BIA health assessment -
Our results clearly show that assessing body composition and diagnosing sarcopenia using the DSMF-BIA method is comparable to the DXA scan in older adults with T2DM.
This was not affected by a week intervention period with treatment modalities often used in the treatment of T2DM. The degree of agreement between the methods was overall better when comparing parameters of LBM than parameters of FM.
For diagnosing sarcopenia in the clinical setting, DSMF-BIA had high specificity and high negative predictive value, suggesting it may be a useful screening tool for this condition.
Discrepancies between DXA and DSMF-BIA have been previously noted in different populations. This discrepancy highlights the importance of validation of DSMF-BIA in different populations and under different physiologic interventions.
Given the increasing rates of diabetes in general and in older adults in particular [ 2 ] and the wide use of BIA methods in studies testing diabetes and sarcopenia outcomes [ 31 ], it is not surprising that there was a call for validation studies testing the accuracy of BIA for this population [ 31 ].
Using DXA as a method to diagnose sarcopenia has several inherent limitations. DXA scan is less accessible and more expensive than DSMF-BIA. Very tall and very obese individuals cannot be adequately measured in a standard DXA machine and body thickness and hydration status e.
Moreover, to ensure the accuracy of any method for assessing muscle mass, standardization is needed. Calibration of materials and equations used to derive lean mass should be standardized across manufacturers. It is important to standardize the local regions of interest, such as trunk, arms, legs, which are different across manufacturers.
Finally, defining a reference population in the same way as has been achieved for the use of DXA in diagnosing osteoporosis should be considered [ 43 ]. The strengths of this manuscript include its relatively large population, its prospective nature and focus on a relatively poorly studied population of older adults with diabetes and low physical activity level.
Moreover, we present the lack of a significant effect of commonly used interventions for the treatment of T2DM on the validity of DSMF-BIA. Its weaknesses include the limited sample size in the prospective phase, the relatively short period of follow up and the fact that the study was not specifically designed to validate MF-BIA vs.
Also, the validity tested in the current paper is limited to relatively young older adults with T2DM who have limited rate of complications with low levels of sarcopenia.
In that sense the significance of the findings presented here are important for early detecting lower muscle mass for early prevention, but with the cost of limited external validity.
In conclusion, the DSMF-BIA as compared to DXA is a reliable screening technique for sarcopenia in older patients with T2DM. Accurate and accessible diagnosis of sarcopenia is crucial in older subjects with diabetes and directly affects clinical decisions and treatment [ 44 , 45 , 46 ].
The routine use of DSMF-BIA as a screening tool for sarcopenia in clinics treating older patients with diabetes should be considered. World Health Organization. World report on ageing and health.
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Sarcopenic obesity assessed using dual energy X-ray absorptiometry DXA can predict cardiovascular disease in patients with type 2 diabetes: a retrospective observational study.
Cardiovasc Diabetol. Marra M, Sammarco R, De Lorenzo A, Iellamo F, Siervo M, Pietrobelli A, et al. Assessment of body composition in health and disease using bioelectrical impedance analysis BIA and dual energy X-ray absorptiometry DXA : a critical overview [Internet].
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Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population. Sartorio A, Malavolti M, Agosti F, Marinone PG, Caiti O, Battistini N, et al. Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis.
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The analyzer calculates your tissue and fluid compartments using an imperceptible electrical current passed through pads placed on one hand and foot as you lie comfortably on a treatment couch.
Fatty tissue, which is low in water, is not. Thus, the resistance to the flow of electrical current measured by the analyzer can be used to calculate the body composition. Over independent studies conducted over the past 20 years have demonstrated that BIA can provide an accurate and clinically useful assessment of body composition.
Nutrition and Wellness Institute. Home About Us Services Appointments Insurance Dispensary Contact Us. BIA Bioelectrical Impedance Analysis What is Bioimpedance Analysis and why do you need one?
Once current has been sent to active tactile electrodes at a frequency at 50 KHz, its intensity enables the system to measure the reactance and resistance between 2 other passive tactile electrodes tetra-polar mode. BIA and Its Calculated Parameters Total Body Water TBW Impedance measurements provide a quite accurate picture of electrolyte water contained in tissue.
Orally ingested water, which has not yet been absorbed by the body, is not measured; the same goes for ascites, because it is not part of the lean body mass. Administered solutions, however, are detected immediately.
Lean Body Mass LBM The lean body mass is for the most part made up of inner organs, muscles, the skeletal system and the central nervous system, and refers to the tissue mass of the body that contains no fat. These organ systems, although morphologically very different, contain matching functional structures.
All of them contain matrix substance and extra-cellular fluids that support the metabolic exchange and assist in substrate transport and are made of cells that execute the synthesis and metabolism processes in the body.
In cases of for example edema or intensive car patients, where the quantity of lean body mass hydration is pathological, irregular calculations may be gathered for body cell mass, lean body mass, and extra-cellular mass - the secondary parameters - and will make the assessment of BIA measurements more difficult.
It helps in these cases, to look at the initial assessment and values for resistance, phase angle and reactance. The lean body mass contains of two subdivisions. One is the body cell mass BCM, also referred to as the motor of the organism, and the other one is the connective tissues and transport medium, the extra-cellular mass ECM.
Body Cell Mass BCM All tissue of the human organism entails to a certain degree Body cell mass, and the sum of all cells that are actively involved in the metabolic processes is called BCM.
While it is rather a functionally defined section and not so much an anatomically one above all, it consists all of the cells of the inner organs and muscles, with the muscles and the highest percentage to constitute the largest part of the BCM. Connective tissue with low fibrocyte content however only makes up a small percentage of the entire BCM, and adipocytes, due to their low energy metabolism are not at all considered being part of the BCM.
Consequently, the sum of adipocyte cells therefore forms its own compartment in the body. Included in the BCM are the following tissue forms: the smooth muscles, the cells of the skeletal muscle system, the inner organs, the cardiac muscles, the blood, the gastrointestinal tract, the nervous systems and the glands.
As all of the body's metabolic function is performed within the cells of the BCM, the BCM is the main specification for the analysis of a patient's nutritional state. It is also used as the standard specification for establishing the calorific requirement of the body and for the assessment of energy consumption.
In addition to the catabolism, the BCM also performs work on the anabolism including the keeping up of synthesis and cell structures for the ECM: For example the transportation proteins and enzymes, and the formation of connective tissue fibres, cartilage tissues and bones.
A person's body cell mass is a fractional constituent of the lean body mass, and a number of factors, such as age and physical condition or genetics constitution type play a role in the BCM that is available in an individual.
A higher percentage of body cell mass present in lean body mass is for example found in young people with high physical activity, such as competitive athletes.
Their muscles are trained in the maturation phase of the body, and as a result, this higher proportion tends to be found in these individuals throughout their lives persistent hypertrophy of the muscle cells.
Age is also a factor in BCM. Older persons that are active, however, can retain their BCM to a large degree. These are optimal figures for BCM in the lean body mass.
In view of the easy measuring methods for the assessment of the body composition, only phase sensitive BIA can be regarded to determine the BCM, and the maintenance of the BCM should be the main goal in any form of nutritional therapy.
A reduction of the body cell mass in BIA happens because of a genuine substantial loss of body cell mass, that can however also be accompanied by a temporary intracellular water loss. Extra-Cellular Mass ECM The extra-cellular mass ECM is the term for the lean body mass that exists outside the cells of the BCM.
Skin, elastin, collagen, tendons, bone and fasciae are the established connective tissue structures of the ECM, with the fluid parts consisting of plasma, interstitial and trans-cellular water. Trans-cellular water is the description of fluids that are present in the body cavities, for example the contents of the gastro-intestinal lumen and the spinal fluid, while non-physiological trans-cellular fluids appear as ascites, or as pericardial or pleural effusions.
As approx. For example in an ascites of 5 litres, the trunk's resistance would only change by a few ohms, leaving the total resistance practically uninfluenced. Differences in fat mass that were brought about by weight changes generally appear without a change of resistance, hence the reason why BIA measurements are calculated as changes in fat mass, when it pertains to weight increases caused by ascites or pregnancy.
As the body cell mass BCM in healthy persons is always considerably larger than the extra-cellular mass ECM, resulting in an index that is smaller than 1. A decrease of BCM points to early stages of malnutrition. It is accompanied by an increase of extra-cellular mass, while weight and lean body mass remain constant.
Catabolism of the BCM: A reduction of body cell mass is what usually follows catabolic changes of all origins. In order to keep the total body water constant, the body then compensates by storing water in the extra-cellular mass.
Hyperinsulinism caused water deposition in the ECM: Sodium and water retention begin in the extra-cellular mass in cases of chronic hyperinsulinism and the metabolic syndrome.
Other reason for water deposition in the ECM: Even without changes in weight, water depositions in the ECM are possible, for example in catabolic processes in the BCM or in cases of concomitant water loss.
Body Fat BF Body fat performs as an insulator to alternating current. With a density of 0. The difference between body weight and lean body mass is calculated as the fat mass. The BCM cell percentage of the lean body mass is unit of measurement that evaluates a body's physical and nutritional condition.
Called cell percentage, it is a good qualifier of the lean body mass in an individual. This percentage is lower in cases of extra-cellular hyperhydration or malnutrition. Cell percentages below these guideline values and without a visible edema, are an indicator for malnutrition.
They are also lower in patients with genetic diseases that are accompanied by muscular dystrophy. For the assessment of the stage of malnutrition, reduced cell percentage provides important clues.
The human organism activates intracellular protein to glucohomeostasis and creates sugar from this source, once it takes in food or once there are nutritional deficiencies. While he intracellular loss of protein leads to a reduction of the cell mass, the extra-cellular domain increases in size at the same time.
This is caused due to the release of protein-bound intra-cellular water, and in such a situation, the BCM and ECM mass reacts in the reverse way and causes the cell percentage to plummet disproportionately.
On the other hand, athletic training or physical training over a period of many years will result in a high cell percentage. The same goes for people with a high degree of physical activity - the cell percentage increases.
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