Efficacy of Bioelectrical Impedance Analysis for the Evaluation of Physical Impairment in Chronic Low Back Pain. Results from a Cohort Study

Introduction: Determining the effect of body composition on chronic low back pain seems to have the potential to improve our understanding of its mechanism and to develop novel preventive and therapeutic approaches.  Aim: The purpose of the present study was to assess by electrical impedance the composition of lower extremities of individuals with chronic low back pain. Materials and methods: One hundred and twenty-one adult participants with diagnosed chronic low back pain were recruited in this study. The study activities were divided into three phases: phase 1 – self-administered questionnaires, phase 2 – biomedical examination (including anthropometric measurements and physical function performance tests), and phase 3 – bioimpedance analysis. Results: Our results showed that chronic low back pain differentiates the circumference of thigh and calf of the symptomatic leg. Besides, patients experience pain also in hip, thigh, and calf, which act as a barrier to patient’s personal, professional, social, and recreational activities. Furthermore, patients appear with ‘unstable’ walking, reduced balance, and reduced general physical condition that affect all of the neuromuscular structures of the locomotor system. Interestingly, patients seem to be characterized by a tendency to deposit fat and to decrease muscle mass in the symptomatic limb regardless of the gender. Conclusions: In the present study, we determine the profile of a patient with chronic low back pain through a variety of measurements. Chronic low back pain causes several structural changes to the symptomatic leg of the patients leading to ‘unstable’ walking, reduced balance, and reduced general physical condition. It is clear that further studies using bioimpedance analysis are needed to address the concerns raised by investigating a multifactorial condition such as chronic low back pain.

Bioimpedance analysis of body composition in the diagnosis of physical development disorders in children and adolescents

Traditionally, anthropometric method is used in clinical practice for the diagnosis of excess body weight. Obesity is the excess development of primarily visceral and subcutaneous adipose tissue, which can be diagnosed by bioimpedance analysis (BIA). The study was aimed to assess the role of BIA of body composition in the diagnosis of the physical development disorders in children and adolescents. Anthropometric assessment and BIA were performed in 431 Samara school students aged 12–16 of the health status groups I and II (230 boys and 201 girls). The results were analyzed with the use of the regional regression scores, BAZ indices, and the body fat percentage values. The results of estimation using the regression scores showed that 22.61% of boys and 23.43% of girls were overweight, while more than 2/3 of the sample had a normal pattern of physical development. The BAZ indices revealed a significantly higher proportion of overweight children among boys (25.7%), than among girls (11.5%, p < 0.01). The body fat percentage fluctuations based on the BIA data were found not only in children with disharmonious physical development, but also in 60% of children with normal body weight. Moreover, the data of BIA confirmed the body weight fluctuations, revealed with the use of the regression scores, in the significantly larger number of cases compared to the low body weight and excess body weight, diagnosed based on the BAZ indices. Accordingly, anthropometric analysis with the use of the regional regression scores may be used at the baseline for the early diagnosis of the nutritional status disorders in children. To confirm overweight and obesity in children, as well as to provide further treatment, the reliable method for estimation of the body fat content is required, which may be the method of BIA.

Bioimpedance Analysis of Human Body Composition: Medical Applications, Terminology.

This article discusses the terminology features of bioimpedance analysis of body composition and the most common mistakes in the use of terms. In the Russian-speaking medical environment, you can often find the use of a number of inaccurate terms related to bioimpedance analysis of the human body composition. At the same time, the terminology of bioimpedance analysis of human body composition in English-language publications has long been established. The article presents the Russian and English terms of bioimpedance analysis of the human body composition with corresponding abbreviations, as well as the hierarchy of the terms body composition components, body composition parameters, parameters of bioimpedance analysis of body composition and bioimpedance parameters. The most developed areas of application of bioimpedance analysis in medical practice are discussed: assessment of nutrition and dynamic observations of changes in body composition, assessment of the body mineral mass, assessment of the body hydration parameters, assessment of blood supply to tissues and organs, including in the monitoring mode, assessment of the asymmetry of paired organs and limbs, assessment of pre-start readiness, physical development and the level of fitness of the athlete's muscular system.

Obesity in children with acute lymphoblastic leukemia in remission: the evaluation of causes, hidden nutritional deficiency and the experience of its correction by using artificial enteral nutrition

Background. Antineoplastic treatment can have late toxic manifestations that can often appear after end of treatment. Children after treatment for acute lymphoblastic leukemia (ALL) have a risk of developing both obesity and undernutrition, which may be concealed by increased fat mass.Objective: to explore the incidence of obesity and hidden undernutrition in children with ALL and to describe the effect of enteral feeding using in these children.Materials and methods. In a retrospective study the data of 62 children with obesity that was revealed by standard examination was analyzed. The criterion of obesity was increased value of fat mass received by bioimpedance analysis. For this evaluation Russian bioimpedance analysis standards were used. Additionally, the included data were following: presence of endocrine pathology, weight change during latter 6 months before admission, physical activity and alimentary characteristics (usual regimen and structure of daily feed).Results. Only 54.8 % of patients with an actual excess of fat body mass index detected obesity (Z‑score higher than +2.00) and another 29 % body mass index was within the normal range (Z‑score from –1.00 to +1.00). This was the result of a tissue imbalance: reduce fat‑free mass. Some patients were diagnosed with insulin resistance and hyperinsulinemia. 83.7 % have a completely passive lifestyle. 49.0 % almost do not eat fruits and berries, 79.6 % – vegetables and 91.8 % – fish and seafood. Frequent intake of sweet dishes – 22.4 %, sausage products – 49.0 %, bakery products – 42.9 %, dishes from fast food restaurants – 42.9 %. 55.1 % of patients had more than 5 meals a day, while 18.4 % – less than 3. In or‑ der to correct hidden nutritional deficiencies, 22 patients received artificial nutritional formulas. They had a significant increase in fat‑free mass and a decrease in fat, in comparison with those who did not receive enteral feeding.Conclusion. Treatment‑associated factors, physical activity and alimentary causes play an important role in formation of not only obesity, but also hidden nutritional insufficiency in children with ALL after treatment. Enteral feeding using artificial polymeric formulas showed its effectiveness. An integrated and multidisciplinary approach to solving the problem is appropriate of prevention and treatment of obesity.

Justification of the need to create a new classification of obesity

Результаты многочисленных исследований, проведенных в последние десятилетия, показали, что наибольшее значение в определении риска развития заболеваний и смерти на индивидуальном уровне имеет накопление висцеральной жировой ткани, сопряженное с развитием метаболических нарушений и местным влиянием при ее накоплении во внутренних органах. Биоимпедансный анализ служит простым и доступным в широкой клинической практике способом определения избыточного содержания висцеральной жировой ткани, позволяя тем самым выявлять пациентов с ожирением и высоким риском развития сердечно-сосудистых осложнений даже в рамках первой встречи с врачом. Результаты определения висцеральной жировой ткани с помощью биоимпедансного анализа сопоставимы с данными, полученными при КТ и МРТ. По нашим наблюдениям, проведенным на 154 больных с различными сердечно-сосудистыми заболеваниями, содержание висцеральной жировой ткани, составляющее 14% и более по данным биоимпедансного анализа, сочеталось с нарушениями, характерными для метаболического синдрома. При этом нарастание индекса массы тела от 1-й до 3-й степени никак не отражало степень тяжести метаболических нарушений. Достоверных отличий по содержанию висцеральной жировой ткани и уровням содержания в крови триглицеридов, глюкозы и липопротеинов высокой плотности у больных с разными степенями ожирения также выявлено не было. На сегодняшний день очевидно, что ожирение, определяемое с помощью индекса массы тела, является очень гетерогенным и его отрицательная роль в развитии заболеваний выявляется только при наблюдении за очень большими группами населения. Данные исследований о значении висцеральной жировой ткани и ее связи с факторами риска развития сердечно-сосудистых заболеваний свидетельствуют о необходимости создания новой классификации ожирения. Проект для ее обсуждения приводится в нашей статье. The results of numerous studies conducted over the past decades have shown that the greatest importance in determining the risk of disease and death at the individual level is the accumulation of visceral adipose tissue, associated with the development of metabolic disorders and local influence when it accumulates in the internal organs. Bioimpedance analysis is a simple and widely available clinical method for determining the excess content of visceral adipose tissue, thereby allowing you to identify patients with obesity and a high risk of developing cardiovascular complications, even in the first meeting with a doctor. The results of the determination of visceral adipose tissue by bioimpedance analysis are comparable with the data obtained by CT and MRI. According to our observations conducted on 154 patients with various cardiovascular diseases, the content of visceral adipose tissue , which is 14% or more according to bioimpedance analysis, was combined with disorders characteristic of the metabolic syndrome. At the same time, the increase in BMI from the 1st to the 3rd degree did not reflect the severity of metabolic disorders. There were no significant differences in the content of visceral adipose tissue and blood levels of triglycerides, glucose, and HDL-C in patients with different degrees of obesity. To date, it is obvious that obesity, determined by BMI, is very heterogeneous and its negative role in the development of diseases is revealed only when observing very large groups of the population. Research data on the importance of visceral adipose tissue and its association with risk factors for cardiovascular disease suggest the need for a new classification of obesity. We present a draft for discussing the new classification of obesity in our article.