Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients

Player, Emily; Morris, Paul; Thomas, Tom; Chan, Wei Yee; Vyas, Riddhi; Dutton, John; Tang, Jonathan; Alexandre, Leo; Forbes, Alastair

doi:10.1016/j.clnu.2018.08.003

Cited by 47 publications

(41 citation statements)

References 27 publications

(29 reference statements)

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“…Based on ASMI and PhA data and in accordance with the GLIM criteria, we could speculate that among the factors that cause malnutrition loss in metabolic cellular mass may play a role. In our study, cellular health, cell integrity and cell function were evaluated with PhA [25] and values below the 5th PhA percentile indicate a higher risk for malnutrition and mortality, as recently reported [26].…”

Section: Discussionsupporting

confidence: 55%

Nutritional status in post SARS-Cov2 rehabilitation patients

et al. 2022

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Background & aims: After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status. Methods: We recruited 48 patients (26 males/22 females) admitted to our Rehabilitation Unit after discharge from acute Covid Hospitals in northern Italy with negative swab for SARS-Cov2. We used the Global Leadership Initiative on Malnutrition (GLIM) criteria to identify patients with different degrees of malnutrition. Patients underwent a 3 to 4-week individual multidisciplinary rehabilitation program consisting of nutritional intervention (energy intake 27to30 kcal/die/kg and protein intake 1e1.3 g/die/ kg), exercise for total body conditioning and progressive aerobic exercise with cycle-and arm-ergometer (45 min, 5 days/week). At admission and discharge from our Rehabilitation Unit, body composition and phase angle (PhA) (BIA101 Akern), muscle strength (handgrip, HG) and physical performance (Timed-Upand-Go, TUG) were assessed. Results: At admission in all patients the mean weight loss, as compared to the habitual weight, was À12.1 (7.6)%, mean BMI was 25.9 (7.9) kg/m 2 , mean Appendicular Skeletal Muscle Index (ASMI) was 6.6 (1.7) kg/ m 2 for males and 5.4 (1.4) kg/m 2 for females, mean phase angle was 2.9 (0.9) , mean muscle strength (HG) was 21.1 (7.8) kg for males and 16.4 (5.9) kg for females, mean TUG value was 23.7 (19.2) s. Based on GLIM criteria 29 patients (60% of the total) showed a malnutrition condition. 7 out of those 29 patients (24%) presented a mild/moderate grade and 22 patients (76%) a severe grade. After a rehabilitation program of an average duration of 25 days (range 13e46) ASMI increased, with statistically significant differences only in females (p ¼ 0.001) and HG improved only in males (p ¼ 0.0014). In all of the patients, body weight did not change, CRP/albumin (p < 0.05) and TUG (p < 0.001) were reduced and PhA increased (p < 0.01). Conclusions: We diagnosed a malnutrition condition in 60% of our post SARS-Cov2 patients. An individualized nutritional intervention with adequate energy and protein intake combined with tailored aerobic and strengthening exercise improved nutritional and functional status.

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Section: Discussionsupporting

confidence: 55%

Nutritional status in post SARS-Cov2 rehabilitation patients

et al. 2022

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“…In the present study, we found no significant differences in weight change during hospital stay between the intervention and control groups. At week 4 of the hospital stay, patients in the intervention group had a significantly higher phase angle than patients in the control group, indicating a reduced nutritional status [32] in the control group compared to the intervention group at this point of hospital stay. Both groups deteriorated with regard to risk of malnutrition, defined by NRS 2002, during the hospital stay.…”

Section: Discussionmentioning

confidence: 91%

Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial

et al. 2020

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Background & aims: Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. Methods: The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. Results: We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n ¼ 49) and the control group (n ¼ 51) between August 2018 and February 2019. Losses to follow-up were n ¼ 5 in the intervention group and n ¼ 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p ¼ 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p ¼ 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). Conclusions:The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).

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“…ALB is commonly used as the indicator for monitoring nutrition level, and a lower level of ALB has been found in some studies to serve as a risk factor for the poor prognosis of CHF patients, but with a longer half-life, ALB is not sensitive in reflecting short-term acute malnutrition (11). PA is an indicator for the early detection of malnutrition, and determining the concentration of plasma PA, more sensitive than ALB, has a special diagnostic value for understanding malnutrition, liver and kidney dysfunctions and disease severity (12)(13)(14). One study measured the level of serum PA in patients with renal failure, and the results manifested that it can be used as one of the highly sensitive indicators reflecting the nutrition status and survival rate of renal failure patients.…”

Section: Discussionmentioning

confidence: 99%

Application of blood pre-albumin and NT-pro BNP levels in evaluating prognosis of elderly chronic heart failure patients

Shi

Zhang

et al. 2020

Exp Ther Med

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Levels of blood pre-albumin (PA) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) in elderly patients with chronic heart failure (CHF) and their clinical value in prognosis evaluation were explored. A total of 410 elderly patients aged ≥65 years hospitalized for CHF were enrolled. The concentrations of blood PA and NT-pro BNP, routine blood test and biochemistry indicators were determined and color Doppler echocardiography was performed. Additionally, the patients were followed up after discharge, and based on the occurrence of major adverse cardiac events (MACE), they were divided into MACE group and non-MACE group. MACE group had an older age and a higher level of plasma NT-pro BNP than non-MACE group (77.82±6.57) years vs. (76.39±6.18) years, and (8,864.52±9,718.36) pg/ml vs. (4,165.62+6,437.28) pg/ml (P<0.05), and the left ventricular ejection fraction and serum PA level in MACE group were lower than those in non-MACE group (P<0.05). According to the results of multivariate regression analysis, serum PA [odds ratio (OR)=0.242, 95% confidence interval (CI)=0.137-0.406, P<0.001] and plasma NT-pro BNP (OR=1.847, 95% CI=1.024-3.158, P=0.036) were independent risk factors for the occurrence of cardiac events during follow-up. Decline in PA level and elevation in NT-pro BNP level have a strong correlation with poor prognosis of elderly CHF patients, and they can be used for clinically evaluating disease conditions, guiding treatment and improving prognosis.

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Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients

Cited by 47 publications

References 27 publications

Nutritional status in post SARS-Cov2 rehabilitation patients

Nutritional status in post SARS-Cov2 rehabilitation patients

Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial

Application of blood pre-albumin and NT-pro BNP levels in evaluating prognosis of elderly chronic heart failure patients

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