Significant differences between two commonly used bioimpedance methods in hemodialysis patients.

INTRODUCTION: Bioimpedance methods are currently used abundantly in patients on chronic hemodialysis. In this population, their most important role is to determine the level of fluid volume, respectively its intra- and extracellular components. There are several bioimpedance devices on the market. In this project, we compared two frequently used devices: Body Composition Monitor and InBody S10. MATERIALS AND METHODS: We invited patients on chronic hemodialysis who are being treated in our institution. Inclusion criteria were: clinically stable condition, lack of artificial joints, pacemakers, or other implanted metal objects. The examinations were performed just prior to hemodialysis by both methods 5 minutes apart. Patients were examined in the supine position after 15 minutes at rest to stabilize body fluids. Studied parameters were those that are obtainable by both methods: total body water (TBW) (L), extracellular water (ECW) (L) and intracellular water (ICW) (kg), lean tissue mass (LTM) (L), and fat tissue mass (kg). RESULTS: We included 14 participants (aged 64.4 ± 18.0 years). Statistically and clinically significant differences between data from compared devices were observed for all variables. Inbody S10 overestimated TBW by 2.58 ± 2.73 L and ICW by 4.56 ± 2.27 L in comparison to BCM. The highest difference (27%) was measured for LTM and ICW 22%. LTM, fat, and ECW were higher when measured by BCM (LTM by 8.54 ± 6.43 kg, p < 0.001; fat by 3.41 ± 4.22, p = 0.01; ECW by 2.01 ± 0.89 L, p < 0.001). CONCLUSION: The differences between tested devices were significant not only statistically, but also clinically. These two devices cannot be used interchangeably for dry weight setting of hemodialysis patients.

Nutrition care in bariatric/metabolic surgery.

The dietitian is an integral part of the multidisciplinary team of bariatric and metabolic surgery. The nutritional intervention is started already in the period of preparation for the bariatric procedure and focuses on the modification of the patient's current eating habits, weight reduction and understanding of the principles of the postoperative diet. After the bariatric procedure, the nutritional intervention ensures optimal nutrition of the patient within a specific diet regime implemented in the first weeks after the operation. However, nutritional care should continue at regular intervals for a long time after the procedure. It includes, for example, control of the appropriate diet composition, adherence to portion sizes and adequate drinking regime, as well as supplementation recommendations, all in relation to weight development, body composition and laboratory results.

Role of dietitian in obese patients care.

Setting the right eating habits is one of the basic pillars of non-pharmacological treatment of obese patient. Nutritional interventions led by dietitians are a key part of obesity management. The principle of modern nutritional therapy is not the transmission of general information about nutrition, but individualized recommendations. The task of a dietitian is to provide information that is specific, requested, at the right time and in the right form, information that is understandable to the patient and can be included in his/her life. Dietitian creates a therapeutic relationship with the patient based on trust and accompanies them on his path to mastering the principle of a diet for weight loss. There is thus a shift from a rigid approach to dietary treatment of obese patients, where instead of prescribing a diet aiming at weight loss, the patient is given space for their own active involvement. Emphasis is placed on the long-term sustainability of the newly set regime. Therefore, not only the present comorbidities of obesity, but also other factors such as the patient's daily routine, level of physical activity and individual habits are considered in a well-performed nutritional intervention.