to 44.1 kg/m(2). MEASUREMENTS: The reference measurements for TBW were obtained by deuterium oxide dilution, Body height (h), hip circumference (C) as well as body impedance at 100 kHz (Z(100)) were also measured.
RESULTS: The values obtained for h, C and Z(100) were introduced in the calculations and the following developed formula for total body water was determined: TBW = 0.069 .[hC(2)/(4 pi . Z(100))]+1 9.671. The validity of this formula was assessed through the statistical test of Bland and Altman which we also performed for other formulas containing the weight and/or the height.
CONCLUSION: We found that the accuracy of the prediction of TBW by our formula, although lower than those formulas using body weight, is higher than that which takes into account only body height. We conclude that body volume, expressed through body height and hip circumference, is a good choice of parameter in bioelectrical impedance measurements. The new approach can be useful in clinical settings for repeated monitoring of obese women, during diet-restricted treatment.

Depasquale, M.J.; Fossa, A.A.
Use of bioimpedance for measuring cardiac output in the conscious dog
Journal Drug Development Research
38
2
JUN
1996
105-113
MJ Depasquale
Pfizer Inc
Div Cent Res
Dept Gen Pharmacol
Box 343
Eastern Point Rd
Groton, CT 06340 USA

0272-4391
bioimpedance; cardiac output; conscious; canine THORACIC ELECTRICAL BIOIMPEDANCE; LEFT-VENTRICULAR FUNCTION; STROKE VOLUME; IMPEDANCE CARDIOGRAPHY; THERMODILUTION METHODS; HEART-FAILURE; BLOOD-FLOW; ANGIOTENSIN
Cardiovascular profiling of developmental compounds by General Pharmacology/Safety Pharmacology is an integral part of the drug discovery process in support of registration of clinical candidates. Non-invasive screening tools which provide hemodynamic measurements can facilitate the drug development process. One such method, bioimpedance cardiography, is an indirect means of evaluating cardiac output. Changes in thoracic impedance in response to an applied current are related to changes in volume and velocity of blood flow in the thorax for the determination of stroke volume, which is coupled to heart rate for calculating cardiac output. Commercially available bioimpedance cardiography units have evolved considerably in recent years in step with advances in computing power. The use of these units, with modification, in the preclinical arena for determinations in anesthetized dogs and pigs has shown good correlation with other accepted methodologies for measuring cardiac output. Data presented here are the first to describe the application of this technology in conscious dogs. The utility and limitations of this method as a screening tool in the conscious dog are discussed. These cardiac output measurements combined with arterial pressure and electrocardiogram measurements, provide a simple means for more complete hemodynamic profiling of drug candidates. (C) 1996 Wiley-Liss, Inc.

Deurenberg, P.
Multi-frequency impedance technique - Reply
British Journal of Nutrition
75
3
MAR
1996
509-510
AF P Deurenberg
Agr Univ Wageningen
Dept Human Nutr
6703 HD Wageningen, Netherlands
0007-1145

Deurenberg, P.; Schutz, Y.
Body composition: Overview of methods and future directions of research
Annals of Nutrition and Metabolism
39
6
NOV-DEC
1995
325-333
P Deurenberg
Agr Univ Wageningen
Dept Human Nutr
Bomenweg 2
6703 HD Wageningen, Netherlands
0250-6807
body composition, analytical methods; body fat; body water; fat-free mass, RESTING METABOLIC-RATE; X-RAY ABSORPTIOMETRY; FAT-FREE MASS; ADIPOSE-TISSUE; IMPEDANCE; INVIVO; TOMOGRAPHY; DENSITY; HUMANS
A short overview is given on the most important analytical body composition methods. Principles of the methods and advantages and limitations of the methods are discussed also in relation to other fields of research such as energy metabolism. Attention is given to some new developments in body composition research such as chemical multiple-compartment models, computerized tomography or nuclear magnetic resonance imaging (tissue level), and multifrequency bioelectrical impedance. Possible future directions of body composition research in the light of these new developments are discussed.

Deurenberg, P.; Woldegebriel, Z.; Schouten, F.J.M.
Validity of predicted total body water and extracellular water using multifrequency bioelectrical impedance in an Ethiopian population
Journal Annals of Nutrition and Metabolism
39
4
JUL-AUG
1995
234-241
P Deurenberg
Agr Univ Wageningen
Dept Human Nutr
Bomenweg 2
6703 HD Wageningen, Netherlands
0250-6807
bioelectrical impedance; total body water; extracellular water; body build SEGMENTS
Total body water (TBW) and extracellular water (ECW) were measured by deuterium oxide dilution and bromide dilution, respectively, in a group of 24 male and 20 female healthy Ethiopians, living in the capital Addis Ababa. Body weight, body height, skinfolds and total body impedance at 1 and at 100 kHz were also measured. TBW and ECW were predicted from impedance values at 1 and 100 kHz, respectively, using prediction equations developed in a Dutch adult population. ECW was overestimated by 1.3 +/- 1.0 kg (p < 0.05) and 0.6 +/- 0.8 kg (p < 0.05) in males and females, respectively. TBW was accurately predicted in males (0.1 +/- 1.9 kg, n.s.), but overestimated in females (1.0 +/- 1.3, p < 0.05). TBW/height and ECW/height were substantially lower in the Ethiopians compared to values recently published in Dutch and Italian adult subjects, indicating a different, more slender body build of the Ethiopians. After correcting for these differences in body build and for the slight differences in body water distribution (ECW/TBW), the differences between measured and predicted TBW and ECW decreased and were no longer significant. The results indicate that the validity of predicted body water from impedance depends on the body build of the subjects, which should be taken into account to avoid systematic errors when applying prediction formulas from a reference population to another population under study.

Deurenberg, P.; Woldegebriel, Z.; Schouten, F.J.M.
Validity of predicted total body water and extracellular water using multifrequency bioelectrical impedance in an Ethiopian population
Journal Annals of Nutrition and Metabolism
39
4
JUL-AUG
1995
234-241
P Deurenberg
Agr Univ Wageningen
Dept Human Nutr
Bomenweg 2
6703 HD Wageningen, Netherlands
0250-6807
bioelectrical impedance; total body water; extracellular water; body build SEGMENTS
Total body water (TBW) and extracellular water (ECW) were measured by deuterium oxide dilution and bromide dilution, respectively, in a group of 24 male and 20 female healthy Ethiopians, living in the capital Addis Ababa. Body weight, body height, skinfolds and total body impedance at 1 and at 100 kHz were also measured. TBW and ECW were predicted from impedance values at 1 and 100 kHz, respectively, using prediction equations developed in a Dutch adult population. ECW was overestimated by 1.3 +/- 1.0 kg (p < 0.05) and 0.6 +/- 0.8 kg (p < 0.05) in males and females, respectively. TBW was accurately predicted in males (0.1 +/- 1.9 kg, n.s.), but overestimated in females (1.0 +/- 1.3, p < 0.05). TBW/height and ECW/height were substantially lower in the Ethiopians compared to values recently published in Dutch and Italian adult subjects, indicating a different, more slender body build of the Ethiopians. After correcting for these differences in body build and for the slight differences in body water distribution (ECW/TBW), the differences between measured and predicted TBW and ECW decreased and were no longer significant. The results indicate that the validity of predicted body water from impedance depends on the body build of the subjects, which should be taken into account to avoid systematic errors when applying prediction formulas from a reference population to another population under study.

Dowsett, J.
Nutrition in the management of cystic fibrosis
Journal Nutrition Reviews
54
1 Part 1
JAN
1996
31-33
J Dowsett
St Vincents Hosp
Dublin 4, Ireland
0029-6643