Comparison of Bioelectrical Impedance Vector Analysis (BIVA) to 7-point Subjective Global Assessment for the diagnosis of malnutrition / Comparação da Análise Vetorial de Impedância Bioelétrica (BIVA) com a Avaliação Subjetiva Global de 7 pontos para o diagnóstico de desnutrição

Abstract Introduction: Bioelectrical impedance vector analysis (BIVA) is a non-invasive and low-cost strategy. The methods used to assess malnutrition in patients undergoing HD are still a challenge. The aim of the present study was to compare BIVA to 7-Point Subjective Global Assessment (7-point SGA) to identify malnutrition. We also investigated the sensitivity and specificity of the previously proposed cutoffs point for BIVA parameters. Methods: Patients of both sexes, over 20 years of age, on HD treatment were included. Anthropometric parameters, laboratory data, and bioelectrical impedance analysis (BIA) were evaluated. Values of resistance (R) and reactance (Xc) obtained by mono-frequency BIA were normalized to body height (H) to generate a graph of the bioimpedance vector with the BIVA software. The analysis of the area under the receiver operating curve ROC (AUC) was performed. Results: Among the included 104 patients, the mean age was 51.70 (±15.10) years, and 52% were male. The BIVA had a sensitivity of 35% for diagnosing malnutrition. The specificity of BIVA for identifying the well-nourished patients was 85.7%. The diagnostic accuracy between the BIVA and 7-point SGA was AUC=0.604; 95%CI 0.490-0.726, higher than the previously established cutoff values (AUC=0.514; 95%CI: 0.369-0.631). The 95% confidence ellipses did not overlap (p<0.05). Conclusion: Our study showed low accuracy of BIVA for diagnosing malnutrition using a 7-point SGA as a reference standard. However, it is a complementary method for assessing nutritional status as it provides data on cellularity and hydration, which are important aspects for the HD population.

Resumo Introdução: Análise vetorial de impedância bioelétrica (BIVA) é uma estratégia não invasiva e de baixo custo. Os métodos usados para avaliar desnutrição em pacientes em HD ainda são um desafio. O objetivo do presente estudo foi comparar BIVA com Avaliação Subjetiva Global de 7 pontos (ASG de 7 pontos) para identificar desnutrição. Também investigamos sensibilidade e especificidade do ponto de corte proposto anteriormente para parâmetros de BIVA. Métodos: Foram incluídos pacientes de ambos os sexos, acima de 20 anos, em HD. Foram avaliados parâmetros antropométricos, dados laboratoriais e análise de impedância bioelétrica (BIA). Valores de resistência (R) e reatância (Xc) obtidos por BIA de mono-frequência foram normalizados para altura corporal (H) gerando um gráfico do vetor de bioimpedância com a ajuda do software BIVA. Foi realizada uma análise da área sob a curva ROC (AUC). Resultados: Entre 104 pacientes incluídos, a idade média foi 51,70 (±15,10) anos, e 52% eram homens. BIVA demonstrou sensibilidade de 35% para diagnosticar desnutrição. A especificidade da BIVA para identificar pacientes bem nutridos foi 85,7%. A precisão diagnóstica entre BIVA e ASG de 7 pontos foi AUC=0,604; IC95%: 0,490-0,726, superior aos valores de corte estabelecidos anteriormente (AUC=0,514; IC95%: 0,369-0,631). Elipses de confiança de 95% não se sobrepuseram (p<0,05). Conclusão: Nosso estudo mostrou baixa precisão da BIVA para diagnóstico de desnutrição usando ASG-7 pontos como padrão de referência. Entretanto, é um método complementar para avaliar estado nutricional, pois fornece dados sobre celularidade e hidratação, aspectos importantes para a população em HD.

Comparison of Bioelectrical Impedance Vector Analysis (BIVA) to 7-point Subjective Global Assessment for the diagnosis of malnutrition.

INTRODUCTION: Bioelectrical impedance vector analysis (BIVA) is a non-invasive and low-cost strategy. The methods used to assess malnutrition in patients undergoing HD are still a challenge. The aim of the present study was to compare BIVA to 7-Point Subjective Global Assessment (7-point SGA) to identify malnutrition. We also investigated the sensitivity and specificity of the previously proposed cutoffs point for BIVA parameters. METHODS: Patients of both sexes, over 20 years of age, on HD treatment were included. Anthropometric parameters, laboratory data, and bioelectrical impedance analysis (BIA) were evaluated. Values of resistance (R) and reactance (Xc) obtained by mono-frequency BIA were normalized to body height (H) to generate a graph of the bioimpedance vector with the BIVA software. The analysis of the area under the receiver operating curve ROC (AUC) was performed. RESULTS: Among the included 104 patients, the mean age was 51.70 (±15.10) years, and 52% were male. The BIVA had a sensitivity of 35% for diagnosing malnutrition. The specificity of BIVA for identifying the well-nourished patients was 85.7%. The diagnostic accuracy between the BIVA and 7-point SGA was AUC=0.604; 95%CI 0.490-0.726, higher than the previously established cutoff values (AUC=0.514; 95%CI: 0.369-0.631). The 95% confidence ellipses did not overlap (p<0.05). CONCLUSION: Our study showed low accuracy of BIVA for diagnosing malnutrition using a 7-point SGA as a reference standard. However, it is a complementary method for assessing nutritional status as it provides data on cellularity and hydration, which are important aspects for the HD population.

Serum advanced glycation end products are not associated with muscle strength in hemodialysis patients.

BACKGROUND: Advanced glycation end products (AGEs) are elevated in patients with renal failure and may potentially affect skeletal muscle. The aim of this study was to evaluate whether serum concentrations of AGEs are associated with muscle strength in hemodialysis (HD) patients, since this association is not clear in the literature. METHODS: This research has a cross-sectional design and included 96 patients on hemodialysis treatment (20-69 years). Serum AGEs (ELISA), three-day dietary records, anthropometric and bioimpedance variables and handgrip strength (HGS) were analysed. Serum AGEs were analyzed by ELISA test. RESULTS: Men's HGS were significantly higher than women's (p < 0.001). Serum AGEs of the individuals of the highest HGS quartile versus the lowest quartile were 11.27 ± 2.52 and 9.06 ± 2.14 (µg/mL), respectively (p = 0.02). After adjustment for potential confounders, the correlation between serum AGEs and HGS lost statistical significance. The main factors that were associated to muscle strength were aging, BMI, percentage of fat-free mass and serum albumin. CONCLUSION: Contrary to our hypothesis, serum AGEs were not associated with muscular strength in HD patients. These results suggest that serum AGE is not a good indicator of muscle strength in this population and others factors related to the disease may be more important and significant in reducing muscle strength than the serum concentrations of AGEs alone.

Oral Leiomyomatous Hamartoma of the Anterior Maxillary Gingiva.

INTRODUCTION: Oral leiomyomatous hamartoma (OLH) is a rare developmental tumor-like anomaly of the oral cavity. CASE PRESENTATION: This report documents a 4-year-old female who was diagnosed with an OLH of the palatal gingiva between the maxillary central incisors. This lesion was treated successfully by local surgical excision. CONCLUSION: Because many of the reported cases of this lesion have developed on the anterior maxillary gingiva, it is important for the periodontist to be aware of this entity.

Do different casein concentrations increase the adverse effect of rutin on the biology of Anticarsia gemmatalis Hübner (Lepidoptera: Noctuidae)?

The flavonoid rutin is recognized as playing an important role in the protection of plants against lepidopterans. Bioassays with this compound are generally carried out using artificial diets. Proteins of high energy value, such as casein, are important ingredients of insect artificial diets as a source of essential amino acids. However, such proteins can generally increase the allelochemical activity. Our objective was to evaluate the effects of rutin on larvae of the velvetbean caterpillar Anticarsia gemmatalis Hübner by incorporating this allelochemical into diets with different concentrations of casein. Three casein concentrations (0, 7 g, or 14 g) combined with none, 0.65%, or 1.30% of rutin were added to the rearing diet and offered to the larvae from hatching to pupation. Rutin negatively affected larval development, the amount of food consumed, and pupal weight of A. gemmatalis. These negative effects were clearly seen in insects fed on diets with 7 g of casein to which any concentration of rutin was added. The effects of rutin when added to the diets without casein were stronger than in diets containing a suitable amount of casein (14 g). The greater negative effects of rutin in diets containing suboptimal concentrations of casein indicate that casein can increase the effects of rutin only when the diets are nutritionally unsuitable for insect development.

Do different casein concentrations increase the adverse effect of rutin on the biology of Anticarsia gemmatalis Hübner (Lepidoptera: Noctuidae)?

The flavonoid rutin is recognized as playing an important role in the protection of plants against lepidopterans. Bioassays with this compound are generally carried out using artificial diets. Proteins of high energy value, such as casein, are important ingredients of insect artificial diets as a source of essential amino acids. However, such proteins can generally increase the allelochemical activity. Our objective was to evaluate the effects of rutin on larvae of the velvetbean caterpillar Anticarsia gemmatalis Hübner by incorporating this allelochemical into diets with different concentrations of casein. Three casein concentrations (0, 7 g, or 14 g) combined with none, 0.65 percent, or 1.30 percent of rutin were added to the rearing diet and offered to the larvae from hatching to pupation. Rutin negatively affected larval development, the amount of food consumed, and pupal weight of A. gemmatalis. These negative effects were clearly seen in insects fed on diets with 7 g of casein to which any concentration of rutin was added. The effects of rutin when added to the diets without casein were stronger than in diets containing a suitable amount of casein (14 g). The greater negative effects of rutin in diets containing suboptimal concentrations of casein indicate that casein can increase the effects of rutin only when the diets are nutritionally unsuitable for insect development.