BIA Basics

I can think of two reasons off the top of my head. Let me illustrate with two types of cases.

First, let’s take the case of Jimmy W. who has been admitted with decubitus ulcers. We get our best people on it and work to heal the wound. But Jimmy doesn’t seem to heal and he is definitely overstaying his welcome!! What can be going on?

Scenario One:

BIA shows the expected response with some fluid shifts and a mild BCM drop from optimal. Now his fat is dropping, too! In this case, he may have some continued assault (like an infection) that needs to be investigated and he is probably not getting the calories and protein he needs to blunt this continuous response.

Scenario Two:

BIA shows that his BCM is very diminished (<95% of the bottom range of normal). In this case, he will be hard pressed to ever heal despite your best efforts. What he really needs is a boost in the BCM. And, from my point of view, you always need to feed him somehow. But if his BCM is too low to make good progress or the wounds are in the “ebb” zone, you may find it difficult to reconstitute that BCM quickly enough to keep him from being at risk for complicating problems, like further infection and worsening wounds.

Well, first off, Jimmy needs to be fed adequately. This is not a very good time to starve! Second, any of the appropriate anabolic or anticatabolic treatments needs to be initiated. If there is an identified infection that can be treated with an antibiotic, then the antibiotic will (for all intents and purposes) act as an anticatabolism agent indirectly by getting rid of an assault on BCM (the infection). If Jimmy is a diabetic, controlling blood sugar and appropriate hypoglycemic agents may also help with wound healing (anticatabolic property) and anabolism of tissues. If Jimmy needs additional help or immediate work on his BCM, you may be looking at an anabolic medication to slow, stop, and reverse the loss of weight and body cell mass caused by this event.

Great! Ya with me still?? If not, read it over again and follow the illustration below:

Treatment of event à add treatment for other confounding problems (infection, chronic disease, inadequate nutrient intake) à and/or if compromised in weight and BCM at a significant level (weight 5-10% loss or 5% BCM loss), add anabolic therapy

Some people, especially in compromised patients or chronic disease, don’t “reconstitute” normally. Let’s take Billy B, for instance. Billy has a chronic HIV infection. This means that body composition is being challenged (as in any other chronic inflammatory disease) daily! Billy has a past history of wasting and had subscribed to the “Haagen Dazs” ice cream diet. He finally decided to give HAART (combination anti-HIV therapy) a try, but didn’t change over to a more reasonable diet. And the weight returned. Man, how the weight returned!! Way past his original svelte 180-pound figure and well into the mid 200s. Not a happy camper, he wanted to diet to get it off in two months before beach season began.

You know from reading the earlier part of this monologue that when you gain weight normally, all body compartments evaluated by BIA should increase. What happened with Billy was in the “Abby Normal” (or “abnormal” for those of you not familiar with Mel Brook’s “Frankenstein” movie) category. And you may also know that starvation (a.k.a. dieting in this case) would decrease all compartments. So, Billy had some room to roam on the fat and ECM, but not much on the BCM (“not a square to spare” for you Seinfeld fans). Any loss of BCM would have put him at a higher than already risking functional compromise and potential for getting sick.

In his case the decision was made to support BCM with anabolic therapy, get Billy back to the healthy eating habits he had prior to his gelato days, and start him on a progressive exercise program. He was able to initiate weight loss while maintaining his BCM. He is in pretty good shape at this time and happier with the results than he would have been with diet alone.

So, you get the picture? If not, head back to the beginning…and pay attention this time!