Total body water and percentage fat mass measurements using bioelectrical impedance analysis and anthropometry in spinal cord-injured patients.

BACKGROUND AND AIMS: Spinal cord injured patients may be adversely affected by disturbances of nutritional status, particularly malnutrition and fat mass overload. Malnutrition increases the risk for development of pressure sores, and fat mass excess increases the cardiovascular and respiratory risks of these patients, as well as predisposing to the development of diabetes mellitus, pressures sores and bony fractures. Body impedance analysis and anthopometry are easy bedside methods for body composition assessment. The aims of the study were to validate, in 20 spinal cord injured patients, body impedance analysis as a means to estimate total body water, and to validate a skinfold measurement of percentage fat independent of hydration of fat-free mass in the same population. METHODS: Total body water was measured by (18)O dilution as a reference method. Impedance and anthropometric measurements (four different skinfolds) were obtained. The results of total body water given by impedance analysis and calculated with three formulas were compared to the reference method. The fat mass percentage obtained with each of the skinfolds using the 3-compartment Siri's formula was compared to a reference value using the sum of the skinfolds. RESULTS AND CONCLUSION: The formula using 100 kHz resistance, height, weight and gender overestimated total body water by only 0.76 +/- 1.85 L, with an acceptable concordance with labeled water results. The formula with 50 kHz resistance was less accurate and concordant. Each skinfold may be used for assessing percentage fat mass. Based on these findings, we feel that the triceps skinfold, whose the variability is the lowest compared to the reference values, can be used alone in clinical practice.

[Nutritional status and clinical score of 95 patients examined by radiovideoscopy for deglutition]. / Etat nutritionnel et score clinique de 95 patients explorés en radiovidéoscopie de la déglutition.

Ninety five consecutive patients were examined. One performed swallowing videoradioscopy, swallowing clinical score calculation and nutritional assessment with four different methods: Body Mass Index (BMI), arm muscle circumference, dual frequency bioelectrical impedance analysis and serum albumin level. The easiest and the most reliable method for nutritional assessment, comparing to the others, was BMI, where only weight ant height were necessary to measure. So, the prevalence of protein-energy malnutrition was 24.2%, unlinked neither with the presence of videoradioscopy swallowing disorders nor with clinical swallowing score level. The score level was inversely correlated with the presence of videoradioscopy swallowing disorders, and correlated with feeding types: the highest for per os normal feeding, the lowest for patients with parenteral nutrition. The presence of videoradioscopy swallowing disorders was inversely correlated with feeding types. Swallowing clinical score was validated.

[Rehabilitation of female urinary incontinence]. / Rééducation de l'incontinence urinaire féminine.

Perineal rehabilitation is an appropriate alternative to surgery in the treatment of urinary female incontinence. The most important factors influencing the success of this technique is the ability of the patient to identify correctly the muscles of the pelvic floor, to strengthen this muscles using exercises, electrical stimulation and biofeedback, to contract voluntarily the pelvic floor musculature during stress or sensation of voiding for having a preventive effect on loss of urine, and also to change, if necessary, the micturitional and drinking customs. Some conditions are required to complete a good result: strong motivation of the woman, ability of the physiotherapist or the midwife, quality of care and follow-up of the physician who must clearly know the place of this conservative treatment in selected patients, particularly in moderate stress incontinence, without important prolapse, urge incontinence, pregnancy and post-partum, two conditions in which this technique must have a preventive and curative efficiency.