Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.489
Filtrar
1.
Nutr. hosp ; 37(6): 1150-1156, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198306

RESUMEN

INTRODUCCIÓN: en pacientes con obesidad severa y mórbida se ha observado que la evaluación por bioimpedanciometría (BIA) genera una subestimación de la masa grasa (MG) y del peso perdido como MG después de la cirugía bariátrica, sobreestimándose la pérdida de masa libre de grasa (MLG) y la masa muscular. OBJETIVO: evaluar la confiabilidad de la BIA para estimar el agua corporal total (ACT), la MLG, la MG y sus cambios después de 6 meses de un baipás gástrico en Y de Roux (BPGYR) en pacientes con obesidad severa y mórbida. MÉTODOS: 36 adultos con indicación de BPGYR se estudiaron prospectivamente. Se midió el ACT por deuterio (D) y se calcularon la MLG y MG. Con BIA de doble frecuencia (5 y 200 kHz) (Bodystat Dualscan(R)) se estimaron la MG, la MLG, el ACT, el agua extracelular (AEC), el agua intracelular (AIC) y la relación AEC/AIC. RESULTADOS: antes del BPGYR, la BIA sobreestimó el ACT en 2,6 ± 4,3 L (p = 0,002) y la MLG en 3,5 ± 5,7 kg (p = 0,002), y subestimó el %MG en 2,98 ± 4,7% (p = 0,002). La relación AEC/AIC mostró una correlación positiva con la sobreestimación de la MLG por BIA (r = 0,49; p = 0,002). Después de la cirugía, las diferencias entre BIA y D no fueron significativas y el error de estimación de la MLG no se correlacionó con la relación AEC/AIC. CONCLUSIONES: la BIA genera una subestimación de la MG como la reportada, la cual se atenúa después de la reducción de peso, subestimando el peso perdido como MG y sobreestimando la pérdida de MLG. Futuras investigaciones podrán evaluar si estos errores se reproducen con otros equipos de BIA


INTRODUCTION: in patients with severe and morbid obesity it has been observed that bioimpedance (BIA) assessment generates an underestimation of fat mass (FM) and weight loss as FM after bariatric surgery, overestimating the loss of fat-free mass (FFM) and muscle mass. OBJECTIVE: to evaluate the reliability of bioelectrical impedance analysis (BIA) to estimate total body water (TBW), fat-free mass (FFM), fat mass (FM), and its changes after 6 months of a Roux-en-Y gastric bypass (RYGBP), in patients with severe and morbid obesity. METHODS: thirty-six patients approved for RYGBP were prospectively studied. TBW was measured by deuterium (D), and FM and FFM were calculated. A dual-frequency BIA device (5 and 200 kHz) (Bodystat Dualscan(R)) was used to estimate FM, FFM, TBW, extracellular water (ECW), intracellular water (ICW), and ECW/ICW ratio. RESULTS: before RYGBP, BIA overestimated TBW by 2.6 ± 4.3 L (p = 0.002) and FFM by 3.5 ± 5.7 kg (p = 0.002), and underestimated FM% by 2.98 ± 4.7% (p = 0.002). The ECW/ICW ratio showed a significant and positive correlation with the difference BIA-D for FFM (r = 0.49; p = 0.002). After surgery, the differences between BIA and D were not significant, and the estimation error of FFM did not correlate with the ECW/ICW ratio. CONCLUSIONS: BIA generates an underestimation of FM as reported in patients with severe and morbid obesity, which is attenuated after weight reduction, underestimating weight loss as FM and overestimating FFM loss. Future research may assess whether these errors are reproduced by other BIA devices


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Composición Corporal/fisiología , Pérdida de Peso/fisiología , Anastomosis en-Y de Roux/métodos , Agua Corporal/fisiología , Índice de Severidad de la Enfermedad , Impedancia Eléctrica , Obesidad Mórbida/cirugía , Cirugía Bariátrica/métodos , Estudios Prospectivos , Distribución de la Grasa Corporal/métodos , Índice de Masa Corporal
2.
Nefrología (Madrid) ; 40(5): 522-530, sept.-oct. 2020. tab
Artículo en Inglés | IBECS | ID: ibc-199033

RESUMEN

BACKGROUND: Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients. METHODS: This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV. RESULTS: The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP. CONCLUSION: Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD


ANTECEDENTES: El aumento en la variabilidad en la presión arterial (VPA) se asocia con un mayor riesgo cardiovascular. Hasta el momento no se ha investigado la asociación entre la VPA y el estado hidroelectrolítico en pacientes hipertensos. El objetivo del presente estudio fue determinar la contribución del equilibrio hidroelectrolítico a la VPA y el impacto en las funciones endoteliales y cardíacas entre los pacientes con hipertensión primaria. MÉTODOS: Se trata de un estudio intervencionista prospectivo realizado en pacientes con hipertensión primaria con seguimiento de un año. Se llevaron a cabo mediciones del estado volumétrico mediante un monitor de composición corporal, monitorización de presión arterial (PA) ambulatoria, mediciones ecocardiográficas y del grosor de la íntima-media de la carótida (GIMC) en la inclusión y en el duodécimo mes. En los pacientes de uno de los 2 grupos se mantuvo hidratación negativa durante el ensayo con tratamiento diurético. Los pacientes de otro grupo presentaban hidratación positiva (hipervolemia) en la inclusión, y se añadieron o se intensificaron los fármacos antihipertensivos distintos de los diuréticos (vasodilatadores) en función de la monitorización de la PA. Se utilizó el índice de variabilidad real promedio (VRP) para establecer la significación pronóstica de la VPA. RESULTADOS: La población del estudio consistió en 50 pacientes con una media de edad de 54,5±8,8 años. Al final del seguimiento, al cabo de un año, los pacientes del grupo con hidratación negativa presentaron una PA, un GIMC, un índice de masa del ventrículo izquierdo (IMVI) y una VRP sistólica y diastólica significativamente menores. El mayor aumento de peso y una PA sistólica superior fueron factores de riesgo importantes de la VRP sistólica alta. Los pacientes con mejoras en el GIMC y el IMVI se consideraron pacientes con recuperación del daño de órganos diana (DOD). En el grupo con hidratación negativa, el DOD se redujo significativamente durante el ensayo. En los pacientes con recuperación del DOD, la VPA se redujo significativamente en mayor medida, al igual que la PA sistólica y diastólica. Los factores de riesgo significativos asociados con la presencia de DOC fueron la PA sistólica de 24h, la VPA diastólica diurna y nocturna y la PA diastólica nocturna. CONCLUSIÓN: La adición de diuréticos al tratamiento establecido o la intensificación del tratamiento diurético y el mantenimiento de los pacientes en estado de hidratación negativa provocó la reducción de la VPA en el duodécimo mes de seguimiento. El mayor aumento de peso y una PA sistólica superior son factores de riesgo importantes de VRP sistólica alta, pero no así la hipervolemia. La VPA, en especial la VPA diastólica se asoció de forma significativa al DOD


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Agua Corporal/fisiología , Estado de Hidratación del Organismo/fisiología , Presión Arterial , Hipertensión/fisiopatología , Riñón/fisiopatología , Equilibrio Hidroelectrolítico , Estudios Prospectivos , Factores de Riesgo , Diuréticos/uso terapéutico , Índice de Masa Corporal , Monitoreo Ambulatorio de la Presión Arterial
3.
Nutr. hosp ; 37(5): 1072-1086, sept.-oct. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198024

RESUMEN

Aunque el agua es un nutriente esencial para la vida y el componente más abundante de nuestro cuerpo, recibe escasa atención en las recomendaciones dietéticas y las guías clínicas. Existen inconvenientes para determinar las cifras óptimas, tanto para la cantidad de agua que debe contener el cuerpo como para su ingesta. La ingesta y eliminación del agua dependen de factores no constantes y difíciles de medir, a su vez compensados por la capacidad del organismo para la homeostasis. Dada la falta de evidencia científica para el establecimiento de recomendaciones, se han estimado las "ingestas adecuadas" (para mantener un estado de hidratación adecuado) utilizando datos de ingestas de agua en grupos de personas sanas. La Autoridad Europea de Seguridad Alimentaria (EFSA) también considera la osmolaridad deseable en la orina para estimar la ingesta adecuada de agua en los adultos. Los estudios clínicos han mostrado en general beneficios con una hidratación adecuada y perjuicios con sus desequilibrios, ya sean cuantitativos (deshidratación y sobrehidratación) o cualitativos (agua extracelular e intracelular). Desafortunadamente, estos estudios son escasos y suelen tener diseños deficientes, ya sean transversales, de casos y controles o prospectivos, utilizando muestras pequeñas o métodos indirectos para evaluar el estado de hidratación. En este artículo se presenta información de actualización respecto a: 1) la adherencia a las recomendaciones de consumo de agua y sugerencias para mejorarla; 2) técnicas disponibles para medir el estado de hidratación y sus aplicaciones clínicas; 3) efectos de la hidratación/deshidratación en las actividades físicas o cognitivas y en las enfermedades crónicas; y 4) normativa española sobre calidad y salubridad del agua


Water is an essential nutrient for life and the most abundant component in the human body. However, its dietary recommendations or clinical management guidelines do not receive as much attention as they deserve. In addition, there are some obstacles to establishing optimal values, both for the amount of water the body must contain and for water ingestion. Water intake and elimination depend on unsteady factors that are difficult to measure and, at the same time, compensated by the body's ability to regulate homeostasis. Since scientific evidence is lacking for establishing recommendations, "adequate intakes" (to maintain an adequate hydration state) have been estimated using data on water intake from groups of healthy people. The European Food Safety Authority (EFSA) also considers desirable the use of urine osmolarity to estimate the adequacy of water intake in adults. Clinical studies have generally shown the benefits of adequate hydration and the damage caused by water imbalance, whether quantitative (dehydration and overhydration) or qualitative (extracellular and intracellular water). Unfortunately, these studies are few and often have poor cross-sectional, case-control, or prospective designs, and use small samples or indirect methods to assess hydration status. This article presents up-to-date information on subjects such as: 1) compliance with water consumption recommendations and suggestions for improvement; 2) techniques available to measure hydration status and their clinical applications; 3) effects of hydration/dehydration on physical or cognitive activities and chronic diseases; and 4) existing Spanish regulations on the quality and salubrity of water


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Ingestión de Líquidos/fisiología , Agua/administración & dosificación , Medicina Preventiva , Agua Corporal/fisiología , Necesidades Nutricionales , Composición Corporal/fisiología , Bebidas , Deshidratación/prevención & control , Deshidratación/terapia , Estado de Salud , Grupos de Riesgo
4.
Am Surg ; 86(9): 1169-1174, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862663

RESUMEN

BACKGROUND: Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. METHODS: The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. RESULTS: 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. CONCLUSION: Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.


Asunto(s)
Cirugía Bariátrica/métodos , Agua Corporal/fisiología , Fluidoterapia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Pacientes Ambulatorios , Complicaciones Posoperatorias/terapia , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/metabolismo , Complicaciones Posoperatorias/metabolismo , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos
5.
PLoS One ; 15(8): e0232733, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764762

RESUMEN

Ferrets (Mustela putorius furo) are a valuable animal model used in biomedical research. Like many animals, ferrets undergo significant variation in body weight seasonally, affected by photoperiod, and these variations complicate the use weight as an indicator of health status. To overcome this requires a better understanding of these seasonal weight changes. We provide a normative weight data set for the female ferret accounting for seasonal changes, and also investigate the effect of fluid regulation on weight change. Female ferrets (n = 39) underwent behavioural testing from May 2017 to August 2019 and were weighed daily, while housed in an animal care facility with controlled light exposure. In the winter (October to March), animals experienced 10 hours of light and 14 hours of dark, while in summer (March to October), this contingency was reversed. Individual animals varied in their body weight from approximately 700 to 1200 g. However, weights fluctuated with light cycle, with animals losing weight in summer, and gaining weight in winter such that they fluctuated between approximately 80% and 120% of their long-term average. Ferrets were weighed as part of their health assessment while experiencing water regulation for behavioural training. Water regulation superimposed additional weight changes on these seasonal fluctuations, with weight loss during the 5-day water regulation period being greater in summer than winter. Analysing the data with a Generalised Linear Model confirmed that the percentage decrease in weight per week was relatively constant throughout the summer months, while the percentage increase in body weight per week in winter decreased through the season. Finally, we noted that the timing of oestrus was reliably triggered by the increase in day length in spring. These data establish a normative benchmark for seasonal weight variation in female ferrets that can be incorporated into the health assessment of an animal's condition.


Asunto(s)
Peso Corporal , Hurones/anatomía & histología , Crianza de Animales Domésticos , Animales , Animales de Laboratorio/anatomía & histología , Animales de Laboratorio/fisiología , Agua Corporal/fisiología , Estro/fisiología , Femenino , Hurones/fisiología , Modelos Lineales , Modelos Animales , Modelos Biológicos , Fotoperiodo , Valores de Referencia , Estaciones del Año
6.
Am J Physiol Regul Integr Comp Physiol ; 318(3): R512-R514, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31940233

RESUMEN

Work in adult humans and animals suggest sodium (Na) is stored in tissue reservoirs without commensurate water retention. These stores may protect from water loss, regulate immune function, and participate in blood pressure regulation. A role for such stores early in life, during which total body Na sufficiency is vital for optimal growth, has not been explored. Using data from previously published literature, we calculated total body stores of Na, potassium (K), and chloride (Cl) during fetal development (24-40 wk gestation) using two methods 1) based on the distribution of body water mass within extracellular and intracellular compartments, and 2) reported total mineral content. Based on differences between the models, we argue that Na, and to a lesser extent Cl, but not K, are stored in osmotically inactive pools within the fetus that increase with advancing gestational age. Because human breastmilk is relatively Na deficient, we speculate the fetal osmotically inactive Na pool is vital for providing a sufficient total body Na content that supports optimal postnatal growth.


Asunto(s)
Feto/fisiología , Hipertensión/fisiopatología , Minerales/metabolismo , Sodio/metabolismo , Equilibrio Hidroelectrolítico/fisiología , Animales , Presión Sanguínea/fisiología , Agua Corporal/fisiología , Humanos , Potasio/metabolismo , Conducta Sedentaria
7.
Am J Hum Biol ; 32(1): e23338, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31631450

RESUMEN

Body water homeostasis is critical for optimal physiological and cognitive function for humans. The majority of research has illustrated the negative biological consequences of failing to meet water needs. The human body has several mechanisms for detecting, regulating, and correcting body water deficits and excesses. However, variation exists in total water intake and how people meet those water needs as well as thirst thresholds and how well people tolerate water restriction. An evolutionary and developmental framework provides an underexplored perspective into human water needs by examining how adaptations, early life experiences and environments, as well as life course changes in health states and behaviors may shape these critical factors in body water homeostasis. This article first reviews biological and behavioral adaptations to water scarcity among animals and humans. It then examines human variation in water intake in a mostly water secure environment through the analysis of National Health and Nutrition Examination Survey dietary data and the link between water intake patterns and hydration biomarkers. Next, it reviews existing evidence of how maternal water restriction in utero and during lactation shape vasopressin release, thirst thresholds, drinking patterns, and body water homeostasis for the infant. Early life water restriction appears to have implications for hydration status, body size, and cardiovascular health. Finally, it examines how life course changes in health states and behaviors, including obesity, sleep, and parasitic infection, affect body water homeostasis. This article poses new questions about the plasticity and shaping of human water needs, thirst, and hydration behaviors.


Asunto(s)
Aclimatación , Adaptación Biológica , Agua Corporal/fisiología , Ingestión de Líquidos , Acontecimientos que Cambian la Vida , Adaptación Fisiológica , Biomarcadores/metabolismo , Homeostasis , Humanos
8.
Nutrients ; 11(11)2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31703309

RESUMEN

At present, obesity and overweight are major public health concerns. Their classical determinants do not sufficiently explain the current situation and it is urgent to investigate other possible causes. In recent years, it has been suggested that water intake could have important implications for weight management. Thus, the aim of this study was to examine the effect of hydration status on body weight and composition in healthy adolescents from Spain. The study involved 372 subjects, aged 12-18 years. Water intake was assessed through the validated "hydration status questionnaire adolescent young". Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK) and body composition was estimated by bioelectrical impedance analysis. Water intake normalized by body weight was positively correlated with body water content (boys (B): r = 0.316, p = 0.000; girls (G): r = 0.245, p = 0.000) and inversely with body mass index (BMI) (B: r = -0.515, p = 0.000; G: r = -0.385, p =0.000) and fat body mass (B: r = -0.306, p = 0.000; G: r = -0.250, p = 0.001). Moreover, according to BMI, overweight/obese individuals consumed less water than normal weight ones. In conclusion, higher water balance and intake seems to be related with a healthier body composition. In conclusion, higher water balance and intake is associated with a healthier body composition.


Asunto(s)
Composición Corporal/fisiología , Agua Corporal/fisiología , Ingestión de Líquidos/fisiología , Adolescente , Peso Corporal/fisiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Obesidad/fisiopatología , Sobrepeso/fisiopatología , España/epidemiología
9.
Kidney Blood Press Res ; 44(6): 1423-1431, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31715600

RESUMEN

BACKGROUND: Cardiac death is increased in peritoneal dialysis (PD) patients. Pulse wave velocity (PWV) is a measurement of arterial stiffness, and previous reports linked PWV to increased extracellular water (ECW). As cyclers and icodextrin are increasingly used, we wished to determine whether this association between PWV and ECW remains. METHODS: We measured aortic PWV (aPWV) and bioimpedance (InBody, Seoul, South Korea) in consecutive PD patients attending for peritoneal membrane testing. RESULTS: 189 patients were included, 62.4% male, mean age 63.1 ± 15.2 years, 45.3% diabetic, median dialysis duration 12.3 (6.5-25.1) months, 71.4% using cyclers, weight 73.0 ± 16.1 kg, systolic blood pressure 142 ± 21 mm Hg, aPWV 10.4 ± 5.1 m/s. aPWV was associated with pulse pressure (r = 0.26, p = 0.001), Davies comorbidity score (r = 0.18, p = 0.013), and N-terminal pro-brain-type natriuretic peptide (NTproBNP; r = 0.18, p = 0.011). Patients with aPWV ≥10 m/s were older (65.9 ± 13.6 vs. 60.1 ± 16.3 years, p < 0.01) with a higher ECW-to-total body water ratio (0.400 ± 0.012 vs. 0.396 ± 0.013, p < 0.05), but ECW/height was not different (8.52 ± 2.32 vs. 8.75 ± 1.78 L/m), as was NTproBNP (2,472 [788-5,422] vs. 1,234 [410-6,230] ng/L). On multivariable testing, aPWV was positively associated with ß-blocker prescription (standardised ß coefficient [Stß] 0.3, 95% confidence limits [95% CL] 0.7-2.6, p = 0.001) and negatively with icodextrin prescription (Stß 0.19, 95% CL -0.2 to -2.1, p = 0.04). CONCLUSIONS: Compared to previous studies, we did not find an independent association between aPWV and ECW and estimates of ECW excess, using the InBody bioimpedance device, suggesting that vascular stiffness in PD patients is more complex than simple ECW volume expansion in PD patients.


Asunto(s)
Diálisis Peritoneal , Análisis de la Onda del Pulso/métodos , Rigidez Vascular/fisiología , Anciano , Aorta/fisiología , Agua Corporal/fisiología , Impedancia Eléctrica , Líquido Extracelular/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea
10.
Med Sci Monit ; 25: 8438-8446, 2019 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-31705647

RESUMEN

BACKGROUND Hypernatremia is associated with poor outcomes in critically ill patients, and an accurate assessment of water volume is important to determine appropriate fluid hydration. Bioelectrical impedance analysis (BIA) is a new, noninvasive, and relatively easy method for measuring hydration status. This study aimed to investigate whether bioelectrical impedance measurements of body water could reduce the frequency of blood sampling for fluid replacement in patients with hypernatremia. MATERIAL AND METHODS Fifty-one hospitalized patients were studied with hypernatremia, defined as a serum sodium ≥150 mmol/L determined by laboratory testing. Laboratory and BIA measurements were compared, and water deficiency was calculated with a conventional formula (sodium-corrected Watson formula) and measured by BIA. RESULTS The value of the absolute fluid overload (AFO) equivalent to the overhydration (OH) value, determined using BIA, did not accurately represent water deficit in patients with hypernatremia (r=0.137, P=0.347). Although the total body water (TBW) measured by BIA showed a significant correlation with that determined by the conventional formula (r=0.861, P<0.001), there was a proportional bias (r=0.617, P<0.001). The intracellular water (ICW) measured by BIA underestimated the TBW level calculated by the conventional formula by about 14.06±4.0 L in the Bland-Altman analysis. CONCLUSIONS It is not currently possible to replace blood testing with BIA for assessing volume status in hypernatremic patients. However, ICW value measured by BIA might represent plasma sodium level more accurately than extracellular water (ECW) or TBW value in patients with hypernatremia.


Asunto(s)
Hipernatremia/diagnóstico , Hipernatremia/metabolismo , Estado de Hidratación del Organismo/fisiología , Adulto , Composición Corporal , Agua Corporal/fisiología , Deshidratación/diagnóstico , Impedancia Eléctrica , Espacio Extracelular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agua
11.
Nutrients ; 11(8)2019 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-31394869

RESUMEN

With the collection of water-intake data, the National Health and Nutrition Examination Survey (NHANES) is becoming an increasingly popular resource for large-scale inquiry into human hydration. However, are we leveraging this resource properly? We sought to identify the opportunities and limitations inherent in hydration-related inquiry within a commonly studied database of hydration and nutrition. We also sought to critically review models published from this dataset. We reproduced two models published from the NHANES dataset, assessing the goodness of fit through conventional means (proportion of variance, R2). We also assessed model sensitivity to parameter configuration. Models published from the NHANES dataset typically yielded a very low goodness of fit R2 < 0.15. A reconfiguration of variables did not substantially improve model fit, and the goodness of fit of models published from the NHANES dataset may be low. Database-driven inquiry into human hydration requires the complete reporting of model diagnostics in order to fully contextualize findings. There are several emergent opportunities to potentially increase the proportion of explained variance in the NHANES dataset, including novel biomarkers, capturing situational variables (meteorology, for example), and consensus practices for adjustment of co-variates.


Asunto(s)
Agua Corporal/fisiología , Ingestión de Líquidos , Encuestas Nutricionales , Índice de Masa Corporal , Bases de Datos Factuales , Humanos , Modelos Teóricos , Estado Nutricional , Estado de Hidratación del Organismo , Concentración Osmolar , Reproducibilidad de los Resultados , Orina
12.
Clin J Am Soc Nephrol ; 14(9): 1297-1305, 2019 09 06.
Artículo en Inglés | MEDLINE | ID: mdl-31413064

RESUMEN

BACKGROUND AND OBJECTIVES: Marathon runners develop transient AKI with urine sediments and injury biomarkers suggesting nephron damage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: To investigate the etiology, we examined volume and thermoregulatory responses as possible mechanisms in runners' AKI using a prospective cohort of runners in the 2017 Hartford Marathon. Vitals, blood, and urine samples were collected in 23 runners 1 day premarathon and immediately and 1 day postmarathon. We measured copeptin at each time point. Continuous core body temperature, sweat sodium, and volume were assessed during the race. The primary outcome of interest was AKI, defined by AKIN criteria. RESULTS: Runners ranged from 22 to 63 years old; 43% were men. Runners lost a median (range) of 2.34 (0.50-7.21) g of sodium and 2.47 (0.36-6.81) L of volume via sweat. After accounting for intake, they had a net negative sodium and volume balance at the end of the race. The majority of runners had increases in core body temperature to 38.4 (35.8-41)°C during the race from their baseline. Fifty-five percent of runners developed AKI, yet 74% had positive urine microscopy for acute tubular injury. Runners with more running experience and increased participation in prior marathons developed a rise in creatinine as compared with those with lesser experience. Sweat sodium losses were higher in runners with AKI versus non-AKI (median, 3.41 [interquartile range (IQR), 1.7-4.8] versus median, 1.4 [IQR, 0.97-2.8] g; P=0.06, respectively). Sweat volume losses were higher in runners with AKI versus non-AKI (median, 3.89 [IQR, 1.49-5.09] versus median, 1.66 [IQR, 0.72-2.84] L; P=0.03, respectively). Copeptin was significantly higher in runners with AKI versus those without (median, 79.9 [IQR, 25.2-104.4] versus median, 11.3 [IQR, 6.6-43.7]; P=0.02, respectively). Estimated temperature was not significantly different. CONCLUSIONS: All runners experienced a substantial rise in copeptin and body temperature along with salt and water loss due to sweating. Sodium and volume loss via sweat as well as plasma copeptin concentrations were associated with AKI in runners. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_13_CJASNPodcast_19_09_.mp3.


Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/fisiopatología , Regulación de la Temperatura Corporal/fisiología , Agua Corporal/fisiología , Carrera/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
13.
Nutrients ; 11(8)2019 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-31405195

RESUMEN

Hypohydration, defined as a state of low body water, increases thirst sensations, arginine vasopressin release, and elicits renin-angiotensin-aldosterone system activation to replenish intra- and extra-cellular fluid stores. Hypohydration impairs mental and physical performance, but new evidence suggests hypohydration may also have deleterious effects on cardiovascular health. This is alarming because cardiovascular disease is the leading cause of death in the United States. Observational studies have linked habitual low water intake with increased future risk for adverse cardiovascular events. While it is currently unclear how chronic reductions in water intake may predispose individuals to greater future risk for adverse cardiovascular events, there is evidence that acute hypohydration impairs vascular function and blood pressure (BP) regulation. Specifically, acute hypohydration may reduce endothelial function, increase sympathetic nervous system activity, and worsen orthostatic tolerance. Therefore, the purpose of this review is to present the currently available evidence linking acute hypohydration with altered vascular function and BP regulation.


Asunto(s)
Agua Corporal/fisiología , Enfermedades Cardiovasculares/etiología , Fenómenos Fisiológicos Cardiovasculares , Deshidratación/complicaciones , Equilibrio Hidroelectrolítico/fisiología , Humanos
14.
Eur J Clin Nutr ; 73(10): 1422-1430, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31285552

RESUMEN

BACKGROUND: Most body composition techniques assume constant properties of fat free mass (FFM) (hydration and density) regardless of nutritional status, which may lead to biased values. AIM: To evaluate the interactive associations of age and body mass index (BMI) with hydration and density of FFM. METHODS: Data from subjects aged between 4 and 22 years old from several studies conducted in London, UK were assessed. Hydration (HFFM) and density (DFFM) of FFM obtained from the four-component model in 936 and 905 individuals, respectively, were assessed. BMI was converted in to z-scores, and categorised into five groups using z-score cut-offs (thin, normal weight, overweight, obese, and severely obese). Linear regression models for HFFM and DFFM were developed using age, sex, and BMI group as predictors. RESULTS: Nearly 30% of the variability in HFFM was explained by models including age and BMI groups, showing increasing HFFM values in heavier BMI groups. On the other hand, ∼40% of variability in DFFM was explained by age, sex, and BMI groups, with DFFM values decreasing in association with higher BMI group. CONCLUSION: Nutritional status should be considered when assessing body composition using two-component methods, and reference data for HFFM and DFFM is needed for higher BMI groups to avoid bias. Further research is needed to explain intra-individual variability in FFM properties.


Asunto(s)
Factores de Edad , Composición Corporal , Índice de Masa Corporal , Agua Corporal , Adolescente , Agua Corporal/fisiología , Peso Corporal , Niño , Preescolar , Femenino , Humanos , Londres , Masculino , Trastornos Nutricionales/fisiopatología , Estado de Hidratación del Organismo , Adulto Joven
15.
Ann Med ; 51(3-4): 232-251, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31204514

RESUMEN

Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.


Asunto(s)
Agua Corporal/fisiología , Consenso , Deshidratación/diagnóstico , Estado de Hidratación del Organismo/fisiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Compartimentos de Líquidos Corporales/fisiología , Enfermedad Crítica/epidemiología , Enfermedad Crítica/mortalidad , Deshidratación/epidemiología , Deshidratación/mortalidad , Deshidratación/fisiopatología , Delirio/epidemiología , Delirio/etiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Humanos , Pacientes Internos/estadística & datos numéricos , Persona de Mediana Edad , Casas de Salud/estadística & datos numéricos , Concentración Osmolar , Presión Osmótica/fisiología , Prevalencia , Pronóstico , Medición de Riesgo , Tromboembolia/epidemiología , Tromboembolia/etiología , Tromboembolia/mortalidad , Equilibrio Hidroelectrolítico/fisiología
16.
Skin Res Technol ; 25(5): 595-605, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31111588

RESUMEN

BACKGROUND: The skin provides a permeable barrier which may be impaired in occupational settings. Transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH (SSpH) have been used in occupational settings to predict early onset of occupational skin diseases, to measure the effectiveness of prevention strategies for occupational skin diseases, and to assess skin condition during exposure. The aim was to compare the findings, identify shortcomings in the methodology and data reporting and furthermore, to make recommendations for future studies. MATERIALS AND METHODS: A literature study was conducted on studies published before December 2018 to provide a review on the measurement of TEWL, SCH and SSpH in occupational settings. RESULTS: TEWL, SCH and SSpH were previously measured in a wide variety of industries. Results between studies were highly variable, due to different study designs and different anatomical positions measured. Not all of the measurement conditions were reported and variations in study objectives led to data being reported and interpreted differently for most studies. CONCLUSION: Incomplete reporting of methodology hinders comparison of bioengineering measurements. No bioengineering method has been proven useful as a predictive tool for occupational skin diseases, however, it is useful in the acute assessment of skin condition. It is recommended that future studies on TEWL, SCH and SSpH adhere to guidelines for occupational settings as far as possible to enable comparison between studies.


Asunto(s)
Epidermis/fisiología , Enfermedades Profesionales/fisiopatología , Estado de Hidratación del Organismo/fisiología , Enfermedades de la Piel/fisiopatología , Pérdida Insensible de Agua/fisiología , Agricultura , Agua Corporal/fisiología , Humanos , Concentración de Iones de Hidrógeno , Industrias , Enfermería , Impresión , Fenómenos Fisiológicos de la Piel
17.
Skin Res Technol ; 25(5): 653-661, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30932226

RESUMEN

BACKGROUND: Skin hydration is essential for maintaining stratum corneum (SC) flexibility and facilitating maturation events. Moisturizers contain multiple ingredients to maintain and improve skin hydration although a complete understanding of hydration mechanisms is lacking. The ability to differentiate the source of the hydration (water from the environment or deeper skin regions) upon application of product will aid in designing more efficacious formulations. MATERIALS AND METHODS: Novel confocal Raman microscopy (CRM) experiments allow us to investigate mechanisms and levels of hydration in the SC. Using deuterium oxide (D2 O) as a probe permits the differentiation of endogenous water (H2 O) from exogenous D2 O. Following topical application of D2 O, we first compare in vivo skin depth profiles with those obtained using ex vivo skin. Additional ex vivo experiments are conducted to quantify the kinetics of D2 O diffusion in the epidermis by introducing D2 O under the dermis. RESULTS: Relative D2 O depth profiles from in vivo and ex vivo measurements compare well considering procedural and instrumental differences. Additional in vivo experiments where D2 O was applied following topical glycerin application increased the longevity of D2 O in the SC. Reproducible rates of D2 O diffusion as a function of depth have been established for experiments where D2 O is introduced under ex vivo skin. CONCLUSION: Unique information regarding hydration mechanisms are obtained from CRM experiments using D2 O as a probe. The source and relative rates of hydration can be delineated using ex vivo skin with D2 O underneath. One can envision comparing these depth-dependent rates in the presence and absence of topically applied hydrating agents to obtain mechanistic information.


Asunto(s)
Estado de Hidratación del Organismo/fisiología , Fenómenos Fisiológicos de la Piel , Agua Corporal/fisiología , Óxido de Deuterio/farmacología , Epidermis/fisiología , Humanos , Microscopía Confocal/métodos , Espectrometría Raman/métodos , Pérdida Insensible de Agua/fisiología
18.
Skin Res Technol ; 25(3): 251-257, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30937980

RESUMEN

BACKGROUND: Two clinical methods of assessing a moisturizer's effect on stratum corneum (SC) barrier repair were evaluated in female subjects with dry skin, to identify an assessment method for future studies. METHODS: In this single-centre, split-body study, women with dry skin applied moisturizer before (method A) or after (method B) SC barrier perturbation using D-Squame® stripping discs. Transepidermal water loss (TEWL) and residual protein on D-Squame discs were assessed over 14 days. RESULTS: Twenty-four subjects were included. For method A, the mean slope values of plots of 1/TEWL vs cumulative protein removed decreased over time for both treated and untreated areas, indicating improved SC barrier quality. There were no significant differences between treated and untreated areas, although a trend to a more negative slope was observed by Day 14 in the treated areas (P = 0.082), suggesting treatment improved barrier quality. For method B, using pre- and post-stripping as covariates, no statistical differences/trends were observed between treated and untreated areas for change in TEWL from post-stripping to any evaluation from Days 3-14. TEWL values returned towards pre-stripping values for treated and untreated areas by the initial Day 3 evaluation. CONCLUSION: For method A, there were trends suggesting the moisturizing treatment improved SC barrier quality. For method B, there were no significant differences/trends between treated and untreated areas. Further assessment with different methodologies is warranted to design appropriate clinical protocols for evaluating accelerated skin barrier repair. These data are insufficient to conclude whether the product or methodology was responsible for the results.


Asunto(s)
Emolientes/farmacología , Epidermis/fisiología , Crema para la Piel/farmacología , Pérdida Insensible de Agua/efectos de los fármacos , Adulto , Agua Corporal/fisiología , Epidermis/efectos de los fármacos , Femenino , Humanos , Persona de Mediana Edad , Estado de Hidratación del Organismo/efectos de los fármacos , Adulto Joven
19.
Eur J Radiol ; 113: 158-164, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30927942

RESUMEN

BACKGROUND: Marrow fat accumulates in diabetic conditions but remains elusive. The published works on the relationships between marrow fat phenotypes and glucose homeostasis are controversial. PURPOSE: To detect the association of insulin resistance with marrow adiposity in postmenopausal women with newly diagnosed type 2 diabetes (T2D) using chemical shift-encoded water-fat MRI. METHODS: We measured vertebral proton density fat fraction (PDFF) by 3T-MRI in 75 newly diagnosed T2D and 20 nondiabetic postmenopausal women. Bone mineral density (BMD), whole body fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Insulin sensitivity was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Lumbar spine PDFF was higher in women with T2D (65.9 ± 6.8%) than those without diabetes (59.5 ± 6.1%, P = 0.009). There was a consistent inverse association between the vertebral PDFF and BMD. PDFF had a positive association with glycated hemoglobin and HOMA-IR but not with fasting plasma glucose and insulin. PDFF was significantly increased, and BMD was decreased in a linear trend from the lowest (<1.90) to highest (≥2.77) HOMA-IR quartile. Multivariate linear regression analyses revealed a positive association between log-transformed HOMA-IR and PDFF after adjustment for multiple covariates (ß = 0.382, P < 0.001). The positive association of HOMA-IR with PDFF remained robust when total body lean mass and fat mass, BMD was entered into the multivariate regression model, respectively (ß = 0.293 and ß = 0.251, respectively; all P <0.05). CONCLUSIONS: Elevated HOMA-IR was linked to higher marrow fat fraction in postmenopausal women with newly diagnosed T2D independently of body compositions.


Asunto(s)
Adiposidad/fisiología , Enfermedades de la Médula Ósea/patología , Diabetes Mellitus Tipo 2/patología , Resistencia a la Insulina/fisiología , Absorciometría de Fotón/métodos , Tejido Adiposo/patología , Composición Corporal/fisiología , Agua Corporal/fisiología , Médula Ósea/patología , Estudios Transversales , Femenino , Homeostasis/fisiología , Humanos , Vértebras Lumbares , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Posmenopausia/fisiología
20.
Ann Biomed Eng ; 47(6): 1463-1469, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30891658

RESUMEN

Bio-electrical impedance analysis (BIA) is frequently used to assess body composition in man. Its accuracy in patients is limited, possibly because the employed algorithms are based on the assumption that total body electrical resistance (TBER) is exclusively related to body water volume, and that variation in fluid composition and its effect on fluid resistivity can be ignored. This may introduce substantial calculation errors. The aim of this study was to develop an objective method to assess plasma resistivity (ρplasma) based on measurements by a conductivity probe, as a surrogate for extracellular fluid resistivity (ρe). Sample measurements were standardized at body temperature. Analytical variation was 0.6% within runs and 0.9% between runs. The critical difference, i.e. the smallest difference needed to consider changes within individuals significant, was 1.8% for measurements within runs and 4.3% for measurements between runs. The normal range was defined by a mean ± SD of 66.9 ± 1.8 Ω cm. Multiple regression demonstrated that ρplasma was inversely related to plasma sodium and chloride concentrations, and positively related to total protein (overall R2 = 0.92, p < 0.001). In conclusion, ρplasma measurements were sufficiently robust to be useful as a tool to examine and improve the validity of BIA in clinical settings.


Asunto(s)
Impedancia Eléctrica , Plasma/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Agua Corporal/fisiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Temperatura , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...