Lipedema and Dercum’s Disease: A New Application of Bioimpedance

Rachelle Crescenzi, PhD,1 Paula M.C. Donahue, DPT, MBA, CLT-LANA,2,3 Sandra Weakley, BS,1 Maria Garza, BA,1 Manus J. Donahue, PhD,1,4,5 and Karen L. Herbst, MD, PhD6,7. Lymphatic Research Biology 2019

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Lipedema and Dercum’s Disease: A New Application of Bioimpedance

Rachelle Crescenzi, PhD,1 Paula M.C. Donahue, DPT, MBA, CLT-LANA,2,3 Sandra Weakley, BS,1 Maria Garza, BA,1 Manus J. Donahue, PhD,1,4,5 and Karen L. Herbst, MD, PhD6,7. Lymphatic Research Biology 2019

Background: Lipedema and Dercum’s disease (DD) are incompletely characterized adipose tissue diseases, and objective measures of disease profiles are needed to aid in differential diagnosis. We hypothesized that fluid properties, quantified as tissue water bioimpedance in the upper and lower extremities, differ regionally between these conditions.

Methods and Results: Women (cumulative n=156) with lipedema (n=110), DD (n=25), or without an adipose disease matched for age and body mass index to early stage lipedema patients (i.e., controls n=21) were enrolled. Bioimpedance spectroscopy (BIS) was applied to measure impedance values in the arms and legs, indicative of extracellular water levels. Impedance values were recorded for each limb, as well as the leg-to-arm impedance ratio. Regression models were applied to evaluate hypothesized relationships between impedance and clinical indicators of disease (significance criteria: two-sided p<0.05). Higher extracellular water was indicated (i) in the legs of patients with higher compared with lower stages of lipedema (p=0.03), (ii) in the leg-to-arm impedance ratio in patients with lipedema compared with patients with DD (p£0.001), and (iii) in the leg-to-arm impedance ratio in patients with stage 1 lipedema compared with controls (p£0.01).

Conclusion: BIS is a noninvasive portable modality to assess tissue water, and this device is available in both specialized and nonspecialized centers. These findings support that regional bioimpedance measures may help to distinguish lipedema from DD, as well as to identify early stages of lipedema.

Main findings

  • It remains unclear whether lipedema severity corresponds with changes in tissue composition, namely water retention, and the quantitative extent to which upper and lower extremities are involved. Characterizing these relationships is important for improving our understanding of disease origins, as well as differentiating lipedema from other conditions that share similar external phenotypes as lipedema (e.g., obesity), but have fundamentally discrepant physiological origins and corresponding management strategies.
  • The purpose of this study is to report objective measures of tissue water properties in women who met clinical criteria for lipedema or Dercum’s disease (DD) and women without an adipose tissue disease.
  • Bioimpedance reveals increased extracellular water primarily in the legs of patients with lipedema, and affects the arms and legs differently in patients with lipedema compared with patients with DD, and early-stage lipedema compared with females without an adipose tissue disease.
  • Patients with lipedema have lower impedance values in the legs than patients with DD, indicating higher extracellular and total tissue water volume in the legs of patients with lipedema. The leg/arm impedance ratios were closer to unity in DD and lower in lipedema, suggesting both upper and lower body water retention in DD.
  • In the studies cohort, arm impedance is greater in stage 1 lipedema than that in controls. This trend likely indicates higher fat content in the arms, whereas, in the legs, impedance is lower indicating higher water content. Together, the leg/arm impedance ratio is significantly lower in patients with stage 1 lipedema than that in controls.
  • Although BIS measurements may aid in objective evaluation of adipose tissue diseases, measurement ranges overlap between study cohorts. Therefore, the clinical criteria used in this study must also be met to determine an individual’s differential diagnosis in the clinic. Longitudinal monitoring would be necessary to determine an individual’s progression of lower extremity water levels and lipedema stage, which deserves further investigation.
  • BIS findings indicate higher tissue water levels:
    • In the legs of patients with higher compared with lower stages of lipedema,
    • In lipedema than in DD patients, and
    • in stage 1 lipedema patients than in matched control participants.
  • Bioimpedance may have relevance for further understanding of the aetiology of adipose tissue diseases and quickly evaluating the impact of emerging therapies on tissue composition.