Association between BMI z-score and body composition indexes with blood pressure and grip strength in school-age children: a cross-sectional study.

Childhood obesity is linked to diverse health outcomes, including elevated blood pressure (EBP). Emerging evidence showed that excess fat mass (FM) may have a deleterious impact on blood pressure even in normal-weight children. The primary objective of this study was to assess the association between body weight status by BMI z-score and body composition parameters by conventional bioelectrical impedance analysis (BIA) and bioelectrical impedance vector analysis (BIVA). Also, we aimed to explore the performance of BMI z-score, %FM, and FM index (FMI) in discriminating EBP in a sample of school-age Mexican children. Children were classified as having normal weight, overweight or obesity according to WHO criteria for BMI z-score. FMI was considered high when above 75th percentile, and fat free mass index (FFMI) was considered low when below 25th percentile of the reference population. Body composition was also classified according to the BIVA method and EBP was determined when systolic and/or diastolic blood pressure ≥ 90th percentile. BMI z-score groups were compared by Student´s t-test or the Mann-Whitney U test, or by the chi-square test or Fisher exact test. Receiving operating characteristic (ROC) analysis was performed. 61 children were included (52.5% boys, median age 9.8 (25th, 75th percentiles: 8.5, 11.0)) years. High FMI was observed in 32.3% of children with normal weight. Low FFMI was present in 93.5% of children with normal weight and 53.3% of those with overweight/obesity. According to BIVA, 58.1% and 43.3% of children with normal weight and overweight/obesity were classified as having cachexia. All the three adiposity indicators showed significant areas under the ROC curve (AURC) greater than 0.775 for EBP, with the largest one displayed for FM% (0.794). Hight FMI and low FFMI are common in children with normal weight. Identifying deficiency of FFM might be limited by using solely BMI indicators. Cachexia by BIVA was present in a high proportion of children with either normal weight or overweight/obesity. Both BMI z-score and FM (% and FMI) performed well at discriminating EBP, with a numerically greater AURC observed for FM%. Body composition in pediatric population is relevant for identifying body composition abnormalities at early age.

Agreement between vector analysis and body composition measurements by four types of bioelectrical impedance technology in hemodialysis patients.

Introduction: Background: the differences in bioelectrical impedance vector analysis (BIVA) results from different analyzers that use different bioelectrical impedance analysis (BIA) measurement technologies are not known. This study aimed to identify the degree of agreement between the BIVA results of four different BIA measurement techniques and to evaluate the degree of agreement between their estimates of fat-free mass (FFM) and fat mass (FM) and those determined by the gold-standard method of dual-energy X-ray absorptiometry (DEXA) in a subgroup of patients without overhydration. Methods: a cross-sectional study was conducted with hemodialysis (HD) patients with end-stage renal disease (ESRD) aged 18 to 65 years. BIA was measured with four different techniques: spectroscopic (BIA-BIS), multifrequency (BIA-MF), single-frequency (BIA-SF), and segmental multifrequency (BIA-MS) techniques. The differences and concordance between the components of the BIA (resistance, reactance, and phase angle) of the four devices were analyzed. Patients with a normal hydration status were identified, and concordance between FM and FFM measurements with each impedance device and DEXA was observed only in these patients. Results: thirty patients were included. The concordance between the components of BIA ranged from good to excellent (phase angle: intraclass correlation coefficient (ICC) = 0.82, 95 % confidence interval (CI): 0.77-0.93; resistance: ICC = 0.98, 95 % CI: 0.92-0.99). The overall concordance for BIVA diagnosis between the analyzers was substantial for hydration (k = 0.71, 95 % CI: 0.71-0.72) and for body tissues (k = 0.68, 95 % CI: 0.67-0.68). Bland-Altman plots showed the lowest bias between BIA-BIS and DEXA for both FM and FFM. Conclusions: the agreement among the four devices was good for diagnosis by BIVA. The BIA-BIS analyzer and DEXA had the lowest bias for both FFM and FM, although with higher limits of agreement. The lowest limits of agreement were found with the BIA-MS analyzer.

Introducción: Antecedentes: se desconoce si existen diferencias en el diagnóstico dado por el análisis de vectores de impedancia bioeléctrica (BIVA por sus siglas en inglés) entre los analizadores que utilizan distintas tecnologías de medición de impedancia bioeléctrica (IBE). Este estudio tuvo como objetivo identificar el grado de concordancia entre el diagnóstico por BIVA de cuatro técnicas diferentes de medición de IBE, así como evaluar el grado de concordancia entre sus estimaciones de masa magra (MM) y masa grasa (MG) en comparación con el método de absorciometría de rayos X de energía dual (DEXA) en un subgrupo de pacientes sin sobrecarga de volumen. Métodos: se realizó un estudio transversal en pacientes con enfermedad renal crónica avanzada (ERCA) en hemodiálisis (HD) con edades entre los 18 a 65 años. La IBE se midió con cuatro diferentes tecnologías: espectroscópica (IBE-BIS), multifrecuencia (IBE-MF), una sola frecuencia (IBE-SF) y multifrecuencia segmental (IBE-MS). Se analizaron las diferencias y concordancias entre los componentes de la IBE (resistencia, reactancia y ángulo de fase) de los cuatro analizadores. Se identificaron pacientes con estado de hidratación normal, y solo en ellos se evaluó la concordancia de FFM y FM entre cada analizador de impedancia y DEXA. Resultados: se incluyeron 30 pacientes. La concordancia entre los componentes del IBE varió de buena a excelente (ángulo de fase: coeficiente de correlación intraclase (ICC) = 0,82, IC del 95 %: 0,77-0,93; resistencia: ICC = 0,98, IC del 95 %: 0,92-0,99). La concordancia general en el diagnóstico de BIVA entre los analizadores fue substancial para la hidratación (k = 0,71, IC del 95 %: 0,71-0,72) y los tejidos corporales (k = 0,68, IC del 95 %: 0,67-0,68). Los gráficos de Bland-Altman mostraron un sesgo más bajo entre BIA-BIS y DEXA tanto para FM como para FFM. Conclusiones: la concordancia entre el diagnóstico por BIVA, entre los cuatro dispositivos, fue sunstancial. El analizador BIA-BIS y DEXA mostraron los sesgos más bajos, tanto para FFM como para FM, aunque con límites de concordancia más altos. Los límites más bajos de concordancia se encontraron con el analizador BIA-MS.

Hydration status according to impedance vectors and its association with clinical and biochemical outcomes and mortality in patients with chronic kidney disease.

Introduction: Background: the evaluation of hydration status and body composition in patients with kidney disease is vital for proper management, since overhydration is associated with cardiovascular complications. Patients with chronic kidney disease (CKD) begin to show perceptible alterations in hydration during the intermediate stages of the disease; however, there is little information regarding the evaluation of blood volume status through bioelectrical impedance vector analysis (BIVA) in this population. Objective: to determine the association between hydration status measured with BIVA and biochemical and clinical parameters and mortality in patients with stage G3a, G3b and G4 CKD. Material and methods: A cross-sectional study was conducted with patients with stage G3a, G3b and G4 CKD who underwent bioelectrical impedance analysis (BIA). The following biochemical and clinical parameters were determined: serum and urinary albumin, hematocrit, serum electrolytes and creatinine, estimated glomerular filtration rate (eGFR, using the CKD-EPI formula), 24-hour urine output and blood pressure. The clinical and biochemical variables were associated with the components of the BIA. According to the resistance/height (R/H) and reactance/height (Xc/H) values, the BIVA results were individually plotted on reference ellipses to identify patients with abnormal hydration states. The patients were classified by group according to hydration status and CKD stage z-scores, and differences in clinical, biochemical and BIA parameters were identified. Mortality was determined by hydration status. Results: a total of 138 subjects, 69 men and 69 women, were studied. An association was found between the BIVA components (R/H, Xc/H and phase angle (PA) and serum albumin (albumin and R/H, r = -0.38, p = 0.001; Xc, r = 0.59, p = 0.000; PA, r = 0.58, p ≤ 0.0010). When the biochemical and clinical parameters were compared by hydration status, significant differences were found in eGFR (p = 0.01), serum calcium (p ≤ 0.001), serum albumin (p ≤ 0.001), hemoglobin (p = 0.04), hematocrit, (p = 0.04) and mean arterial pressure (p = 0.03). The patients were followed for a median of 65.5 months (IQR: 53.0 to 207.0), and 12 (8.6 %) patients with CKD died. The Kaplan-Meier curves showed that patients with overhydration had a significantly higher risk of death than patients with normal hydration. Conclusions: there is an association between the hydration status evaluated by BIVA and clinical and biochemical variables. Patients with overhydration are significantly more likely to die than patients with normal hydration.

Introducción: Antecedentes: la evaluación del estado de hidratación y la composición corporal es imprescindible para los pacientes con enfermedad renal crónica en estadios intermedios, ya que en esta etapa inician con alteraciones hídricas perceptibles; sin embargo, existe poca información en dicha población sobre la evaluación del estado de volemia mediante el análisis de vectores de bioimpedancia eléctrica. Objetivo: asociar el estado de hidratación medido por BIVA con parámetros bioquímicos, clínicos y mortalidad en pacientes con ERC G3a G3b y G4 Material y métodos: estudio transversal en el cual se incluyó a pacientes con ERC en estadios G3a G3b y G4 a los que se les realizó un análisis de impedancia bioeléctrica y en los que se determinaron parámetros bioquímicos y clínicos. Las variables clínicas y bioquímicas se asociaron con los componentes de la IBE. Los valores de resistencia/estatura (R/H) y reactancia/estatura se graficaron individualmente sobre las elipses de referencia para identificar a pacientes con estados de hidratación anormales. Se ubicaron grupos según el estado de hidratación y estadio de ERC en z-score y se identificaron las diferencias de parámetros clínicos, bioquímicos y de IBE. Se determinó la mortalidad según el estado de hidratación. Resultados: se estudiaron 138 sujetos 69 hombres y 69 mujeres. Se encontró una asociación entre los componentes de los BIVA y albúmina sérica (albúmina y R/H, r = -0,38, p = 0,001; Xc, r = 0,59, p = 0,000; ángulo de fase, r = 0,58, p ≤ 0,00110). Al comparar los parámetros bioquímicos y clínicos por estado de hidratación se encontraron diferencias significativas en TFGe (p = 0,01), calcio sérico (p ≤ 0,001), albúmina sérica (p ≤ 0.001), hemoglobina (p = 0,04), hematocrito (p = 0.04) y presión arterial media (p = 0.03). Se identificó el fallecimiento de 12 (8,6 %) pacientes con ERC, con una mediana de seguimiento de 65,5 meses (RIC: 53,0 a 207,0). Las curvas de Kaplan-Meier mostraron que los pacientes con sobrehidratación tenían significativamente mayor riesgo de morir que los pacientes con normohidratación. Conclusiones: existe asociación entre el estado de hidratación evaluado por BIVA y variables clínicas y bioquímicas. Los pacientes con sobre hidratación son significativamente más propensos a morir que los pacientes con normohidratación.

Hydration status according to impedance vectors and its association with clinical and biochemical outcomes and mortality in patients with chronic kidney disease / Estado de hidratación por vectores de impedancia y su asociación con desenlaces clínicos, bioquímicos y mortalidad en pacientes con enfermedad renal crónica

Background: the evaluation of hydration status and body composition in patients with kidney disease is vital for proper management, since overhydration is associated with cardiovascular complications. Patients with chronic kidney disease (CKD) begin to show perceptible alterations in hydration during the intermediate stages of the disease; however, there is little information regarding the evaluation of blood volume status through bioelectrical impedance vector analysis (BIVA) in this population. Objective: to determine the association between hydration status measured with BIVA and biochemical and clinical parameters and mortality in patients with stage G3a, G3b and G4 CKD. Material and methods: a cross-sectional study was conducted with patients with stage G3a, G3b and G4 CKD who underwent bioelectrical impedance analysis (BIA). The following biochemical and clinical parameters were determined: serum and urinary albumin, hematocrit, serum electrolytes and creatinine, estimated glomerular filtration rate (eGFR, using the CKD-EPI formula), 24-hour urine output and blood pressure. The clinical and biochemical variables were associated with the components of the BIA. According to the resistance/height (R/H) and reactance/height (Xc/H) values, the BIVA results were individually plotted on reference ellipses to identify patients with abnormal hydration states. The patients were classified by group according to hydration status and CKD stage z-scores, and differences in clinical, biochemical and BIA parameters were identified. Mortality was determined by hydration status. (AU)

Antecedentes: la evaluación del estado de hidratación y la composición corporal es imprescindible para los pacientes con enfermedad renal crónica (ERC) en estadios intermedios, ya que en esta etapa inician con alteraciones hídricas perceptibles; sin embargo, existe poca información en dicha población sobre la evaluación del estado de volemia mediante el análisis de vectores de bioimpedancia eléctrica (BIVA). Objetivo: asociar el estado de hidratación medido por BIVA con parámetros bioquímicos, clínicos y mortalidad en pacientes con ERC G3a G3b y G4 Material y métodos: estudio transversal en el cual se incluyó a pacientes con ERC en estadios G3a G3b y G4 a los que se les realizó un análisis de impedancia bioeléctrica (IBE) y en los que se determinaron parámetros bioquímicos y clínicos: albúmina sérica y urinaria, hematocrito, electrólitos y creatinina séricos, tasa de filtrado glomerular estimada (TFGe) (fórmula CKD-EPI), diuresis de 24 horas y presión arterial. Las variables clínicas y bioquímicas se asociaron con los componentes de la IBE. Los valores de resistencia/estatura (R/H) y reactancia/estatura (Xc/H) se graficaron individualmente sobre las elipses de referencia para identificar a pacientes con estados de hidratación anormales. Se ubicaron grupos según el estado de hidratación y estadio de ERC en z-score y se identificaron las diferencias de parámetros clínicos, bioquímicos y de IBE. Se determinó la mortalidad según el estado de hidratación. (AU)

Agreement between vector analysis and body composition measurements by four types of bioelectrical impedance technology in hemodialysis patients / Concordancia del análisis vectorial y medidas de composición corporal de cuatro tipos de tecnología de impedancia bioeléctrica en pacientes en hemodiálisis

Background: the differences in bioelectrical impedance vector analysis (BIVA) results from different analyzers that use different bioelectrical impedance analysis (BIA) measurement technologies are not known. This study aimed to identify the degree of agreement between the BIVA results of four different BIA measurement techniques and to evaluate the degree of agreement between their estimates of fat-free mass (FFM) and fat mass (FM) and those determined by the gold-standard method of dual-energy X-ray absorptiometry (DEXA) in a subgroup of patients without overhydration. Methods: a cross-sectional study was conducted with hemodialysis (HD) patients with end-stage renal disease (ESRD) aged 18 to 65 years. BIA was measured with four different techniques: spectroscopic (BIA-BIS), multifrequency (BIA-MF), single-frequency (BIA-SF), and segmental multifrequency (BIA-MS) techniques. The differences and concordance between the components of the BIA (resistance, reactance, and phase angle) of the four devices were analyzed. Patients with a normal hydration status were identified, and concordance between FM and FFM measurements with each impedance device and DEXA was observed only in these patients. Results: thirty patients were included. The concordance between the components of BIA ranged from good to excellent (phase angle: intraclass correlation coefficient (ICC) = 0.82, 95 % confidence interval (CI): 0.77-0.93; resistance: ICC = 0.98, 95 % CI: 0.92-0.99). The overall concordance for BIVA diagnosis between the analyzers was substantial for hydration (k = 0.71, 95 % CI: 0.71-0.72) and for body tissues (k = 0.68, 95 % CI: 0.67-0.68). Bland–Altman plots showed the lowest bias between BIA-BIS and DEXA for both FM and FFM. (AU)

Antecedentes: se desconoce si existen diferencias en el diagnóstico dado por el análisis de vectores de impedancia bioeléctrica (BIVA por sus siglas en inglés) entre los analizadores que utilizan distintas tecnologías de medición de impedancia bioeléctrica (IBE). Este estudio tuvo como objetivo identificar el grado de concordancia entre el diagnóstico por BIVA de cuatro técnicas diferentes de medición de IBE, así como evaluar el grado de concordancia entre sus estimaciones de masa magra (MM) y masa grasa (MG) en comparación con el método de absorciometría de rayos X de energía dual (DEXA) en un subgrupo de pacientes sin sobrecarga de volumen. Métodos: se realizó un estudio transversal en pacientes con enfermedad renal crónica avanzada (ERCA) en hemodiálisis (HD) con edades entre los 18 a 65 años. La IBE se midió con cuatro diferentes tecnologías: espectroscópica (IBE-BIS), multifrecuencia (IBE-MF), una sola frecuencia (IBE-SF) y multifrecuencia segmental (IBE-MS). Se analizaron las diferencias y concordancias entre los componentes de la IBE (resistencia, reactancia y ángulo de fase) de los cuatro analizadores. Se identificaron pacientes con estado de hidratación normal, y solo en ellos se evaluó la concordancia de FFM y FM entre cada analizador de impedancia y DEXA. Resultados: se incluyeron 30 pacientes. La concordancia entre los componentes del IBE varió de buena a excelente (ángulo de fase: coeficiente de correlación intraclase (ICC) = 0,82, IC del 95 %: 0,77-0,93; resistencia: ICC = 0,98, IC del 95 %: 0,92-0,99). La concordancia general en el diagnóstico de BIVA entre los analizadores fue substancial para la hidratación (k = 0,71, IC del 95 %: 0,71-0,72) y los tejidos corporales (k = 0,68, IC del 95 %: 0,67-0,68). Los gráficos de Bland-Altman mostraron un sesgo más bajo entre BIA-BIS y DEXA tanto para FM como para FFM. (AU)

[Development of a screening tool for a high sodium intake in an adult Mexican population]. / Desarrollo de una herramienta de tamizaje para consumo elevado de sodio en una población adulta mexicana.

BACKGROUND: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed. OBJECTIVES: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population. METHODS: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method. RESULTS: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index. CONCLUSIONS: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake.

INTRODUCCIÓN: la excreción de sodio en orina de 24 horas es el método de referencia para evaluar la ingesta de sodio; sin embargo, se  requieren herramientas que puedan aplicarse de manera más práctica tanto en el ámbito clínico como en el poblacional. OBJETIVOS: desarrollar y evaluar un cuestionario autoadministrable de frecuencia de consumo de alimentos ricos en sodio (CFCA-S) como herramienta de tamizaje para consumo elevado de sodio en una población adulta de la Ciudad de México. MÉTODOS: se desarrolló un CFCA-S con 28 categorías de alimentos ricos en sodio y su sistema de puntuación respectivo. El percentil 75 del puntaje total del CFCA-S se probó como punto de corte para clasificar a las personas con alto consumo de sodio a dos niveles (≥ 2.000 y ≥ 3.000 mg/día), considerando la excreción urinaria de sodio en 24 horas como método de referencia. RESULTADOS: se incluyeron 95 participantes (mediana de edad: 39 [percentiles 25-75: 26-46] años; hombres: 39 [41,1%]). Un puntaje total de 51,2 en el CFCA-S mostró una sensibilidad del 31,6% (intervalo de confianza [IC] 95%: 19,1-47,5), una especificidad del 78,9% (IC 95%: 66,7-87,5), valor predictivo positivo del 50% (IC 95%: 31,4-68,6) y valor predictivo negativo del 63,4% (IC 95%: 51,8-73,6), para clasificar a las personas con consumo de sodio ≥ 3.000 mg/día. Un puntaje ≥ 51,2 se asoció significativamente con una ingesta de sodio ≥ 3.000 mg/día, resultando en una razón de momios de 3,12 (IC 95%: 1,03-9,44, p = 0,04), después de ajustar por sexo, edad e índice de masa corporal (IMC). CONCLUSIONES: el CFCA-S es una herramienta práctica, factible de aplicarse y útil para identificar a personas en riesgo de tener un consumo elevado de sodio.

Desarrollo de una herramienta de tamizaje para consumo elevado de sodio en una población adulta mexicana / Development of a screening tool for a high sodium intake in an adult Mexican population

Introducción: la excreción de sodio en orina de 24 horas es el método de referencia para evaluar la ingesta de sodio; sin embargo, se requieren herramientas que puedan aplicarse de manera más práctica tanto en el ámbito clínico como en el poblacional. Objetivos: desarrollar y evaluar un cuestionario autoadministrable de frecuencia de consumo de alimentos ricos en sodio (CFCA-S) como herramienta de tamizaje para consumo elevado de sodio en una población adulta de la Ciudad de México. Métodos: se desarrolló un CFCA-S con 28 categorías de alimentos ricos en sodio y su sistema de puntuación respectivo. El percentil 75 del puntaje total del CFCA-S se probó como punto de corte para clasificar a las personas con alto consumo de sodio a dos niveles (≥ 2.000 y ≥ 3.000 mg/día), considerando la excreción urinaria de sodio en 24 horas como método de referencia. Resultados: se incluyeron 95 participantes (mediana de edad: 39 [percentiles 25-75: 26-46] años; hombres: 39 [41,1%]). Un puntaje total de 51,2 en el CFCA-S mostró una sensibilidad del 31,6% (intervalo de confianza [IC] 95%: 19,1-47,5), una especificidad del 78,9% (IC 95%: 66,7-87,5), valor predictivo positivo del 50% (IC 95%: 31,4-68,6) y valor predictivo negativo del 63,4% (IC 95%: 51,8-73,6), para clasificar a las personas con consumo de sodio ≥ 3.000 mg/día. Un puntaje ≥ 51,2 se asoció significativamente con una ingesta de sodio ≥ 3.000 mg/día, resultando en una razón de momios de 3,12 (IC 95%: 1,03-9,44, p = 0,04), después de ajustar por sexo, edad e índice de masa corporal (IMC). Conclusiones: el CFCA-S es una herramienta práctica, factible de aplicarse y útil para identificar a personas en riesgo de tener un consumo elevado de sodio

Background: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed. Objectives: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population. Methods: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method. Results: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index. Conclusions: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake

Combined assessment of nutritional status in patients with peritoneal dialysis using bioelectrical impedance vectors and malnutrition inflammation score.

BACKGROUND AND OBJECTIVE: Protein energy wasting (PEW) is a common syndrome in patients with chronic kidney disease, related to changes in hydration status, decreased food intake and inflammation. There are several tools for the assessment and diagnosis of such alterations. Bioimpedance vector analysis (BIVA) assess the state of nutrition and hydration, but not the inflammatory component, while the malnutrition inflammation score (MIS) comprises the inflammatory and nutritional factors, but not the state of hydration. The aim of the study was to determine the concordance between MIS and BIVA to assess nutritional status in peritoneal dialysis patients. METHODS: We studied 50 patients on peritoneal dialysis which underwent  bioelectrical impedance measurements with an empty peritoneal cavity, also MIS was applied and biochemical parameters were evaluated. RESULTS: The prevalence of malnutrition with VIBE and MIS was 38% and 24% respectively. Statistically significant differences in body mass index (BMI) and phase angle between normally nourished and wasted patients by both methods were found. Body composition, biochemical parameters and impedance vectors were not statistically different between normally nourished and wasted patients. Concordance between methods was 0.314 (p = 0.019). CONCLUSIONS: Combined nutritional assessment with MIS and BIVA is necessary for the diagnosis of protein energy wasting syndrome in patients undergoing peritoneal dialysis.

Food Sources of Sodium Intake in an Adult Mexican Population: A Sub-Analysis of the SALMEX Study.

Excessive dietary sodium intake increases blood pressure and cardiovascular risk. In Western diets, the majority of dietary sodium comes from packaged and prepared foods (≈75%); however, in Mexico there is no available data on the main food sources of dietary sodium. The main objective of this study was to identify and characterize the major food sources of dietary sodium in a sample of the Mexican Salt and Mexico (SALMEX) cohort. Adult male and female participants of the SALMEX study who provided a complete and valid three-day food record during the baseline visit were included. Overall, 950 participants (mean age 38.6 ± 10.7 years) were analyzed to determine the total sodium contributed by the main food sources of sodium identified. Mean daily sodium intake estimated by three-day food records and 24-h urinary sodium excretion was 2647.2 ± 976.9 mg/day and 3497.2 ± 1393.0, in the overall population, respectively. Processed meat was the main contributor to daily sodium intake, representing 8% of total sodium intake per capita as measured by three-day food records. When savory bread (8%) and sweet bakery goods (8%) were considered together as bread products, these were the major contributor to daily sodium intake, accounting for the 16% of total sodium intake, followed by processed meat (8%), natural cheeses (5%), and tacos (5%). These results highlight the need for public health policies focused on reducing the sodium content of processed food in Mexico.

Effect of probiotics on human blood urea levels in patients with chronic renal failure.

INTRODUCTION: Patients with chronic kidney disease (CKD) show an increase in bowel aerobic bacteria that produce uremic toxins and decreased anaerobic bacteria as bifidobacteria and lactobacillus. The latter can be used as probiotics. The probiotic with greater availability in Mexico, is the lactobacillus casei shirota (LcS), currently there is no known LcS specified dose that produces a benefit to the patient with CKD. OBJECTIVE: To determine the effectiveness of two different LcS doses in achieving a decrease in urea concentrations of at least 10% in patients with KDOQI stage 3 and stage 4 CKD. METODOLOGY: A simple randomized, controlled clinical trial. Outpatients treated at the National Institute of Medical Sciences and Nutrition Salvador Zubirán in México D.F. Patients were provided the LcS, as follows: Group A: 8 x 10(9) colony-forming units (CFU) and Group B: 16 x 10(9) CFU. Patients were followed-up for eight weeks, and baseline and final samples were obtained to calculate the basal and final concentrations, respectively, of blood urea and serum creatinine (CrS). During the follow-up, both groups consumed a diet of 30 kcal/kg/weight and 0.8 g/kg/weight of protein, and a food diary was made to assess both the adherence to the diet and LcS. RESULTS: Thirty patients with CKD were evaluated. When analyzing the percentage change between the different doses, a decrease > 10% was found in the blood urea concentrations for patients treated with the 16 x 109 dose, which was significant with respect to the baseline measurement. CONCLUSION: There was a > 10% decrease in the serum urea concentrations with LcS in patients with stage 3 and 4 CRF.

Introducción: Los pacientes con enfermedad renal crónica (ERC) muestran un aumento a nivel intestinal de bacterias aeróbicas que generan toxinas urémicas y disminución de bacterias anaeróbicas como bifidobacterias y lactobacilos. Estas últimas se pueden utilizar como probióticos. El probiótico con mayor disponibilidad en México, es el lactobacillus casei shirota (LcS), actualmente no se conoce que dosis de LcS puede generar un beneficio para el paciente con ERC. Objetivo: Determinar el efecto de 2 dosis diferentes de LcS para disminuir al menos 10% las concentraciones de urea en pacientes con ERC estadios KDOQI 3 y 4. Métodos: Ensayo clínico controlado con asignación aleatoria en el cual se incluyeron pacientes ambulatorios con ERC del Instituto Nacional de Ciencias Médica y Nutrición Salvador Zubiran. Se asignó a los pacientes a uno de los dos grupos, grupo A: 8 x 109 unidades formadoras de colonias (UFC) y grupo B: 16 x 109 UFC. El seguimiento fue de ocho semanas, obteniendose una muestra de sangre basal y otra final para conocer concentraciones de urea y creatinina. Ambos grupos consumieron una dieta de 30 kcal/kg/peso y 0,8 g/kg/peso de proteína, se realizó un diario de alimentación para evaluar el cumplimiento de la dieta y del tratamiento del LcS. Resultados: Se evaluaron 30 pacientes. Al analizar el porcentaje de cambio entre las diferentes dosis se encontró una disminución mayor al 10% en urea sanguínea en pacientes con la dosis de 16 x 109 con respecto a su medición basal. Conclusión: Existe una disminución > 10% de la concentración sérica de urea con el LcS en pacientes con ERC 3 y 4.

Effect of probiotics on human blood urea levels in patients with chronic renal failure / Efecto de lactobacillus casei shirota sobre concentraciones de urea en la enfermedad renal crónica

Introduction: Patients with chronic kidney disease(CKD) show an increase in bowel aerobic bacteria that produce uremic toxins and decreased anaerobic bacteria as bifidobacteria and lactobacillus. The latter can be used as probiotics. The probiotic with greater availability in Mexico, is the lactobacillus casei shirota (LcS), currently there is no known LcS specified dose that produces a benefit to the patient with CKD. Objective: To determine the effectiveness of two different LcS doses in achieving a decrease in urea concentrations of at least 10% in patients with KDOQI stage 3 and stage 4 CKD. Metodology: A simple randomized, controlled clinical trial. Outpatients treated at the National Institute of Medical Sciences and Nutrition Salvador Zubirán in México D.F. Patients were provided the LcS, as follows: Group A: 8 x 109 colony-forming units (CFU) and Group B: 16 x 109 CFU. Patients were followed-up for eight weeks, and baseline and final samples were obtained to calculate the basal and final concentrations, respectively, of blood urea and serum creatinine (CrS). During the follow-up, both groups consumed a diet of 30 kcal/kg/weight and 0.8g/kg/weight of protein, and a food diary was made to assess both the adherence to the diet and LcS. Results: Thirty patients with CKD were evaluated. When analyzing the percentage change between the different doses, a decrease > 10% was found in the bloodurea concentrations for patients treated with the 16 x 109dose, which was significant with respect to the baseline measurement. Conclusion: There was a > 10% decrease in the serumurea concentrations with LcS in patients with stage 3 and4 CRF (AU)

Introducción: Los pacientes con enfermedad renal crónica(ERC) muestran un aumento a nivel intestinal de bacterias aeróbicas que generan toxinas urémicas y disminución de bacterias anaeróbicas como bifidobacteriasy lactobacilos. Estas últimas se pueden utilizar como probióticos. El probiótico con mayor disponibilidad en México, es el lactobacillus casei shirota (LcS), actualmente no se conoce que dosis de LcS puede generar un beneficio para el paciente con ERC. Objetivo: Determinar el efecto de 2 dosis diferentes de LcS para disminuir al menos 10% las concentraciones de urea en pacientes con ERC estadios KDOQI 3 y 4.Métodos: Ensayo clínico controlado con asignación aleatoria en el cual se incluyeron pacientes ambulatorios con ERC del Instituto Nacional de Ciencias Médica y Nutrición Salvador Zubiran. Se asignó a los pacientes a uno de los dos grupos, grupo A: 8 x 109 unidades formadoras de colonias (UFC) y grupo B: 16 x 109 UFC. El seguimiento fue de ocho semanas, obteniéndose una muestra desangre basal y otra final para conocer concentraciones de urea y creatinina. Ambos grupos consumieron una dieta de 30 kcal/kg/peso y 0,8 g/kg/peso de proteína, se realizó un diario de alimentación para evaluar el cumplimiento de la dieta y del tratamiento del LcS. Resultados: Se evaluaron 30 pacientes. Al analizar el porcentaje de cambio entre las diferentes dosis se encontró una disminución mayor al 10% en urea sanguínea en pacientes con la dosis de 16 x 109 con respecto a su medición basal. Conclusión: Existe una disminución > 10% de la concentración sérica de urea con el LcS en pacientes con ERC 3 y 4 (AU)