Comparison of fluid and body composition measures in women with lipoedema, lymphoedema, and control participants

Lipoedema is the accumulation of adipose tissue in the lower body, affecting the bilateral legs of women. The onset of lipoedema usually occurs due to hormonal changes in the body, including puberty and pregnancy. Lipoedema is often misdiagnosed as lymphoedema, which is the accumulation of protein rich fluid due to the inadequate function of the lymphatic system. These conditions can present similar symptoms, making them hard to distinguish without proper examination. Currently there is no universal diagnostic criterion to diagnose lipoedema. Many imaging technologies have been utilized to examine difference between lipoedema and other similar chronic conditions. Through a systematic review of the literature, we critically evaluated articles that examined the differences in body composition and physical function in women with lipoedema compared to control groups or other conditions. Out of 115 articles found, 11 met our inclusion criteria and were analysed. Lipoedema had a significantly higher subcutaneous adipose tissue area, fat/ water volume and calf skin and tissue sodium content when compared between other conditions. Although differences in body composition between individuals with lipoedema and lymphoedema, lipolymphoedema, obesity and/ or Dercum's Disease were reported, a clear diagnostic method was not present. Determining an accurate diagnostic criterion would not only decrease misdiagnosis but help improve disease management. Using bioimpedance spectroscopy (BIS) technology we performed a retrospective cross-sectional study investigating the differences in body composition and fluid between lipoedema, lymphoedema and control participants. BIS measures tissue conductivity in response to a small bioelectrical current allowing for total body, extracellular and intracellular water to be calculated. Each group included 37 participants from the Australian Lymphoedema Education, Research and Treatment diagnostic and surgical clinics at Macquarie University. Therefore 111 participants were included in the study and analysed. All participants presented with lower limb swelling and underwent an indocyanine green (ICG) lymphography imaging assessment. Clear differences were present in body composition between the lipoedema and lymphoedema groups. However, no differences were present between the lipoedema and control groups. Although it highlights clear differences in total body water and overall fat mass between lymphoedema and lipoedema, BIS technology alone could not be used to diagnose lipoedema. Future research should incorporate BIS technology alongside dual x-ray absorptiometry or magnetic resonance imaging to uncover an accurate diagnostic method for lipoedema. In a clinical setting this would assist in the decrease of lipoedema misdiagnosis and reduce incorrect treatments. With a correct diagnostic criterion lipoedema could be distinguished between lymphoedema and obesity. Disease management could also be achieved in the early stages of their condition, helping to increase the individual's overall quality of life.