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Bioelectrical impedance measurements in patients with gastrointestinal disease: validation of the spectrum approach and a comparison of different methods for screening for nutritional depletion^1,2,3

¹ From the Departments of Dietetics (PLMC-R), Clinical Chemistry (BVK), and Surgery (PBS), University Hospital Maastricht, Maastricht, Netherlands.

Background: Bioelectrical impedance spectroscopy (BIS) may be of value in identifying patients with nutritional depletion.

Objective: The primary aim of the study was to assess the validity of BIS in patients with gastrointestinal disease. The secondary aim was to compare different screening methods for identifying nutritionally depleted patients.

Design: In 70 patients with gastrointestinal disease, BIS measurements were performed and fluid compartments were calculated from extrapolated resistance (R) values of extracellular (R_ECW) and intracellular (R_ICW) water based on mixture equations. Results were compared with total body water and ECW, which were measured by dilution methods. Patients were classified as depleted if their actual fat-free mass (FFM) was <90% of their ideal FFM (iFFM). Different screening approaches for depletion were compared: the impedance vector method and the resistance index (RI) in relation to iFFM (RI/iFFM).

Results: Total body water and ICW were largely underestimated (4 L) in the not-depleted patients but not in the depleted patients. In both groups, ECW was slightly overestimated (0.6–0.7 L). The critical frequency was 60% higher and the membrane capacitance was 40% lower in the depleted than in the not-depleted patients. The impedance vector method failed to identify depleted patients, whereas the proposed ratio at R₅₀ (R measured at 50 kHz) and R_inf (R at infinite frequency) resulted in comparable sensitivity (86%) and specificity (73–80%).

Conclusions: BIS measures of body fluids are influenced by the presence of depletion, probably because of alterations in the electric properties of the body at the cellular level. However, for screening purposes, the use of the ratio (L²/R)/iFFM at R₅₀ and R_inf may be of value.

Key Words: Patients • gastrointestinal disease • depletion • body composition • bioelectrical impedance spectroscopy • BIS • total body water • extracellular water • intracellular water • screening

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