Sarcopenia: The need to establish different cutoff points of fat-free mass for the Chilean population.

OBJECTIVES: International cutoff points for the diagnosis of sarcopenia are not applicable to the Chilean population due to previous evidence of a lower lean mass and strength in this population. Dual-energy x-ray absorptiometry is used to establish fat-free mass cutoff points to define sarcopenia in the Chilean population and analyze its association with handgrip strength in older adults. METHODS: Appendicular fat-free mass (AFFM) was calculated from 4062 dual-energy x-ray absorptiometries of healthy Chileans, ages 18 to 99 y. Possible cutoff points for sarcopenia were obtained using four methods: A) Normative, -2 standard deviation (SD) below mean AFFM/height2 (AFFMI) of adults age <40 y; B) normative -1 SD, -1 SD under the average AFFMI of adults age <40 y; C) stratification, 25th percentile of the residual distribution obtained with the regression equation to predict AFFM in the entire sample; and D) percentage, -2 SD under the average skeletal muscle mass/total body mass of individuals age <40 y. Additionally, in a subsample of elderly subjects, the correlation between handgrip strength and the four calculated cutoff points was analyzed. RESULTS: Using the normative method, sarcopenia was defined as an AFFMI <6.4 kg/m2 in men and <4.8 kg/m2 in women and at -1 SD, the cutoff points were <7.5 kg/m2 and <5.6 kg/m2, respectively. With the stratification method, sarcopenia was defined as -1.33 kg and -1.05 kg of AFFM with respect to the expected value according to the regression equation in men and women, respectively. According to the percentage method, the cutoff points for sarcopenia were <30% and <22.9% in men and women, respectively. The concordance of the four methods was slight to moderate. Only the percentage method showed a progressive increase in the proportion of subjects with sarcopenia as age increased. The latter and the normative -1 DS predicted lower handgrip strength in elderly women, unlike the other diagnostic methods. For elderly men, only the normative -1 DS method predicted weaker handgrip strength. CONCLUSIONS: The AFFM of young Chileans is lower than that reported in Western countries but similar to Latin American data; therefore, the use of the traditional normative method would not be appropriate with -2 SD to establish cutoff points, and using -1 DS resulted in values that are higher than Baumgartner's. Stratification is advantageous because this method throws expected values of AFFM for each population; however, overdiagnosis of sarcopenia is a possibility and thus the method requires a representative sample. The percentage method is simple and showed the expected decrease of muscle mass with age, and also correlated well with handgrip strength in elderly women. Thus, this method represented our method of choice to detect sarcopenia.

Incidencia del edema pulmonar no cardiogénico mediante estudio histopatológico periodo 2013 ­ 2016 / Incidence of noncardiogenic pulmonary edema by histopathological study period 2013 ­ 2016

El edema pulmonar no cardiogénico es una entidad fisiopatológica caracterizada por una lesión generalizada de los capilares pulmonares que provoca un aumento de su permeabilidad a los líquidos, proteínas y otros elementos formes de la sangre, ocasionando un constante flujo de líquidos desde la circulación pulmonar hacia el espacio intersticial y los alvéolos, resultando el edema pulmonar no cardiogénico. El objetivo de este estudio es considerar la incidencia de esta entidad en los casos de muertes súbitas, por medio del estudio histopatológico y caracterizar los factores predisponentes relacionados a esta patología. Todas las muestras fueron sometidas a procedimientos técnicos para estudio histopatológico para confirmar o descartar el diagnóstico macroscópico emitido en la necropsia. Para este estudio se analizaron 518 informes de estudio histopatológico correspondientes a los años 2013, 2014, 2015 y 2016, las cuales 119 correspondieron a edema pulmonar no cardiogénico, siendo el 22,97 % de estos 119 informes de estudio histopatológico se analizaron e interpretaron de acuerdo con los factores predisponentes teniendo como hallazgo importante 39,49 % al síndrome metabólico; 21,84 % a la intoxicación alcohólica; 14,28 % a la intoxicación medicamentosa, entre otros. De esto concluimos que es importante realizar el estudio histopatológico a los casos de muerte súbita sin diagnóstico, puesto que algunas pueden ser encasilladas en un síndrome metabólico o intoxicaciones que ameritan investigación para determinar la causa de muerte.

Non-cardiogenic pulmonary edema is a pathophysiological entity characterized by a generalized lesion of the pulmonary capillaries that causes an increase of its permeability to the fluids, proteins and other form elements of the blood, causing a constant flow of liquids from the pulmonary circulation towards the interstitial space and alveoli, resulting in non-cardiogenic pulmonary edema. The aim of this study is to consider the incidence of this entity in cases of sudden deaths, through the histopathological study and to characterize the predisposing factors related to this pathology. All samples were subjected to technical procedures for histopathological study to confirm or rule out the macroscopic diagnosis emitted at necropsy. For this study, 518 histopathological reports corresponding to the years 2013, 2014, 2015 and 2016 were analyzed, of which 119 corresponded to non-cardiogenic pulmonary edema, with 22.97% of these 119 histopathological reports being analyzed and interpreted according to to the predisposing factors having as important finding 39.49% to the metabolic syndrome; 21.84% to alcoholic intoxication; 14.28% to drug intoxication among others. From this we conclude that it is important to carry out the histopathological study to cases of sudden death without diagnosis since some may be pigeonholed in a metabolic syndrome or poisonings that warrant investigation to determine the cause of death.

The Prognostic Role of Phase Angle in Advanced Cancer Patients: A Systematic Review.

Phase angle (PA) is a ratio between the reactance and resistance obtained by bioelectric impedance analysis and has been interpreted as a cell membrane integrity indicator and a predictor of total body cell mass. A low PA may suggest deterioration of the cell membrane, which in advanced cancer patients may result in a reduced overall survival (OS). This systematic review sought to investigate the current evidence regarding whether there is an association between PA and OS in patients with advanced cancer (ie, metastatic disease). The search was conducted on electronic databases in August 2017. A total of 34 articles were identified in the initial literature search. Nine studies reporting on 1496 patients were deemed eligible according to our inclusion criteria. PA data were analyzed as continuous variables or according to different cutoffs, under a frequency of 50 Khz. Low PA was associated with worse nutrition status evaluated by body mass index, serum albumin level, transferrin, and fat-free mass. The median OS of the included papers varied from 25.5-330 days, and all studies analyzed showed a significant association between PA and OS, in that patients with low PA had worse OS. Future studies are necessary to justify the use of PA in therapeutic decisions for this population and to evaluate whether nutrition status can influence the association between PA and survival.

Accuracy of octa-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in children and adolescents with HIV: comparison with dual energy X-ray absorptiometry and air displacement plethysmography.

BACKGROUND: Body composition analysis has been used to investigate fat mass (FM) and bone mineral content (BMC) in children and adolescents diagnosed with HIV. Investigating the validity of bioelectrical impedance analysis (BIA) is interesting with respect to testing useful techniques for monitoring body composition in children and adolescents in clinical practice. The present study aimed to determine the validity of body composition analysis by BIA compared to dual-energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) in children and adolescents an HIV diagnosis. METHODS: Sixty-four children and adolescents (35 females and 29 males) with a mean (SD) age of 12.22 (2.13) years and with an HIV diagnosis participated in the study. Fat-free mass (FFM), FM and body fat percentage (%BF) were obtained by BIA for comparison with DXA and ADP. Segmented FM (trunk, legs and arms), lean soft tissue mass (LSTM) (total and segmented) and BMC were obtained by BIA for comparison with DXA. RESULTS: BIA presented a clinically acceptable correlation with DXA and ADP for FFM. Values found by BIA were underestimated compared to ADP, and overestimated compared to DXA. BIA presented a clinically acceptable correlation with DXA for LSTM estimates (total and segmented parameters) in both sexes (underestimating FM and overestimating LSTM). For other components (%BF, FM and BMC), BIA had a clinically unacceptable correlation with the reference methods in both sexes. CONCLUSIONS: BIA was suitable for evaluating FFM and LSTM in children and adolescents with an HIV diagnosis. For FM, %BF and BMC, BIA was not suitable for performing an evaluation in both sexes.

Modificación del volumen de los compartimientos líquidos corporales en pacientes tratados con cirugía correctora por cardiopatía isquémica / Volume modification of body fluids compartments in patients treated with corrective surgery due to ischemic heart disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 36 pacientes del sexo masculino con cardiopatía isquémica, intervenidos mediante cirugía correctora sin circulación extracorpórea en el Centro Territorial de Cirugía Cardiovascular de Santiago de Cuba, durante el primer cuatrimestre de 2010, a fin de identificar las modificaciones del vector de impedancia ante cambios del volumen del agua corporal por estrés quirúrgico en comparación con una población de referencia, para lo cual se utilizó el método de bioimpedancia eléctrica a 50 kHz. En la serie se apreciaron diferencias significativas en el eje mayor de las elipses de tolerancia (asociado al estado de hidratación) y en el eje menor (asociado a cambios de estructura), y la distribución del agua fue significativamente diferente entre la población de referencia y los pacientes en los estados preoperatorio y posoperatorio. Pudo concluirse que el método del análisis vectorial por bioimpedancia resulta útil para detectar las modificaciones del volumen de agua corporal provocadas por el estrés quirúrgico(AU)

A descriptive, longitudinal and prospective study of 36 patients of the male sex with ischemic heart disease was carried out. They were surgically treated by means of corrective surgery without extracorporeal circulation in the Territorial Center of Cardiovascular Surgery in Santiago de Cuba, during the first quarter of 2010, in order to identify the modifications of the impedance vector because of volume changes in body water due to surgical stress in comparison with a reference population, for which the electric bioimpedance method was used at 50 kHz. In the series significant differences in the highest axis of the tolerance ellipses were seen (associated to the hydration state) and in the smallest axis (associated to structure changes), and the distribution of water was significantly different between the reference population and the patients in the preoperative and postoperative conditions. It was concluded that the method of the vectorial analysis through bioimpedance is useful to detect the volume modifications of the body water caused by surgical stress(AU)

Modificación del volumen de los compartimientos líquidos corporales en pacientes tratados con cirugía correctora por cardiopatía isquémica / Volume modification of body fluids compartments in patients treated with corrective surgery due to ischemic heart disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 36 pacientes del sexo masculino con cardiopatía isquémica, intervenidos mediante cirugía correctora sin circulación extracorpórea en el Centro Territorial de Cirugía Cardiovascular de Santiago de Cuba, durante el primer cuatrimestre de 2010, a fin de identificar las modificaciones del vector de impedancia ante cambios del volumen del agua corporal por estrés quirúrgico en comparación con una población de referencia, para lo cual se utilizó el método de bioimpedancia eléctrica a 50 kHz. En la serie se apreciaron diferencias significativas en el eje mayor de las elipses de tolerancia (asociado al estado de hidratación) y en el eje menor (asociado a cambios de estructura), y la distribución del agua fue significativamente diferente entre la población de referencia y los pacientes en los estados preoperatorio y posoperatorio. Pudo concluirse que el método del análisis vectorial por bioimpedancia resulta útil para detectar las modificaciones del volumen de agua corporal provocadas por el estrés quirúrgico

A descriptive, longitudinal and prospective study of 36 patients of the male sex with ischemic heart disease was carried out. They were surgically treated by means of corrective surgery without extracorporeal circulation in the Territorial Center of Cardiovascular Surgery in Santiago de Cuba, during the first quarter of 2010, in order to identify the modifications of the impedance vector because of volume changes in body water due to surgical stress in comparison with a reference population, for which the electric bioimpedance method was used at 50 kHz. In the series significant differences in the highest axis of the tolerance ellipses were seen (associated to the hydration state) and in the smallest axis (associated to structure changes), and the distribution of water was significantly different between the reference population and the patients in the preoperative and postoperative conditions. It was concluded that the method of the vectorial analysis through bioimpedance is useful to detect the volume modifications of the body water caused by surgical stress

Association between fat mass and bone mineral density among Brazilian women differs by menopausal status: The Pró-Saúde Study.

OBJECTIVE: The aim of this study was to investigate the association between bone mineral density (BMD) and fat mass (FM) in a multiethnic population of Brazilian women and to evaluate the influence of total body mass and lean mass on this association. METHODS: This was a cross-sectional study nested within the Pro-Saúde Study, a prospective cohort of university civil servants in Rio de Janeiro. Participants were pre- (n = 100) and postmenopausal (n = 166) women. Total fat, lean mass, and BMD of total body, lumbar spine, and femoral neck were measured using dual energy x-ray absorptiometry. The association of BMD with FM was investigated after adjustment for total body mass (model 1) and lean mass (model 2) and potential confounding variables using multivariate linear regression models. RESULTS: In model 1, FM was inversely associated with BMD for total body (B = -0.010; P < 0.01) and for femoral neck (B = -0.009 P < 0.05) in premenopausal women. No association between FM and BMD was observed in postmenopausal women. Model 2 yielded direct associations between FM and BMD (total and specific sites; B = 0.003-0.008; P < 0.01) in postmenopausal women only. CONCLUSIONS: Independently of the adjustment used, the results of the present study suggest the absence of an inverse association between FM and BMD in postmenopausal women. Additionally, when adjusted for lean mass, a direct association between FM and bone mass can be observed, suggesting that for postmenopausal women being slightly obese does not confer excessive risk for bone loss and may even result in a bone density advantage.

Physical activity throughout adolescence and body composition at 18 years: 1993 Pelotas (Brazil) birth cohort study.

BACKGROUND: Adolescence is a period of accelerated development and increases in body composition. Physical activity (PA) practice has been associated with the development of major components of body composition (bone, muscle and fat). However, the longitudinal effects of PA of different intensities during adolescence are still not well understood. Thus, the main goal this study has investigate the association between practice of moderate- and vigorous-intensity physical activity throughout adolescence and body composition, specifically lean mass (LM) and fat mass (FM), at age 18. METHODS: In this cohort study, physical activity was measured at 11, 15 and 18 years, using questionnaires. Thresholds of 300, 150 and 75 min per week, were used for MVPA, moderate- and vigorous-intensity physical activity, respectively. Consistent physical activity was defined as reaching the thresholds at the three follow-ups. FM and LM at age 18 were assessed by DXA and expressed as fat mass (FMI) and lean mass (LMI) indexes. To verify the association between the trajectories of MVPA, moderate- and vigorous-intensity physical activity in adolescence and FM and LM at 18, multivariate analyses were performed through multiple linear regressions adjusted for co-variables. RESULTS: A total of 3,176 adolescents were evaluated. The consistent practice of moderate- and vigorous-intensity physical activity according to thresholds during adolescence were directly related to the LMI in boys (moderate-intensity - ß = 0.40 and CI95 % 0.13; 0.68 and vigorous-intensity - ß = 0.95 and CI95 % 0.69; 1.21) and girls (Moderate-intensity - ß = 0.23 and CI95 % 0.02; 0.45 and vigorous-intensity - ß = 0.80 and CI95 % 0.29; 1.32). Practice of vigorous-intensity physical activity alone showed to be inversely associated with the FMI in boys (ß = -0.53 and CI95 % -0.96;-0.10). CONCLUSION: Consistent physical activity practice during adolescence was associated with greater lean mass in both sexes. In boys, vigorous-intensity physical activity was associated with less fat mass.

Effects of 12 weeks of combined training without caloric restriction on inflammatory markers in overweight girls.

The objective of the present study was to investigate the effects of combined training without caloric restriction on inflammatory markers in overweight girls. Thirty-three girls (13-17 years) were assigned into overweight training (n = 17) or overweight control (n = 16) groups. Additionally, a normal-weight group (n = 15) was used as control for the baseline values. The combined training programme consisted of six resistance exercises (three sets of 6-10 repetitions at 60-70% 1 RM) followed by 30 min of aerobic exercise (walking/running) at 50-80% VO2peak, performed in the same 60 min session, 3 days/weeks, for 12 weeks. Body composition, dietary intake, aerobic fitness (VO2peak), muscular strength (1 RM), glycaemia, insulinemia, lipid profile and inflammatory markers (C-reactive protein, interleukin-6, tumour necrosis factor-alpha, interleukin-10, leptin, resistin and adiponectin) were measured before and after intervention. There was a significant decrease in body fat (P < 0.01) and increase in fat-free mass (P < 0.01), VO2peak (P < 0.01), 1 RM for leg press (P < 0.01) and bench press (P < 0.01) in the overweight training group. Concomitantly, this group presented significant decreases in serum concentrations of C-reactive protein (P < 0.05) and leptin (P < 0.05), as well as in insulin resistance (P < 0.05) after the experimental period. In conclusion, 12 weeks of combined training without caloric restriction reduced inflammatory markers associated with obesity in overweight girls.

Exposición a fluidos corporales en trabajadores de salud del Hospital Universitario de Caracas: primer reporte: años 1991-1999 Caracas República de Venezuela / Exposure to body fluids in health workers the Hospital Universitario de Caracas: first report: years 1991-1999 Caracas República de Venezuela

Estudio prospectivo diseñado con el fin de evaluar a los trabajadores de salud del Hospital Universitario de Caracas que notificaran exposición a fluidos corporales al Sistema de Vigilancia de Virus de Inmunodeficiencia Humana y Hepatitis Viral, desde los años 1991 hasta 1999. Las variables estudiadas fueron: fecha y sitio del accidente, categoría del personal, edad, género, fluido involucrado, tipo de exposición, instrumento utilizado, serología basal para Virus de Inmunodeficiencia Humana y hepatitis viral del paciente índice y del TS, tipo de profilaxis antirretroviral, efectos adversos y seroconversión al Virus de Inmunodeficiencia Humana. Se utilizó el método descriptivo serie de casos los cuales fueron analizados por Epi-info. Versión 5. Durante el período de estudio fueron evaluados 242 trabajadores de la salud con exposición a fluidos corporales, 65% accidentes fueron notificados los dos últimos años. Ciento sesenta y tres femeninos y 79 masculinos, edad promedio 43 años (rango de 21-65 años). Los trabajadores de la salud que notificaron exposición a fluidos corporales procedían principalmente de los servicios de medicina interna, emergencia y cirugía. El mayor número de los accidentes correspondió a los médicos, principalmente residentes de posgrado. Exposición de tipo parenteral fue observada en 197 casos (179 percutáneas, y 18 salpicaduras en mucosas). Exposición cutánea se observó en 14 y combinada (piel y mucosas) 23 casos. El instrumento utilizado en 179 exposiciones percutáneas fue aguja con lumen en 48%. El fluido corporal involucrado fue la sangre en el 73% de los casos. La fuente fue conocida en 65% de las exposiciones. La profilaxis antirretroviral posexposición fue indicada inicialmente en 52% de los TS. Los efectos adversos se presentaron en 40%, en 7 casos fue motivo de abandono de tratamiento. El seguimiento se realizó en el 80% de los casos. Un trabajador de salud presentó Virus de Inmunodeficiencia Humana ocupacional...

Prospective study designed to assess the health workers at the Hospital Universitario de Caracas to notify body fluid exposure to Human Immunodeficiency Virus Surveillance System and Viral Hepatitis, from the years 1991-1999. The variables studied were: date and place of the accident, staff category, age, gender, fluid involved, type of exposure, instrument used, and baseline serology for Human Immunodeficiency Virus and Viral Hepatitis of health workers and index patient, type of prophylaxis antiretroviral, side effects and Human Immunodeficiency Virus seroconversion. Descriptive method was used series of cases which were analyzed by Epi-info. Version 5. During the study period were evaluated health workers 242 with body fluid exposure, 65% accidents were reported the past two years. 163 female and 79 male, mean age 43 years (range 21-65 years). Health workers who reported exposure to body fluids were mainly of Internal Medicine, Emergency and Surgery. The greatest numbers of injuries were doctors, mainly postgraduate residents. Parenteral exposure rate was observed in 197 cases (179 percutaneous, splash to mucous membranes 18). Dermal exposure was observed in 14 and combined (skin and mucosa) 23 cases. The instrument used in 179 percutaneous exposures was needle lumen in 48%. The body fluid blood was involved in 73% of cases. The source was known in 65% of exposures. Antiretroviral prophylaxis post exposure was initially indicated in 52% of the TS. Adverse events occurred in 40 %, in 7 cases was cause for withdrawals. The monitoring was performed in 80%. A case of Human Immunodeficiency Virus occupational in which it ruled out other risk factors

Excess body fat negatively affects bone mass in adolescents.

OBJECTIVE: The aim of this study was to investigate the effects of excess body fat on bone mass in overweight, obese, and extremely obese adolescents. METHODS: This study included 377 adolescents of both sexes, ages 10 to 19 y. Weight, height, body mass index (BMI), bone age, bone mineral content (BMC), and bone mineral density (BMD) were obtained by dual-energy x-ray absorptiometry. The results were adjusted for chronological age and bone age. Comparisons according to nutritional classification were performed by analysis of variance, followed by Tukey test. Linear regression models were used to explain the variation in BMD and BMC in the L1-L4 lumbar spinal region, proximal femur, and whole body in relation to BMI, lean mass, fat mass (FM), and body fat percentage (BF%), considering P < 0.05. RESULTS: For all nutritional groups, average bone age was higher than chronological age. In both sexes, weight and BMI values increased from eutrophic to extremely obese groups, except for BMD and BMC, which did not differ among male adolescents, and were smaller in extremely obese than in obese female adolescents (P < 0.01). Significant differences were observed for FM and BF% values among all nutritional groups (P < 0.01). Positive, moderate to strong correlations were detected between BMD and BMC for BMI, lean mass, and FM. A negative and moderate correlation was found between BMC and BF%, and between BMD and BF% at all bone sites analyzed in males and between BF% and spine and femur BMD, in females. CONCLUSION: The results reveal a negative effect of BF% on bone mass in males and indicate that the higher the BF% among overweight adolescents, the lower the BMD and BMC values.

Bioelectrical impedance vector analysis in obese women before and after bariatric surgery: changes in body composition.

OBJECTIVE: Because of the inefficacy of standard methods for the evaluation of body composition of grade III obese individuals, it is difficult to analyze the quality of weight loss after bariatric surgery in these patients. Electrical bioimpedance vector analysis and the RXc graph uses crude resistance (R) and reactance (Xc) values, like components of the Z vector, to monitor variations in body fluid and the nutritional status of obese individuals. Using bioelectrical impedance vector analysis (BIVA) and the RXc graph, the objective of the present study was to evaluate long-term changes in weight and body composition of obese women after Roux-en-Y bariatric surgery. METHODS: A study was conducted on 43 grade III obese women submitted to bariatric surgery. Anthropometric and bioimpedance (800 mA-50 kHz) data were obtained during the preoperative period and 1, 2, 3, and 4 y after surgery. BIVA was performed by plotting resistance and reactance values corrected for body height (R/H and Xc/H, Ohm/m) as bivariates on the RXc graph. BIVA software was used to plot the vectors of the RXc plane. RESULTS: Surgery promoted changes in body composition, with a reduction of fat mass and of fat-free mass. During the postoperative period, the vectors demonstrated migration to the right lower quadrant of the graph, corresponding to the classification of cachexia and water retention. CONCLUSION: Weight loss due to surgery results in an important reduction of fat-free mass characterized by the position of most individuals in the cachexia quadrant throughout the postoperative period.

Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents.

The purpose of this study was to determine whether aerobic plus resistance training (AT + RT) is more effective than aerobic training (AT) at reducing inflammatory markers and cardiovascular risk in obese adolescents. A total of 139 obese adolescents were enrolled, aged 15-19 years, body mass index (BMI) ≥ 95th percentile and participated in 1 year of interdisciplinary intervention. They were randomised into two groups: AT (n = 55), AT + RT (n = 61). Blood samples were collected to analyse glycaemia, insulin, the lipid profile, leptin and adiponectin concentrations. Insulin resistance was measured by homeostasis model assessment of insulin resistance index (HOMA-IR). The AT + RT group showed better results with regard to decreased body fat mass, low-density lipoprotein concentration (LDL-c) levels, subcutaneous and visceral fat and increased body lean mass. Indeed, a reduction of hyperleptinaemia and an increase in adiponectin concentrations, promoting an improvement in the leptin/adiponectin ratio, was observed. Important clinical parameters were improved in both types of exercise; however, AT + RT was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than AT alone, suggesting clinical applications for the control of intra-abdominal obesity and cardiovascular risk in the paediatric population.

Comparison of two bioelectrical impedance devices and dual-energy X-ray absorptiometry to evaluate body composition in heart failure.

BACKGROUND: The utilisation of bioelectrical impedance analysis (BIA) in heart failure can be affected by many factors and its applicability remains controversial. The present study aimed to verify the adequacy of single-frequency BIA (SF-BIA) and multifrequency BIA (MF-BIA) compared to dual-energy x-ray absorptiometry (DEXA) for evaluating body composition in outpatients with heart failure. METHODS: In this cross-sectional study, 55 patients with stable heart failure and left ventricle ejection fraction ≤45% were evaluated for fat mass percentage, fat mass and fat-free mass by DEXA and compared with the results obtained by SF-BIA (single frequency of 50 kHz) and MF-BIA (frequencies of 20 and 100 kHz). RESULTS: MF-BIA and DEXA gave similar mean values for fat mass percentage, fat mass and fat-free mass, whereas values from SF-BIA were significantly different from DEXA. Both SF-BIA and MF-BIA measures of body composition correlated strongly with DEXA (r > 0.8; P < 0.001), except for fat mass assessed by SF-BIA, which showed a moderate correlation (r = 0.760; P < 0.001). MF-BIA also showed a better agreement with DEXA by Bland-Altman analysis in all measurements. However, both types of equipment showed wide limits of agreement and a significant relationship between variance and bias (Pitmans's test P > 0.05), except MF-BIA for fat-free mass. CONCLUSIONS: Compared with DEXA, MF-BIA showed better accuracy than SF-BIA, although both types of equipment showed wide limits of agreement. The BIA technique should be used with caution, and regression equations might be useful for correcting the observed variations, mainly in extreme values of body composition.

Ventajas de los biosensores en hemodiálisis / Advantages of biosensors in haemodialysis

Fundamento: los avances tecnológicos en el campo de la electrónica y la informática han proporcionado grandes mejoras en la seguridad y tolerancia a la hemodiálisis. La incorporación de biosensores que informan del desarrollo de la sesión de hemodiálisis en tiempo real ha supuesto una novedad relevante.Objetivo: profundizar sobre la utilidad y los principios de los biosensores aplicados a las máquinas actuales de la hemodiálisis.Método: se realizó una revisión de investigaciones publicadas en revista de nefrología biomed.uninet; asn-online.org y scielo., libros, revistas y manuales de funcionamiento de las máquinas de hemodiálisis seleccionándose 34 artículos científicos sobre los biosensores y su empleo.Desarrollo:revisión de los avances tecnológicos en las máquinas de hemodiálisis, los biosensores existentes, con las señales captadas por el sensor, su equivalente biológico y la señal clínica que nos aportan.Conclusiones: los biosensores son monitores que, a través de señales fisicoquímicas obtenidas del circuito extracorpóreo de sangre o del baño de diálisis, proporcionan datos de la eficacia de la sesión de hemodiálisis o de los cambios que produce en el medio interno del enfermo(AU)

Background: technological advances in the fields of electronics and computer science have provided great improvements concerning safety and tolerance to haemodialysis. The incorporation of biosensors that inform about the progress of the haemodialysis session in real time has meant a significant innovation.Objective: to look in depth at the usefulness and principles of biosensors applied to current haemodialysis machines.Method: a review of researches published in nephrology journals, biomed.uninet, as-online.org, Scielo, books, other journals, and training manuals about the workings of haemodialysis machines, was made. Thirty-four scientific articles related to biosensors and the instructions for their use, were selected.Development: a review of the technological advances related to haemodialysis machines, the existing biosensors, the signals received by the sensor, the biological equivalent and the clinical signal they contribute with, was made.Conclusions: biosensors are monitors that, by means of physical-chemical signals obtained from the extracorporeal circuit of blood or of the dialysis bath, provide information of the effectiveness of the session of haemodialysis or of the changes that it produces in the organism of the patient(AU)

The impact of nutritional supplementation on quality of life in patients infected with hepatitis C virus.

BACKGROUND: The present study aimed to evaluate the impact of animal and vegetable protein supplementation on health-related quality of life (HRQL) in patients with hepatitis C virus (HCV) and to investigate clinical and nutritional variables related to quality of life in these patients. METHODS: One hundred and forty patients infected with HCV were randomly assigned to one of two groups: the Soy Group (SG; n = 72), where patients received a soy supplement diet and the Casein Group (CG; n = 68), where patients received casein as a supplement. Anthropometric, biochemical and clinical assessments were performed in all patients, and the Short-Form Health Survey was applied at baseline and 12 weeks after study initiation. RESULTS: Before supplementation, poor HRQL scores were associated with female sex (P = 0.004) and advanced fibrosis (F3/F4; P = 0.04). Reduced HRQL scores were correlated with age (r = -0.263; P = 0.002), serum albumin levels (r = 0.245; P = 0.004), lean mass (r = 0.301; P < 0.0001) and body fat percentage (r = -0.262; P = 0.002). After 12 weeks of intervention, patients in both supplementation groups showed significantly increased HRQL scores, with no difference being observed between the SG and the CG. CONCLUSIONS: Nutritional therapy with either soybean or casein supplementation improved quality of life in patients infected with HCV. Quality of life was influenced by anthropometric, biochemical, clinical and sociodemographic factors in patients with HCV before nutritional supplementation.

Body composition in prepubertal, HIV-infected children: a comparison of bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

BACKGROUND: The aim of this study was to compare bioelectrical impedance analysis (BIA) equations developed for healthy pediatric populations and for HIV-infected children using dual-energy X-ray absorptiometry (DXA) as the gold standard. MATERIALS AND METHODS: A cross-sectional study was carried out with 40 prepubertal, HIV-infected children who regularly attended the Pediatric Infectious Disease Clinic at the Universidade Federal de São Paulo, São Paulo, Brazil. The study was conducted from August to November 2008. Demographic data, clinical parameters, immunological status, and use of antiretroviral therapy were obtained from the patients' medical records. We performed anthropometric parameters and body composition analyses, analyzed body composition by BIA and DXA, and compared the results obtained from BIA through using equations for both healthy and HIV-infected populations. RESULTS: The mean ± SD age of the study population was 9.8 ± 1.2 years. Half of the population were females, and 82.5% of the children were clinically classified as B and C. Total body fat, by both absolute mass and by percentage, exhibited high homogeneity between the results obtained from BIA and DXA. However, there was no concordance in fat-free mass. The equation for healthy children showed good sensitivity and specificity when comparing the percentage of total body fat measured by DXA. CONCLUSION: BIA provides reliable data on total body fat but not fat-free mass when compared with DXA. The BIA equation developed for healthy pediatric populations can be used to determine total body fat in HIV-infected children.

Effects of pregnancy and feeding level on carcass and meat quality traits of Nellore cows.

Carcass and meat quality traits of 16 pregnant and 5 non-pregnant cows fed at 1.2 times maintenance and 16 pregnant and 6 non-pregnant fed ad libitum were evaluated. Pregnancy did not affect final body weight (FBW; P=0.0923), cold carcass yield (CCY; P=0.0513), longissimus muscle area (LMA; P=0.8260), rib fat thickness (RFT; P=0.1873) and shear force (WBSF; P=0.9707). A lower FBW (P=0.0028), LMA (P=0.0048) and RFT (P=0.0001) were observed in feed restricted cows. However, no differences were found for CCY (P=0.7243) and WBSF (P=0.0759) among feeding level groups. These data suggests that carcass and meat quality traits are not affected by pregnancy status in Nellore cows. Moreover, although cows experiencing feed restriction did have reduced deposition of subcutaneous fat and lean tissue, there were no major impacts on meat quality traits.

Manejo odontológico del paciente con enfermedad renal crónica terminal: revisión bibliográfica / Dental management of patients with chronic renal disease: a review

La enfermedad renal avanzada es la incapacidad de los riñones para excretar los productos de desecho del organismo, concentrar la orina y conservar los electrolitos, que trae como consecuencia manifestaciones sistémicas que provocan patologías bucales entre otras entidades. El objetivo de esta investigación es realizar una revisión bibliográfica destacando las manifestaciones bucales más importantes, el manejo y cuidados que debe tener el odontólogo al momento de atender a un paciente que presente este trastorno

Advanced renal disease is the inability of the kidneys to excrete waste products from the body, concentrate urine and conserve electrolytes, which results in systemic manifestations that cause oral pathologies among others. The objective of this research is to review literature highlighting the most important oral manifestations, management and care that should the dentist have when treating a patient with this disorder

Is a body mass index of 23 kg/m² a reliable marker of protein-energy wasting in hemodialysis patients?

OBJECTIVE: To evaluate the body composition and inflammatory status in patients on hemodialysis (HD) according to the cutoff of 23 kg/m² for the body mass index (BMI). METHODS: Forty-seven patients (30 men, 11 diabetics, 53.8 ± 12.2 y of age, 58.2 ± 50.9 mo on HD) were studied. Anthropometric data and handgrip strength were evaluated. C-reactive protein, tumor necrosis factor-α, leptin, and interleukin-6 were measured. Mortality was assessed after 24 mo of follow-up. RESULTS: Nineteen patients (40.4%) presented BMI values lower than 23 kg/m² and leptin levels, midarm muscle area, and free-fat mass were significantly lower in these patients. The prevalence of functional muscle loss according to handgrip strength was not different between the BMI groups. The sum of skinfold thicknesses, the percentage of body fat, fat mass, the fat mass/free-fat mass ratio, and waist circumference were significantly lower in patients with a BMI lower than 23 kg/m², but the mean values did not indicate energy wasting. Patients with a BMI higher than 23 kg/m² presented a higher prevalence of inflammation and higher waist circumference and body fat values. The adiposity parameters were correlated with C-reactive protein and leptin. A Cox multivariate regression analysis demonstrated that C-reactive protein, tumor necrosis factor-α, and interleukin-6 predict cardiovascular mortality. CONCLUSION: Patients on HD with a BMI lower than 23 kg/m² did not present signs of energy wasting, whereas those with a BMI higher than 23 kg/m² had more inflammation, probably because of a greater adiposity. Thus, the BMI value of 23 kg/m² does not seem to be a reliable marker of protein-energy wasting in patients on HD.