Bioelectric Impedance Vector Analysis (BIVA) in Breast Cancer Patients: A Tool for Research and Clinical Practice

Abstract

Background and objectives: Body composition assessment can provide information associated with breast cancer patients’ (BCP) prognosis, that can lead interventions to improve survival outcomes. The aim of this study was to evaluate the effect of an individualized nutrition intervention program on breast cancer patients using bioelectrical impedance vector analysis (BIVA). Materials and Methods: This is a pretest-posttest study in recently diagnosed nonmetastatic BCP undergoing antineoplastic treatment, free of co-morbidities and dietary supplementation. Body composition was assessed at baseline and 6 months after an individualized nutrition intervention program, by dual-energy X-ray absorptiometry and BIVA. According to BIVA, each participant was located in the bivariate tolerance ellipses for Mexican population (50%, 75%, and 95%). In clinical practice, the 50% and 75% ellipses are considered within normality ranges. Results: Nine nonmetastatic BCP completed the intervention and were included in the analysis. After the intervention, they decreased by 5.8 kg of body weight (IQR, 3–6; p < 0.05), 3.8 kg of fat mass (IQR, 0.1–4.2; p < 0.05), and 1.4 kg of fat-free mass (IQR, −0.1 to 4; p < 0.05) while appendicular skeletal muscle mass remained unchanged (−0.2 kg, IQR, −0.8 to 2.3; p = 0.4). Using BIVA at baseline, five participants were among the 50% and 75% ellipses, mainly located in the area corresponding to edema and low lean tissue, two in the cachexia quadrant and two in the athletic quadrant (≥95% ellipse). After 6 months of intervention, six out of nine participants were in the athletic quadrant and eight of nine BCP were above the 5° phase angle cut-off point. One patient initially presented cachexia (≥95% ellipse); at postintervention her vector changed to the 50% ellipse. Conclusions: An individualized nutrition intervention program designed for nonmetastatic BCP was effective to improve the nutritional status of BCP as assessed by BIVA, therefore BIVA can be a useful tool to monitor changes in nonmetastatic BCP body composition in research and clinical practice.

Nutrition Counseling in an Academic Medical Center According to Socioeconomic Status and Grocery Shopping Consumer Behavior Decreased Relative Fat Mass in Breast Cancer Survivors

“…At the end of the study, this risk was no longer prevalent in the participating breast cancer population, also related to our RFM results and better health outcomes. The MEM is a methodological strength of this study because it guarantees strict calculation of energy and macronutrients to match theoretical and actual g/ day and kcal/day translated into seven interchangeable meal options within each mealtime to provide patients with an individualized, yet flexible, nutrition plan, and also has been recently used in a similar population 12,26 .…”

“…In this sense, it is imperative for RDNs to integrate all the baseline information provided by breast cancer patients regarding their socioeconomic, educational, occupational, dietary, and cultural background into the dietary plan, through an empathic and systematic way for patients to feel guided into making better decisions within their personal means. By preventing unaffordable nutrition plans and social isolation, dietary plans following the MEM can empower breast cancer patients to make healthy and informed food choices, improving adherence, dietary habits, nutritional status, and overall health 12,26 . This is one of the first studies to identify grocery shopping consumer behavior in breast cancer survivors, to design dietary plans according to the patients' preferences, family income, and energy nutrient requirements 38 .…”

“…Patients were encouraged to consume all the food servings contained in their individual dietary plan. For each follow-up session (every 2 weeks ± 0.5 week), participants provided a self-reported single item for adherence in a 10-point Likert scale (0 = poor adherence and 10 = full adherence during the preceding period) 26,27 . The nutrition plan was modified and adapted according to the individual's needs in each follow-up session 12 .…”

“…Given the exploratory nature of this study, conducted at the initial stages of a new nutrition area in an academic medical center, an emphasis on descriptive statistics was done, as proportions for categorical variables, while means and standard deviations (SDs) were used for normally distributed continuous variables and medians and interquartile ranges (IQRs) for data not normally distributed. Furthermore, sample size was calculated based on a previous study conducted in Sonoran breast cancer patients undergoing cancer treatment and following an individualized nutrition intervention using the MEM 26 . The SD of the change in the outcome (BW) of the previous study was inserted in the formula to calculate sample size for a before-after study (paired t-test) with an independent continuous outcome (Equation S5) 28 .…”

Nutritional Status in Patients with Medication-Related Osteonecrosis of the Jaw (MRONJ)

“…On the one hand, assessments at a single point in time are reported [ 49 ]. On the other hand, the effect of nutritional therapy on the nutritional status over time is described [ 47 , 50 ]. Furthermore, scientific data suggest a correlation of certain BIA parameters (especially the phase angle) with the overall survival rate [ 47 ].…”