Discordance between bioelectrical impedance vector analysis and the new ESPEN definition of malnutrition for the diagnosis of hospital malnutrition

Dehesa-López, Edgar; Martínez-Félix, Jesús Israel; Ruiz-Ramos, Arturo; Atilano-Carsi, Ximena

doi:10.1016/j.clnesp.2017.01.006

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…Currently, no universally accepted diagnostic criteria for malnutrition are available. 21 The ESPEN has recently put forward a consensus definition for malnutrition with the aim of reaching uniformity between countries and studies, in which a low FFMI is taken into the diagnostic criteria as is the common use of BIA. While many studies showed that malnutrition was associated with lower physical functioning, lower immune status, more severe CCRT toxicities, treatment interruption, lower chemotherapy response rates, hospital readmission, impaired QOL, and increased mortality, 22 , 23 the problem of predicting malnutrition for early intervention still remains unsolved.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Body Composition Changes and the Importance of Fat-Free Mass Index in Locally Advanced Nasopharyngeal Carcinoma Patients Undergoing Concurrent Chemoradiotherapy

et al. 2018

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Aim: This was a prospective investigation of longitudinal body composition changes in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy (CCRT) and a comparison of the Patient-Generated Subjective Global Assessment (PG-SGA) and the ESPEN (European Society for Clinical Nutrition and Metabolism) diagnostic criteria (EDC) as evaluation methods. Methods: All patients received standard CCRT according to 2 centers’ current practices. Body composition parameters were determined by bioelectrical impedance analysis and obtained weekly from baseline until the end of treatment. The nutritional status of all patients was evaluated by the PG-SGA and EDC. Results: Forty-eight patients were eligible for analysis. Most body composition parameters, including body cell mass, fat mass, fat-free mass, and skeletal mass, as well as body weight, body mass index, and PG-SGA score, significantly decreased during CCRT (P = .00). The PG-SGA was shown to have better sensitivity than the EDC; however, the 2 different evaluation methods were found to have a perfect concordance at Week 4 and Week 6 (κ = 0.91 and 0.96, P = .00 and .00, respectively). Pearson correlation analyses showed that fat-free mass index and body weight were positively correlated with global quality of life score (r = 0.81, P = .00; r = 0.78, P = .00, respectively). Conclusions: This study has shown that body composition parameters, especially fat-free mass index, are valuable for diagnosing malnutrition in patients with nasopharyngeal carcinoma receiving CCRT. We recommend that these bioelectrical impedance analysis techniques should be increasingly implemented in nutritional assessments.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Body Composition Changes and the Importance of Fat-Free Mass Index in Locally Advanced Nasopharyngeal Carcinoma Patients Undergoing Concurrent Chemoradiotherapy

et al. 2018

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“…This method provides better understanding of the hydration status and cell mass, and offers an easier and unbiased interpretation of the nutritional status in comparison to phase angles [13]. Moreover, BIVA has recently shown excellent sensitivity for the diagnosis of malnutrition in acutely hospitalized patients with fluid overload as compared to the classical ESPEN (European Society for Clinical Nutrition and Metabolism) criteria [14]. Therefore, the aim of our study was to assess, by BIVA, the prevalence of malnutrition in hospitalized patients with COVID-19 pneumonia, and to evaluate its relationships with the severity and outcome of the disease.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Role of Malnutrition Diagnosed by Bioelectrical Impedance Vector Analysis in Older Adults Hospitalized with COVID-19 Pneumonia: A Prospective Study

et al. 2021

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Background: Little is known on the clinical relevance of the nutritional status and body composition of patients hospitalized with SARS-CoV-2 infection. The aim of our study was to assess the prevalence of malnutrition in patients with COVID-19 pneumonia using bioelectrical impedance vector analysis (BIVA), and to evaluate the relationship of their nutritional status with the severity and outcome of disease. Methods: Among 150 consecutive patients who were hospitalized with COVID-19 pneumonia, 37 (24.3%) were classified as malnourished by BIVA, and were followed-up for 60 days from admission. Outcome measures were differences in the need for invasive mechanical ventilation, in-hospital mortality, and the duration of hospital stay in survivors. Results: During 60 days of follow-up, 10 (27%) malnourished patients and 13 (12%) non-malnourished patients required invasive mechanical ventilation (p = 0.023), and 13 (35%) malnourished patients and 9 (8%) non-malnourished patients died (p < 0.001). The average duration of the hospital stay in survivors was longer in patients with malnutrition (18.2 ± 15.7 vs. 13.2 ± 14.8 days, p < 0.001). In survival analyses, mechanical ventilation free (log-rank 7.887, p = 0.050) and overall (log-rank 17.886, p < 0.001) survival were significantly longer in non-malnourished than malnourished patients. The Cox proportional ratio showed that malnutrition was associated with an increased risk of mechanical ventilation (HR 4.375, p = 0.004) and death (HR 4.478, p = 0.004) after adjusting for major confounders such as age, sex, and BMI. Conclusions: Malnutrition diagnosed with BIVA was associated with worse outcomes in hospitalized patients with COVID-19 pneumonia.

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“…In a consensus statement of the European Society for Clinical Nutrition and Metabolism (ESPEN), diagnostic criteria for malnutrition were suggested based on body mass index (BMI), or combined determination of unintentional weight loss together with a reduced age-specific BMI or a low fat-free mass index (FFMI) using sex-specific cut-offs 14 . However, the use of these diagnostic criteria in practice has revealed limitations because 20% of different populations showing both a low BMI and low FFMI were not classified as malnourished as they had not reported unintentional weight loss and also diagnostic concordance of the ESPEN criteria with bioelectrical impedance vector analysis was poor 10,15 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of malnutrition using harmonized definitions in older adults from different settings – A MaNuEL study

et al. 2019

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Background & Aims: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. Methods: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m 2 ; age-specific BMI <20 if age 65-<70 and <22 kg/m 2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and of combined BMI <20 kg/m 2 and/or WL in participants aged ≥65 years. Results: Fifteen samples with in total 5,956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m 2 , 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cutoffs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m 2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. Conclusions: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.

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Discordance between bioelectrical impedance vector analysis and the new ESPEN definition of malnutrition for the diagnosis of hospital malnutrition

Cited by 9 publications

References 19 publications

Longitudinal Body Composition Changes and the Importance of Fat-Free Mass Index in Locally Advanced Nasopharyngeal Carcinoma Patients Undergoing Concurrent Chemoradiotherapy

Longitudinal Body Composition Changes and the Importance of Fat-Free Mass Index in Locally Advanced Nasopharyngeal Carcinoma Patients Undergoing Concurrent Chemoradiotherapy

Prognostic Role of Malnutrition Diagnosed by Bioelectrical Impedance Vector Analysis in Older Adults Hospitalized with COVID-19 Pneumonia: A Prospective Study

Prevalence of malnutrition using harmonized definitions in older adults from different settings – A MaNuEL study

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