The altered fluid distribution in obesity may reflect plasma hypertonicity

This study explored whether the increased extracellular relative to intracellular fluid (ECF/ICF) ratio in obesity might reflect osmotic effects of elevated plasma solute concentrations.

Cross-sectional, epidemiological survey.

The present analysis used nationally representative data from the Third National Health and Nutrition Examination Survey on community-dwelling adults (aged 40-59 years) in the US without evidence of glucose dysregulation or chronic disease (n=1285).

Body mass index (BMI) was estimated from measured height and weight. Total body reactance, an index of body fluid distribution, was determined by bioelectrical impedance analysis. Plasma tonicity (the cumulative index of osmotically effective plasma solute) was estimated from plasma glucose, sodium and potassium. Sex-specific relative odds of lower reactance (or=295 mmol/l) associated with overweight (25or=30) were estimated using logistic regression models that controlled for sociodemographic variables, smoking, leisure-time physical activity, total energy intake, serum creatinine, plasma insulin and glucose. Multinomial logistic regression models tested for associations between weight status and specific serum solute.

Independent of covariates, in men and women, overweight and obesity were associated with increased odds of lower reactance and hypertonicity. Overweight and obese individuals with lower reactance had significantly higher serum sodium than normal weight individuals.

Elevated plasma solute concentrations are associated with obesity in free-living adults. Physicians and researchers should be alert to a possible link between hypertonicity and obesity.

Grants from the NIH, Nestle Waters.