Bioelectrical impedance analysis in the assessment of pre-eclampsia.

PURPOSE: Aim of this prospective investigation was to assess pre-eclampsia by bioelectrical impedance analysis (BIA). METHODS: A total of 22 pre-eclamptic as well as matched (patients' age, gestational age, parity, gravidity) healthy pregnant women underwent whole body BIA on admission and then, pre-eclamptic patients, every 2 days until childbirth. For all measured BIA single values and their corresponding reference value mean, standard deviation, minimum and maximum were calculated to compare pre-eclamptic women with corresponding reference values. Furthermore a paired t test and an ANOVA of repeated measurements were performed to detect differences of intraindividual measurements. Subsequently an analysis of variance was accomplished to analyse general changes in the course of time of investigated patients, who were measured more than once. RESULTS: Except for the phase angle, BIA parameters of pre-eclamptic women compared to corresponding reference values were significantly different, suggesting an increase of total body water in pre-eclampsia. Repeated measurements did not reveal statistically significant intra- or interindividual differences in the course of time. CONCLUSION: Bioelectrical impedance analysis allows differentiating healthy from pre-eclamptic women. Further investigations are needed to analyse if BIA is capable to serve as a prognostic diagnostic tool in the detection of deterioration of pre-eclampsia.

Pragmatic management of hyperglycaemia in acute ischaemic stroke: safety and feasibility of intensive intravenous insulin treatment.

BACKGROUND: In patients with acute ischaemic stroke, hyperglycaemia has been retrospectively associated with negative outcome. There is an ongoing discussion as to which treatment algorithm, if any, provides the most effective prospective intervention. Here we test the safety and feasibility of an intravenous insulin-only infusion protocol designed for pragmatic routine clinical use. METHODS: 40 ischaemic stroke patients with onset <24 h ago, admitted to our stroke unit, were randomized either to the study regimen (50 IU insulin in 50 ml 0.9% saline solution applied intravenously via a perfusor pump), with the aim of reaching and maintaining blood glucose levels between 4.44 mmol/l (80 mg/dl) and 6.11 mmol/l (110 mg/dl), or were treated with insulin subcutaneously if concentrations were above 11.10 mmol/l (200 mg/dl). Treatment was continued for 5 days. Primary outcome was the number of hypoglycaemic (<3.33 mmol/l; <60 mg/dl) and severe hyperglycaemic (>16.65 mmol/l; >300 mg/dl) events. RESULTS: Hypoglycaemic events were significantly more common in patients treated intensively (total n = 25; incidence rate ratio, IRR = 5.3; 95% CI = 1.2-22.4; p < 0.05). Symptomatic events were rare (total n = 5). Severe hyperglycaemia was associated with conventional treatment (IRR = 4.9; 95% CI = 1.5-15.9; p < 0.05). Though those treated intensively attained near-normoglycaemic levels quicker and had significantly lower blood glucose levels over the study period (6.49 +/- 2.19 mmol/l vs. 8.01 +/- 3.06 mmol/l; 95% CI = -1.78 to -1.28, p < 0.0005), treatment imposes considerable strain on both patients and caregivers. CONCLUSIONS: The intensive intravenous insulin infusion protocol effectively lowers blood glucose levels with an increased risk of manageable hypoglycaemic events. However, a highly motivated and trained staff seems essential, limiting feasibility outside of specialty care settings.

Modification of the Harris-Benedict equation to predict the energy requirements of critically ill patients during mild therapeutic hypothermia.

UNLABELLED: The aim of the present study was the comparison of calculated and measured values of the energy expenditure of critically ill patients during the different phases of therapeutic mild hypothermia. PATIENTS AND METHODS: Five patients (mean age 40.6 years, range 23 to 68 years, 2 females) suffering from severe acute cerebral injuries who underwent mild hypothermia were prospectively included into the study. Indirect calorimetry measurements were made at intervals of 3-4 hours and subsequently, during the steady state, at least every 12 hours. The results were compared with the basal metabolic rate calculated by the Harris-Benedict equation. RESULTS: A close linear correlation between body temperature and basal metabolism could be observed across a wide range of temperatures from 30.5 degrees C to 38.3 degrees C (r=0.82, p<0.001). One degree drop in temperature led to a 5.9% reduction in energy. During mild hypothermia, oxygen consumption was reduced by 71 mL/min (95% confidence interval 57 to 86 mL/min; p<0.001) as compared to base line. The basal metabolism rate was decreased by 30.3% (95% confidence interval 24.7 to 35.9%, p<0.001). The average value recorded was 16.7% below the values calculated in accordance with the Harris-Benedict equation (95% confidence interval 12.8 to 20.6%). CONCLUSION: The immediate reduction in oxygen requirements achieved by hypothermia is linearly correlated with the reduction in temperature and the hypothermia induced reduction in oxygen requirement recorded by indirect calorimetry is considerably below that calculated in accordance with the Harris-Benedict equation. If indirect calorimetry should not be available and the Harris-Benedict equation is used, a corrective factor is therefore needed to avoid an inaccurate calorie administration.

Effects of alimentary lipemia and inflammation on platelet CD40-ligand.

INTRODUCTION: In patients with chronic hypercholesterolemia, the CD40-CD40L dyad is upregulated, contributing to the initiation and progression of atherosclerosis. Our aim was to describe the role of postprandial lipemia and inflammatory stimulation on platelet and monocyte activation and CD40-ligand (CD40L) levels. METHODS AND RESULTS: Before and 2 h after consumption of a defined fatty meal, whole blood samples of 31 healthy subjects were incubated with endotoxin (LPS). CD40-ligand and CD62P expression on platelets, tissue-factor expression on monocytes and platelet-monocyte aggregates were measured with flow cytometry. Soluble CD40-ligand plasma levels were measured with an ELISA. After the meal, serum triglyceride levels increased from 137.6+/-60.5 mg/dl to 201.5+/-75.0 mg/dl. Expression of CD40L and CD62P on platelets and plasma levels of soluble CD40L were significantly decreased. No significant changes after the meal were observed concerning tissue factor expression on monocytes and platelet-monocyte aggregates. Addition of LPS showed no significant effect concerning CD40L or CD62P expression on platelets, whereas the amount of platelet-monocyte aggregates significantly increased under LPS stimulation after the fatty meal. CONCLUSIONS: Acute alimenatry lipemia leads to a decreased expression of CD40L on platelets and a reduced plasma level of sCD40L, suggesting an increased turnover in the CD40L system. CONDENSED ABSTRACT: Before and after a fatty meal, blood samples of 31 healthy subjects were incubated with LPS. After the meal, expression of CD40L and CD62P on platelets and plasma levels of soluble CD40L were significantly decreased. Addition of LPS showed no effect concerning CD40L or CD62P expression, whereas the amount of platelet-monocyte aggregates significantly increased under LPS stimulation after the fatty meal.

Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study.

BACKGROUND: Patients with cancer are characterized by a profound impairment of glucose utilization, with lipids being the preferred metabolic fuel. In contrast, the energy needs of malignant tumors are almost entirely met by glucose. We therefore studied the effects of a high-fat diet, particularly on body composition. PATIENTS AND METHODS: Twenty-three moderately malnourished patients with gastrointestinal carcinomas were randomized to receive either a conventional diet supplying 35 nonprotein kcal and 1.1 g of protein/kg per day (group A, n = 11) or a fat-enriched artificial liquid diet (20 nonprotein kcal/kg per day) plus normal meals (group B, n = 12) for a period of eight weeks, i.e., from the first to the third chemotherapy cycle. The fat content of the artificial diet was 66% of the nonprotein calories. The day before the nutritional interventions, and again after four and eight weeks, body compartments were determined using bioelectrical impedance analysis, lymphocyte subpopulations were quantified using flow cytometry, and some aspects of the quality of life were rated using four linear analog self-assessment (LASA) scales. The statistical calculations were done as an exploratory data analysis. RESULTS: The consumption of non-protein calories did not differ significantly between the two patient groups. An average weight gain in group B contrasted with an average weight loss in group A after four (P < 0.01) and eight weeks (P < 0.05). Fat-free mass showed an intergroup difference in favor of group B after eight weeks (P < 0.05). Body cell mass was maintained throughout the study in group B, but declined significantly up to weeks 4 and 8 in group A (intergroup difference: P < 0.05 and 0.01, respectively). A decrease in the total lymphocyte count by 559 cells/mul occurred with the fat-enriched diet (P < 0.05). Several aspects of the quality of life were rated to be better in group B than in group A, although not all differences reached statistical significance. CONCLUSION: In patients with cancer, a high-fat diet may possibly support the maintenance of both body weight and body cell mass. However, monitoring the lymphocyte count is advisable.

Whole-body versus segmental bioelectrical impedance analysis in patients with edema of the upper limb after breast cancer treatment.

AIM: The purpose of this study was to compare whole-body (50 kHz alternating current) and segmental (5 kHz alternating current) bioelectrical impedance analysis (BIA) in the assessment of manifested edema of the upper limbs. PATIENTS AND METHODS: Whole-body and segmental BIA were performed in 30 patients with edema of the upper limb following breast cancer treatment. RESULTS: Pearson correlation coefficient comparing both measurements was 0.8891 (p-value <0.0001) with corresponding least squares (r(2)) of 0.7904. CONCLUSION: Whole-body BIA seems to be a suitable method in the assessment of manifested edema of the upper limbs.

Whole-body bioelectrical impedance analysis in assessing upper-limb lymphedema after breast cancer therapy.

AIM: The purpose of this prospective study was to evaluate single-frequency whole-body bioelectrical impedance analysis (BIA) as a predictor for the onset of edema of the upper limb in patients undergoing treatment for breast cancer. MATERIALS AND METHODS: Whole-body BIA was performed before surgery, as well as at two days, and one, three, six and twelve months after surgery. RESULTS: Sixty women undergoing breast cancer surgery were examined, with loss of follow-up of 18 patients. Seven patients (14.3%) developed an edema of the upper limb within the first 12 months after surgery. Resistance (R) using whole-body BIA showed a fairly good performance in terms of sensitivity (85.71%) and specificity (97.4%) at predicting edema. The positive predictive value of 54.6% was unsatisfactory, whereas the negative predictive value was 97.4%. CONCLUSION: Resistance in whole-body BIA can be used to rule-out a developing edema of the upper limb.

Bioelectrical impedance analysis in pregnancy: reference ranges.

AIM: To generate reference values for bioelectrical impedance analysis (BIA) in a German collective of healthy pregnant women. MATERIALS AND METHODS: A total of 90 women with a singleton gestation from 23+0 to 40+6 weeks of pregnancy were enrolled from April 2012 until May 2013. Each week of gestation was represented by the same number of women (n=5). Mean BIA indices were generated for all patients and according to gestational age so that three collectives <30, 30 to 35 and >35 weeks of gestation were formed. Multiple regression analysis was implemented using maternal height, weight, body-mass index, gestational age, hematocrit and abdominal circumference to generate formulae to calculate individualized reference values for resistance, reactance, phase angle, height(2)/resistance, and total body water adjusted for gestation. RESULTS: Individualised reference values using the new formulae led to results which are more accurate than general mean values or mean values corresponding to the gestational age only. CONCLUSION: As far as we are aware of the present study is the first to report reference values for BIA indices in a German collective of healthy pregnant women. The new formulae generated by multiple regression analysis enabled for assessment of individualized reference values for BIA indices.

Comparing bioelectrical impedance values in assessing early upper limb lymphedema after breast cancer surgery.

AIM: The purpose of this prospective study was to evaluate resistance (R) and phase angle (Pa) determined by single-frequency whole-body bioelectrical impedance analysis (BIA), as predictors for the early onset of edema of the upper limb in patients undergoing surgical treatment for breast cancer. MATERIALS AND METHODS: Whole-body BIA was performed before surgery, as well as at two days, at one and three months after surgery. RESULTS: A total of 33 women undergoing breast cancer surgery were examined. Four patients developed an edema of the upper limb within the first three months after surgery. Both analyzed parameters showed a fairly good performance in terms of sensitivity (R=75%, Pa=75%) and specificity (R=86%, Pa=83%). The positive predictive values of 43% (R) and 38% (Pa) were unsatisfactory, whereas the negative predictive values were 96% for both parameters. CONCLUSION: Pa, as well as R, in whole-body BIA can be used to rule out a developing edema of the upper limb.

Bioimpedance analysis parameters and epicardial adipose tissue assessed by cardiac magnetic resonance imaging in patients with heart failure.

There is increasing evidence that body composition should be considered as a systemic marker of disease severity in congestive heart failure (CHF). Prior studies established bioelectrical impedance analysis (BIA) as an objective indicator of body composition. Epicardial adipose tissue (EAT) quantified by cardiac magnetic resonance (CMR) is the visceral fat around the heart secreting various bioactive molecules. Our purpose was to investigate the association between BIA parameters and EAT assessed by CMR in patients with CHF. BIA and CMR analysis were performed in 41 patients with CHF and in 16 healthy controls. Patients with CHF showed a decreased indexed EAT (22 ± 5 vs. 34 ± 4 g/m(2), P < 0.001) and phase angle (PA) (5.5° vs. 6.4°, P < 0.02) compared to healthy controls. Linear regression analysis showed a significant correlation of CMR indexed EAT with left ventricular ejection fraction (LV-EF) (r = 0.56, P < 0.001), PA (r = 0.31, P = 0.01), total body muscle mass (TBMM) (r = 0.41, P = 0.001), fat-free mass (FFM) (r = 0.30, P = 0.02), and intracellular water (ICW) (0.47, P = 0.0003). Multivariable analysis demonstrated that LV-EF was the only independent determinant of indexed EAT (P < 0.0001). Receiver operating characteristic curve analysis indicated good predictive performance of PA and EAT (area under the curve (AUC) = 0.86 and 0.82, respectively) with respect to cardiac death. After a follow-up period of 5 years, 8/41 (19.5%) patients suffered from cardiac death. Only indexed EAT <22 g/m(2) revealed a statistically significant higher risk of cardiac death (P = 0.02). EAT assessed by CMR correlated with the BIA-derived PA in patients with CHF. EAT and BIA-derived PA might serve as additional prognostic indicators for survival in these patients. However, further clinical studies are needed to elucidate the prognostic relevance of these new findings.

Alimentary lipemia enhances procoagulatory effects of inflammation in patients with a history of acute myocardial infarction complicated by ventricular fibrillation.

INTRODUCTION: Acute myocardial infarction, often occurring postprandially, can be complicated by ventricular fibrillation. The role of acute alimentary lipemia and inflammation in the occurrence of ventricular arrhythmias in acute myocardial infarction has not been described yet. METHODS AND RESULTS: Before and 2 h after consumption of a defined fatty meal, blood samples of 27 patients with a history of acute myocardial infarction (AMI) were incubated with lipopolysaccharide (LPS). In 10 patients, AMI was complicated by ventricular fibrillation (VF), in 17 patients, AMI occurred without VF. CD40-ligand and CD62P expression on platelets, tissue-factor binding on monocytes and platelet-monocyte aggregates were measured with flow cytometry. Soluble CD40-ligand plasma levels were measured with an ELISA. With the meal, serum triglyceride levels increased from 211.85+/-94.60 mg/dl to 273.59+/-122.52 mg/dl (p=0.0002). LPS stimulation before the meal showed a non-significant tendency to increase platelet-monocyte aggregates and tissue factor on monocytes in both patient groups. LPS stimulation in acute alimentary lipemia significantly increased tissue-factor expression on monocytes in both patient groups and platelet-monocyte aggregates in patients with VF. Baseline plasma levels of soluble CD40L did not differ significantly between both groups. Acute alimentary lipemia significantly decreased total plasma levels of sCD40L, leading to a significantly lower level of sCD40L in patients with a history of VF. CONCLUSIONS: Alimentary lipemia enhances procoagulatory effects of inflammatory stimulation in patients with a history of AMI complicated by ventricular fibrillation. These observations might reveal a mechanism for an increased risk of VF in acute coronary syndromes in a postprandial state.

Activation of coagulation during alimentary lipemia under real-life conditions.

High intake of saturated fat is a predictor of coronary heart disease mortality. The phenomenon of postprandial angina pectoris has been described many years ago. Although earlier studies have demonstrated postprandial activation of coagulation factors VII and XII, platelets and monocytes, conclusive evidence for intravascular fibrin formation after a fat-rich meal has not been reported yet. The present study included 33 healthy physicians (7 females, 26 males) with a mean age of 42 years (range 27-62 years), and 27 coronary heart disease patients (8 females, 19 males) with a mean age of 63 years (range 47-81 years). Of the coronary heart disease patients, 26/27 were treated with acetylsalicylic acid and 25/27 with lipid-lowering drugs simvastatin or atorvastatin. Blood samples were drawn 30-60 min before and 30-60 min after a dinner consisting of rye bread with liversausage and black pudding as hors d'oeuvre, lettuce with smoked bacon in a lard dressing, stuffed fried goose with red cabbage, potato dumplings and sweet chestnuts, and white and brown mousse au chocolat. Average intake per person was 3760 kcal, with 125.9 g protein, 238.0 g fat and 268.9 g carbohydrate. We measured a significant postprandial increase in fibrinopeptide A (FpA) levels from 1.14+/-1.23 microg/l to 4.18+/-2.86 microg/l (p<0.0001) in healthy probands, and 4.66+/-13.61 microg/l to 12.80+/-15.04 microg/l (p<0.0001) in coronary heart disease patients. Triglycerides increased from 137.6+/-60.5 to 201.5+/-75.0 mg/dl in healthy probands and from 211.9+/-94.6 to 273.6+/-122.5 mg/dl in coronary heart disease patients. Fat-rich meals may cause procoagulant episodes, which may promote vascular complications such as myocardial infarction, transient ischemia attacks in susceptible persons.

Multiple sclerosis and nutrition.

Benefits from any particular diet in multiple sclerosis (MS) have not yet been proven. It is, however, frequent that malnutrition may potentially exacerbate the symptoms of MS. There is some evidence that a high intake of saturated fat increases the incidence of MS. Epidemiological studies imply that unsaturated fatty acids may have a positive effect on the course of MS. However, the results of controlled studies are ambiguous. A meta-analysis of three small controlled clinical trials suggests a benefit from linoleic acid. Intake of Vitamin D is associated with a lower incidence of MS. In MS, the risk of osteoporosis is high, and prophylactic vitamin D and calcium should be considered at an early stage. The role of minerals, trace elements, antioxidants, vitamins or fish oil is unclear. The possible relationships between diet and MS have not been subjected to adequate study. It seems possible that in the future, diets or dietary supplements may become recommended forms of treatment for MS.