Relación del volumen de agua corporal total, el extracelular, y preeclampsia. Revisión narrativa de la literatura / Relation of total and extracellular body water and preeclampsia. Literature review

RESUMEN La preeclampsia es una importante causa de mortalidad materna mundial, identificar de manera temprana las gestantes con riesgo de desarrollarla, es una medida preventiva de gran impacto. La medición del agua corporal se ha documentado desde 1994, y desde 2015 se demostró su relación con el riesgo de desarrollar preeclampsia. Por lo anterior se realizó una revisión de la relación del agua corporal y la preeclampsia hasta junio de 2019, con 17 artículos seleccionados. Producto de la revisión se concluyó que la medición del agua corporal en gestantes podría detectar la aparición de preeclampsia para establecer un seguimiento estricto temprano a las mujeres con mayor riesgo de presentarla. Estas mediciones se realizan con métodos sencillos, no invasivos y de bajo costo, como la impedancia eléctrica por análisis espectral. Sin embargo, se requieren estudios con mayor rigor metodológico para el estudio de una prueba diagnóstica como la que se propone. MÉD.UIS.2021;34(2): 49-60.

ABSTRACT Preeclampsia is an important cause of maternal mortality worldwide. Early identification of pregnant women at risk of developing it is a preventive measure of great impact. Body water measurement has been documented since 1994, and since 2015 it was stablished its relationship with risk of developing preeclampsia. Therefore, a review of the relationship between body water and preeclampsia was carried out until June 2019, with 17 papers selected. As a result of the review, it was concluded that the measurement of body water in pregnant women could detect the appearance of preeclampsia to establish a strict early follow-up of women with a higher risk of presenting it. These measurements are made with simple, non-invasive and low-cost procedure, such as electrical impedance by spectral analysis. However, studies with greater methodological rigor are required for the study of a diagnostic test such as the one proposed. MÉD.UIS.2021;34(2): 49-60.

Agua corporal total y composición corporal: efecto del ejercicio de 30 minutos y rehidratación con agua en adultos residentes permanentes de gran altitud, La Paz Bolivia / Total body water and body composition: effect of the 30 minute exercise and water rehydration in high altitude permanent resident adults, La Paz-Bolivia

PREGUNTA DE INVESTIGACIÓN: ¿Cuál será la composición corporal, el agua corporal total, y el agua extra e intracelular relacionados a los cambios después del ejercicio submáximo de 30 minutos y post rehidratación con agua pura en adultos residentes permanentes de gran altitud, La Paz, Bolivia, gestión 2019? OBJETIVO: Determinar la composición corporal, el agua corporal total, y el agua extra e intracelular relacionados a los cambios después del ejercicio submáximo de 30 minutos y post rehidratación con agua pura en adultos residentes permanentes de gran altitud, La Paz, Bolivia, gestión 2019. MATERIAL Y MÉTODOS: el trabajo de investigación fue tipo experimental, antes y después, sobre Fisiología de Altitud, en 29 jóvenes residentes de gran altitud (3600 m.s.n.m.). Se evaluó variables antes y después de realizar una prueba de ejercicio submáxima, de 30 minutos, y la rehidratación post ejercicio, tras el consumo de agua pura. Variables dependientes fueron: 1. Composición corporal, medida a través del análisis de impedancia bioeléctrica (AIB), 2. Volumen de agua corporal total, determinado por AIB. 3. Agua extra e intracelular evaluada por AIB y 4. Estado de rehidratación, evaluado por el cambio de peso post ejercicio, y mediante el AIB. Las variables independientes fueron el ejercicio a través de la prueba submáxima de 30 minutos y la rehidratación con agua pura. RESULTADOS: en jóvenes residentes de gran altitud, se estima que el porcentaje de agua corporal total en las mujeres está disminuida en relación a la referencia de poblaciones del nivel del mar. La masa grasa corporal está muy incrementada en las mujeres. La diferencia de agua basal versus el agua post ejercicio entre varones y mujeres no es significativa. La diferencia de agua del líquido extra e intracelular basal versus el agua post ejercicio entre varones y mujeres no es significativa. La diferencia en la distancia recorrida en 30 minutos de ejercicio de trote submáximo es estadísticamente significativa a favor de los varones (4424 vs. 3619 metros). La correlación del IMC y el porcentaje de masa grasa es muy baja (r=0.109). El IMC entre varones y mujeres no presenta diferencia estadísticamente significativa (26±3 vs 24±3 respectivamente). La frecuencia de exceso de grasa corporal evaluada por AIB, es del 55% en las mujeres y de 0% en varones. La presión arterial sistémica en varones (PS: 107±6 y PD:73± 4mmHg) y en mujeres (PS:104±8 y PD:70± 7mmHg), está disminuida en relación a referencia del nivel del mar. La frecuencia respiratoria esta incrementada tanto en varones (21±2) y mujeres (23±3). CONCLUSIONES: el método de AIB permite evaluar la composición corporal y el agua corporal total y por tanto la masa grasa, mismo que fue validado en altitud por el método estándar de referencia de dilución isotópica en estudios previos en altitud. El ejercicio de trote submáximo ejecutado, ha exigido más a los universitarios estudiados. Se verifica que en el mismo tiempo los varones han recorrido una mayor distancia que las mujeres. Se estima que en mujeres la masa grasa corporal (MGC) esta incrementada y que el exceso de grasa (obesidad) es del 55%. La diferencia del agua al momento basal y post ejercicio y el LEC y LIC entre varones y mujeres no es significativa. El IMC subestima en este grupo la frecuencia de obesidad, principalmente en mujeres. El uso de técnicas nucleares, ha permitido a través del análisis del deuterio estudiar el agua, la composición corporal, y se asocia fuertemente con determinaciones similares mediante el uso de la bioimpedancia eléctrica.

RESEARCH QUESTION: what will be the body composition, the total body water, and the extra and intracellular water related to the changes after submaximal exercise of 30 minutes and post rehydration with pure water in permanent resident adults of high altitude, La Paz, Bolivia, management 2019? OBJECTIVE: to determine the body composition, the total body water, and the extra and intracellular water related to the changes after submaximal exercise of 30 minutes and post rehydration with pure water in permanent residents of high altitude adults, La Paz, Bolivia, management 2019. MATERIAL AND METHODS: the research work was experimental, before and after, on Altitude Physiology, in 29 young residents of high altitude (3600 m.a.s.l.). Variables were evaluated before and after performing a 30-minute submaximal exercise test and post-exercise rehydration after consuming pure water. Dependent variables were: 1. Body composition, measured through bioelectrical impedance analysis (AIB), 2. Total body water volume, determined by AIB. 3. Extra and intracellular water evaluated by AIB and 4. Rehydration status, evaluated by post-exercise weight change, and by AIB. The independent variables were exercise through the 30-minute submaximal test and rehydration with pure water. RESULTS: in young residents of high altitude, it is estimated that the percentage of total body water in women is decreased in relation to the reference of sea level populations. Body fat mass is greatly increased in women. The difference in basal water versus post-exercise water between men and women is not significant. The difference in water from basal extra and intracellular fluid versus post-exercise water between men and women is not significant. The difference in distance covered in 30 minutes of submaximal jogging exercise is statistically significant in favor of men (4424 vs. 3619 meters). The correlation of BMI and the percentage of fat mass is very low (r = 0.109). The BMI between men and women did not present a statistically significant difference (26 ± 3 vs 24 ± 3 respectively). The frequency of excess body fat evaluated by AIB is 55% in women and 0% in men. The systemic blood pressure in men (PS: 107 ± 6 and PD: 73 ± 4mmHg) and in women (PS: 104 ± 8 and PD: 70 ± 7mmHg), is decreased in relation to the sea level reference. Respiratory rate is increased in both men (21 ± 2) and women (23 ± 3). CONCLUSIONS: the AIB method allows evaluating body composition and total body water and therefore fat mass, which was validated at altitude by the isotopic dilution reference standard method in previous studies at altitude. The submaximal trot exercise performed has demanded more from the university students studied. It is verified that in the same time the men have traveled a greater distance than the women. It is estimated that in women the body fat mass (FGM) is increased and that the excess fat (obesity) is 55%. The difference in water at baseline and post-exercise and the LEC and LIC between men and women is not significant. The BMI underestimates the frequency of obesity in this group, mainly in women. The use of nuclear techniques has allowed the analysis of deuterium to study water, body composition, and is strongly associated with similar determinations through the use of electrical bioimpedance.

Aspectos prácticos para la clasificación, diagnóstico y manejo de hiponatremia en el paciente hospitalizado / Practical aspects for the classification and management of hyponatremia in the hospitalized patient

Resumen La hiponatremia es el trastorno hidroelectrolítico más frecuente observado en pacientes hospitalizados y es importante resaltar que se ha asociado a morbilidad y mortalidad de estos. Esta entidad representa un proceso fisiopatológico relacionado con una alteración en la homeostasis del agua, en la cual los pacientes presentan síntomas en su mayoría neurológicos, que se correlacionan con el nivel de sodio y el tiempo de aparición del trastorno. Se realizó una búsqueda en las bases de datos PubMed y Lilacs de monografías, artículos de revisión y artículos originales con el objetivo de revisar aspectos sobre la clínica, diagnóstico y manejo de la entidad. Para el diagnóstico, la batería de estudios se solicita en función del contexto clínico, actuando temprano y permitiendo la corrección del trastorno de acuerdo al escenario respectivo. La hiponatremia es un problema médico frecuente que bajo un abordaje práctico y sencillo permite tomar decisiones clínicas de forma oportuna. MÉD.UIS. 2020;33(2):85-93.

Abstract Hyponatremia is the most frequent hydroelectrolytic disorder observed in hospitalized patients and it is important to note that it has been associated with morbidity and mortality in this patients. This entity represents a pathophysiological process related to an alteration in water homeostasis, in which patients present symptoms mostly neurological, that correlate with the sodium level and the time of onset of the disorder. A search of the PubMed and Lilacs databases of monographies, review articles and originals articles was performed with the objective to review clinical, diagnostic and management aspects of this entity. For diagnosis, the clinical laboratory studies are requested depending on the clinical context, acting early and allowing correction of the disorder according to the respective scenario. Hyponatremia is a frequent medical problem that requires a practical and simple approach favoring clinical decisions in a timely manner. MÉD.UIS. 2020;33(2):85-93.

Cambios en el agua corporal, grasa y masa magra de personas con y sin disfunción renal en sus diversos estadios de enfermedad renal crónica / Changes in body water, fat and lean mass of people with and without kidney dysfunction in their various stages of chronic kidney disease

Resumen Objetivo: Estudiar los cambios en el agua corporal, grasa y masa magra de personas sanas y enfermas (20-80 años) categorizadas según tasa de filtración glomerular (TFG). Material y métodos: Estudio descriptivo y analítico de 198 sujetos (sanos, con enfermedades crónicas sin azoemia y con diferentes estados de enfermedad renal crónica normalizados por sexo) según categorías: Categoría 1 (TFG >140 ml/min/1,73 m2SC); Categoría 2 (TFG 90-140); Categoría 3 (TFG 60-89); Categoría 4 (TFG 30-59); Categoría 5 (TFG<30) y Categoría 6 (diálisis). Se midió peso, talla, agua corporal, grasa y masa magra con balanza de bioimpedancia; aclaramiento de creatinina (TFG), aclaramiento de urea y sodio y potasio en orina de 24 horas. Con estos datos se calculó la masa corporal, agua corporal, grasa y masa magra, la ingesta de sal sódica, potasio y proteínas. Se relacionaron las diversas variables según categorías propuestas con ANOVA y eta cuadrado. Se correlacionó con la TFG y la masa magra mediante regresión bivariada y el resto de variables mediante regresión múltiple lineal, para definir las relevantes. Resultados: Las variables relevantes asociadas con pérdida de TFG fueron la masa magra y el agua corporal: ANOVA (p=0,000 ambas) y eta cuadrado (0,178 y 0,165), respectivamente. El análisis multivariado solo relacionó la TFG con la edad (r=-0,34; p=0,000) y la masa magra mostró correlación bivariada relevante con el agua (r=0,861; p=0,000). Conclusión: La pérdida de TFG implica fundamentalmente pérdida de masa magra y agua corporal en la estructura corporal.

SUMMARY Objective : Study changes in body water, fat and lean mass of healthy and sick people (20-80 years) categorized according to glomerular filtration rate (GFR). Material and Methods: Descriptive and analytical study of 198 subjects (healthy, with chronic disease without azotemia and with different stages of chronic kidney disease standardized by sex) according to stages: Stage 1 (GFR> 140 ml / min / 1.73 m2SC); Stage 2 (TFG 90-140); Stage 3 (TFG 60-89); Stage 4 (TFG 30-59); Stage 5 (TFG <30) and Stage 6 (dialysis). We measured weight, height, body water, fat and lean (with bio impedance scales); creatinine clearance (GFR) and urea clearance. In 24-hour urine: sodium and potassium. With these data, body mass, body water, fat and lean mass, sodium salt intake, potassium and proteins were calculated. The analysis was descriptive and analytical, relating the various variables according to the proposed categories with ANOVA and eta squared. The rest of the variables were correlated with the TFG and lean mass by bivariate regression and linear multiple regression to define the relevant ones. Results: The relevant variables associated with loss of GFR were lean body mass and water: ANOVA (p = 0.000 both) and eta squared (0.178 and 0,165) respectively. The multivariate analysis only related the GFR with age (r = -0.34, p = 0.000) and the lean mass showed significant bivariate correlation with water (r = 0.861, p = 0.000). Conclusion: The loss of TFG mainly involves loss of lean body mass and water in the body structure.

Ecuaciones para la estimación del agua corporal total por el método de análisis de impedancia bioeléctrica a 50 kHz / Equations for the estimate of total body water by the method of bioelectric impedance at 50 kHz

Introducción: El agua mantiene un rango normal en personas aparentemente sanas, el cual se altera ante la existencia de diversas enfermedades. Objetivo: Conocer cuánto se diferencian los valores de agua corporal total estimados por las ecuaciones de agua corporal total, de Kushner, de Deurenberg y de Heitman, con respecto a los obtenidos clínicamente por el método de impedancia bioeléctrica a 50 kHz. Métodos: Se realizó un estudio descriptivo y transversal, de abril a diciembre del 2018, en 62 individuos: 31 adultos aparentemente sanos y 31 niños y adolescentes con diferentes enfermedades, ingresados en el Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba (24 en el Servicio de Misceláneas y 7 en el de Oncopediatría). El agua corporal total y los parámetros bioeléctricos se estimaron con el analizador de impedancia bioeléctrica Bodystat® 1500-MDD, a 50 kHz, por el método tetrapolar ipsilateral derecho. Se utilizó el criterio de Bland-Altman, para un 95 % de confianza, a fin de conocer si las ecuaciones de Kushner, de Deurenberg y de Heitman podían sustituir a la ecuación de referencia. Resultados: Las ecuaciones de agua corporal total, de Kushner y de Deurenberg no mostraron diferencias significativas respecto a la ecuación de referencia, mientras que la ecuación de Heitman sí presentó diferencias significativas en relación con el resto de las ecuaciones. El método de Bland-Altman demostró que la ecuación de Kushner posee mayor concordancia con la ecuación de referencia. Conclusiones: La ecuación de Kushner es la de mayor exactitud para la estimación del agua corporal total en personas sanas y en las afectadas por entidades clínicas.

Introduction: The water maintains a normal range in apparently healthy people, which changes with the existence of diverse diseases. Objective: To know how the values of total body water estimated by Kushner, Deurenberg and Heitman equations of total body water, differ regarding those obtained clinically by the method of bioelectric impedance at 50 kHz. Methods: A descriptive and cross-sectional study was carried out, from April to December, 2018, in 62 individuals: 31 apparently healthy adults and 31 children and adolescents with different diseases, admitted to "Dr. Antonio María Béguez César" Southern Teaching Children Hospital in Santiago de Cuba (24 in the Miscellaneous Service and 7 in Oncopediatrics Service). The total body water and the bioelectric parameters were considered with the analyzer of bioelectric impedance Bodystat® 1500-MDD, at 50 kHz, for the right ipsilateral tetrapolar method. The approach of Bland-Altman was used, for 95% of confidence in order to know if Kushner, Deurenberg and Heitman equations could substitute the reference equation. Results: Kushner and Deurenberg equations of total body water didn't show significant differences regarding the reference equation, while Heitman equation presented significant differences related to the rest of the equations. The Bland-Altman method demonstrated that the equation of Kushner has higher concordance with the reference equation. Conclusions: Kushner equation has the highest accuracy for the estimate of total body water in healthy people and in those affected by diseases.

Cambios de la estructura corporal y la función renal a través de la vida de pacientes con enfermedades crónicas sin azoemia, comparada con la persona sana / Changes in body structure and renal function throughout life in patients with chronic diseases without renal insufficiency compared to healthy persons

Objetivo: Determinar si hay diferencia entre la persona crónicamente enferma sin azoemia respecto al sano en: estructura corporal, función renal y hábitos alimentarios. Material y métodos: Conclusiones: Las enfermedades crónicas disminuyen tempranamente la función renal, la excreción urinaria de creatinina y limitan la ingesta de proteínas y potasio respecto al sano. Esto ocurre aun cuando la creatinina sérica está en límites normales.

Objective: To determine if there are differences between persons with chronic diseases with no renal insufficiency compared to health persons in body structure, renal function and dietary habits. Methods: Conclusions: chronic diseases reduce early the renal function, urinary excretion of creatinine and reduce daily intake of proteins and potassium compared to healthy people. These abnormalities do occur despite of normal serum creatinine levels.

Desidratação, acidente vascular cerebral e disfagia: revisão sistemática da literatura / Dehydration, stroke and dysphagia: systematic review

RESUMO Objetivos trata-se de revisão sistemática da literatura científica sobre a associação entre o acidente vascular cerebral, desidratação e disfagia orofaríngea. Estratégia de pesquisa o levantamento bibliográfico foi realizado nas bases de dados científicos: MEDLINE, LILACS, SciELO, Web of Science e Cochrane. Critérios de seleção foram incluídos os estudos que preencheram os seguintes critérios de inclusão: ser artigo original, com resumo disponível; ter sido publicado entre os anos de 2001 e 2018 e nos idiomas português, inglês ou espanhol; abordar o tema desidratação em indivíduos após acidente vascular cerebral. A triagem e análise dos estudos foram realizadas por dois avaliadores independentes. Resultados dentre os 484 artigos localizados para a triagem, 43 foram selecionados para leitura completa e 18 foram incluídos na análise final. Foram descritos diferentes métodos de avaliação do estado de hidratação nos indivíduos após acidente vascular cerebral, tais como: análise da relação BUN /creatinina, osmolaridade plasmática, relação ureia/creatinina, gravidade específica da urina, coloração da urina, ingestão hídrica, balanço hídrico, bioimpedância elétrica, avaliação clínica, análise de eletrólitos isolados. A prevalência de desidratação em pacientes após acidente vascular cerebral, durante a internação, variou de 11% a 66% e está associada à gravidade e piora na evolução clínica. Conclusão foi possível compreender a complexidade do processo de mensuração do estado de hidratação em indivíduos após acidente vascular cerebral e sua associação com a disfagia. Estudos enfocando essa temática são de extrema relevância, visto a sua influência sobre a taxa de mortalidade e morbidade nesta população.

ABSTRACT Purpose this is a systematic review of scientific literature associated with stroke, dehydration and oropharyngeal dysphagia (OD). Research Strategy bibliographic survey was conducted in scientific databases: MEDLINE, LILACS, SciELO, Web of Science and Cochrane. Selection criteria studies that met the following inclusion criteria were included: being original article with summary available; have been published in the last seventeen years (2001-2018) and in Portuguese, English or Spanish languages; and addressing dehydration in individuals after stroke Screening and analysis of the studies were performed by two independent evaluators. Results among the 484 articles found for screening, 43 were selected for full reading and 18 articles were included in the final analysis. Different methods of assessing hydration status have been described in individuals post-stroke, such as ratio analysis blood urea nitrogen (BUN)/creatinine, plasma osmolality, urea / creatinine, urine specific gravity, urine color, water intake, water balance, bioelectrical impedance analysis (BIA), clinical evaluation and analysis of electrolytes. The prevalence of dehydration in post-stroke during hospitalization varied from 11% to 66% and is associated with severity and deterioration in the clinical evolution. Conclusion It was possible to understand the complexity of the measurement of hydration status in individuals after stroke and its association with dysphagia. Studies focusing on the association between dehydration and stroke are very important, due to its influence on mortality and morbidity in this population.

Comportamento das variáveis morfológicas e da água corporal durante as fases de um ciclo menstrual / Behavior of variable morphological and body water during the phases of a cycle menstrual

A existência de mudanças cíclicas no peso corporal e no metabolismo de água e eletrólitos no ciclo menstrual é amplamente estudada na literatura, porém os resultados a este respeito mostram-se divergentes. Acredita-se que a progesterona seja a principal responsável pela retenção de líquidos e sódio, principalmente após a fase ovulatória, onde ocorre a maior concentração deste hormônio e, desta forma, a retenção de líquidos pode interferir na composição corporal. Para confirmar essa hipótese, sete mulheres saudáveis (22,71 ± 2,63 anos; 62,20 ± 7,62 kg; 161,57 ± 3,15 cm; 27,40 ± 3,58 %G), praticantes de treinamento resistido com peso, há no mínimo, dois meses e que não faziam uso de contraceptivos orais, foram avaliadas durante as fases do ciclo menstrual ­ fase folicular, entre o 3º e 5º dia; fase ovulatória, entre o 9º e 10º dia; e fase lútea, entre 17º e 21º dia ­ pelo método da impedância bioelétrica (Quantum BIA-II® - RJL Systems, Inc. Clinton: MI-EUA), no qual foram mensuradas as variáveis: água corporal total, água intracelular e água extracelular em litros; percentual de gordura; massa gorda e massa magra em kg. Para verificar a distribuição da amostra foi utilizado o teste de Shapiro Wilk e a homogeneidade através do teste de Levene. Foi adotado o teste ANOVA One Way, com o Post-Hoc de Bonferroni. Para comprovação estatística foi adotado o p ≤ 0,05. Não foram encontradas diferenças significativas entre as variáveis analisadas em cada fase do ciclo menstrual. Sendo assim, conclui-se que variações que ocorrem durante o CM não são capazes de influenciar morfologicamente a composição corporal de mulheres saudáveis e fisicamente ativas....(AU)

The existence of cyclical changes in body weight and in the metabolism of water and electrolytes in the course of the menstrual cycle is widely studied in the literature, but the results in this regard show themselves to be divergent. It is believed that progesterone is the main responsible for the retention of liquids and sodium, especially after the ovulatory phase, when the highest concentration of this hormone occurs and, in this way, fl uid retention can interfere in body composition. To confi rm this hypothesis, seven healthy women (22.71 ± 2.63 years, 62.20 ± 7.62 kg, 161.57 ± 3.15 cm, 27.40 ± 3.58 % fat), training practitioners who were weighted for at least two months and did not use oral contraceptives, were evaluated during the menstrual cycle - follicular phase, between the 3rd and 5th days; ovulatory phase, between the 9th and 10th days; and Luteal Phase, between 17 and 21 days - by the bioelectrical impedance method (Quantum BIA-II® - RJL Systems, Inc. Clinton: MI-USA), in which the following variables were measured: total body water, intracellular water and extracellular water in liters; fat percentage; fat mass and lean mass in kg. The Shapiro Wilk test and the homogeneity through the Levene test were used to verify the distribution of the sample. The ANOVA One Way test was adopted with Bonferroni Post-Hoc. For statistical proof, p ≤ 0.05 was adopted. No signifi cant diff erences were found between the variables analyzed at each stage of the menstrual cycle. Therefore, it is concluded that variations that occur during MC are not able to morphologically infl uence the body composition of healthy and physically active women....(AU)

Principio y práctica de la ciencia nuclear en salud: evaluación del agua corporal total y la composición corporal, en población residente de gran altitud, La Paz, Bolivia / Principle and practice of nuclear science in health: evaluation of total body water and body composition, in high altitude resident population, La Paz, Bolivia

Mediante la utilización de la Ciencia Nuclear es posible hacer uso de los isótopos estables, identificados como trazadores, que permiten la aplicación del principio fisiológico de "dilución isotópica" en el organismo y con él se puede medir el agua corporal total. En los estudios de fisiología de altura, también se aplica el fundamento que aporta la ley de conservación de masas en un organismo. La práctica de este método permite generar conocimiento en altitud, haciendo bien las cosas correctas, por lo que se logra ser efectivo en los estudios realizados en diferentes grupos poblacionales habitantes permanentes de gran altitud. La técnica nuclear, ha permitido mediante el análisis del deuterio en sujetos estudiados, establecer la composición corporal, determinando el porcentaje del agua corporal total y la masa grasa corporal. Se estima que los habitantes permanentes de gran altitud presentarían una composición corporal con menor porcentaje de agua corporal que los habitantes de nivel del mar.

Using the Nuclear Science it is possible to make use of stable isotopes, identified as tracers, which allow the application ofthe physiological principle of "isotopic dilution" in the organism and with it the total body water can be measured. In the studies of physiology at high altitude, the foundation that the law of conservation of masses in an organism is also applied. The practice of this method allows to generate knowledge at altitude doing the right things well, so it is effective in studies conducted in different population groups permanent inhabitants of high altitude. The nuclear technique, has allowed by means of the analysis of the deuterium in studied subjects, to establish the corporal composition, determining the percentage of the total corporal water and the body  fat mass. It is estimated that permanent inhabitants of high altitude would have a body composition with a lower percentage of body water than sea level inhabitants.

Evaluación del agua corporal medida por bioimpedancia eléctrica en adultos jóvenes sanos y su correlación estimada según formulaciones convencionales / Evaluation of body water measured by electric bio impedance in young healthy adults and its estimated correlation using conventional formula

Objetivos: Comparar la precisión de las fórmulas antropométricas de Watson, Hume-Weyers, y el basado en elporcentaje del peso según sexo, para estimar el agua corporal total en relación a la medida por bioimpedanciaeléctrica considerando ésta como gold standard. Material y métodos: Se enrolaron 17 voluntarios sanos entre 21a 29 años de edad, con antropometría normal y en condiciones de vida cotidiana. Para evaluar la precisión en laestimación del agua corporal se usó la t de Student pareada y para estimar el error sistemático se usó el análisisde regresión lineal y la correlación de Pearson...

Objectives: To compare the precision of Watson´s, Hume-Weyers´ anthropometric formula and that based on thebody percentage by gender to estimate de total body water in relation to that measured by electric bio impedanceconsidering the latter as the gold standard. Methods: 17 healthy volunteers with normal anthropometric valuesbetween 21 and 29 years were recruited. Paired students´ t-test was used to evaluate the precision in the estimationof body water, and logistic regression analysis and Pearson´s correlation was used to evaluate systematic error...

El agua corporal medida por impedancia eléctrica y su estimación según fórmulas convencionales y en función del peso ideal y sexo, en adultos con sobrepeso u obesidad / Body water measured by electric bio impedance and its estimation by conventional formula based on idealbody weight and gender in overweight or obese adults

Objetivos: Determinar el grado de precisión de las fórmulas antropométricas de Watson, Hume-Weyers, y lacalculada en función del peso ideal y el sexo para estimar el agua corporal con la medida por impedancia eléctrica,en jóvenes con sobrepeso u obesidad. Material y métodos: Se enroló a 13 voluntarios sanos con edad entre 21 a29 años, asintomáticos y con índice masa corporal (IMC) mayor de 25. Se evaluó la precisión en estimar el aguacorporal en relación con la impedancia eléctrica de cada individuo con la t de Student apareada, y para estimar elerror sistemático se utilizó análisis de regresión lineal...

Objectives: To determine the precision in estimating body water using the anthropometric formula of Watsonïs, Hume-Weyersï, and ideal body water and gender, compared to that measured by electric bio impedance in overweight or obese young adults. Methods: 13 healthy volunteers with body mass index above 25 between 21 and 29 years were recruited. Paired studentsï t-test was used to evaluate the precision in the estimation of body water, and logistic regression analysis was used to evaluate systematic error...

Creatina e treinamento resistido: efeito na hidratação e massa corporal magra / Creatine and resistance training: effect on hydration and lean body mass / Creatina y entrenamiento resistido: efecto en la hidratación y masa corporal magra

INTRODUÇÃO: a creatina é um recurso ergogênico cuja suplementação tem sido associada ao aumento da hidratação corporal total e ao aumento da massa muscular dos consumidores. Entretanto, estudiosos questionam se o aumento da massa muscular é um ganho real. OBJETIVO: avaliar o efeito da suplementação de creatina sobre a hidratação e o aumento de massa magra em indivíduos previamente treinados e não treinados, submetidos a um programa de treinamento resistido. MÉTODOS: ensaio clínico não randomizado, constituído por três momentos, M1 - Início da suplementação com 20g/dia de creatina; M2 - 7 dias após iniciada a suplementação e redução da suplementação para 5g/dia; M3 - 28 dias de suplementação. Nos momentos propostos, foram realizadas aferições de peso, estatura e avaliação da composição corporal (massa magra, água corporal total) com a utilização do BYODINAMICS(r) Modelo 310. Para todos os testes estatísticos, foi adotado o nível de significância de 95% (p<0,05). RESULTADOS: participaram desse estudo 14 voluntários adultos do sexo masculino, com idade média de 22,57(±1,45) anos, dos quais sete eram treinados e sete não treinados. Após 28 dias de suplementação, no grupo treinado observou-se um aumento significativo no peso, água corporal total, massa magra e hidratação da massa magra, mas nenhum aumento significativo foi observado no grupo não treinado. Em relação ao ângulo de fase, este aumentou no grupo não treinado e reduziu no grupo treinado. CONCLUSÃO: a suplementação de creatina associada ao treinamento resistido é mais efetiva na hidratação de indivíduos treinados, como também é suficiente para reduzir a diferença significativa do ângulo de fase intergrupos, sugerindo assim, maior hidratação celular em ambos os grupos. Contudo, esse aumento na hidratação não revelou aumento significativo no tecido muscular. .

INTRODUCTION: creatine is an ergogenic aid which supplementation has been associated to increased hydration and increased muscle mass of consumers. However, researchers have questioned whether the increase in muscle mass is a real gain. OBJECTIVE: to evaluate the effect of creatine supplementation on hydration and increased lean mass in individuals previously trained and untrained, under a resistance training program. METHODS: clinical non-randomized study, consisting of three moments, M1 - start of 20g/day creatine supplementation; M2 - 7 days after the beginning of supplementation and reduction to 5g/day; M3 - 28 days of supplementation. In the proposed moments were made measurements of weight, height and evaluation of body composition (lean mass, total body water) using the BYODINAMICS (r) Model 310. For all statistical tests, we used a significance level of 95% (p<0.05). RESULTS: 14 adult male volunteers with a mean age of 22.57 (±1.45) years, including seven trained and seven untrained individuals, participated in the study. After 28 days of supplementation, the trained group had a significant increase in weight, total body water, lean body mass and hydration of lean mass, but no significant increase was observed in the untrained group. Regarding the phase angle, it increased in the untrained group and decreased in the trained group. CONCLUSION: creatine supplementation combined with resistance training is more effective in hydrating trained individuals and it's also sufficient to reduce the difference of the angle phase intergroup, thus suggesting improved cellular hydration in both groups. However, this increase in hydration revealed no significant increase in muscle tissue. .

INTRODUCCIÓN: la creatina es un recurso ergogénico cuya suplementación ha sido asociada al aumento de la hidratación corporal total y al aumento de la masa muscular de los consumidores. Entretanto, estudiosos cuestionan si el aumento de la masa muscular es un aumento real. OBJETIVO: evaluar el efecto de la suplementación de creatina sobre la hidratación y el aumento de masa magra en individuos previamente entrenados y no entrenados, sometidos a un programa de entrenamiento resistido. MÉTODOS: ensayo clínico no aleatorio, constituido por tres momentos, M1 - Inicio de la suplementación con 20g/día de creatina; M2 - 7 días después de iniciada la suplementación y reducción de la suplementación para 5g/día; M3 - 28 días de suplementación. En los momentos propuestos, fueron realizadas mediciones de peso, estatura y evaluación de la composición corporal (masa magra, agua corporal total) con el uso de BYODINAMICS(r) Modelo 310. Para todos los tests estadísticos, fue adoptado el nivel de significancia de 95% (p<0,05). RESULTADOS: participaron en este estudio 14 voluntarios adultos del sexo masculino, con edad promedio de 22,57(±1,45) años, de los que siete eran entrenados y siete no entrenados. Después de 28 días de suplementación, en el grupo entrenado se observó un aumento significativo en el peso, agua corporal total, masa magra e hidratación de la masa magra, pero ningún aumento significativo fue observado en el grupo no entrenado. En relación al ángulo de fase, aumentó en el grupo no entrenado y se redujo en el grupo entrenado. CONCLUSIÓN: la suplementación de creatina asociada al entrenamiento resistido es más efectiva en la hidratación de individuos entrenados, como también es suficiente para reducir la diferencia significativa del ángulo de fase intergrupos, sugiriendo así mayor hidratación celular en ambos grupos. Sin embargo, ese aumento en la hidratación no reveló aumento significativo en el tejido muscular. .

Estimación del agua corporal total y del peso seco, usando impedancia bioeléctrica tetrapolar de multifrecuencia (BIA-4) en pacientes en hemodiálisis / Total body water and dry weight estimation by using multi-frequency tetrapolar bioelectrical impedance

Antecedentes. La medición del "peso seco" en pacientes renales se ha tornado difícil por el sinnúmero de variables que en él intervienen, dada la importancia de conocerlo por cuanto con él se determina el tratamiento diálitico, farmacólogico y nutricional se ha trabajado en diferentes ecuaciones y métodos para obtenerlo. Objetivo. Describir la composición corporal, el agua corporal total y el peso seco de pacientes con enfermedad renal en Hemodiálisis Materiales y Métodos. Se realizó un estudio descriptivo transversal en seis fases, desde el año 2001 al 2010. Con el método de BIA-1 Y BIA-4 (bioimpedancia de unifrecuencia y tetrapolar) y la ecuación Ramírez-Almanza. Para la determinación del peso seco se utilizaron los valores de normovolemia e hipervolemia y se utilizó un nuevo instrumento para diagnóstico nutricional VGS-MIS. Resultados. El 50% de los pacientes estudiados tenían un diagnóstico de Diabetes e Hipertensión, el 87% con riesgo leve de desnutrición, solo el 3% sin riesgo de desnutrición. El punto de cohorte de la Resistencia dada por la bioimpedancia de 550 permite determinar que pacientes con valores por debajo de éste son sintomáticos con una alta sensibilidad 73% y una especificidad de 50%. Para el agua total corporal es posible utilizar la ecuación Ramirez-Almanza pues tiene una buena correlacion mediana (0.76)con el índice de impedancia de Kushner. La VGS-MIS es el mejor método de valoración encontrada hasta ahora para paciente renal porque involucra diferentes parámetros físicos, nutricionales, clìnicos y bioquímicos. Conclusión. El uso de la Bioimpedancia en paciente en hemodiálisis ha permitido una mayor exactitud en el cálculo del agua corporal total, peso seco y estado nutricional de los pacientes en hemodiálisis.

Background. Dry weight assessment in renal patients has got difficult because of many variables which are taken into account to do it. Because it is used to determine the dialytic, pharmacological and nutritional treatment in such patients, it has worked on different equations and methods in order to obtain it. Objetive. To describe body composition, total body water and dry weight of patiens who suffer from renal disease and are under hemodialysis. Materials and methods. A transversal descriptive study was carried out by six phases from the year 2001 to 2010. It was used the Unifrequency Tetrapolar Bioimpedance (BIA-1), the Multifrequency Tetrapolar Bioimpedance (BIA-4) and the Ramírez-Almanza equation. Normovolemia and hipervolemia values were used to establish dry weight and a new instrument was used in nutritional diagnosis to global subjective valuation in renal patient under hemodialysis, the Malnutrition Inflammation Score (MIS). Results. 50% of the studied patients had a diabetes and hipertension diagnosis, 87% were in a low risk of desnutrition, just 3% without any risk of desnutrition. The Resistance cohort point given by the bioimpedance of 550 allows to determine who patients with values under of this are somatics with 73% a hight sensibility and a 50% specificity. To total water weight it is possible to use the Ramirez-Almanza equation due to it has a good mediana correlation (0.76) with the Kushner Impedance Index. VGS-MIS is the best assessment method used until know on renal patient because it involves different physic, nutritional, clinic and biochemic parameters. Conclusion. Bioimpedance use on patient under hemodialysis has led a higher precision in the total body water, dry weight and nutritional state in such patients.

Marcadores de estrés oxidativo y su relación con el estado nutricional en adultos, Ecuador / Relationships between biomarkers of oxidative stress and nutritional status in adults, Ecuador

Se evaluó la relación entre biomarcadores de estrés oxidativo (ácido úrico, bilirrubina y proteína C-reactiva) con el estado nutricional en 321 adultos de Ecuador, pertenecientes al personal administrativo de la Universidad Técnica del Norte, con edades de 43 ± 10 años, (46,30% femenino y 53,61% masculino). Se obtuvo información sociodemográfica, de estilo de vida y epidemiológica; se calculó el índice de Masa Corporal (IMC), porcentaje de grasa y agua corporal, se midió la circunferencia de la cintura (CC) y la presión arterial y se determinó las concentraciones de ácido úrico, bilirrubina y Proteína C reactiva (PCR). Se encontró que 17,9% de la población presentó obesidad y 51,72% sobrepeso. Los valores más elevados de ácido úrico se encontraron en obesos, hipertensos y en quienes realizan actividad física. La bilirrubina total, directa e indirecta se encontró en límites superiores en los grupos con obesidad abdominal, y con actividad física. Las variables % de grasa y de agua influyen en la PCR en el grupo con baja grasa corporal y en las mujeres. En hombres, la PCR se asocia con IMC y CC. En los grupos sobrepeso, alta grasa corporal y PHT, el ácido úrico mostró relación con el % de grasa y la CC En los obesos con el % de agua e IMC y en los grupos obesidad abdominal e HT se asoció con % de agua y CC Se concluye que el porcentaje de agua corporal es un importante indicador nutricional para el desarrollo de estrés oxidativo en esta población.

In this work it was evaluated the relationship between oxidative stress biomarkers (uric acid, bilirubin and C-reactive protein) with nutritional status in 321 adults of Ecuador, belonging to administrative staff of of the Universidad Tècnica del Norte , aged 43 ± 10 years old (46 30% female and 53.61% male). Socio demographic and epidemiological information and lifestyle were obtained through a survey; The Body Mass Index (BMI) and body fat and body water percentages were calculated; waist circumference (WC) and blood pressure was measured. Determinations of uric acid, bilirubin, and serum C-reactive protein (PCR) were performed. 17.9% of the populations were obese and 51.72% overweight. The highest values of uric acid were found in obese, hypertensive and physical activity groups. The total direct and indirect bilirubin were found in upper limits in abdominal obesity and physical activity groups. The CRP level was influenced by % fat and % water in the low body fat group and in females. In male, BMI and WC were associated with CRP. Uric acid showed relationship with % fat and WC in overweight, high body fat and PHT groups, uric acid was associated with the % water and BMI in obese. Finally, uric acid was associated with % water and the WC in the abdominal obesity, and HT groups’ .The body water percentage is an important indicator to development of oxidative stress in this population.

Redução da água corporal de renais crônicos em diálise peritoneal se associa com melhor controle da hipertensão arterial / Total body water reduction in subjects with chronic kidney disease on peritoneal dialysis is associated with a better hypertension control

Introdução: A hipertensão arterial tem alta prevalência em renais crônicos, sendo a hipervolemia um de seus fatores causais. Objetivo: Avaliar a influência da redução da volemia no controle pressórico e em parâmetros ecocardiográficos de pacientes renais crônicos em diálise peritoneal contínua. Métodos: Doze renais crônicos sem sinais clínicos de hipervolemia foram submetidos à intensificação da diálise com o objetivo de reduzir o peso corporal em 5%. A volemia foi avaliada pela bioimpedância elétrica e pela ultrassonografia de veia cava inferior (VCI). Os voluntários foram submetidos à monitorização ambulatorial da pressão arterial e a exame ecocardiográfico no período basal e após 5 semanas de intervenção. Resultados: Após a intensificação da ultrafiltração, houve redução significativa do peso corporal, da água extracelular e do diâmetro inspiratório da VCI, enquanto o índice de colapsamento da VCI não alterou de modo significativo. A despeito da redução do número de anti-hipertensivos, a pressão sistólica do período de sono reduziu de 138,4 ± 18,6 para 126,7 ± 18,0 mmHg, o descenso pressórico do sono aumentou e o diâmetro sistólico final do ventrículo esquerdo reduziu significantemente. Conclusão: A redução da volemia de pacientes em diálise peritoneal, clinicamente euvolêmicos, se associou a melhor controle pressórico e à diminuição do diâmetro sistólico final do ventrículo esquerdo. .

Introduction: Hypertension is highly prevalent in patients with chronic kidney disease and hypervolemia is one of the principal causes. Objective: To evaluate the influence of the reduction of volemia on blood pressure as well as on echocardiographic parameters in patients on continuous ambulatory peritoneal dialysis. Methods: Twelve patients with no clinical evidence of hypervolemia were submitted to an increase in the rate of the dialysis with the purpose of reducing body weight by 5%. The volemia was evaluated by electrical bioimpedance and by ultrasound of the inferior cava vena (ICV). Blood pressure was measured by ambulatory blood pressure monitoring and cardiac function was evaluated by echocardiography both at baseline and 5 weeks after the intervention period. Results: After the increase in the ultrafiltration, body weight, extracellular water and the inspiratory diameter of the ICV decreased significantly in parallel with a non-significant increase in the collapsing ICV index. Despite the reduction of anti-hypertensive drugs, systolic blood pressure during the sleep period decreased from 138.4 ± 18.6 to 126.7 ± 18.0 mmHg, the nocturnal blood pressure drop increased and the final systolic left ventricular diameter decreased significantly. Conclusion: Reduction of the volemia of patients on peritoneal dialysis, with no signs of hypervolemia, was associated with a better blood pressure control and with a decrease of the final systolic left ventricular diameter. .

Influencia de la resistencia eléctrica en la estimación del agua corporal total y la masa libre de grasa / Influence of the electric resistance in the estimate of the total body water and the fat free mass

Se realizó un estudio transversal y controlado, a fin de evaluar la influencia de los valores no corregidos y corregidos de la resistencia eléctrica, medidos con los analizadores Bodystat® 1500-MDD y BioScan® 98 en el agua corporal total y la masa libre de grasa, de 31 sujetos aparentemente sanos y 31 niños con diferentes afecciones, atendidos en el Servicio de Oncohematología del Hospital Infantil Sur de Santiago de Cuba, desde septiembre hasta octubre del 2009. Se emplearon 2 ecuaciones por cada parámetro biológico, y como criterio estadístico la prueba t de student de 2 medias de muestras apareadas. La diferencia entre los valores no corregidos y corregidos de la resistencia eléctrica no influyó significativamente en los 2 parámetros biológicos; por tanto, es posible usarlos indistintamente para estimar el agua corporal total y la masa libre de grasa en individuos aparentemente sanos y pacientes con diferentes enfermedades.

A cross-sectional and controlled study was carried out, in order to evaluate the influence of the unadjusted and adjusted values of electric resistance, measured with the analyzers Bodystat® 1500-MDD and BioScan® 98 in the total body water and the fat free mass, of 31 apparently healthy persons and 31 children with different disorders, assisted in the Oncohematology Service of the Southern Pediatric Hospital in Santiago de Cuba, from September to October, 2009. Two equations were used for each biological parameter, and as statistical criterium the paired samples T test was used. The difference between the unadjusted and adjusted values of the electric resistance didn't influence significantly in the 2 biological parameters; therefore, it is possible to use them indistinctly to estimate the total body water and the fat free mass in apparently healthy individuals and patients with different diseases.

Evaluation of hydration status following soccer matches of different categories / Avaliação de parâmetros de hidratação após jogos de futebol de diferentes categorias

The purpose of this study was to evaluate the hydration status and thermoregulatory responses, during official soccer matches, of soccer players in different categories. The participants of the under-15 (U-15, n=36) and of the under-17 category (U-17, n=14) were placed into different groups according to the amount of time spent in the field: Main group; Partial group; Intermediate group; Control group. The thermoregulatory responses and hydration status were measured. The Main group and the Partial group presented significantly higher water intake, weight loss and sweat rate compared with the Intermediate and Control group (p< 0.05). The under-17 players of the Main group had a larger weight difference pre and post match compared with the under-15 players of the same group (p< 0.05). It was concluded that an official soccer match altered significantly the hydration status of the players, and it was related with the time spent in the match.

Objetivo do presente estudo foi avaliar o padrão de hidratação e respostas termorregulatórias de jogadores de futebol de diferentes categorias ao longo de um jogo oficial. Participaram desse estudo jogadores de futebol das categorias sub-15 (N 36) e sub-17 anos (N 14). Os jogadores foram divididos em grupos de acordo com o tempo de atuação em nos jogos: grupo principal, o grupo parcial, grupo intermediário grupo controle. As respostas termorregulatórias decorrentes dos jogos e o estatus de hidratação foram determinados e comparados entre os grupos apresentados. Os grupos principal e parcial apresentaram maiores valores de consumo de água, perda de peso e taxa de sudorese em comparação aos grupos intermediário e controle (p< 0,05). A diferença de peso pré e pós-jogo entre as categorias foi maior nos atletas da categoria sub17 em comparação com os atletas sub 15 no mesmo grupo (p< 0,05). Conclui-se que um jogo de futebol foi capaz de alterar de forma significativa os parâmetros de hidratação dos jogadores de futebol tendo relação direta com o tempo de atuação em campo.

Uso de la bioimpedancia eléctrica para la estimación de la composición corporal en niños y adolescentes / Use of bioelectrical impedance for the prediction of body composition in children and adolescents

El análisis de la composición corporal constituye el eje central de la valoración del estado nutricional. Su estimación en el área pediátrica ha cobrado gran relevancia debido a la creciente prevalencia de la obesidad en las primeras etapas de la vida y los efectos adversos sobre la salud. La bioimpedancia eléctrica es uno de los métodos desarrollados para estimar la composición corporal; tanto en investigación como en el área clínica. Se fundamenta en la oposición de las células, tejidos o líquidos corporales al paso de una corriente eléctrica. Este método mide el agua corporal total y permite estimar la masa corporal libre de grasa y la masa grasa. Entre sus ventajas están el bajo costo, facilidad de transporte, inocuidad, sencillez en el manejo y la baja variabilidad interobservador. Este artículo hace una revisión de la bioimpedancia eléctrica como técnica para evaluar la composición corporal. Se presentan los aspectos relacionados a las suposiciones metodológicas, así como sus ventajas, limitaciones y aplicaciones de la bioimpedancia eléctrica en la estimación de la composición corporal en niños y adolescentes. Se concluye que la validez y aplicabilidad demostrada por la bioimpedancia eléctrica en estudios epidemiológicos, le permite ubicarse dentro de los métodos recomendables para el estudio de la composición corporal en niños y adolescentes.

The analysis of body composition constitutes the center of nutritional state evaluation. Its estimation in the pediatric area has become highly relevant due to the growing prevalence of obesity in the first stages of life and the adverse effects on health. Bioelectrical impedance is one of the methods developed to estimate body composition in research as well as in clinic. Bioelectrical impedance is based on the opposition of cells, tissues or body fluids to the pass of an electric current. This method measures total body water and allows the estimation of fat and fat free body mass. Among its advantages are low cost, easy transportation and handling and low variability between observers. This article makes a revision of bioelectric impedance as a technique to evaluate body composition. Aspects related to its methodological assumptions are presented, as well as its advantages, limitations and applications in the estimation of body composition of children and adolescents. The applicability and validity shown by bioelectric impedance in epidemiologic studies place it next to reliable methods for the study of body composition.