Assessment of total body water and its compartments in elite judo athletes: comparison of bioelectrical impedance spectroscopy with dilution techniques
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Abstract
Bioelectrical impedance spectroscopy (BIS) is an inexpensive and non-invasive technique
to measure total body water (TBW), extracellular water (ECW), and intracellular water
(ICW). The purpose of this study was to validate TBW, ECW and ICW assessed by BIS,
using dilution techniques as the reference method (REF) in elite judo athletes. Thirty-two
Portuguese elite male judo athletes were evaluated during a period of weight stability.
TBW, ECW and ICW were assessed by BIS (Xitron 4000). Deuterium and bromide dilution
techniques were used as the criterion method for measuring TBW and ECW, while ICW
was calculated as the difference between the two. BIS explained 96%, 77% and 94% of
the total variability from REFs for TBW, ECW and ICW, respectively. BIS also demonstrated
high precision (ρ ≥ 0.88) and accuracy (Cb = 0.98), with a minimum concordance coefficient
correlation of 0.87 for ECW. The mean bias demonstrated that BIS slightly overestimated
the REF in 1.1 kg (2.3%), 0.3 kg (1.6%) and 0.8 kg (2.7%) for TBW, ECW and ICW, respectively.
The 95% limits of agreement ranged from -1.2 to 3.3 kg in TBW, from -1.8 to 2.4 kg
in ECW and from -1.0 to 2.6 kg in ICW. A non-significant trend was found between the
difference and the mean of reference and alternative methods. These findings highlight
the efficacy of BIS as a valid non-biased tool for the assessment of TBW and its compartments
in elite male judo athletes, during a period of weight stability.
A new reproducibility index is developed and studied. This index is the correlation between the two readings that fall on the 45 degree line through the origin. It is simple to use and possesses desirable properties. The statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation. A Monte Carlo experiment with 5,000 runs was performed to confirm the estimate's validity. An application using actual data is given.
Athletes and researchers could benefit from a simple and universally accepted technique to determine whether humans are well-hydrated, euhydrated, or hypohydrated. Two laboratory studies (A, B) and one field study (C) were conducted to determine if urine color (Ucol) indicates hydration status accurately and to clarify the interchangeability of Ucol, urine osmolality (Uosm), and urine specific gravity (Usg) in research. Ucol, Uosm, and Usg were not significantly correlated with plasma osmolality, plasma sodium, or hematocrit. This suggested that these hematologic measurements are not as sensitive to mild hypohydration (between days) as the selected urinary indices are. When the data from A, B, and C were combined, Ucol was strongly correlated with Usg and Uosm. It was concluded that (a) Ucol may be used in athletic/industrial settings or field studies, where close estimates of Usg or Uosm are acceptable, but should not be utilized in laboratories where greater precision and accuracy are required, and (b) Uosm and Usg may be used interchangeably to determine hydration status.
Introduction: Achieving normohydration remains a non-trivial issue in haemodialysis therapy. Preventing the deleterious effects of fluid overload and dehydration is difficult to achieve. Objective and clinically applicable methods for the determination of a target representing normohydration are needed. Methods: Whole-body bioimpedance spectroscopy (50 frequencies, 5–1,000 kHz) in combination with a physiologic tissue model can provide an objective target for normohydration based on the concept of excess extracellular volume. We review the efficacy of this approach in a number of recent clinical applications. The accuracy to determine fluid volumes (e.g. extracellular water), body composition (e.g. fat mass) and fluid overload was evaluated in more than 1,000 healthy individuals and patients against available gold standard reference methods (e.g. bromide, deuterium, dual-energy X-ray absorptiometry, air displacement plethysmography, clinical assessment). Results: The comparison with gold standard methods showed excellent accordance [e.g. R 2 (total body water) = 0.88; median ± SD (total body water) = –0.17 ± 2.7 litres]. Agreement with high-quality clinical assessment of fluid status was demonstrated in several hundred patients (median ± SD = –0.23 ± 1.5 litres). The association between ultrafiltration volume and change in fluid overload was reflected well by the method (median ± SD = 0.015 ± 0.8 litres). The predictive value of fluid overload on mortality underlines forcefully the clinical relevance of the normohydration target, being secondary only to the presence of diabetes. The objective normohydration target could be achieved in prevalent haemodialysis patients leading to an improvement in hypertension and reduction of adverse events. Conclusion: Whole-body bioimpedance spectroscopy in combination with a physiologic tissue model provides for the first time an objective and relevant target for clinical dry weight assessment.
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