measuring and managing healthy living bioelectric impedance analysis advanced edition

Measuring and Managing Healthy Living Bioelectric Impedance Analysis

Advanced Edition

Measuring and Managing Healthy Living

PLEASE NOTE

The content of this slide deck is for informational purposes only.

BIA technology is not intended to prevent, cure, diagnose, or treat any particular disease state.

BIA technology does not replace the educated judgment of a licensed health care professional.


Objectives

• Brief history of body composition assessment

• Bioelectrical Impedance Analysis• Scientific foundations• Types of BIA• Utilization of RJL BIA

• RJL BIA Report highlights

• Summary and Q&A


Kerrie SaundersDirector of Education

Paul MaletzProduction Manager

Michael LiedtkeDirector of

Business Development

Barry CallahanChief Technology

Officer

William J. PaulyDirector of Sales

Joshua MyersEngineering Technician

Jeff PollyOffice Manager

Rudolph J. LiedtkeFounder & CEO


INDICATIONS OF USE The following outlines RJL Systems Indications of Use approved by the FDA. Calculation and Historical Tracking of: ■ Actual Impedance■ Actual Phase Angle PA)■ Estimated Body Fat (FAT)■ Estimated Fat Free Mass (FFM)■ Lean Dry Mass (LDM)■ Estimated Total Body Water (TBW)■ Estimated Intra-Cellular Water (ICW)■ Estimated Extra-Cellular Water (ECW)■ Estimated Basal Metabolic Rate (BMR)■ Estimated Daily Energy Expenditure ■ Actual Body Mass Index (BMI)


INDICATIONS OF USE

Intended Population:BC is intended only for use on normally healthy adults and adolescents age 3-94. The prediction equations used by the BC software assume that the person being tested has not had either arm or leg amputated. It is not intended to be used to diagnose, treat, or cure any disease or medical condition. Contraindications:No known contraindications exist. Warnings:The BC software provides body composition estimates based on the electrical characteristics measured by a Bioelectrical Impedance Analyzer (BIA). BIA works by introducing an alternating current (AC) signal into the body and then measuring how that signal is affected by the body. This device should not be used on subjects with any implanted electronic devices such as pacemakers or implantable cardioverter-defibrillators (ICD)’s.


Evidence-based medicine

requires evidence

Which components are changing - fat, lean dry mass, fat free mass, intracellular water, extracellular water…?


Contribution of body composition to nutritional assessment at hospital admission in 995 patients: a controlled population study U. Kyle, A. Morabia, et al, BJN (2001), 86, 725-731,

• Degree of malnutrition was significantly underestimated by BMI and serum albumin

• BIA-FFM identified patients with low FFM, and low or high Fat

• DXA-BIA correlate r=0.986 FFM• FFM should therefore be included in optimal

objective nutritional assessment



Bioelectrical Impedance Analysis


Actual• Body Mass Index• Impedance• Phase Angle

Research equation• Body Fat• Fat Free Mass• Total Body Water• Intra-Cellular Water• Extra-Cellular Water• Basal Metabolic Rate• Daily Energy Expenditure

RJL Sciences Quantum BioelectricalImpedance Analyzers

have received FDA clearance to measure:


Proper BIA Protocol


Proper BIA protocol

• Remove sock, stocking, jewelry, and any other metal objects from the electrode sites and the side of the body being tested.

• Remove cellphone or other electronic device from body

• Supine position on a flat surface

• Arms out 30’ from waist, and palms down


Proper BIA protocol

Proper BIA protocol

• Clean the 4 electrode sites with alcohol pad, and allow to dry (about 30 seconds)



Proper BIA protocol

• Supine position on a flat surface – AMA definition

• Knees separated, with arms out 30 degreesfrom waist, palms down


• BIA technology has been utilized in over 2000 research studies and scientific articlesto date.


10/2013AMA Annual Meeting

• CPT 0358T formally definesBIA Whole Body Composition, supine position,

with interpretation and reporteffective July 1, 2014


• BIA measures whole body reactance (Xc) and resistance (R), the two components of impedance.


Evidence-based medicine

requires evidence


FatFat Free Mass

(aka Lean Body Mass =skeletal muscle, nerves, organs,

water, smooth muscle)

Extra-Cellular Water

Intra- Cellular Water

Total Body Water LDM(Lean Dry Mass)

TOTAL BODY WEIGHT


Awareness

• The body normally varies +/- 3% total weight within 24 hours, due to food in stomach, bladder and bowel contents, etc.


Watch percent

comparison to outside

reference and then

pounds for change over

time.


FAT STORAGE

• Visceralaround the organs, aka:central, abdominal

(generally include hepatic fat)

• Subcutaneous just beneath the skin, and in limbs

So…..


Fat Pounds & Fat PercentPractitioners discuss:

• Dietary fats (dairy, oils, meat, chicken, fish, nuts, seeds, avocado, coconut, olives)

• Omega 3:6 balance• Higher fiber (plant) foods, to 40+ grams per day for

average adult• Activity level (strength, stamina, stretching)• Proper sleep cycle• Rule out endocrine hormone imbalance• Rule out reproductive hormone imbalance• Rule out liver dysfunction• Rule out food relationship issues


Why Correct the Omega-3 deficiency and the

Om-6:Om-3 Ratio?

SAD is several times higher in omega 6 than required, competing for omega 3 for absorption


Omega 3 Sources

(and generally decrease omega 6s)

• Purslane• Ground flaxseeds• Hempseeds• English walnuts• Chia seeds• Pumpkin seeds• Greens, soy, pumpkin• Plant-based supplements• Follow cautions on fish oils,

and if using salmon or mackerel, it must be 3.5-4 oz., ‘open water’


Lean Mass


Lean Mass

Practitioners discuss:

• Activity (especially strength and stretching)• Stamina/ Endurance• VARIETY• NASA Study


Lean Mass

Practitioners discuss:

• Plant proteins (beans, peas, lentils, sprouts, quinoa)• Rule out tobacco, alcohol or other drug use• Rule out cachexia• Proper sleep cycle


Awareness

Over-training with too few calories can lead to sarcopenia. Cytokines, Growth Mediators and Physical Activity in Children during Puberty, edited by J. Jürimäe, A.P. Hills, T. Jürimäe, 2010


Source credit: http://www.funfitnessforum.co.uk


Hydrated cells vs. Dehydrated cells


Intracellular WaterPractitioners discuss:

• Ensure proper water intake

• Decrease alcohol and caffeine

• Salt balance

• Electrolytes

• B Vitamins

• Omega 3: Omega 6 balance

• Rule out toxicity, allergies, kidney issues

• Rule out inflammatory processes

• Consider chronic stress


High Electrolyte Foods

• Celery• Cucumber• Berries• Grapes• Oranges• Bananas


High Electrolyte Foods

• Ultima Replenisher• Accelerade• Alacer EmerGenC• VEGA Electrolytes• UNflavored Pedialyte


Phase Angle(Humans typically range between 3-9)

• Optimal Reference Values, decreasing, as Men age from 20-80 years = 7.9-5.1

• Optimal Reference Values, decreasing, as Women age from 20-80 years = 7.3-4.5

• Rakowski, 2005

barryc

INCOMPLETE CITATION!!!


Can phase angle determined by BIA assess nutritional risk? A comparison between healthy and hospitalized

subjectsU. Kyle, E. Soundar, et. al. Clin Nutr (2012), 875-881.

• Low PA associated with low serum albumin and moderate-to-severe risk by NRS2000 and SGA.

• PA is a useful screening tool at hospital admission without constraints of measuring body weight or body height


Phase Angle• See the specified reference range on each individual report, based upon unique

client factors

• Many practitioners report making a referral for further assessment and diagnosis for Phase Angle under 4

• Phase angle is calculated by finding the ratio of reactance divided by resistance, and taking the arctangent of that ratio.

• Phase angle is normally expressed in degrees

• Increased hydration is usually associated with higher phase angle

• Practitioners typically say “higher is better”


Practitioners specifically target FATloss to help achieve…

Cardiovascular riskBlood sugar & insulinTotal cholesterolBlood pressureLDL cholesterolTriglyceridesMedication reduction/elimination when possibleGynecological conditionsSymptoms of arthritis

Cardiovascular functionImproved quality of lifeHealthy sexual functionHDL cholesterolBetter fitness & lifestyle complianceHormone balance


Upcoming this year…

• New measures: Lean Soft Tissue, Skeletal Muscle Mass, Bone Mineral Content

• Practitioner Report format option

• Segmental BIA

• 35th Anniversary Event October 2014

barryc

Not Upcoming


• Target Weight• Notations (recent exercise, surgery, etc.)• Lab biomarkers: measurements, HgBA1C, Lipids, BP,

etc.• Store, email, print• Tables, graphs, F&F, size of report• Equation Sets

BC 3.0 Software for MAC & PC(included in device kit)

Report Options


Population Equation Options

• NHANES-III (General Population) This equation set is appropriate for general populations, and the Fat, FFM, and TBW formulas have been validated with NHANES-III

• New Pediatric (Ages 4 – 19; also validated for obese children) • Mexican Adults (Male & Female ) • Native Americans • Obese (BMI > 30 ) • African American (Obese ) • Athletic • HIV • All Body Types (BMI adjustable)


Lifestyle FactorUpgrades:

Food & Fitness


Designed to allow patients to see and navigate CHOICES, helping to make food fun again.


Food Categories

Categories help lifestyle medicine practitioners target and customize patient preferences and nutritional needs and patient preferences.


Food Category Titles

Higher ProteinHigher CarbohydrateHigher FatCalcium richSnacks


Designed to allow practitioners to more easily address and customize many sample food options, including:

wheat-, dairy-, egg-, gluten-,and cholesterol-free, and high fiber, vegan, and vegetarian diets


HummusSprouted breadEarth Balance™Yam or sweet potatoAlmond milkSoy milkHemp milkCoconut milkRice milkGreen/red/purple grapesCherriesDates/figsSpinachCollard greensBok choyVegetarian chiliBlack bean salsaGarbanzo beansBlueberriesStrawberriesRaspberriesNon-dairy mayonnaiseSliced red or green peppersAll fruit jam/conserves

Veggie BurgerBlack bean burgerBrown/wild riceQuinoaBaked potatoTeffMillettChia seedsGround flax seedsWalnutsPurslane greensRomaine or red lettuceGreen beansJicamasoy/rice/oat/coconut ice creamwhole grain muffinMueslix or granola3-bean saladLentil couscous or bulgur wheat saladBean, rice & veggie burritoMinestrone soupVegetable soupBean soupPea soup

HealthEnhancedOptions


Menu Options

Note: The Standard Menu Options are listed for patient familiarity. Specific recommendations are determined during the patient-practitioner interaction.


The many forms of fitness…


Designed to include a spectrum of lifestyle activities and exercises, helping you show your patients they are already moving, they just might need to move MORE.


Note: FFM could also be divided into Bone Mineral Content (BMC) + Lean Soft Tissue (LST)

BMC is the mineral deposits of the skeleton.

LST includes organs, connective & supportive tissues, & SMM.

Skeletal Muscle Mass (SMM) is required for posture and movement.


TRAINING RESOURCES

YouTube videosWebsite resourcesUSB drive included

Superb customer service

William Pauly, Director of Sales33939 Harper AvenueClinton Township, MI 48035(800) 528-4513 www.RJLSystems.com

Photo Credits: Sunrise – Santa Banta, Midday – Dreamstime.com, Sunset –David baker

We invite your Questions!(feel free to also use the Chatbox option)

measuring and managing healthy living bioelectric impedance analysis advanced edition

Documents