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Extracellular water-to-total body water ratio is an essential confounding factor in bioelectrical impedance analysis for sarcopenia diagnosis in women

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Key summary points

AbstractSection Aim

To examine the relationships of extracellular water-to-total body water ratio (ECW/TBW) with handgrip strength, gait speed, and skeletal muscle mass index (SMI) in older women.

AbstractSection Findings

This study reveals an association between SMI and handgrip strength in community-dwelling older women with ECW/TBW values less than 0.40, although there was no such association in women with ECW/TBW values of 0.40 or higher.

AbstractSection Message

The ECW/TBW ratio represents a confounding factor, which should be considered when using bioelectrical impedance analysis for sarcopenia diagnosis.

Abstract

Purpose

The extracellular water-to-total body water ratio (ECW/TBW) is used in bioelectrical impedance analysis (BIA) for measuring muscle mass; however, ECW/TBW may be affected by several factors common in older individuals. Here, we assessed the relationships of ECW/TBW with handgrip strength, gait speed, and skeletal muscle mass index (SMI) in older women.

Methods

In this cross-sectional study, 73 community-dwelling women aged ≥ 65 years who could independently perform activities of daily living were included. ECW/TBW was measured using direct segmental multifrequency BIA. The participants were divided into ECW/TBW < 0.40 (n = 54) and ECW/TBW ≥ 0.40 (n = 19) groups, with the latter indicating overhydration. SMI was calculated as appendicular skeletal muscle mass/(height)2 (kg/m2). The relationships of SMI with handgrip strength and gait speed were assessed using partial correlation coefficients. Age, number of medications, pain, and medical history were treated as control variables.

Results

The average age of participants was 77.6 ± 6.0 years. The SMI was significantly related to handgrip strength (partial correlation coefficient = 0.293, P = 0.016) but not to gait speed (partial correlation coefficient = − 0.183, P = 0.138). Similarly, the SMI of the ECW/TBW < 0.40 group was significantly related to handgrip strength (partial correlation coefficient = 0.372, P = 0.009) but not gait speed (partial correlation coefficient = − 0.267, P = 0.066); however, the SMI of the ECW/TBW ≥ 0.40 group was not related to either variable.

Conclusion

ECW/TBW represents a confounding factor, which should be considered when using BIA for sarcopenia diagnosis.

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Acknowledgements

We thank the participants and the Yoshinogawa City office for assistance with participant recruitment.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, 180 Hoji, Yamashiro-cho, Tokushima City, 770-8514, Japan

    Akemi Hioka & Naoki Akazawa

  2. Yoshinogawa Hospital, Itano-gun, Japan

    Naomi Okawa & Shinji Nagahiro

Authors
  1. Akemi Hioka
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  2. Naoki Akazawa
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  3. Naomi Okawa
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  4. Shinji Nagahiro
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Corresponding author

Correspondence to Naoki Akazawa.

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The authors declare that there is no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of our institution, and was conducted in accordance with the Declaration of Helsinki of 1996.

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Each participant provided written informed consent prior to participation.

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Hioka, A., Akazawa, N., Okawa, N. et al. Extracellular water-to-total body water ratio is an essential confounding factor in bioelectrical impedance analysis for sarcopenia diagnosis in women. Eur Geriatr Med 13, 789–794 (2022). https://doi.org/10.1007/s41999-022-00652-2

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  • DOI: https://doi.org/10.1007/s41999-022-00652-2

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