Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis

Lukaski, Henry C.; Kyle, Ursula G.; Kondrup, J.

doi:10.1097/mco.0000000000000387

Cited by 294 publications

(270 citation statements)

References 55 publications

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“…Conventional BIA parameters, including total body water and muscle mass, are calculated using regression equations for each population studied and must be interpreted cautiously in some clinical situations, as the BIA algorithm is shown to be inaccurate in participants with very low or very high body mass index (BMI) values or abnormal hydration levels . On the other hand, phase angle has emerged as a sensitive indicator of cellular health, with higher values reflecting cell membrane integrity or vitality of living tissue . Healthy cell membranes behave like good capacitors, which store the current and consequently cause a delay in its flow.…”

Section: Introductionmentioning

confidence: 99%

“…7 On the other hand, phase angle has emerged as a sensitive indicator of cellular health, with higher values reflecting cell membrane integrity or vitality of living tissue. 8 Healthy cell membranes behave like good capacitors, which store the current and consequently cause a delay in its flow. The phase difference between the voltage and current, caused by the lag of the current penetrating the cell membranes and tissue interfaces, is expressed as phase angle.…”

Section: Introductionmentioning

confidence: 99%

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Predictivity of bioimpedance phase angle for incident disability in older adults

Uemura

Doi

Tsutsumimoto

et al. 2019

J cachexia sarcopenia muscle

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Background Bioelectrical impedance analysis (BIA)‐derived phase angle is expected to be an efficient prognostic marker of health adverse events with aging as an alternative of muscle mass. We aimed to examine the predictive ability of phase angle for incident disability in community‐dwelling elderly and determine the optimal cut‐off values. Methods Community‐dwelling elderly aged ≥65 years (n = 4452; mean age = 71.8 ± 5.3 years, 48.3% women) without disability at baseline participated in this prospective cohort study. Phase angle and appendicular skeletal muscle mass (ASM) were examined using a multi‐frequency BIA at baseline. Other potential confounding factors (demographics, cognitive function, depressive symptoms, medications, and physical performance) were also assessed. Incident disability was monitored on the basis of long‐term care insurance certification. Results Over a follow‐up of 24 months, 4.0% (n = 174) experienced disability, with an overall incidence rate of 20.6 per 1000 person‐years. The Cox hazard regression analysis showed that phase angle, as a continuous variable, was independently associated with incident disability after adjusting the covariates [male: hazard ratios (HRs) = 0.61, 95% confidence interval (CI) = 0.37–0.98; female: HR = 0.58, 95% CI = 0.37–0.90], although body mass index adjusted ASM was not. Receiver operating characteristic analysis indicated moderate predictive abilities of phase angle for incident disability [male: area under the receiver operating characteristic curve (AUC) = 0.76, 95% CI = 0.70–0.83; female: AUC = 0.71, 95% CI = 0.65–0.76], while those of body mass index adjusted ASM were low (male: AUC = 0.59, 95% CI = 0.521–0.66; female: AUC = 0.58, 95% CI = 0.52–0.63). Multivariate Cox regression analysis showed that low phase angle categorized by cut‐off value (male, ≤4.95°; female, ≤4.35°) was independently related to increased risk of incident disability (HR = 1.95, 95% CI = 1.37–2.78). Conclusions Lower phase angle independently predicts the incident disability separately from known risk factors. BIA‐derived phase angle can be used as a valuable and simple prognostic tool to identify the elderly at risk of disability as targets of preventive treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictivity of bioimpedance phase angle for incident disability in older adults

Uemura

Doi

Tsutsumimoto

et al. 2019

J cachexia sarcopenia muscle

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“…On the other hand, athletes and physically active individuals present higher phase angle values . Evidence has established that lower phase angle values (<5.0 degrees) may indicate inflammation, dysfunction, and cell damage …”

Section: Introductionmentioning

confidence: 99%

Phase angle is associated with the physical fitness of HIV‐infected children and adolescents

Martins

Lima

Silva

et al. 2019

Scandinavian Med Sci Sports

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The objective of this study was to identify the association of phase angle with physical fitness in children and adolescents infected with HIV. Sixty‐four children and adolescents infected with HIV (8‐15 years old) were tested for vertical transmission. The electrical bioimpedance was used to obtain the phase angle. Body fat (BF) and lean soft tissue mass (LSTM) were measured by x‐ray absorptiometry, and the manual grip strength was evaluated by dynamometry. The peak oxygen consumption (VO2 peak) was measured by respiratory change in a submaximal incremental test. Moderate‐vigorous physical activity (MVP) and sedentary behavior were measured using accelerometers and were used as covariates. Multiple linear regression was used. The linear correlation analyses demonstrated that the phase angle was inversely proportional to relative BF (r = −0.26), but was not associated with absolute body fat (r = −0.02). The phase angle was directly associated with LSTM (r = 0.57), handgrip strength, and (r = 0.43) peak VO2 (r = 0.55). The phase angle was not associated with absolute BF (β = −0.017, P = 0.413) and relative (β = −0.014, P = 0.175). The phase angle presented a direct association with LSTM (β = 0.041, P = 0.019) and peak VO2 (β = 0.005; P = 0.019), regardless of age, sex, sexual maturation, MVPA, sedentary behavior, antiretroviral drugs, and viral load. No association was found between phase angle and handgrip strength (β = 0.153; P = 0.199). It was concluded that phase angle was associated with LSTM and the aerobic fitness in HIV‐infected children and adolescents.

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“…Phase angle is positively correlated with lean body mass and body cell mass and negatively correlated to the extracellular‐to‐intracellular fluid ratio (ECW/ICW) in healthy adults. As disease‐related malnutrition is classically characterized by an increase ECW/ICW and decreased body cell mass, malnutrition (assessed by pre‐albumin, albumin, and malnutrition questionnaires [SGA and nutrition risk score in the ICU]) has been shown to be negatively correlated with phase angle . Due to the contributions of age, sex, and BMI to phase angle measurements, reference values were established and validated in order to calculate the standardized phase angle (SPhA), which controls for these variables.…”

Section: Introductionmentioning

confidence: 99%

“…As disease-related malnutrition is classically characterized by an increase ECW/ ICW and decreased body cell mass, malnutrition (assessed by pre-albumin, albumin, and malnutrition questionnaires [SGA and nutrition risk score in the ICU]) has been shown to be negatively correlated with phase angle. [23][24][25][26][27] Due to the contributions of age, sex, and BMI to phase angle measurements, reference values were established and validated in order to calculate the standardized phase angle (SPhA), which controls for these variables. Standardized phase angle has proven to be a strong prognostic marker for various survival outcomes in numerous solid malignancies (lung, head and neck, pancreatic, breast, and gastrointestinal) and hematopoietic stem cell transplant (HSCT) patients.…”

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confidence: 99%

The prognostic value of standardized phase angle in adults with acute leukemia: A prospective study

et al. 2020

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Standardized phase angle (SPhA) is a tool used to estimate body composition and cell membrane integrity. Standardized phase angle has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. We investigated the predictive value of SPhA on 60‐day mortality, overall survival (OS), and length of hospital stay (LHS) for adults with acute myelogenous and lymphoblastic leukemia (AML and ALL). Consecutive patients ≥18 years with newly diagnosed acute leukemia receiving intensive chemotherapy were enrolled. Phase angle measurements were taken on day 1 of therapy for all patients and on the day of nadir marrow for AML patients. Measurements were standardized by BMI, gender, and age to calculate the SPhA. The difference between SPhA at nadir bone marrow compared to day 1 of induction was used to calculate change in SPhA. A cutoff of 25th percentile was used to dichotomize baseline SPhA. Among 100 patients, 88% were AML, 56% were female, and mean age was 59 years. Though not statistically significant, OS by Kaplan‐Meier analysis was shorter for those below the 25th percentile SPhA compared to those above (median OS: 11.0 months vs 19.5 months; P = .09). Lower baseline SPhA was associated with increased incidence of 60‐day mortality in univariable (odds ratio [OR] = 5.25; 1.35, 20.44; P = .02) but not multivariable analysis (OR = 3.12; 0.67, 14.48; P = .15) adjusted for age, creatinine, and cytogenetics. Increased change in SPhA was associated with worse OS (hazard ratio = 1.15; 1.00,1.33; P = .05) in multivariable analysis. Standardized phase angle is a rapid, noninvasive, and objective measure that may be used to inform risk stratification.

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Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis

Cited by 294 publications

References 55 publications

Predictivity of bioimpedance phase angle for incident disability in older adults

Predictivity of bioimpedance phase angle for incident disability in older adults

Phase angle is associated with the physical fitness of HIV‐infected children and adolescents

The prognostic value of standardized phase angle in adults with acute leukemia: A prospective study

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