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The prediction of total body water from body impedance in young obese subjects.

Almost all formulae for the prediction of total body water (TBW) from body impedance are based on the assumption of a constant conductor configuration--i.e. a constant subject section. In this paper we report on data obtained for a group of 19 young obese subjects (relative weight greater than 120%) and 10 young normal subjects (relative weight 80-110%). In obese subjects, the application of two different formulae generated from normal children gave biased results and led to an underestimation of TBW with respect to the reference value obtained by deuterium oxide dilution. Body mass index accounted for more than 40% of the inter-individual variability, suggesting that body size was not taken sufficiently into consideration by the predictive formulae used. We have used the body surface area as the anthropometrical parameter for the prediction of TBW from body impedance. The regression formula that we propose (TBW = 1.156 x (surface area/body impedance) - 2.356; R = 0.96), although requiring further validation on external populations, seems to provide a more realistic assessment of TBW in young obese subjects. We therefore suggest that the assessment of TBW in young obese subjects requires specifically designed prediction formulae.

Adolescent

Comparison of estimates of fat-free mass in normal and obese women from measurements of body potassium, body water and body density.

The relation between the estimates of fat-free mass (FFM) obtained from measurements of density, total body potassium and water was investigated in 104 women with Quetelet's Index between 19.9 and 49.7 kg/m2, body weight between 42.3 and 133.5 kg. The mean difference between the estimates based on water and potassium, previously reported as 2.2 kg or 4.4 per cent, was found to be independent of Quetelet's Index. The mean difference (s.e.m.) between the estimates of FFM based on density, compared with the average values from water and potassium, was found to be +7.0 (1.0), +6.3 (0.7) and +7.4 (1.1) kg in the ranges of Quetelet's Index 19.9-30.0, 30.1-40.0, and 40.1-49.7, respectively. The relative independence on Quetelet's Index of the difference between the estimates based on density compared with (water + potassium) is consistent with the idea that tissues of a higher density (ie, skin and bone) make up a larger proportion of the fat-free body weight in thin subjects than in fat ones.

Adult

Effective body water half-life and total body water in rhesus and cynomolgus monkeys.

Although body water content and effective water half-life have been determined in several mammalian species, including man, these measurements are not available for sub-human primates to our knowledge. Values were therefore determined in a group of rhesus and cynomolgus monkeys. A fairly wide range of water half-life values was found in each of the two species between animals, but there was little variation within animals who had more than one determination over the course of 1 year. Mean values for effective water half-life were 7.2 days and 3.7 days for naturally menstruating females of the cynomolgus and rhesus species, respectively. Water half-life in female rhesus monkeys with artificial menstrual cycles averaged 6.2 days. Females of both species had a similar percentage of body water content of 64%. Water half-life measured 7.1 and 8.5 days in two male rhesus; and water content was 62% of body weight in one of these animals.

Animals

Total body water and lean body mass estimated by ethanol dilution.

Total body water (TBW) was determined on 35 subjects with a tritium (HTO) and an ethanol (ETH) dilution method, the latter using breath analyses for blood ethanol content. Lean body mass (LBM) was estimated by hydrostatic weighing. Mean values for water fraction (TBW/wt) were 0.618 +/- 0.05 with HTO and 0.603 +/- 0.06 with ETH. The difference was not significant. The correlation between the two methods was highly significant (r = 0.90, SEE = 3.5 liters, P less than 0.0001). High correlations were also found between TBW and LBM with either method for TBW (r = 0.94 with HTO, r = 0.91 with ETH). Mean values for TBW/LBM were 0.735 with HTO and 0.717 with ETH. The ETH method compares favorably with the HTO, it has the advantage that it is nonradioactive and can be repeated daily if necessary.

Body Composition

Mastalgia and total body water.

Total body water (TBW) was measured early and late in a menstrual cycle in 56 women, 39 of whom had breast pain. The remainder were asymphtomatic controls. Most women did not conform to the traditional view that there is a premenstrual increase in TBW. In some TBW decreased, while in others there was no change from the early cycle measurement. No TBW pattern correlated with any syndromes of breast pain or with any psychoneurotic profile.

Adult

Long term changes in total body water, total exchangable sodium and total body potassium before and after ileostomy.

In 10 patients with inflammatory bowel disease, total body water, total body potassium and total exchangable sodium were measured both before and 6 months after the establishment of a permanent iseostomy. All 10 patients underwent elective surgery for their inflammatory bowel disease but all were malnourished before surgery when their body composition was first measured. Six months later, when the body composition was again determined, all the patients were in good health and had normally functioning ileostomies. As a group they had gained 6-8 kg in body weight and 372 mEq total body potassium over the 6-month period. When the 'normal' total body water was calculated for each patient, a deficit of 12-4 per cent for the group was found before surgery and this was still present (11-1 per cent) 6 months later. The concentration of exchangable sodium in the body water fell from an abnormally high level before surgery to within the normal range 6 months later. These data show that defictis in total body water occurring preoperatively are not repaired in the months following the establishment of a well-functioning ileostomy, and that a reduction of total exchangeable sodium is present in patients with an ileostomy who are otherwise well. It is suggested that these findings should encourage the surgeon managing patients with intractable inflammatory bowel disease to strive for good nutrition and normal body composition before embarking on excisional surgery and the establishment of a permanent ileostomy.

Adult

Comparative pharmacokinetics of ethanol in inbred strains of mice using doses based on total body water.

The mean total body water was determined by desiccation in DBA/2J, CBA/J, and C57BL/6J mice to be 60.6, 65.6, and 68.6 percent of body weight, respectively. The pharmacokinetics of ethanol was subsequently studied in mice of these strains given an intraperitoneal dose of 116 mmoles/l of total body water based on the desiccation study. This dose was equivalent to 70, 76, and 80 mmoles/kg in the DBA/2J, CBA/J, and C57BL/6J strains, respectively. The zero time concentrations were nearly identical between strains; therefore volume of distribution (VD) estimates based on mmole/kg doses reflected interstrain differences in total body water. The apparent zero order elimination rate was significantly greater in the DBA/2J strain versus the other two strains using this regimen. Interstrain differences in ethanol sleep time paralleled the differences in anesthetic sensitivity evidenced by blood concentrations at the time of regaining the righting reflex. The results demonstrate the importance of considering differences in total body water and hence ethanol VD when comparing the effects of ethanol in inbred mouse strains.

Animals

Hydroelectrolytic determination in paraplegics (total body water; exchangeable sodium and total body potassium).

Measurements of total body water and total exchangeable sodium, by isotopic dilution, and of total body potassium by whole body counting of the naturally occurring 40K isotope, were performed on stabilised paraplegic or tetraplegic subjects. Nineteen patients were investigated by the complete set of tests, six by only body counting. The results of total body potassium are expressed, following a uniform scale, as "relative values", which were established by the processing of reference values, from numberous paired healthy subjects.

Adolescent

A comparison of total body water measurements using whole-body magnetic resonance imaging versus tritium dilution in primates.

Standard techniques conventionally used to assess body composition have various drawbacks which include a requirement for specialized equipment and expertise not widely available, radiation exposure, extensive study time periods, and limited clinical utility. Anthropometric methods, which are more clinically feasible, also involve substantially greater calculation error. This study was designed to compare a newly developed whole-body magnetic resonance (MR) imaging technique with standard tritium dilution (THO) to measure total body water (TBW) in eight primates (Macaca fascicularis). Sedated primates underwent whole-body MR imaging (10-12 contiguous 50-mm slices) and TBW was computed using a previously validated program. After 5 days to allow for primate recovery and stabilization, TBW measurements were repeated using THO methodology. Linear regression analysis of TBWMRI (72.1 +/- 5.7% body wt) compared with TBWTHO (73.8 +/- 3.2% body wt) yielded a Pearson correlation of r = 0.8145, P = 0.02 with a mean squared error of 2.14. Whole-body MR imaging determination of TBW correlates well with THO, requires less time (20 min versus 24 hr), and does not expose the subject to radiation. This study suggests that whole-body MR imaging is an accurate technique for in vivo body composition analysis. As demonstrated by the body size of this investigational primate model, the technique maybe particularly applicable to the study of human infants.

Animals

Body water and weight in patients with premenstrual tension.

The total body water, total body potassium and weight were studied during the follicular and luteal phases of the cycle in 20 patients with severe premenstrual tension and 20 controls without symptoms. The effects of a diuretic (bumetanide) and bromocriptine were also studied in the patients with premenstrual tension. The mean body water in the premenstrual tension group did not differ significantly from that in the controls neither did the mean body potassium levels. However, during the late luteal phase the water/potassium ratio in liters per mol of potassium was significantly higher in the patients with premenstrual tension than in the controls. In the women with premenstrual tension the body water values varied more widely between the luteal phase and follicular phase than in the controls. The mean body water and weight in the premenstrual tension group were similar in the late luteal and early follicular phases. Treatment with bumetanide or bromocriptine had no effect on the parameters studied.

Adult

A relationship between bioelectrical impedance and total body water in young adults.

Total body water was measured using the stable isotope H2(18)O in 14 young adults. Body resistance was assessed using a tetrapolar technique using a Holtain body-composition analyzer. Total body water was highly correlated (r = 0.96; p less than 0.001) with height2/resistance. The inclusion of body weight in the prediction equation reduced the standard error of estimate from 1.9 to 1.51. Bioelectrical resistance can be used to assess other body-composition parameters such as fat-free mass and fat mass, but this use involves a number of assumptions which may confound the relationship. We suggest that the measurement of bioelectrical impedance may, however, have a role in the estimation of total body water.

Adolescent

Total body water content in normal and grossly obese women.

Total body water content was estimated for 27 normal and 27 obese women by an isotope dilution technique using tritiated water. The mean total body water content expressed in absolute amounts was significantly raised in the obese group (P less than 0-001), but was significantly lower (P less than 0-001) when the values were expressed as a percentage of body weight. Significant correlations were found between weight and total body water content (P less than 0-001 and P less than 0-05) for the normal and obese subjects respectively. Separate regression equations based on height and weight were calculated for the normal and obese subjects, and good agreement was found in most instances between the measured and calculated total body water contents. The overweight women, with two exceptions, had total body water values in the expected range, which indicated that they were accumulating fat, not water. Although excess water was found in 2 women, this contributed only about 50% to their overweight.

Adolescent

Total body water, extracellular water, plasma volume, and total body potassium in cirrhosis of the liver.

Extracellular water (EWC; 82-bromide), total body water (TBW; 3-THO), intracellular water (ICW = TBW-ECW), plasma volume (PV; 51-Cr), and total body potassium (TBK; 40-K) were studied in patients with cirrhosis of the liver (n = 12) and in controls (n = 12). ECW (39%), TBW (28%), ICW (19%), and PV (24%) increased, TBK (28%) however, decreased in cirrhosis. The results indicate that it is less the lean body mass, but rather the intracellular potassium concentration that is lowered (cirrhosis: 84 +/- 21 mmol/l ICW; controls: 115 +/- 23 mmol/l ICW). Decreased potassium per cell (mmol) and increased intracellular water are discussed as possible reasons for this. The correlation between TBK (%) and serum potassium (mmol/l) was found to be r = 0.56 (p less than 0.002). Correlations between the biochemical parameters gamma-globulins, cholin esterase, serum sodium and serum albumin (g/l PV) and characteristic fluid disturbances in cirrhosis are highly significant whereas albumin (g/kg bodyweight) was the same in both groups. We can support the 'overflow theory' of ascites formation.

Adult